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Keywords: dependence, a narcotic, a stimulator, a medicine, an amphetamine, Phenaminum, an ephedrine, Pervitinum, a coffeine, pharmacology, the abstract, euphoria, accustoming, predilection, a psychostimulant

DEPENDENCE ON PSYCHOSTIMULANTS

DEFINITION OF STIMULATORS

The given group of toxic substances includes what are capable to cause a unusual elation, aspiration to activity, to remove feeling of weariness, to frame subjective sensation of indefatigability, vivacity, unusual clearness of mind and ease of movements, fast ingenuity, confidence of the forces and abilities, even fearlessness. As against action of agents causing the euphoria, similar rise though it is accompanied by high spirits, but it cannot be named "solar" or serene. On the contrary, the raised mental tone is combined with vozbuzhdennostju, more or less expressed uneasiness, constant vigilance, even suspiciousness to an event around.

By-effects become a sleeplessness, oppression of appetite, a tachycardia, sometimes with extrasystoles, rising of arterial pressure, a muscular tremor.

The conditions caused by stimulators have similarity with hypomaniacal rising of activity and sensation of the general rise, but differ from them alarming vigilance and downstroke of appetite that does their similar to the mixed conditions at schizoaffective psychosises at teenagers [Lichko A.E., 1985].

One of the most wide-spread stimulators are: an amphetamine (Phenaminum), ephedrone (a handicraft way the prepared preparation similar to an ephedrine), and also derivatives of Pervitinum.

EPHEDRON DEPENDENCE

The picture of an acute intoxication is described by an ephedrine P. Boyd (1971), I.T.Stankushevym (1982), I.N.Pjatnitskoj and co-authors (1986), G.J.Lukacherom, A.G.Vrublevskim and co-authors (1987), N.G.Najdenovoj (1988). Its displays differ at the peroral use (more infrequent) and at intravenous injections a little.

At the peroral use through 10-15 mines after reception euphoria with original psychosensorial infringements develops. There is a sensation of unusual ease of a body - "weightlessness". Paints environmental seem bright and juicy. There are synesthesias - at sounds in eyes appear iridescent a stain. Typically also the feeling of " own kindness ", " love to people ", empathies to anyone another's, is more often imaginary, I burn, and also unusual clearness and a sharpness of ideas [Pjatnitskaja I.N., etc., 1986]. To some extent the similar condition of " the aggravated sensitivity " represents as though an antipode of what in psychiatry is known as " morbid loss of consciousness " - anaesthesia dolorosa.

At intravenous introduction of ephedrone the symptomatology develops with prompt speed. The first phase of action comes within several minutes ("arrival", "pressure", etc.). There is a mild fever, sensation of a pricking in arms and legs. It seems, that hair on a head move, " become on end ", " start to grow ". Palpitation is felt.

The second phase begins through 10-20 mines - the arising condition can be characterized as atypical hypomaniacal. The mood is raised, the elation is felt. But the persons who earlier have tested action of opiates, notice essential difference between "kaif" (euphoria with feeling of physical and mental comfort without aspiration to activity and dialogue), them caused, and unusual "rise" of all vital forces after an injection of an ephedrine. This rise differs a superactivity, pulls to roverstnikam, to adventures. Restlessness can reach restless fussiness. Teenagers become talkative, speak quickly and unceasingly, jumping with themes on a theme, distracting and repeating. To all are obsessional, want to share the ideas and feelings, "kindness". Thus briskly gesticulate. Mimic support of statements happens is exaggerated up to grimaces. The attention is the extremely unstable. Easily distract at change of a situation.

At purposeful inquiry quite often confirm the phenomena of a depersonalisation and a derealization. Mark special ease in a body, a condition of "weightlessness". The environmental ordinary situation suddenly becomes unusually "interesting".

At adults productive activity - verses, drawings, etc. [Pjatnitskaja I.N., etc., 1986] which at teenagers practically does not meet is marked.

Aggression under own initiative happens seldom, but she can be easily provoked from the party even by harmless remarks, and the main thing spiteful tone and a kind and the more so attempts to limit activity, to keep. Sex activity raises. Intensifying libido in a combination with described by " the aggravated sensitivity ", impetuous desire of self-feedback plays, probably, the big role in often homosexual excesses.

Neurologic infringements include a mydriasis with weakening reaction of pupils on light, a spontaneous nystagmus, and also occurrence of various "microsymptomatology" which, most likely in the erased or compensated kind existed earlier. Sometimes there are starts by all body - spontaneous or at sharp sounds, and also a muscular tremor.

