Vol 5 n° 2 - Psychiatric disorders in somatic medicine
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lcohol, nicotine, and caffeine share several com- mon features. Being palatable for their mild psychotropic properties,they are the most widely consumed drugs world- wide.As licit psychoactive drugs, they are used mostly by “normal”people,in contrast to illicit “hard drugs,”which are traditionally viewed as the province of the deviant. Known to mankind for several centuries, alcohol, nicotine, and caf- feine have become an important part of culture, serving as a vehicle for social interaction, shaping the urban landscape with dedicated places—from the Ottoman coffeehouse to the German Brauhaus and the Parisian café—stimulating the opening of international trade routes and bringing sub- stantial tax revenues to governments.Abnormal patterns of substance use have been described since antiquity.Aristotle recorded the effects of alcohol withdrawal and warned that drinking could be injurious during pregnancy1; the Roman physician Celsus held that dependence on intoxicating drink was a disease.2 Today, alcohol and nicotine are public health problems because of their association with physical ailments such as cirrhosis,cancer,and cardiovascular disease.Of these three substances, only alcohol causes clear neuropsychiatric sequelae. Frequent heavy drinking, especially when associ- ated with malnutrition, has been shown to lead to central nervous system (CNS) deterioration.The Diagnostic and Statistical  Manual  of  Mental  Disorders, Fourth  Edition (DSM-IV),3 the current nomenclature of the American Psychiatric Association, has specific diagnostic categories for  alcohol-,  nicotine-,  and  caffeine-related  disorders. According to DSM-IV’s definition, all three substances can induce dependence. Conversely, patients presenting with various mental disorders may be more prone than the gen- eral population to use or abuse these three common sub- stances. Thus, patients with bipolar depression are more likely to abuse alcohol at certain times in the course of their illness. Patients with schizophrenia have high rates of con- sumption of all three substances, which they use to relieve dysphoria.4 C l i n i c a l   r e s e a r c h 1 7 5 Alcohol, nicotine, caffeine, and mental disorders Marc-Antoine Crocq, MD Keywords: alcohol; nicotine; caffeine; depression; dependence; withdrawal Author  affiliations:  FORENAP,  Institute  for  Research  in  Neuroscience  and Neuropsychiatry, Rouffach, France Address for correspondence:  Marc-Antoine Crocq, MD, FORENAP, Institute for Research in Neuroscience and Neuropsychiatry, BP29, 68250 Rouffach, France (e-mail: ma.crocq@ch-rouffach.fr) A Alcohol, nicotine, and caffeine are the most widely con- sumed psychotropic drugs worldwide. They are largely consumed by normal individuals, but their use is even more frequent in psychiatric patients. Thus, patients with schizophrenia tend to abuse all three substances. The interrelationships between depression and alcohol are complex.  These  drugs  can  all  create  dependence,  as understood in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Alcohol abuse is clearly deleterious to the brain, provoking acute and chronic mental disorders, ranging from intoxication with impairment of cognition, to delirium tremens, hallucin- osis, and dementia. In contrast, the main health conse- quences of nicotine, notably cancer and cardiovascular dis- eases, lie outside the realm of psychiatry. However, the issues of nicotine dependence and motivation to smoke or quit are of concern to psychiatrists. Dialogues Clin Neurosci. 2003;5:175-185.