Mental Emotional Disorder due to Inhalant

Abstract
BACKGROUND: Inhalants called volatile substances or solvents, are volatile
hydrocarbons, which become gases at room temperature. Inhalants are substances
commonly used in teenage street children. The effects of this substance in addition
to strengthening also agitation, paranoid, hallucinations, self-resistance and chest
pain. We wrote this article with the aim of showing a low socioeconomic level and
street children who have the vulnerability to become users of illegal drugs, especially
inhalants.

CASE REPORT: A 15-year-old man with a primary cause of anger, self-talk, and a
major complaint of headaches, which was experienced 1 month ago. He also heard
voices and was often seen discussing with these voices. Other complaints are
sleepless, aloof, don't want to take care of themselves like bathing. He is known that
along with his friends, street children often suck the glue that is bought at the stalls, if
they get money from busking on the streets this has been done for 1 year. His father
passed away 1.5 years ago due to a traffic accident, since then his family's economic
life, which has been lacking, has become worse. His mother had to work as a
housemaid to make ends meet and he was forced to quit school to help his mother
earn a living by singing on the streets. He has 3 younger siblings. He often gets into
fights with other street children who have different opinions with him and together
with his friends have committed theft in traditional markets. Previous history of illness
was not found, a history of womb and childhood did not occur. Education history is
only up to grade 1 junior high school, history of suicide is not found, history
associated with law enforcement is found, psychosocial stressors are a problem with
the social environment. From special psychiatric examinations, there were
inappropriate affections, dysforic mood, impaired reality testing of abilities, psychosis
was found, auditory hallucinations were encountered, alertness composmentis, good
orientation, impaired concentration and calculation, old memory, rather long, just
good, immediate memory impaired, knowledge general and good abstract mind,
insight degree 1 and good judgment test, social judgment is interrupted. Normal vital
sign, normal physical examination, normal neurological examination. This case was
diagnosed as a mental and behavioral disorder due to the use of inhalation by these
findings. Therapy given risperidone 2mg 2x1 / 2 / day / oral.

Conclusion: several studies show that the use of inhalants in street children is quite
high.

Introduction
Inhalants, sometimes called volatile substances or solvents, are volatile
hydrocarbons, which become gases at room temperature. These compounds are
used in many household products as solvents, propellants, thinners, and fuels. For
example, toluene, one such volatile hydrocarbon, is a key ingredient in some glues. 1
Individuals, especially adolescents, inhale these products for their
intoxicating effects. Among US eighth graders, inhalants are among the most
commonly used illicit drugs, with about 11 percent reporting lifetime use, a
prevalence rate higher than those of all other illicit drugs except marijuana. However,
with increasing age, prevalence of past-year inhalant use declines; most adolescents
discontinue their inhalant use and few people ever meet criteria for inhalant use
disorder. However, inhalants are associated with multiple problems, including
conduct disorder, noninhalant SUDs, mood, anxiety and personality disorders,
suicidality, and a history of physical/sexual abuse and neglect victimization; for some
adolescents, an early time-limited use of inhalants may signal a lifelong problem with
externalizing behaviors, novelty seeking, impulsivity, and risk-taking propensity. 1
We wrote this article with the aim of showing a low socioeconomic level and
street children who have the vulnerability to become users of illegal drugs, especially
inhalants.

Case Report

A 15-year-old man with a primary cause of anger, self-talk, and a major

complaint of headaches, which was experienced 1 month ago. He also heard voices
and was often seen discussing with these voices. Other complaints are sleepless,
aloof, don't want to take care of themselves like bathing. He is known that along with
his friends, street children often suck the glue that is bought at the stalls, if they get
money from busking on the streets this has been done for 1 year. His father passed
away 1.5 years ago due to a traffic accident, since then his family's economic life,
which has been lacking, has become worse. His mother had to work as a housemaid
to make ends meet and he was forced to quit school to help his mother earn a living
by singing on the streets. He has 3 younger siblings. He often gets into fights with
other street children who have different opinions with him and together with his
friends have committed theft in traditional markets. Previous history of illness was
not found, a history of womb and childhood did not occur. Education history is only
up to grade 1 junior high school, history of suicide is not found, history associated
with law enforcement is found, psychosocial stressors are a problem with the social
environment. From special psychiatric examinations, there were inappropriate
affections, dysforic mood, impaired reality testing of abilities, psychosis was found,
auditory hallucinations were encountered, alertness composmentis, good orientation,
impaired concentration and calculation, old memory, rather long, just good,
immediate memory impaired, knowledge general and good abstract mind, insight
degree 1 and good judgment test, social judgment is interrupted. Normal vital sign,
normal physical examination, normal neurological examination. This case was
diagnosed as a mental and behavioral disorder due to the use of inhalation by these
findings. Therapy given risperidone 2mg 2x1 / 2 / day / oral.

