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Phase 3A Medicine > Psychiatry - Addictive behaviour > Flashcards

Psychiatry - Addictive behaviour Flashcards

1
Q

Define TOLERANCE

A

Higher dose of drug required to produce the same response

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2
Q

Define WITHDRAWAL

A

Transient state occurring whilst readjusting to lower levels of drug in the body

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3
Q

Define DEPENDENCE SYNDROME

A

Cluster of physiological, behavioural and cognitive symptoms in which the use of a substance takes on a much higher priority than other behaviours that once had a greater value

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4
Q

Outline 5 key criteria of a dependence syndrome

A
  1. Withdrawal
  2. Desire to take substance
  3. Difficulty in controlling substance taking behaviour
  4. Tolerance
  5. Neglect of alternative pleasures
  6. Primacy
  7. Persisting despite harmful consequences
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5
Q

What two features are seen in alcohol dependence which are not seen in drug dependence?

A
  1. Narrowing of repertoire
  2. Rapid reinstalment (people who stop when they start again wil get back to the level of tolerance they had previously, very quickly)
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6
Q

Allowed weekly units for men and women including per day

A

14

3 per day

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7
Q

More than how many units for women and men would be classified as a binge?

A

Women 6

Men 8

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8
Q

How many mls of pure alcohol in a unit

A

10

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9
Q

Give three risk factors for substance abuse

A
  1. Genetics
  2. Occupation - doctor, armed forces, journalist
  3. Social background - difficult childhood, parental separation, poor educational achievement
  4. Psychiatric illness
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10
Q

Presenting features of a patient intoxicated with alcohol?

A
  1. Initially relaxed and euphoric
  2. Then aggressive, irritated, weepy, disinhibited
  3. Impulsive
  4. Poor judgement
  5. Physical: ataxic gate, dysarthria, sedation, confusion, coma
  6. Narrowing of repertoire
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11
Q

Give two questionnaires that you could use to determine alcohol dependence?

A
  1. CAGE

2. AUDIT (alcohol use disorder identification test)

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12
Q

What investigations would you do in an individual suspected to have alcohol dependence?

A
  1. FBC (Macrocytic anaemia due to B12 deficiency)
  2. LFT (yGT rises with recent heavy alcohol use and raises transaminases)
  3. CAGE/audit
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13
Q

What are the 6 phases of the stages of change model?

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse
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14
Q

What would the management of a patient with alcohol dependence syndrome entail?

A
  1. Motivational interviewing
  2. Stages of change model - where are they
  3. Detoxification
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15
Q

What is the standard detoxification regime for a patient with alcohol dependence syndrome?

A
  1. Chlordiazepoxide to replace alcohol and prevent withdrawal symptoms including seizures and DT
  2. Thiamine (vit B1 as prophylaxis against Wernicke’s encephalopathy)
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16
Q

How do you decide whether a patient will have a detox regime at home or as an inpatient?

A

Do at home if uncomplicated using Chlordiazepoxide regime for 5-7 days

If patient drinking more than 30 units a day keep as inpatient

If patient has history of withdrawal fits, or comorbid medical or psychiatric illness or patient lacks support can be done as inpatient

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17
Q

How is Thiamine delivered to a patient in a detox regime?

A

Either IV or IM (Parenterally)

Not PO because poorly absorbed in the gut

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18
Q

What type of drug is chlordiazepoxide?

A

Long acting benzodiazepine

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19
Q

What is the purpose of giving benzodiazepines in alcohol detox?

A

Prevents delirium tremens

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20
Q

What is the name of the medical emergency that occurs as a result of alcohol withdrawal?

A

Delirium tremens

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21
Q

What two medications are used to prevent relapse in an individual with previous alcohol dependence syndrome?

A
  1. Acamprosate (anti-craving)

2. Disulfuram (mimics flush reaction so makes drinking unpleasant)

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22
Q

Give 5 alcohol withdrawal symptoms

A
  1. Headache
  2. Nausea
  3. AUTONOMIC Sweating, tachycardia, hypotension, tremor
  4. Insomnia
  5. Agitation
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23
Q

Why can dependent drinkers get delirium tremens when they stop drinking?

A

Alcohol is a CNS depressant

Stimulates GABA inhibitory system to reduce brain excitability

When don’t drink neuro pathways become hyper excitable and seizures can occur or if severe DT

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24
Q

How long after abstinence begins does DT tend to occur?

A

48

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25
Q

How long does DT last?

A

3-4 days

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26
Q

Mortality rate of DT?

A

10-15%

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27
Q

Presenting factors of DT?

A
  1. Autonomic disturbance (sweating, tachycardia, hypertension, dilated pupils, fever)
  2. Delusions
  3. Hallucinations (visual and tactile)
  4. Affective changes (extreme fear and hilarity)
  5. Gross tremor
28
Q

How is DT managed?

A
  1. Benzodiazepine (DIAZEPAM)
  2. Paraenteral thiamine
  3. Manage dehydration and electrolyte abnormalities
29
Q

Give 5 physical consequences of excess alcohol consumption

A
  1. GI - alcoholic hepatitis, liver cirrhosis in 10-20%, pancreatitis, oesophageal varices, gastritis, PUD, malnutrition
  2. Neuro - peripheral neuropathy, seizures, dementia, subdural haematoma
  3. Cancer - bowel, breast, oesophageal, liver
  4. Cardiovascular- hypertension, dilated cardiomyopathy
30
Q

Give 5 psychological consequences of long-term alcohol consumption

A
  1. Depression, anxiety, self-harm, suicide
  2. Amnesia
  3. Cognitive impairment - dementia/Korsakoff
  4. Alcoholic hallucinosis
  5. Morbid jealousy
31
Q

Social consequences of long term alcohol consumption (5)?

