648 



Ooioid Intoxication 



151 



Complications. Whether severe Nicotine Withdrawal decreases the abiiitv to stop 

 smoking or remain abstinent from smoking is unknown. 



Differential diagnosis. The diagnosis of Nicotine Withdrawal is usuailv seif-evident 

 from the person's historv, and disappearance of the symptoms if smoking is resumed is 

 confirmator. However, withdrawal from other psychoactive substances mav take 

 place simultaneously, and produce similar svmptoms. 



OiagnosticcriteriafiorZSZLfla Nicotine WithdrawaL 



A. Dail'. -ise of nicotine for at least several weeks. 



B. Abr'j::t cessation of nicotine use, or reduction in the amount of nicotine used. 

 folio'.\ed within 24 hours by at least four of the following signs; 



(11 craving for nicotine 



(2) irntabilitv, frustration, or anger 



(3) an.xiety 



(4) Gifficultv concentrating 



(5) -estlessness 



{6i cecreased heart rate 



(7) increased appetite or weight gain 



OPIOiD-INDUCED ORGANIC MENTAL DISORDERS 



See p. 18; :or a description of substances in this class and Opioid Dependence and 

 Abuse. 



305.50 Opioid Intoxication 



The essential features of this disorder are maladaptive behavioral changes and specific 

 neurologic signs due to the recent use of an opioid. 



The initial maladaptive behavioral changes from intravenous opioids occur within 

 2 to 5 minutes after use and often include euphoria that mav last 10 to 30 minutes. This 

 is followed by a longer period (two to six hours, depending upon the type of opioid, the 

 dose, and the previous history of drug-takingj of lethargy, somnolence, and apathv or 

 dysphoria. Other maladaptive behavioral etrects during the period of intoxication 

 include imioaired judgment and impa.-reo -.OvJial and occupational functioning. Unlike 

 in Alcohol Intoxication, aggression and violence are rare. 



Pupillary constriction is always present (or dilation due to anoxia from a severe 

 overdose;. Other neurologic signs commonly observed are drowsiness, slurred speech, 

 and impairment in attention and memory. 



Associated features. Pupillarv constriction may lead to reduced visual acuity. The 

 inhibitorv effect of the psvchoactive substance on gastrointestinal motility mav cause 

 constipation. There mav be analgesia. 



For many people, the effect of taking an opioid for the first time is dysphoric rather 

 than euphoric, and nausea and vomiting may result. 