Discussion

Adolescent inhalant use is a serious public health problem that

disproportionally affects antisocial youth. The prevalence rates for antisocial youth
approach 40%, compared to nearly 8.8% of youth in the general population. The
National Institute on Drug Abuse defines inhalants as “volatile substances that
produce chemical vapors that can be inhaled to induce a psychoactive, or mind-
altering effect”, Examples of inhalants include glue, paint, gasoline, solvents,
whipped cream dispensers, and nail polish remover. Effects of inhalant intoxication
last only a few minutes and similar to alcohol, include slurred speech, ataxia,
euphoria, and dizziness.
Inhalant use can have deleterious health consequences including brain
damage, heart irregularities, optic nerve damage, hearing loss, liver damage, muscle
atrophy, and death. Population-based studies have found that inhalant use is
associated with mental illnesses, criminal activity, and use of multiple drugs. 2
 For more than thirty years, nationally representative surveys have identified
inhalant use as among the most prevalent forms of adolescent substance use. For
example, findings from the 2006 Monitoring the Future survey indicated that 16.1%
of U.S. 8th graders had used inhalants, compared to 15.7% who had used
marijuana/hashish, and 7.3%, 3.4%, 3.4%, and 1.4% who had used amphetamines,
hallucinogens, cocaine, and heroin, respectively. Wu and colleagues recently
estimated that two million 12-to-17 year-olds in the U.S. had used inhalants based
on data from the National Survey on Drug Use and Health. 3
Inhalants such as toluene are thought to be direct releasers of dopamine in
the nucleus accumbens. “Bath salts” are synthetic stimulants that commonly include
the active ingredient methylenedioxypyrovalerone (MDPV) but may also contain
mephedrone or mehylone. They are also called “plant food” and like other stimulants
can have reinforcing effects but also cause agitation, paranoia, hallucinations,
suicidality, and chest pain.4
Based on the DSM-5 diagnostic criteria for inhalant use disorders:
A. A problematic pattern of use of a hydrocarbon-based inhalant substance leading
to
clinically significant impairment or distress, as manifested by at least two of the
following, occurring within a 12-month period:
1. The inhalant substance is often taken in larger amounts or over a longer
period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control use
of the inhalant substance.
3. A great deal of time is spent in activities necessary to obtain the inhalant
substance, use it, or recover from its effects.
4. Craving, or a strong desire or urge to use the inhalant substance.
5. Recurrent use of the inhalant substance resulting in a failure to fulfill major
role obligations at work, school, or home.
6. Continued use of the inhalant substance despite having persistent or recurrent
social or interpersonal problems caused or exacerbated by the effects of its
use.
7. Important social, occupational, or recreational activities are given up or
reduced because of use of the inhalant substance.
 8. Recurrent use of the inhalant substance in situations in which it is physically
hazardous.
9. Use of the inhalant substance is continued despite knowledge of having a
persistent or recurrent physical or psychological problem that is likely to have
been caused or exacerbated by the substance.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of the inhalant substance to
achieve
intoxication or desired effect.
b. A markedly diminished effect with continued use of the same amount of the
inhalant substance.5

In 2013, Embleton et al. Reported that street children from resource-

constrained settings reported high life-time substance use. Inhalants are the
predominant substances used, followed by tobacco, alcohol and marijuana. 6
In 2015, Dhawan et al reported Among adolescent substance users, inhalant
use was the most prevalent and a common substance used by street children.
Results show that about 96% of the sample had been regularly using these volatile
substances in the past month; with 83% reporting use of eraser fluids, which are a
form of typewriting correction fluid containing toluene and highly preferred because
of its euphoric effect, cheapness and easy availability. Studies indicate that
inhalants, are often the first category of substances to be abused by adolescents and
thus constitute a gateway drug preceding cigarettes by 1.5 years. 7
Risperidone is a second generation antipsychotic introduced after clozapine
in the United States. This drug blocks D2 receptors. This drug also has an
antagonistic effect on the 5-HT2 receptor and possibly also on the 5-HT1 receptor.
Risperidone is an α1 and α2 adrenergic antagonist and histamine receptor. The
recommended initial dose of risperidone is 1 mg / day in divided doses, raised 1 mg /
day until the desired effect is obtained. The maximum dose is 16mg / day, the
maximum effect is usually seen in a dose range of 4-8mg / day / oral. 8
In conclusion, several studies show that the use of inhalants in street
children is quite high. We suggest the role of various parties to reduce the incidence
of inhalant use in street children.
References

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