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(.)

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(.)

A Literature Review

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ISBN : 978-616-11-1978-2

(.) (.)

(.) 2 131 501000 5328 0228 60236, 60525 0 5327 3201 08 0491 0505, 08 0500 2140www.i-mapthailand.org

1 : 2556 : 58 : 3,000 / : 0 5311 0503-4, 08 1783 8569

: , . . : (.); 2556.

.0 5328 0228 60236, 60525 0 5327 3201 www.i-mapthailand.org

Review of Emergency Management in Methamphetamine Abusers

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(.) (.)

.

(.)

Eme

rgencyManagementinMetham

phetamineAbusers

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1 ...................................................................................... 1

2 ............................................................. 8

3 .................. 16 3.1 ................................................................ 19 3.2 ................................. 21 3.3 ............................................................................................ 23

3.4 .......................................................... 25 3.5 .................................................... 28

4 ...................... 32

5 ........................................................ 45

..................................................................................................................................... 48

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(methamphetamine)

() () ()

(risk of anydose) (risks from high-dose use) (risks from long-term use)

EmergencyManagem

entinMetham

phetamineAbusers

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benzodiazepines (antipsychotics)

EmergencyManagem

entinMetham

phetamineAbusers

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5. (tea) (smoking) (chewing)

Mitragynine

.. 2554

3.2 (2.4 ) (1.2 ) (0.9 ) 25-44 1 12-24 45-65 12-19

80

14 .. 2550 50 .. 2553 47 .. 2550 773 .. 2553

2

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185,316 86.2.. 2554 .. 2553 40

7.. 2553 3 .. 2554 3 10 60 23-27

() ()

1 3-8

3

(.)

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30-60

1. Experimental users:

2. Recreational users:

3. Circumstantial users:

4

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4. Intermittent or binge users: 2-10

5. Regular users: (dependence)

6. Poly drug users:

alprazolam

4 1.

15-20

2. 3-5

3.

5-10 4.

5

(.)

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1 3

active ingredient

6

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(methamphetamine)

() () ()

7

(.)

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2

(Risk of any dose) (Risks from high-dose use) (Risks from long-term use)

(Risk of any dose)

1. (Contents) 1

2. (Unsafe sex)

3. (Accident)

8

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4. (Poly drug use) (toxicity)

5. (During Pregnancy)

6. (Overheating (hyperthermia) and dehydration)

(rhabdomyolysis)

7. (Risks from injecting) (septicemia) (infective endocarditis) (osteomyelitis/infectivearthritis) HIV (Hepatitis)

(Risks from high-dose use)

1. (Behavior Changes)

9

(.)

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2. (Neurotoxicity)

3. (crash) (i ntox icat ion)

4. Serotonin toxicity serotonin toxicity (myoclonus) (muscle rigid ity )

5. (Overdose)

(Risks from long-term use)

1. (Poor nutrition)

2. (Dependence)

15 32 23 15

10

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3. (Psychosis)

4. (Mood and affective disorders) (intoxication) (withdrawal)

5. (Neurocognitive impairment)

1. Mild effects

2. Moderate effects

3. Severe or toxic effects

11

(.)

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1.

2.

3.

stroke4. 5. /6. 7. 8. 9. 10.

3-5 4-8 24 2

12

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(dopamine producing cell)

Buffenstein single photon emission computedtomogrophy (SPECT) brain perfusion 16 21 ( 76) perfusion frontal, parietal temperal lobe

Ernst, Chang magnetic resonance spectroscopy (MRS) N acetyl-aspartate glial cell

14

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Volkow positron emissiontomography (PET) (dopamine transporters: DAT)

DAT striatum ( 9 ) DAT

(risk of any dose) (risks from high-dose use)

(risks from long-term use)

15

(.)

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3

1. intoxication

2.

3.

16

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4.

1:

2:

17

(.)

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3.1 (Intoxication)

( 38oC)

19

(.)

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(Management of ATS intoxication)

intoxication

( )

benzodiazepines (antipsychotics) 250-500

monitor EKG

20

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3.2

- - -

21

(.)