On data EEG attributes of an intracranial hypertension [by Lukacher G.J., etc., 1987] are taped.

Among vegetative infringements paleness of the person, rising of arterial pressure, a moderate tachycardia, sometimes extrasystoles are observed dryness mucous (drying labiums frequently lick).

The picture of an ephedron intoxication in the beginning of abusing is kept after injection till 8 o'clock. On a measure of repetition of daily injections tolerance grows, that becomes obvious on decrease of the period of "rise" till 1-2 o'clock.

The condition after an intoxication (i.e. the output from ephedron intoxication) differs that the depressed mood, the flaccidity, fast fatigability, feeling of complete exhaustion are combined with somatic discomfort - the bad state of health, whining pains in different parts of a body, is especial in a nape, parestezijami - seems, that on a body creep murashki. The arterial hypertension and a tachycardia can be kept. The need for dream is combined with impossibility to fall asleep, and a sleepiness - with restless dream.

Ephedrone in Russia is included in the list of narcotics, and with occurrence of dependence on him the narcomania is diagnosticated.

Abusing begins at once with intravenous injections more often. Familiarizing usually occurs in group where the grown-up on age the experienced narcomaniac ("teacher") enters. Influence of the similar leader, and also property of ephedrone quickly to cause mental, and then and physical dependence cause high risk to begin the narcomaniac for the teenager who was once dared on his intravenous injection. It is possible, that not less than at half from those who has once entered to itself ephedrone intravenously, the narcomania is shaped.

The main motive of the first abusing G.J.Lukacher and co-authors (1987) have noted " imitation comrades ". More likely business is not simple in imitation, and in influence of group on the teenager (reaction of grouping, group conformism, etc.).

The ephedron narcomania differs special speed. There are enough 2-3 intravenous injections that attributes of mental dependence have appeared - uncontrollable desire more and more time to test ephedron intoxication. On a measure of repetition of injections everyone become more serious intoksikatsionnye than a condition on an output from ephedron intoxication. There are gripping pains in the field of heart and loins, excruciating ischurias. Attacks of a fever alternate with down-pour then. Especially restless there is a dream with often awakenings, dreadful dreamings, attacks of pavor. Develop a hyperacusia (start at unexpected sounds) and a photophobia (wear dark glasses even in the evening at electric illumination). Through day - two this excruciating condition Najdenova N.G., 1988] is replaced by an asthenia and a sleepiness [.

Depending on frequency of abusing passes from 2-3 weeks about several months when it is already possible to reveal a serious abstinent set of symptoms and a compulsive inclination. The last is always especially strong on an output from ephedron intoxication. Because of it narcomaniacs start to do to themselves injections on some times in day, one by one, each 2-4 hours. There are the conditions similar with serious alcoholic start singing [Pjatnitskaja I.N., etc., 1986: Najdenova N.G., 1988]. The daily dose entered (handicraft image prepared) ephedrone grows in comparison with initial about 2-3 ml up to 30-80 ml. The single dose is seldom enlarged more than twice because of unpleasant by-effects at an overdosage (strong palpitation, etc.).

Similar excesses usually become periodic. The cycle of abusing proceeds 2-5 day. During him do not sleep, do not eat, quickly grow thin, tire itself out. By this moment the inclination to ephedrone falls [Pjatnitskaja I.N., etc., 1986]. There comes an intoxication a condition ("withdrawal") with a sharp asthenia, an excruciating sleeplessness, a giddiness, a pain in eyes. In 6-12 hours there comes a new phase - develops somnolentnoe a condition: strong sleep, woken - immediately fall asleep again. But on a measure of development of a narcomania to fall asleep there is all more difficultly. Start to resort to tranquilizers and soporific. Gradually their dose also grows in 2-4 times. Having slept off day - other, feel " brutal appetite ", all time something chew, at absence of nutrition near at hand - her steal. At the first cycles during this period the sexual inclination also amplifies, but on a measure of development of a narcomania it is completely oppressed, and at young men the impotency develops. In some days the inclination to ephedrone flashes with new force, and the cycle repeats. With development of a narcomania intervals between cycles are shortened from 5-10 till 2-3 days.

