Dissociative Explained

Dissociatives, colloquially dissos, are a subclass of hallucinogens that distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self. Although many kinds of drugs are capable of such action, dissociatives are unique in that they do so in such a way that they produce hallucinogenic effects, which may include dissociation, a general decrease in sensory experience, hallucinations, dream-like states or anesthesia.[1] Despite most dissociatives' main mechanism of action being tied to NMDA receptor antagonism, some of these substances, which are nonselective in action and affect the dopamine[2] and/or opioid[3] systems, may be capable of inducing more direct and repeatable euphoria or symptoms which are more akin to the effects of typical "hard drugs" or common drugs of abuse. This is likely why dissociatives are considered to be addictive with a fair to moderate potential for abuse, unlike psychedelics. Despite some dissociatives, such as phencyclidine (PCP) possessing stimulating properties, most dissociatives seem to have a general depressant effect and can produce sedation, respiratory depression, nausea, disorientation, analgesia, anesthesia, ataxia, cognitive and memory impairment as well as amnesia.

Effects

The effects of dissociatives can include sensory dissociation, hallucinations, mania, catalepsy, analgesia and amnesia.[4] [5] [6] According to Pender (1972), "the state has been designated as dissociative anesthesia since the patient truly seems disassociated from his environment."[7] Both Pender (1970) and Johnstone et al. (1959) reported that patients under anaesthesia due to either ketamine or phencyclidine were prone to purposeless movements and had hallucinations (or "dreams"[8]) during and after anaesthesia. Some patients found the hallucinations euphoric while others found them disturbing.

At sub-anesthetic doses, dissociatives alter many of the same cognitive and perceptual processes affected by other hallucinogenic drugs such as mescaline, LSD, and psilocybin; hence they are often contrasted and also considered hallucinogenic.[9] [10] [11] Perhaps the most significant subjective differences between dissociatives and the classical hallucinogens (such as LSD and mescaline) are the detaching effects, including: depersonalization, the feeling of being unreal, disconnected from one's self, or unable to control one's actions; and derealization, the feeling that the outside world is unreal or that one is dreaming.[12]

Use

Medical use

Many dissociatives such as ketamine are used as anesthetics for surgery or pain relief in medical contexts such as in hospitals. However, due to possible psychotomimetic reactions they are sometimes used reluctantly.[13] [14] Certain morphinan dissociatives such as dextromethorphan are also used in sub-psychoactive dosages to suppress coughing.[15]

Ketamine is also currently being studied and is showing promising results as a possible fast-acting antidepressant[16] [17] It may also function as a possible palliative treatment for C-PTSD and chronic pain.[18] [19] [20]

Recreational use

Some dissociative drugs are used recreationally. Ketamine and nitrous oxide are club drugs. Phencyclidine (PCP or angel dust) is available as a street drug. Dextromethorphan-based cough syrups (often labeled DXM) are taken by some users in higher than medically recommended levels for their dissociative effects. Historically, chloroform and diethyl ether have been used recreationally.

