NEUROTIC DISORDERS IN POLYSUBSTANCE USE: CURRENT PERSPECTIVES ON PATHOGENESIS, CLINICAL MANIFESTATIONS, AND TREATMENT APPROACHES

Polysubstance use is characterized by the concurrent or sequential use of different psychoactive substances and is associated with complex neurobiological and functional alterations in the central nervous system. Neurotic and neurosis-like disorders represent an important component of the clinical presentation and may manifest as anxiety, emotional instability, depressive symptoms, sleep disturbances, asthenic complaints, and autonomic dysfunction. This review analyzes current concepts regarding the mechanisms underlying neurotic disorders associated with polysub­stance use. Particular attention is given to neurotransmitter dysregulation, neuroinflammation, alterations in hypo­thalamic–pituitary–adrenal axis activity, and disturbances in the bioelectrical activity of the brain. Clinical manifesta­tions, diagnostic possibilities, and contemporary therapeutic strategies are discussed, including pharmacotherapy with low addictive potential and non-invasive neuromodulation techniques. The available evidence supports a com­prehensive assessment of neurotic manifestations in polysubstance use and further development of pathogenetically oriented approaches to their treatment.