Change of a picture of intoxication also serves as display of the generated narcomania. Euphoria is shortened and done by more "fragile" [Pjatnitskaja I.N., etc., 1986: she is interrupted easily with external irritants, even the reference to the teenager can " break a kaif ". Chaotic activity is replaced by more purposeful activity and enterprise, the behaviour appears more collected. Ephedron paranoids arise on a background of similar narcotic excesses more often. The abstinent set of symptoms is characterized, first of all, by a serious dysphoria [Lukacher G.J., etc., 1987]. The gloomy mood is combined with a malice and an aversion for all environmental. The sleepiness alternates with impellent anxiety. The muscular tremor is observed. Fibrillar twitchings muscles of the person and tongue are very characteristic. Pupils are narrowed, reaction to light is weakened. The spontaneous nystagmus is sometimes seen. Are caused pathological stopnye reflexes. The proof red dermographism, greasiness of the person are marked. Arterial pressure changes, is frequently reduced, there is a predilection to kollaptoidnym to reactions, especially orthostatic. Complain of a headache, weakness, " internal anxiety ".

Various deviations in the neurologic status [Lukacher G.J., etc., 1987], from our point of view, probably, testify to revealing the attributes of residual organic defeat of a brain compensated and flattened in a usual condition.

Duration of an abstinent set of symptoms - 1-2 weeks. Abstinent acute paranoids on a clinical picture do not differ from the acute ephedron paranoids arising at height of an intoxication. Usually they are tightened for some days. Their main difference from acute ephedron paranoids will be, that the next injection of ephedrone of them immediately stops [Najdenova N.G., 1988].

The social degradation occurs rather quickly. Desert study, work. Conduct a parasitic way of life, gathering first of all relatives, begging, stealing. Former interests and attachments are lost. Become careless and unscrpulous. Somatic complications are shown by a myocardial dystrophy (pains in the field of heart, on the electrocardiogram - a hypertrophy of a left ventricle, diffuse muscular changes, infringements of intraventricular conduction), a chronic gastritis and a spastic coloenteritis [Pjatnitskaja I.N., etc., 1986]. Attributes of a chronic intoxication (as impurity in ephedrone) are reduced by manganese to occurrence of choreiform hyperkinesias - wide movements by arms and legs from which it is difficult for patient to be kept, and parezu a soft palate, tongue, facial muscles. These attributes appear after 2-3-летнего abusings ephedrone [Najdenova N.G., 1988].

PERVITINOVAJA DEPENDENCE

The picture of intoxication reminds ephedron [Bitenskij V.S., 1987]. At the first uses through 10-15 mines there is an original euphoria - "enlightenment"; all environmental gets unusual clearness and beauty, there is a feeling of pleasant corporal comfort.

In one half an hour - hour there comes the hypomaniacal condition similar to ephedron intoxication. Rise of mood is combined with the expressed rising activity, confidence of, the forces and opportunities. There is a sensation, that in a head there come especially important and pathetic ideas, and own decisions seem rather successful and clever. Everything, that was earlier represented confusing and not clear, gets clearness.

Doubtless action "shirki" is sharp intensifying a sexual inclination, and at teenagers of a male also a sex potency. All are taken out constraining " social brakes ". The behaviour of teenagers of both of sex is distinguished with naked sexuality. Young men appear capable of tens sexual relations successively, each time reaching an orgasm.

Duration of intoxication - till 6-8 o'clock. Intoksikatsionnoe the condition ("output") is shown by a dysphoria with irritability, embitternment, gloomy melancholy, suspiciousness. However on a background of a dysphoria the asthenia, a flaccidity, an adynamia, apathy gradually are more and more shown.

After the first abusings in intoksikatsionnom a condition there is an invincible inclination to repeated introduction of a preparation, therefore dependence develops quickly.

On a measure of continuation of abusing the period of "rise" is reduced and faster replaced intoksikatsionnoj by a dysphoria and an asthenia.

"SHirka" has property to cause strong dependence, an invincible inclination, and abusing her entails the expressed degradation of the person and represents special social danger.

At development of a narcomania of injection "shirki" start to repeat during 1 day. Also daily, and then and the single dose [Bitenskij V.S., 1987] rather quickly grows. The abstinence is shown not only a serious dysphoria when the malice with aggression is combined with alarming suspiciousness, but also the subsequent serious asthenia and a sleepiness, down to a deafenation and a substruporous condition. Even in a month after the termination of reception the flaccidity, an apathism, nekontaktnost, disability to steady purposeful activity are kept; teenagers hardly think.

Among neurologic infringements on a measure of development of a narcomania appear smazannost speeches, intentsionnyj a muscular tremor, poshatyvanie at walking. Are caused pathological stopnye reflexes, and suhozhilnye at first raise, then are reduced.

