阿片类物质使用障碍

最后审阅: 2 一月 2023
最后更新: 23 十一月 2022

小结

定义

病史和体格检查

关键诊断因素

  • 存在的危险因素
  • 阿片使用的不良反应
  • 高成瘾严重指数(ASI)得分
  • 阿片致欣快作用降低
  • 瞳孔缩小
  • 瞳孔放大
  • 浅/慢呼吸或窒息
  • 针孔、瘢痕或注射处皮肤坏死
  • 意识不清
  • 脉搏小于40次/分
更多 关键诊断因素

其他诊断因素

  • 慢性便秘
  • 体重减轻
  • 恶心/呕吐
  • 镇静
  • 睡眠不稳/失眠
  • 记忆损害
  • 喷嚏
  • 打哈欠
  • 腹部绞痛
  • 腹泻
  • 背痛/肌肉痉挛
  • 忽冷忽热
  • 低血压
  • 镇静
  • 意识模糊
  • 言语不清
  • 攻击行为
  • 过度出汗或流泪
  • 鼻溢(流涕)
  • 多动
  • 毛发竖立
  • 呼吸急促
  • 高血压
  • 心律失常
  • 惊厥
其他诊断因素

危险因素

  • 低龄
  • 心理健康障碍病史
  • 物质使用史
  • 长期的阿片治疗
  • 儿童期创伤
  • 物质使用家族史
更多 危险因素

诊断性检查

首要检查

  • 尿液或唾液药物筛查
  • 气相色谱-质谱联用技术(GC-MS)
  • 血清电解质
  • 全血细胞计数 (FBC)
  • 尿素/肌酐
  • 肝功能检查 (LFT)
  • 肝炎血清学
  • HIV 血清学
  • 纯化蛋白衍生物 (purified protein derivative, PPD) 皮试
更多 首要检查

需考虑的检查

  • 快速血浆反应素试验
  • 血液培养
  • β-人绒毛膜促性腺激素(beta-hCG)
更多 需考虑的检查

治疗流程

急症处理

非孕期成人患者的门诊/住院脱毒计划

非孕期青少年患者住院/门诊脱毒计划

孕妇住院/门诊脱毒计划

持续性治疗

非孕期成人患者脱毒后治疗计划

非孕期青少年脱毒后治疗计划

孕妇脱毒后治疗计划

撰稿人

作者

Ashwin A. Patkar, MD, MRCPsych

Associate Professor

Medical Director

Duke Addictions Program

Department of Psychiatry and Behavioral Sciences

Duke University Medical Center

Durham

NC

利益声明

AAP is a consultant/member of the advisory board for Cubist Pharma, Biodelivery Sciences (BDSI), Kaleo, Forest Research Institute, and Titan Pharma; is on the speaker’s bureau and received honoraria from Otsuka, Alkermes, Sunovion, and BDSI; and is a shareholder in Ironwood Sciences LLC and Patkar Medical Consultants. AAP's institution has received grant support from National Institutes of Health (NIDA, NIAAA), SAMHSA, AstraZeneca, Bristol-Myers Squibb, Cephalon, Daiichi Sankyo, Envivo Pharma, Forest, J & J, Jazz Pharmaceuticals, Lundbeck, Merck, Organon, Pfizer, Sunovion, Shire, and Titan. AAP holds unpaid positions on the Board of Directors of Southlight Inc, the Board of Advisors of People's Medical Care, the Executive Committee of Triangle Indian American Physicians Society, and also as President of Indo American Psychiatric Association.

Jonathan C. Lee, MD

Medical Director

The Farley Center at Williamsburg Place

Williamsburg

Community Assistant Professor

Department of Family Medicine

Eastern Virginia Medical School

Norfolk

Assistant Clinical Professor

Department of Psychiatry

Virginia Commonwealth University

Richmond

VA

Affiliate Assistant Professor

Department of Psychiatric Medicine

East Carolina University

Greenville

NC

利益声明

JCL is a full-time employee at The Farley Center at Williamsburg Place.

Douglas M. Burgess, MD

Assistant Professor

Department of Psychiatry

University of Missouri - Kansas City

Medical Director

Outpatient Behavioral Health

Truman Medical Centers

Kansas City

MO

利益声明

DMB declares that he has no competing interests.

鸣谢

Dr Ashwin A. Patkar, Dr Jonathan C. Lee, and Dr Douglas M. Burgess would like to gratefully acknowledge Dr Kamal Bhatia and Dr Srilakshmi Musham, previous contributors to this topic.

利益声明

KB declares that he has received grant support from National Institutes of Health, Lundbeck, Pfizer, and Titan Pharmaceuticals. SM declares that she has received grant support from Pfizer, Titan Pharmaceuticals, Shire, and the Forest Research Institute.

同行评议者

Christos Kouimtsidis, MBBS, MSc, MRCPsych, PhD

Consultant Psychiatrist and Honorary Senior Lecturer

Institute of Psychiatry

King's College London

London

UK

利益声明

CK declares that he has no competing interests.

George E. Woody, MD

Emeritus Professor

Department of Psychiatry

Perelman School of Medicine

University of Pennsylvania

Philadelphia

PA

利益声明

GEW declares that he has no competing interests. GEW is an author of a number of references cited in this topic.

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