Medical Care
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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.
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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.
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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. [63]
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.
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The patient should participate in group therapy sessions, 12-step programs/chemical dependency groups, rational-emotive therapy, cognitive behavior therapy, and family therapy.
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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.
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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.
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If the patient cannot maintain sobriety, the physician should consider residential treatment options, which can last anywhere from 3-12 months.
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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.
Surgical Care
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Patients may need liver or kidney transplantation.
Consultations
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Chemical dependence counselor
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Attorney, if legal problems develop
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Social worker
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Family therapist
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Peer-group therapist
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Dietitian (possibly)
Diet
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Consultation with a dietitian may be helpful if patients have poor nutrition (eg, liver problems, low protein).
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If no additional medical problems are present, patients can eat a regular diet.
Activity
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Maintain sobriety.
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Patients who are not a danger to themselves or others, are not gravely disabled, and are medically stable can maintain routine activities.