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Mild arousal:

benzodiazepines diazepam 5-10 mg clonazepam 0.5-2 mg lorazepam 1-2.5 mg 30-60

haloperidol 2.5-5 mg olanzapine 5-10 mg risperidone 1-2 mg

Moderate arousal: haloperidol 2.5-5 mg IM

High arousal: () diazepam 5-10 mg 5 mg haloperidol 2.5-5 mg

22

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3.3 (Methamphetamine Psychosis)

(ideasof reference) (loss of insight)

(violence) (suicide or homicide)

(stereotyped behavior patterns)

(intoxication) (withdrawal)

23

(.)

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clinical trials (CTs) (agitation)

(atypical antipsychotic) risperidone olanzapine

(acute) (residual) (craving) (conventional antipsychotics) haloperidol (atypical antipsychotics) risperidone, olanzapine (acute) (chronic)

3.4 (Withdrawal)

(withdrawal)

(cravings) ( panic)

25

(.)

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(peak symptom) 2-10

(residual symptoms) 1-8 10 3

(Managing withdrawal)

(hotline 24 ) (prolonged withdrawal)

26

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prolonged withdrawal dopamine depletion hypothesis

(intensive craving) 12-18

(relapseprevention) tricyclic antidepressant (TCA) amitryptylline imipramine selective serotonin reuptake inhibitor (SSRI) fluoxetine

(lapse)

27

(.)

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3.5 (Depression)

60 3

(withdrawal)

(Sad or blue mood)

(Changes to appetite andweight)

(Changes to sleeping patterns) (early insomnia) (middle insomnia) (early morning awakening)

28

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benzodiazepines antipsychotics

31

(.)

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(Philosophy of Crisis Negotiation)

1. (Self Control)

2.

3. (-)

4.

33

(.)

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(Empathy)

- - -

-

(Active Listening Skill)

1. Mirroring :

,

34

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2. Minimal Encouragements :

3. Paraphrasing :

18

4. Emotion Labeling :

5. Open-end Question :

35

(.)

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6. I Messages : I Messages

2-3 I Messages

7. Effective Pauses :

36

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1. 2. 3.

4.

5.

1. 1.1 1.2 1.3 5

2. 2.1

2.2 2.3 2.4 2.5

2.6

37

(.)

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3. 3.1

3.2 3.3

3.4

3.5 3.6

4.

4.1 4.2

38

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1. 2.

3. 4. 5. 6. 7.

1.

2. 3. 4. ()5. 6. 7. 8. 9.

39

(.)

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1. 2.

3. 3.1 3.2

4.

5. 6. 7.

8. 9. 10.

11.

40

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5

1.

2.

3.

4.

20

5. 1-3

41

(.)

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1.

2.

3.

4.

1. 3

2.

3.

4.

5.

6.

42

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1.

2.

3.

...

43

(.)

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. : .: ; 2548.

44

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5

(HARM REDUCTION)

(Overdose)

(Mental health problems)

45

(.)

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(Pregnancy and breastfeeding)

binge

2

(Withdrawal) ( 3 )

()

( 500 )

46

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47

(.)

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1. , , .

. : ; 25532. , , , .

. : ; 2552.

3. . 2554[]. ...: ...; 2554 [ 20 2556]: http://nctc.oncb.go.th/new/images/stories/conclusion/estimate2011.pdf

4. . . 2552; 17(2): 129-148.

5. . : .: ; 2548.

6. . 11..2555-2559. : ; 2554

7. Australian General Practice Network. Management of patients with psychostimulant useproblems-guidelines for general practitioners. Canberra: Australian Government Departmentof Health and Ageing; 2007.

8. Connolly K, Lee N, Clark C. From Go to Whoa-Psychostimulants training program for healthprofessionals: participant workbook. Canberra, ACT: Commonwealth of Australia; 2006.

9. Jenner L, Lee N. Responding to challenging situations related to the use of psychostimulants:a practical guide for frontline workers. Canberra: Australian Government Department of Healthand Ageing; 2008.

10. Jenner L, Baker A, Whyte I, Carr V. Psychostimulants-management of acute behaviouraldisturbances: guidelines for police services. Canberra: Australian Government Department of Healthand Ageing; 2004.

11. Lee N, Johns L, Jenkinson R, Johnston J, Connolly K, Hall K, Cash R. Clinical treatment guideline

for alcohol and drug clinicians, no.14: Methamphetamine dependence and treatment. Fitzroy,Victoria: Turning Point Alcohol and Drug Center; 2007.

48

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