Amphetamines and substances belonging to the amphetamine genus comprise a large group of drugs that stimulate the central nervous system. The best known of these are dextroamphetamines (Dexedrine), methamphetamines (Methedrine) and meridil (methylphendiate hydrochloride, Ritalin). Phenamine (racemic amphetamine sulfate, Benzedrine), the first drug in this group, was synthesized in 1887, but was not approved as a pharmacological agent until 1932. By this time, amphetamine inhalers appeared and became available, which were distributed without a prescription, “in free sale”, in pharmacies as a remedy for the common cold and asthma. In late 1937, a new drug appeared in tablet form as a remedy for narcolepsy and postencephalic parkinsonism. It has also been recommended for the treatment of depression and for increasing energy potential. Soon, amphetamines gained sensational fame as a means of improving brain activity, instilling vigor and, in general, as pills for “Superman”. Amphetamine addiction reached epidemic proportions in the 1970s. By this time, the legal production of the substance in the United States exceeded 10 million (5 mg) tablets. There has also been a significant increase in both the licit synthesis of amphetamine in laboratories and the illicit manufacture of amphetamine on the black market, which is still the main source of the illicit drug trade. Attempts have been made to limit and control the prescriptions issued by physicians in order to stop drug addiction. Some of these restrictions have resulted, however, in the fact that the drug is not always available to patients taking it for therapeutic purposes. Amphetamine addiction is fairly common among professional athletes and long distance haulers who use the drug to relieve fatigue and increase energy.

Clinical Action

Amphetamines are easily absorbed when administered by mouth and begin to act quickly. Drug addicts often use the drug intravenously. The mechanism of action consists mainly in the release of serotonin from presynaptic endings and inhibition of reuptake. For the average subject, a normal dose of 5 mg produces a sense of well-being and improved performance in written, verbal, and motor tasks. reduces fatigue, anorexia and increased pain horn.

Since doses are increased as a result of drug addiction or misuse of the drug, side effects are usually observed. Tolerance develops and some patients begin to consume 1 g of amphetamine per day. In persons who are not accustomed to the drug, death can occur from a dose of 120 mg.

Substances similar to amphetamines

Substances similar to amphetamines, — это смесь кофеина, эфедрина и пропаноламина (РРА), которая вплоть до недавнего времени легально продавалась в виде таблеток, предназначенных для возникновения действия, напоминающего, но не повторяющего амфетамины. Ephedrine and PPA are still marketed as nasal breathing drugs, and PPA as an appetite suppressant. Both substances are dangerous for people with high blood pressure or diabetes and can cause toxic psychosis after long-term use of high doses. PPA has a relatively small range in which its action is safe, exceeding the average

her dose contained in the tablet, only 3-4 times can cause a hypertensive crisis.

Side effects

physical influence. Both physical and psychological effects begin one hour after the drug is administered and last for several seconds. There are many physical side effects in both acute amphetamine intoxication and chronic amphetamine use. The following are diagnostic criteria for sympathomimetic intoxication with amphetamines or other substances similar to them in action:

A. Recent use of amphetamine or similar active sympathomimetic.

B. Behavioral changes that are maladaptive (eg, belligerence, grandiosity, increased wakefulness, psychomotor agitation, impaired criticism, impaired professional or social activities).

C. At least two of the following within an hour of amphetamine use:

tachycardia,
pupil dilation,
increase in blood pressure,
sweating or chills
nausea or vomiting.

D. No association with any physical or other mental disorder.

Physical signs and symptoms include redness, pallor, cyanosis, fever, headache, tachycardia, palpitations, serious heart problems, severe increase in blood pressure, hemorrhages and other vascular disorders, nausea, vomiting, bruxism (teeth grinding during sleep), difficulty breathing, tremor, ataxia, sensory disturbances, convulsive twitches, tetany, convulsions, and cardiovascular weakness. With intravenous use of the drug, other serious consequences occur, including serous hepatitis, lung abscess, endocarditis and angiitis, accompanied by necrosis. According to some reports, neurochemical changes are observed in the brain with chronic use of the drug.

