Descriptive Psychopathology: The Signs and Symptoms of ...

362 Section 3: Examination domainsRegular users of illicit drugs and other substances (e.g. inhalants) have personalitytraits similar to early-onset alcoholics, but with more extreme behavioral activation.64 Their high behavioral activation combined with low behavioral inhibitionpredispose to impulsivity, aggressiveness and sensation-seeking. 65 The traits areseen as phenotypic markers for drug and alcohol abuse. When found in children,they predict later substance and alcohol abuse. 66 The genetic influences on personality,adverse neurodevelopmental effects from intrauterine exposure to maternalsubstance use, and adverse early developmental effects from impaired maternal–child interactions contribute to the addiction-predicting childhood traits. 67 Someearly-onset cocaine and opiate abusers, however, are found to be hyperthymic orcyclothymic, indicating that their abuse reflects disturbances in mood rather thantrait behavior. They are more likely to have a family history of mood disorder. 68Associated psychopathologyCaffeine and nicotine are the addictive drugs of most common regular usage.Heavy caffeine use presents as anxiety and sleep disorder. Features of caffeinisminclude periodic anxiousness and unease, inner tremulousness, fine tremor,stomach upset, visual blurring or seeing colors as washed out or in the bluerange. Heavy nicotine use is associated with other addictions and depressiveillness. Both caffeine and nicotine are highly addictive and sudden withdrawalelicits headache, irritability, and sluggishness.Some patients with depressive illness and anxiety disorder abuse alcohol andsedatives. These patients have no deviant personality traits or have high behavioralinhibition. Their abuse is understood as an effort at self-medication.The use of illicit drugs has acute and chronic behavioral consequences. Toxicityis associated with psychosis and delirium. Chronic exposure is associated withrecurrent psychotic disorder, cognitive impairment, and functional decline. Theassociated psychopathology is presented in the chapters on motor abnormalities,delusions and perceptual disturbances.Personality change associated with alcoholism and substance abuseChronic heavy alcohol use is associated with personality change. The change istypically observed in men over age 50 that have had few other alcohol-relateddifficulties. These heavy drinkers become increasingly suspicious, sullen, andirritable. They may become the “neighborhood crank” who repeatedly complainsabout the deficiencies or underhanded dealings of local government or litigatesagainst neighbors “encroaching” on property. The syndrome can evolve intodelusions about spouse infidelity, family attempts at stealing wealth, or government“dirty tricks”. 69