Alienations include psihopatizatsiju on epileptoidno-unstable type [Lichko A.E., 1983, 1985] and attributes of a psychoorganic set of symptoms.

Psihopatizatsija it is shown asotsialnym by behaviour: evasion from study and work, delinkventnostju, neglect laws and rules, aspiration to immediate satisfaction of the arisen desires, complete apathy to interests of others, fast satiation of that originally involved, with feeling of boredom and a boring. To remarks and praises become indifferent, to criticism - intolerant, to any steady work - unable, to relatives do not test attachment. At the same time vital inclinations can be forced. The behaviour as a whole is defined by desires and mood, instead of common sense.

The psychoorganic set of symptoms includes such attributes as infringement of concentration of attention, weakening of memory, an emaciation at the slightest mental loads, disability quickly to be guided in a varying situation. Thinking in a slowed-up way, think hardly, but at the same time the tendency to excessive detailed elaboration acts, wallow in trifles.

The expressed narcomania is capable to be generated for some weeks of abusing, and 2-3 months happen enough for development of the described toxic encephalopathy, psihopatizatsii and a psychoorganic set of symptoms.

AMPHETAMIN DEPENDENCE

The amphetamine (Phenaminum) on a chemical structure is close to an epinephrine, but his action essentially differs. It is indirect monoaminovym the antagonist, renders both central, and peripheric action, causing liberation from the presynaptic terminations of Noradrenalinum, a serotonin and Dofaminum. The amphetamine blocks return capture of a mediator, and also is inhibitor MAO. Action is connected to accumulation of catecholamins in sinapticheskoj clefts. Long application - exhausts a stock of catecholamins. To synthesize their necessary quantity - some days are necessary. During this time narcomaniacs test depressive signs.

At abusing an amphetamine use it in the doses many times over exceeding therapeutic, or enter it or preparations similar to it intravenously. There were indicatings that therapeutic doses of Phenaminum approximately at 10 % of people rendered paradoxical effect as a sleepiness, flaccidities, downstrokes of serviceability. Similar reactions at teenagers at abusing the big doses it is not described.

Accept preparations of this group the following categories of persons more often: teenagers - for experiments, students - for rising progress, sportsmen - for overcoming weariness, the persons accepting Phenaminum for growing thin, drivers - truckers - for rising attention.

The first phase at intravenous introduction ("arrival"), essentially does not differ from those, described at ephedron intoxication.

The second phase at intravenous injection or intoxication at peroral application remind atypical hypomaniacal or even the mixed condition especially frequently meeting at schizoaffective psychosises at teenagers. Unusual rise, overexcitement, special vivacity, confidence of the forces and abilities are subjectively felt. This condition of an elation and vozbuzhdennosti has given the basis for lines of names of an amphetamine in English teenage slenge. An amphetamine name booster pill, lift-pill, driver, forward, speeder, leaper, sparkle plenty, bombita.

The feeling of weariness disappears. The pavor before real danger is suppressed, it does his capable of despair and risky acts. Sometimes there is a sensation of " intellectual clearing ", special depths of own ideas, abilities to penetrate into essence of things.

The behaviour differs constant aspiration to activity and movement (" somewhere pulls "), impossibility to remain sitting on one place. Verboseness is observed, and speech becomes emotionally sated, is especial with angry - angry intonations. The facial expression is exaggerated, but corresponds to the maintenance of statements. Predilection to wide gestures is marked. Aggression - not only easily provoked, but also initiative sharply grows. The persons who are taking place in an ebrietas from an amphetamine conceive fights in the slightest occasion. The present serene fun do not test. On the contrary, easily there is a suspiciousness to environmental, vigilance. Steadfastly watch others, as though expecting malicious intention. Show to all excessive curiosity, set mass of unnecessary questions which special sense is clear only for them; persistently demand the answer. Occasionally they sometimes have acoustical hallucinations - from elementary (bells, hooters) up to calls by name. Tactile hallucinations are described also - feel, that on their body insects creep, catch and beat them.

The amphetamine sharply suppresses appetite and need for dream. After the big doses a day - two can not sleep and not is.

At neurologic survey pay attention to wide pupils with the weakened reaction to light and a convergence (because of what teenagers mark deterioration of vision " difficultly to read ", " everything as in a fog "). The muscular tremor, stereotyped movements of labiums and tongue are sometimes appreciable. Somatic infringements are shown by complaints to palpitation, a tachycardia, frequently with extrasystoles, rising of arterial pressure, paleness of the person, dryness in a mouth. There can be a chilling, a nausea and a vomiting, a headache. As complications at an overdosage the stethalgias reminding a stenocardia, syncopes, serious cardiac arrhythmias are marked, and even cases of mors from a stopping of cardiac activity [DSM-III-R, 1987] are described.