A

Unemployment
Domestic violence
Separation
Law breaking

32
Q

What is the encephalopathy related to long term alcohol consumption?

A

Wernicke’s encephalopathy

33
Q

If Wernicke’s isn’t treated what happens?

A

Korsakoff syndrome

34
Q

What causes Wernicke’s encephalopathy?

A

Acute thiamine (b1) deficiency

35
Q

Why does chronic alcohol consumption result in thiamine deficiency?

A
  1. Inadequate nutritional intake
  2. Decreased absorption from GI tract
  3. Impaired utilisation in the cells
36
Q

What is the triad of symptoms seen in Wenicke’s?

A
  1. Ataxia
  2. Mental confusion
  3. Opthalmoplegia
37
Q

How is Wernicke’s treated?

A

Thiamine (parenteral)

38
Q

Give two signs of Korsakoff syndrome

A
  1. Anterograde amnesia (can register new events but can’t recall them within a few minutes)
  2. Patients often confabulate to fill gaps
39
Q

What antibiotic should not be taken with alcohol

A

Metranidazole

40
Q

What are illegal highs?

A

Drugs containing one or more chemical substances that produce similar effects to drugs like cocaine, cannabis or ecstasy. Since 2016 psychoactive substances act it has been illegal to give away or sell them but there is no penalty for possession

41
Q

How does Heroin work?

A

Mu opiate agonist.

42
Q

How is Heroin taken?

A

Smoked and as tolerance builds is injected IV

43
Q

Give 3 complications ofIV drug use

A
  1. Abscess/cellulitis/septicaemia
  2. DVT/ emboli –> gangrene
  3. Infective endocarditis
  4. BBI
  5. Overdose
44
Q

Why are IVDU’s more at risk of DVT

A

Injecting into femoral veins damages valves which slows venous return

45
Q

Clinical presentation of opiate intoxication

A
  1. Intense rush or buzz (euphoria, warmth)
  2. Followed by sedation and analgesia
  3. Vomit/dizziness
  4. Bradycardia and respiratory depression
  5. Pinpoint pupils
46
Q

What effects are seen from opiate use non-IV?

A
  1. Constipation
  2. Anorexia
  3. Decreased libido
47
Q

How is opiate overdose managed?

A

Naloxone

48
Q

What type of drug is naloxone?

A

Opiate receptor antagonist

49
Q

How long after last injection of opiate (heroine) does withdrawal start?

A

6 hours

50
Q

When does opiate withdrawal peak after last taking?

A

36-48 hours

51
Q

Drug withdrawal symptoms?

A
  1. GI - nausea, abdo cramps
  2. Insomnia
  3. Agitation
  4. Fever
  5. Aching muscles

Everything runs - diarrhoea, vomiting, lacrimation, rhinorrhoea

52
Q

What symptoms do babies with neonatal abstinence syndrome have?

A
  1. High pitched cry
  2. Convulsions
  3. Hypertonia
  4. Tremor
  5. Loose stools and vomiting
  6. Sweats
  7. Fever
53
Q

How are babies with neonatal abstinence syndrome treated?

A

Paediatric opiate preparations and anti-convulsants

54
Q

What other morbidities do babies with neonatal abstinence syndrome have?

A
  1. IUGR
  2. LBW
  3. Prematurity
  4. SIDS
55
Q

Management of IV drug use?

A
  1. Harm reduction

2. Substitute prescribing (detox)

56
Q

What is the difference between alcohol and drug withdrawal?

A

Not life threatening with drugs

57
Q

Give three methods of harm reduction in management of IV drug use

A
  1. Sterile needles
  2. Free condoms
  3. Injecting drug users and sex workers offered vaccination and testing for BBV
  4. Accessible sexual health services
58
Q

What two drugs can be prescribed in a opiate detox regime?

A
  1. Methadone - liquid

2. Buprenorphine - sublingual tablet

59
Q

What type of drug is methadone?

A

Full mu receptor agonist

60
Q

Why is methadone prescribed in detox regime?

A

Controlled drug - given orally

Has a longer half life than heroin so withdrawal is longer but milder. Only need to take once a day

61
Q

How can you test whether a patient has taken heroin?

A

Urine test - will show up up to a week after

62
Q

What drugs cannot be tested on urine test?

A
  1. Spice (synthetic cannabinoid)
  2. Pregabalin
  3. Gabapentin
63
Q

How does buprenorphine work and how is it different to methadone?

A

Partial mu receptor agonist. Blocks euphoric effects but prevents withdrawal

64
Q

What drug is prescribed to prevent relapse in opiate use?

A

Naltrexone

65
Q

What type of drug is naltrexone?

A

Mu receptor antagonist

66
Q

How does naltrexone work?

A

Blocks euphoric effects of opiates

67
Q

What drugs other than methadone and buprenorphine can be prescribed during a detox of opiates as adjuncts to improve comfort?

A
  1. Anti-emetic - metoclopramide

2. Anti-diarrhoeal (loperamide)

Phase 3A Medicine (12 decks)

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