Inhalant-Related Psychiatric Disorders Treatment & Management

  • Author: Guy E Brannon, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK)   more...
 
Updated: Oct 5, 2010
 

Medical Care

  • The medical care of patients with inhalant-related psychiatric disorders encompasses many areas.
    • A team of medical professionals must work in unison to ensure that every aspect of the treatment plan is fulfilled.
    • Patients likely require hospitalization. Especially if the patient is delirious, suicidal, homicidal, or gravely disabled. As inpatients, they may require the administration of medications (eg, haloperidol, risperidone, carbamazepine) to relieve any psychosis related to the chemicals inhaled.
    • Counseling (supportive therapy) should be initiated, along with patient education to explain the dangers of huffing. Evaluate patients for psychiatric comorbidity.
  • No controlled studies have been performed to guide the treatment of patients who abuse inhalants and who have inhalant dependence. Additionally, no specific medications indicated by the pharmaceutical industry are available for detoxification from inhalants.
  • Programs are available that specifically treat inhalant abuse; however, they are rare and difficult to find. Therefore, treatment planning most often is tailored much like that of the treatment of patients with chemical dependence, in which the first step is to detoxify the patient.
    • Patients who are addicted to inhalants experience withdrawal symptoms similar to those of any other patient addicted to drugs, including tremors, chills, sweats, cramps, nausea, and hallucinations.
    • Next, a peer system is established.
    • Once these 2 tasks are accomplished, assess the patient for physical, cognitive, and neurologic problems. If any problems are noted in these areas, they must be treated immediately. Identify any strengths the patient has and build on these strengths to increase them and to create new additional strengths for the patient. Address any other problems they may have. The goals are to return the patient to the community with a drug-free peer network and to continue or enhance self-support.
    • Treat any conduct problems noted.
    • Once the patient is detoxified, evaluate for other psychiatric illnesses using the DSM-IV-TR.
  • The patient should participate in group therapy sessions, 12-step programs/chemical dependency groups, rational-emotive therapy, cognitive behavior therapy, and family therapy.
  • Discuss safe sex with the patient, including partner precautions and birth control. In addition, the family should receive education about the disorder, secure substances that could be huffed, and become familiar with local mental health laws regarding commitment policies.
  • No medications should be used unless a treatable DSM-IV-TR diagnosis has been identified.
    • If the patient has depression independent of the inhalant abuse, treat with the antidepressant of choice.
    • If the patient abuses alcohol in addition to inhalants, disulfiram (Antabuse) or naltrexone can be used in appropriate settings.
    • If the patient meets DSM-IV-TR criteria for attention-deficit/hyperactivity disorder, a psychostimulant such as pemoline (Cylert) can be used for treatment. The United States Food and Drug Administration (FDA) concluded that the overall risk of liver toxicity from pemoline outweighs the benefits. In May 2005, Abbott chose to stop sales and marketing of their brand of pemoline (Cylert) in the United States. In October 2005, all companies that produced generic versions of pemoline also agreed to stop sales and marketing of pemoline.
    • If the patient is psychotic as a result of the inhalant abuse (inhalant-induced psychosis), the physician may use an appropriate antipsychotic such as haloperidol (Haldol) or risperidone (Risperdal), with or without a benzodiazepine. This is the physician's choice.
    • If the patient has an inhalant-induced mood disorder, detoxification is recommended, without the use of any medications unless the depression persists for longer than 2-4 weeks after withdrawal.
    • Detoxification is also recommended for patients who are experiencing inhalant-induced anxiety; however, the use of sedatives or antianxiety medications is contraindicated because inhalant intoxication can worsen if the patient uses again.
  • If the patient cannot maintain sobriety, the physician should consider residential treatment options, which can last anywhere from 3-12 months.
  • Most persons who abuse inhalants receive most of their medical care in local emergency departments after they have either passed out or become psychotic from chemical inhalation. In the emergency department, they receive supportive care, social interventions, and appropriate medical care.
Next

Surgical Care

  • Patients may need liver or kidney transplantation.
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Consultations

  • Chemical dependence counselor
  • Attorney, if legal problems develop
  • Social worker
  • Family therapist
  • Peer-group therapist
  • Dietitian (possibly)
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Diet

  • Consultation with a dietitian may be helpful if patients have poor nutrition (eg, liver problems, low protein).
  • If no additional medical problems are present, patients can eat a regular diet.
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Activity

  • Maintain sobriety.
  • Patients who are not a danger to themselves or others, are not gravely disabled, and are medically stable can maintain routine activities.
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Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Guy E Brannon, MD  Associate Clinical Professor of Psychiatry, Louisiana State University Health Sciences Center; Director, Adult Psychiatry Unit, Chemical Dependency Unit, Clinical Research, Brentwood Behavior Health Company

Guy E Brannon, MD is a member of the following medical societies: American Medical Association, American Medical Writers Association, American Psychiatric Association, American Society of Addiction Medicine, Association of Clinical Research Professionals, Louisiana State Medical Society, and Southern Medical Association

Disclosure: AstraZeneca Grant/research funds Other; Janssen Grant/research funds Other; Pfizer Honoraria Speaking and teaching; Sunovion Honoraria Speaking and teaching; Eli Lilly Grant/research funds Other; Forrest Grant/research funds Other

Coauthor(s)

Jennifer M Thomas, MS, MA  Clinical Research Coordinator, Louisiana Clinical Research, LLC

Jennifer M Thomas, MS, MA is a member of the following medical societies: Psi Chi

Disclosure: Nothing to disclose.

Specialty Editor Board

Barry I Liskow, MD  Professor of Psychiatry, Vice Chairman, Psychiatry Department, Director, Psychiatric Residency Program, University of Kansas School of Medicine; Director, Psychiatric Outpatient Clinic, The University of Kansas Medical Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Harold H Harsch, MD  Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin

Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: lilly Honoraria Speaking and teaching; Forest Labs None None; Pfizer Grant/research funds Speaking and teaching; Northstar None None; Novartis Grant/research funds research; Pfizer Honoraria Speaking and teaching; Sunovion Speaking and teaching; Otsuke Grant/research funds reseach; GlaxoSmithKline Grant/research funds research; Merck Honoraria Speaking and teaching

Chief Editor

Iqbal Ahmed, MBBS, FRCPsych (UK)  Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych (UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Association for Geriatric Psychiatry, American Neuropsychiatric Association, American Psychiatric Association, American Society of Clinical Psychopharmacology, and Royal College of Psychiatrists

Disclosure: Nothing to disclose.

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