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03/05/2010
Cocaine-Related Psychiatric Disorders
Cocaine is a naturally occurring alkaloid (one of a large group of basic substances found in plants) found within the leaves of a shrub, Erythroxylon coca. In 1859 cocaine was isolated from the coca leaf and later became prescribed for multiple illnesses. Coca-cola was originally a cocaine-containing drink, however in 1914 the Harrison Narcotics Act banned all nonprescription use of cocaine.
Cocaine abuse is associated with multiple health problems. It is primarily used by inhalation through the nose or snorting, by intravenous injection, and by smoking. In a review of the Diagnostic and Statistical Manual of Mental Disorders, there are ten cocaine-induced psychiatric disorders. These include cocaine intoxication, cocaine withdrawal, cocaine–induced psychotic disorder with delusions, cocaine-intoxication delirium, and others. Medical problems also associated with the use of cocaine include cardiac arrhythmia, hypertension, pneumothorax, myocardial infarction, intracranial bleeding, seizures, and stroke.
Most studies show that cocaine is associated with decreased cerebral blood flow, although the behavioral effects are attributed to the blockade of dopamine reuptake in the synapse. The behavioral effects are almost immediate and last for a brief time period. This causes the user to repeat the dose in order to keep, or repeat the feeling of intoxication. Development of tolerance may occur, thus causing the user to increase the dosage and frequency of use.
PET scans show high activation in the addictive center of the brain, particularly with dopamine receptors when patients describe intense craving. As long as one and one half years after cocaine withdrawal, the brain may show decreased ability to receive dopamine (a primary neurotransmitter associated with mood disorders). This may be associated with signs and symptoms of depression. Cocaine intoxication may be associated with manic behavioral symptoms, poor judgment, aggression, agitation, and irritability.
With complete and total abstinence from all mind-altering substances, the brain may return to normal activity after one year. The status of the dopamine cells is unclear as to a complete return to normality.