See also

Notes and References

  1. Snyder . Solomon H. . Phencyclidine . Nature . 285 . 5764 . 355–6 . 1980 . 7189825 . 10.1038/285355a0. 1980Natur.285..355S . 208653777 .
  2. Giannini . AJ . Eighan . MS . Loiselle . RH . Giannini . MC . Comparison of haloperidol and chlorpromazine in the treatment of phencyclidine psychosis . Journal of Clinical Pharmacology . 24 . 4 . 202–4 . 1984 . 6725621 . 10.1002/j.1552-4604.1984.tb01831.x. 42278510 .
  3. Giannini . A. James . Nageotte . Catherine . Loiselle . Robert H. . Malone . Donald A. . Price . William A. . Comparison of Chlorpromazine, Haloperidol and Pimozide in the Treatment of Phencyclidine Psychosis: Da-2 Receptor Specificity . Clinical Toxicology . 22 . 6 . 573–9 . 1984 . 6535849 . 10.3109/15563658408992586.
  4. John W. . Pender . 1970 . Dissociative Anesthesia . California Medicine . 18730444 . 113 . 5 . 73 . 1501800.
  5. Johnstone . M. . Evans . V. . Baigel . S. . Sernyl (C1-395) in Clinical Anaesthesia . British Journal of Anaesthesia . 31 . 433–9 . 1959 . 10 . 10.1093/bja/31.10.433. 14407580 . free .
  6. Oduntan . S. A. . Gool . R. Y. . Clinical trial of ketamine (ci-581): A preliminary report . Canadian Anaesthetists' Society Journal . 17 . 411–6 . 1970 . 4 . 10.1007/BF03004705. 5429682 . free .
  7. John W. . Pender . October 1972 . Dissociative Anesthesia . California Medicine . 18730832 . 117 . 4 . 46–7 . 1518731.
  8. Virtue . RW . Alanis . JM . Mori . M . Lafargue . RT . Vogel . JH . Metcalf . DR . An anaesthetic agent: 2-orthochlorophenyl, 2-methylamino cyclohexanone HCl (CI-581). . Anesthesiology . 28 . 5 . 823–33 . 1967 . 6035012 . 10.1097/00000542-196709000-00008. 34414786 . free .
  9. Mason . Oliver J. . Morgan . Celia J.M. . Stefanovic . Ana . Curran . H Valerie . The Psychotomimetic States Inventory (PSI): Measuring psychotic-type experiences from ketamine and cannabis . Schizophrenia Research . 103 . 1–3 . 138–42 . 2008 . 18387788 . 10.1016/j.schres.2008.02.020. 807162 .
  10. Gouzoulis-Mayfrank . E. . Heekeren . K. . Neukirch . A. . Stoll . M. . Stock . C. . Obradovic . M. . Kovar . K.-A. . Psychological Effects of (S)-Ketamine and N,N-Dimethyltryptamine (DMT): A Double-Blind, Cross-Over Study in Healthy Volunteers . Pharmacopsychiatry . 38 . 6 . 301–11 . 2005 . 16342002 . 10.1055/s-2005-916185. 260241166 .
  11. 9250944 . Krupitsky . 1997 . EM . 165–83 . 2 . 29 . Grinenko . Journal of Psychoactive Drugs . AY . Ketamine psychedelic therapy (KPT): a review of the results of ten years of research. . 10.1080/02791072.1997.10400185 . 2010-10-25 . https://web.archive.org/web/20100819091706/http://www.eleusis.us/resource-center/references/kpt10yrs.php . 2010-08-19 . dead .
  12. Vollenweider . F . Geyer . MA . A systems model of altered consciousness: integrating natural and drug-induced psychoses . Brain Research Bulletin . 56 . 5 . 495–507 . 2001 . 11750795 . 10.1016/S0361-9230(01)00646-3. 230298 .
  13. Adams HA . [S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation] . DE . Der Anaesthesist . 46 . 12 . 1081–7 . December 1997 . 9451493 . 10.1007/s001010050510 . 36323023 . S-(+)-ketamine. Circulatory interactions during total intravenous anesthesia and analgesia-sedation .
  14. Barrett W, Buxhoeveden M, Dhillon S . Ketamine: a versatile tool for anesthesia and analgesia . Current Opinion in Anesthesiology . 33 . 5 . 633–638 . October 2020 . 32826629 . 10.1097/ACO.0000000000000916 . 221236545 .
  15. Book: Australian Medicines Handbook . 2013 . The Australian Medicines Handbook Unit Trust . 978-0-9805790-9-3 . Adelaide . Rossi, S .
  16. Sanacora G, Frye MA, McDonald W, Mathew SJ, Turner MS, Schatzberg AF, Summergrad P, Nemeroff CB . 6 . A Consensus Statement on the Use of Ketamine in the Treatment of Mood Disorders . JAMA Psychiatry . 74 . 4 . 399–405 . April 2017 . 28249076 . 10.1001/jamapsychiatry.2017.0080 . 28320520 .
  17. Marcantoni WS, Akoumba BS, Wassef M, Mayrand J, Lai H, Richard-Devantoy S, Beauchamp S . A systematic review and meta-analysis of the efficacy of intravenous ketamine infusion for treatment resistant depression: January 2009 - January 2019 . J Affect Disord . 277 . 831–841 . December 2020 . 33065824 . 10.1016/j.jad.2020.09.007 . 223557698 .
  18. Oyetunji . Aderonke . Huelga . Christian . Bunte . Kailee . Tao . Rachel . Bellman . Val . Oyetunji . Aderonke . Huelga . Christian . Bunte . Kailee . Tao . Rachel . Bellman . Val . Use of ketamine for depression and suicidality in cancer and terminal patients: Review of current data . AIMS Public Health . 2023 . 10 . 3 . 610–626 . 10.3934/publichealth.2023043 . 37842268 . 10567968 .
  19. Midega . Thais Dias . Chaves . Renato Carneiro de Freitas . Ashihara . Carolina . Alencar . Roger Monteiro . Queiroz . Verônica Neves Fialho . Zelezoglo . Giovana Roberta . Vilanova . Luiz Carlos da Silva . Olivato . Guilherme Benfatti . Cordioli . Ricardo Luiz . Bravim . Bruno de Arruda . Corrêa . Thiago Domingos . Ketamine use in critically ill patients: a narrative review . Revista Brasileira de Terapia Intensiva . 2022 . 34 . 2 . 10.5935/0103-507X.20220027-en . 9354105 .
  20. Ragnhildstveit . Anya . Roscoe . Jeremy . Bass . Lisa C. . Averill . Christopher L. . Abdallah . Chadi G. . Averill . Lynnette A. . The potential of ketamine for posttraumatic stress disorder: a review of clinical evidence . Therapeutic Advances in Psychopharmacology . January 2023 . 13 . 204512532311541 . 10.1177/20451253231154125 . 36895431 . 9989422 .

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