Psychological influence. The psychological influences are restlessness, dysphoria, logorrhea, insomnia, irritability, hostility, tension, confusion, anxiety, panic reactions, and in some cases psychosis. The following are diagnostic criteria for delusional disorder associated with the use of amphetamines and similarly acting sympathomimetics:

A. An organic delusional syndrome that develops shortly after taking amphetamine or a similarly acting sympathomimetic.

B. Rapidly developing delusions of persecution is the dominant feature in the clinical picture.

B. No association with any physical or other mental disorder.

When amphetamine is administered intravenously, a characteristic “rush” occurs, consisting of a feeling of complete well-being and euphoria. Intoxication at high doses may be accompanied by the appearance of transient ideas of attitude, paranoid ideas, increased libido, tinnitus; the patient sometimes hears being called by name and feels insects crawling under the skin (formication). Stereotypic movements may occur. Delirious episodes are also noted, during which the patient is prone to the use of violence. The following are diagnostic criteria for delirium induced by amphetamine or similarly acting sympathomimetics.

A. Delirium that develops 24 hours after taking amphetamine or a similarly acting sympathomimetic.

B. No association with a physical or other mental disorder.

Symptoms of amphetamine delusional disorder may resemble those of paranoid schizophrenia with dominance and rapid development of delusions of persecution; however, the predominance of visual hallucinations with associated affect, the presence of occasional confusion and coherence disturbances, hyperactivity or absence of thought disturbances help distinguish amphetamine psychosis from schizophrenia. In amphetamine psychosis, there may be disturbances in body schema and the perception of human faces. Sometimes an accurate differential diagnosis based on clinical signs is not possible. The most reliable diagnostic methods are laboratory tests that detect the presence of amphetamine in the urine, but these tests can no longer detect amphetamine if more than 48 hours have passed since the last dose. In the absence of an accurate history, urinalysis, or clear physical signs, amphetamine delusional disorder is often only recognized retrospectively when symptoms disappear—usually within a few days or at most weeks after the drug is no longer ingested. However, delusions, suspicion, and tendencies to misinterpretation, as well as ideas of relation, may persist for months. On the other hand, intoxication usually goes away on its own, and full recovery of health is observed after 48 hours. Deterioration or “collapse” occurs when the effect of high doses weakens. A debilitating cycle of a series of heavy drug use ranging from a few days to a week and subsequent crashes is a typical pattern of amphetamine addiction. The physical and psychological symptoms of collapse include anxiety, tremors, dysphoric mood, lethargy, fatigue, nightmares (due to a severe increase in FBS), headaches, profuse sweating, muscle twitches, stomach cramps, and unquenchable hunger. Loss of self-control can lead to the use of violence in the presence of aggressive impulses. According to the ICD, when the “collapse” lasts more than 24 hours after the last drug intake, this condition is reviewed and reclassified as an amphetamine-induced withdrawal syndrome or a similarly acting sympathomimetic. The following are diagnostic criteria for withdrawal symptoms caused by amphetamine or related sympathomimetics:

A. Termination of a long (several days or more) severe abuse of amphetamine or a similarly acting sympathomimetic or reduction in the amount of substance consumed, followed by mood dysphoria (eg, depression, irritability, anxiety) and at least one of the following persisting after more than 24 hours after stopping the use of the drug:

fatigue,
insomnia or excessive sleepiness
psychomotor agitation.

B. No association with any physical or other mental disorder, such as delusional disorder associated with the use of amphetamines and related sympathomimetics.

The abstinence syndrome usually reaches a maximum in 2 — 4 days. The most characteristic and dangerous syndrome is depression, sometimes with suicide, which is most pronounced 48 hours after the last amphetamine intake, but can persist for several weeks.

Treatment

The physician must decide which combination of drugs to use to treat depression, personality disorders, or both; however, since many of these patients are highly dependent on the drug, psychotherapy is extremely difficult for them.