The intoxication (an after-action of amphetamin intoxication, " an amphetamin hang-over ") meets very much frequently after reception of the big doses. As his main display the dysphoria serves, and at those who repeatedly was exposed to an amphetamin intoxication, also flash of invincible desire of repeated reception or injection of an amphetamin preparation. Postintoksikatsionnoe the condition frequently comes suddenly, as fracture ("crash"): rise is replaced gloomy - depressed by mood, irritability, animosity, feeling of intolerable weariness and exhaustion, sometimes alarm, " internal anxiety " because of which, despite of weariness, without soporific cannot fall asleep.

Duration of an after-action - from several hours about one day. As a matter of fact, the after-action corresponds to a picture of an abstinence at an amphetamin narcomania, and last distinguish from him only to that the abstinence lasts more than day [DSM-III-R, 1987]. To remove or weaken postintoksikatsionnoe an after-action, beforehand accept barbituraty or tranquilizers. In the USA one time widely were issued the medicinal preparations combining an amphetamine and somnolent.

The differential diagnosis should be carried out with the beginning of a hypomaniacal phase as an angry or paranoica mania, that quite often meets at teenagers at a schizoaffective and maniacal - depressive psychosis, and also intoxications other stimulators. The endogenic hypomaniacal phase lasts, as a rule, more than day though, on data Н. Stutte (1960), she can be all some hours. Appetite in these cases is not oppressed, and, on the contrary, there is even a unusual gluttony. Otvlekaemost it is distributed and on aggression - the object of aggression easily varies.

Ephedron and perventinovoe intoxication differs smaller aggression, there is no incessant vigilance and suspiciousness, there is no predilection to development of ideas of the attitude and prosecution.

The diagnosis proves to be true, if the biochemical analysis finds out an amphetamine in bloods or his derivatives in urine.

At abusing without dependence business is limited to incidental reception of an amphetamine or one - two intravenous injections. At repetition of the last quickly there is a mental dependence. By its first display happens invincible desire to repeat injection of an amphetamin preparation or again it to accept in postintoksikatsionnom the period (during a so-called second phase of action). It aspire to avoid arising the depressed mood, " internal anxiety ", somatic discomfort. As an indirect attribute of occurrence of dependence the aspiration to accept somnolent or tranquilizers can serve also during an after-action, and furthermore beforehand that it to avoid. Sometimes these preparations even accept simultaneously with an amphetamine or it enter intravenously, and tranquilizers accept perorally.

Amphetamin narcomanias at teenagers are in most cases characterized by the periodicity of abusing reminding drinking-bouts at an alcoholism. " Excesses on week-end " at the English schoolboys has described P. Connell (1968). On Friday in the evening they disappeared from a house and came back on Monday in a condition of a dysphoria - angry, aggressive to rodnym, is especial to mother. The dysphoria proceeded 1-2 days. Within a week an amphetamine did not accept and continued study, in a weekend all repeated.

More serious form is represented so-called with " the Swedish cycles " [Boyd Ph., 1971], or bindging [DSM-III-R, 1987], that is literally translated as "binge". Teenagers within 2-3 day repeatedly entered Methylamphetaminum or metilfenidat (Centedrinum) intravenously or accepted it repeatedly in the big doses, leading up daily reception up to several hundreds milligrams, i.e. already in some tens times exceeding the maximum therapeutic dose. Intravenous injections repeated each 2-4 hours. In such days teenagers do not sleep, do not eat, all time are " on a platoon " in a condition reminding an angry mania at affective psychosises at teenagers [Lichko A.E., 1985]. Usually similar "bindzhing" it is combined with delinkventnym behaviour and even with criminal cases of aggressive character. Quite often participate in bloody fights between teenage gangs, are initiators of similar collisions, however are capable to show aggression, even severe, concerning casual passers. In 2-3 day reach complete exhaustion, there are syncopes, strong palpitation with faults, are tormented from a sleeplessness, all becomes, as in a fog. Then accept the big dose of soporific, 2-3 day sleep off and eaten off, and then again begins next "bindzhing". At similar abusing at many paranoica psychosises rather quickly develop. Constant abusing an amphetamine is reduced usually to peroral reception: sometimes in the morning - before study, sometimes in the evening - before entertainments. For the night quite often accept soporific or a tranquilizer. At similar abusing tolerance grows slowly - during months and even years. Gradually grow thin. Predilection to pyogenic infections - all time somewhere something nagnaivaetsja is found out, suffer a furunculosis. At men the sex potency appreciablly falls and the sexual inclination is reduced. In due course accrues angedonija - anything in life is not capable to give pleasure, cause interest. Teenagers become inactive, become isolated, gloomy - angry the mood constantly keeps.

The sudden break in the use of an amphetamine results in development of an abstinent set of symptoms. The abstinent set of symptoms at an amphetamin narcomania, as a matter of fact, represents tightened on some days (till 2-3 weeks) a picture postintoksikatsionnogo conditions. The dysphoria with gloomy mood, embitternment, irritability, " internal anxiety ", need on something " develops to break evil ". The sensation of complete exhaustion and an excruciating sleeplessness join this. There is an invincible desire again to accept an amphetamine.

The amphetamin confusion can be not only at height of an intoxication, but also arise as a result of a sudden break of long everyday reception of an amphetamine in the big doses. She can develop in 3-5 days after a break in abusing and proceed till 10 day [Spivak L.I., etc., 1988].

Chronic amphetamin psychosises are shown by a proof galljutsinatorno-paranoica set of symptoms. On a background of a constant dysphoria or pavor develops not only a persecution complex and attitudes, but also true acoustical hallucinations, and it is frequent also delirium of physical influence (from hypnosis and a telepathy up to a nuclear irradiation and laser beams). There can be also separate attributes of a set of symptoms of Kandinsky - Klerambo.

Psychosises last from 2-3 weeks about many months. Their similarity to a paranoica schizophrenia has induced to the assumption, that the amphetamine causes " experimental model of a schizophrenia " [Wainec S. et аl., 1981, - the citation on L.I.Spivaku, etc., 1988]. Whether similar psychosises can really serve as experimental model or the amphetamine is the provoker for " patos schizophrenias " [Snezhnevskij A.V., 1972], i.e. development of them is possible at corresponding predisposition, remains obscure.

CAFFEINIC DEPENDENCE

A coffeine - the stimulating agent most wide-spread in the world. On the average in the USA daily the person consumes about 200 mg of a coffeine that is equivalent to 2 cups of strong coffee.

The mechanism of action of a coffeine is connected to blockade adenozinovyh receptors and inhibition fosfodiesterazy (augmentation tsAMF). Raises respiratory and sosudodvigatelnyj center.

At abusing plenties of strong coffee are used (sometimes with spoons eat the coffee grounds prepared as kissel) or very strong broth of tea (chifir). In seeds of coffee and leaves of tea contains up to 2 % of a coffeine and his alkaloids. It is considered, that in a cup of strong coffee - 0,1 gramme of a coffeine. Signs of an intoxication appear at reception from 0,25 grammes and is higher, but at abusing accept up to 1 gramme. For example, in a pack of tea in 50 gramme from which prepares chifir, contains about 1 gramme of alkaloids of a coffeine [Bathhouse attendants of Century. М., etc., 1971].

The picture of a poisoning also partly reminds a hypomaniacal condition. However intensifying of a motor performance is less expressed. Acceleration of thinking, hasty speech, otvlekaemost, anxiety prevail. Subjectively test activation of mental faculties, improvement of memory, an exacerbation of attention, " creative inspiration ". The mood is a little bit raised, but without the expressed euphoria. The weariness, a sleepiness, a flaccidity are eliminated, vivacity and inflow of forces are felt. Among vegetative signs are characteristic a tachycardia, sometimes with ekstrasistoliej. There can be a small rising of arterial pressure. The gastric secretion sharply amplifies, there can be pains in epigastric area, feeling of famine or a vomiting. The diuresis grows. At the big doses there can be muscular twitchings.

Current of an intoxication sometimes gets wavy character. The periods of rise by duration of 1-2 hours are replaced same on duration by the periods of recession when teenagers feel like weakened, but cannot fall asleep, then again there comes rise, again recession, etc. Duration of the phenomena of an intoxication - from 2-3 till 6-8 o'clock.

Long abusing a coffeine (" coffee kissel ") and very strong broth of tea ("chifir") for a teenage population is uncharacteristic. Begun to use these substances or soon stop their reception, or address to other stupefying agents more strongly working.

TREATMENT AND PROPHYLAXIS

At ephedron, pervitinovom or fenaminovom intoxication medical tactics differs in cases where there are bases to diagnose the generated narcomania and where it is necessary to carry out the differential diagnosis between it and abusing without dependence (for example when the teenager asserts that has entered to itself ephedrone for the first time or occasionally entered it some times). If the teenager rejects presence of an inclination it is possible for it to offer within day to remain without any treatment and to observe of duration postintoksikatsionnoj dysphorias. The dysphoric condition tightened about one day and is longer from the moment of last introduction of a stimulator, specifies that it is not postintoksikatsionnym a condition ("output"), and display of an abstinence.

At the expressed first phase ephedron or fenaminovogo intoxications with a picture of the atypical hypomaniacal or mixed condition it is better to be limited to an intramuscular injection of 0,5 % of Relanium of 2-4 ml (Sibazonum, Diazepamum, Seduxenum) and usual dezintoksikatsionnymi agents (parenteral introduction of an isotonic solution of a sodium of Sodium chloridum, a glucose, etc.). Concerning neuroleptics it is necessary to be careful. Haloperidolum is capable to provoke expressed akatiziju [Lukacher G.J., etc., 1987], aminazine and Tisercinum - collapses. At expressed ekstrasistolii (some extrasystoles in 1 mines) are possible to resort to novokainamidu (5 ml of 10 % of a solution intramuscularly).

At hardly proceeding postintoksikatsionnom the period with the expressed dysphoria injections of Relanium, and for struggle against an excruciating sleeplessness (" it would be desirable to sleep and to not fall asleep ") - eunoktin (Radedormum), Phenazepamum are shown. Barbiturovye somnolent it is necessary to avoid in connection with danger of a polynarcomania on which opportunity repeatedly it was specified in the American researches.

At ephedron, pervitinovoj and an amphetamin abstinence the intensive treatment combining tranquilizers, nebarbiturovye somnolent, antidepressants with anksioliticheskim action, and also dezintoksikatsionnye agents is required. Neuroleptics just as at ephedron and fenaminovom intoxication, remain less shown because of the expressed side effects during an abstinence. Aminazine and even Tisercinum (Levomepromazinum) are capable to cause kollaptoidnye conditions, and Haloperidolum and preparations similar to it - expressed parkinsonopodobnyj a set of symptoms. At a serious dysphoria from fenotiazinovyh preparations Neuleptilum (Periciazinum) in drops (4 % the solution, 1 drop contains 1 mg), since 10 mg 3 times day (a dose about 20-30 mg are possible to increase by reception) can be used. Operates sonapaks (Mellerilum, Thioridazinum) in a dose on 25-50 mg 3 times day (75-150 mg day) more weakly.

If the alarm prevails, Chlorprothixenum on 50 mg 2-3 times day or Relanium (Sibazonum, Seduxenum) on 10 mg 3 times day is more shown. At weak effect from these agents or occurrence of suicidal statements it is possible to appoint in addition amitriptilin (on 25-50 mg in the morning and in the afternoon) or Pyrazidolum (in the same doses).

The expressed vegetative infringements, a vascular dystonia Grandaxinum (Tofizopamum) on 50-100 mg well eliminates 3 times day.

For struggle against an excruciating sleeplessness it is better to use eunoktin (Radedormum) on 10 mg. At awakening among night (eunoktin operates 2-3 ч) reception can be repeated. Somnolent effect eunoktina strengthen and prolong Phenazepamum (1-1,5 mg), Relanium, sonapaksom. If not it is possible to cause dream with the help eunoktina, it is possible to try Theralenum (alimemazin) in a dose of 5 mg. When the acute phenomena of an abstinence minujut, in quality psihofarmakologicheskogo the proof-reader of the residual phenomena are shown Phenazepamum (on 1 mg in the morning and in the afternoon and 1,5 mg for the night), Eglonylum (on 0,1 gramme 3 times day), and also nootropy - Pyracetamum (Nootropilum) on 0,4-0,8 gramme 3 times day.

Dezintoksikatsionnaja therapy should be enough intensive in the first days. Drop intravenous injections of Haemodesum (on 400 ml day within 2-6 days after the termination of an intoxication) with rate in 60-80kap/minutes are recommended. Before the beginning of the first drop injection biological assay is necessary: after 1-2-минутного injections it is necessary to make a break on 15-20 mines to reveal an individual intolerance. Drop injections intravenously 15 % of a glucose - on 500 mg day are used also; to it it is possible to add 8-20 ED an insulin.

At an ephedron or amphetamin paranoid in the first 2-3 days irrespective of, whether there was a paranoid on a background of an intoxication, in postintoksikatsionnom a condition or during an abstinence, it is better to avoid firstly antipsychotic neuroleptics. It is possible to be limited to Relanium (on 2-4 ml of 0,5 % of a solution intramuscularly), in the morning and to appoint Chlorprothixenum on 50 mg, to night - 25 mg of Tisercinum (Levomepromazinum) perorally in the afternoon.

If the paranoid is tightened more than 3-4 days treatment by Haloperidolum is shown, since 1-2 ml of 0,5 % of a solution 2-3 times day intramuscularly, then at improvement of a condition passing on tablets on 5 mg 2-3 times day. Only at sharply expressed parkinsonopodobnyh the phenomena it is necessary to resort to aminazine. Leponexum (Clozapinum) is less shown, as on a background of an abstinence is declined to provoke night deliriums.

At an amphetamin confusion also it is preferable to start intramuscular injections of Relanium, combining them with intensive dezintoksikatsiej. The similar condition is usually accompanied by a wet brain (more precisely - intratselljuljarnym swelling of nervous cells). Therefore dehydrational agents - injections intravenously solutions of Mannitum and a urea, and also an Euphyllinum (1 ml of 24 % of a solution on 20 ml of an isotonic solution or 40 % of a solution of a glucose to enter slowly during 5 mines) are shown also.

On minovanii the phenomena of an abstinence treatment is reduced to application of Nootropilum (Pyracetamum), tranquilizers not causing predilection (for example, Phenazepamum), fortifying and tonic agents. Concerning the last it is necessary to take into account, that development of physical and mental dependence is described at the long use of Tinctura Araliae of a ginseng [Vaile Ch., 1892, - the citation. On L.I.Spivaku, etc., 1988]. Introduction of vitamins is useful also.

In hope to suppress the mental dependence distinguished by great strength and duration, it is used sonapaks (on 10-25 mg in the morning and in the afternoon and on 25-50 mg for the night). The psychotherapy at ephedron, pervitinovoj and an amphetamin narcomania is under construction the same as at a thebaic narcomania.

At a poisoning with a coffeine use tranquilizers and nebarbiturovye somnolent. At strong pains in epigastric area Atropinum (0,5-1 ml of 0,1 % of a solution subcutaneously) is shown. At chronic abusing a coffeine in connection with an opportunity of round ulcers of a stomach the lavage of it should be carried out with the big care.

Prophylaxis of an amphetamin narcomania, first of all, is under construction on strict control measures above use of Phenaminum in the medical purposes. Indications to his application strictly circumscribed, that is why manufacture and holiday from drugstores are very insignificant (as against anesthetizing preparations of opium). It is possible to connect practically complete absence with strict restrictions of use and the rigid control fenaminovoj narcomanias at teenagers in our country.

In the USA the last years the amphetamine and preparations similar to it were rather widely applied as an agent of struggle against weariness at a different sort asthenic conditions, and also to suppression of appetite with the purpose of growing thin. In a result by pharmaceutical firms was issued in one year up to 12 billion pills with an amphetamine, i.e. more than 50 pills per capita [Grinspoon L., Hedblom P., 1975]. In England only in 1968 g when the amphetamin narcomania was already distributed among teenagers, have been withdrawn ampulirovannye preparations of Methylamphetaminum and metilfenidata [Connell P., 1968].

The strict control over ephedrone to carry out much more difficultly. Even if to take under the vigilant account use of ampoules and tablets of an ephedrine at treatment of attacks of a bronchial asthma, allergic reactions, eye drops, and also different Unguentums and drops for a rhinitis, also his containing, remains wild-growing efedra. In Central Asia teenagers already use the ephedrone prepared by a handicraft way from this plant [Abshaihova U.A. 1989]. Thrickets of two kinds efedry - mountain, or hvoshchovoj (Ephedra equisetina), and deserted (Е. intermedia) - wide-spread enough. In the Volga region and in Western Siberia other kind efedry - kuzmicheva a grass (Е. distachya), considerably less rich an ephedrine, than the Central Asian kinds grows. Destruction of these wild-growing plants rather inconveniently.

Preventive measures in the field of sanitary education do not differ on the methods from those at other kinds of narcomanias.

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Keywords: pharmacology, psychostimulants, accustoming, predilection, dependence on chemical substances, a narcotic, an amphetamine, Phenaminum, a coffeine, a narcomania, an ephedrine, an ephedron narcomania, somnolent, Pervitinum, an abstinence

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