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Y4 CBLs > Mental Health: Substance Abuse > Flashcards

Mental Health: Substance Abuse Flashcards

1
Q

Criteria for ‘dependence’

A

Three or more of :

  • Strong desire / compulsion to take the substance
  • Impaired control of substance taking behaviour in terms of onset, termination or levels of use
  • Physiological withdrawal state when use is reduced or stopped
  • Tolerance to effects of the substance leading to increased use
  • Preoccupation with use, to exclusion of other pleasures or interests
  • Persistence despite clear harm
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2
Q

What’s intoxication?

A
  • Follows administration of a psychoactive substance
  • Disturbances in:

–Level of consciousness

–Cognition

–Perception

–Affect

–Behaviour

  • Disturbance directly related to effect of the substance
  • Resolve with time
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3
Q

What’s harmful use?

A
  • Pattern of psychoactive substance use that is causing damage to health
  • Clear evidence of harm → physical or psychological
  • Nature of the harm should be identifiable
  • Pattern of use has persisted for at least one month, or has occurred repeatedly over a 12 month period
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4
Q

What’s Salience/Primacy?

A
  • Obtaining & using the substance takes over
  • Other interests & pursuits are neglected
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5
Q

What’s tolerance?

A
  • Increased doses of the psychoactive substance are required to achieve effects originally produced by lower doses
  • Contributes to escalation of use
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6
Q

What’s narrowing of repertoire?

A

Loss in variation in the use of the substance

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7
Q

What’s Reinstatement?

A

Occurs after a period of abstinence, when the patient re-starts the substance and rapidly increases use to previous harmful levels

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8
Q

Hx in substance abuse

A
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9
Q

Stages of change

A

Pre Contemplation

–Person feels there is no problem, though others recognise it

Contemplation

–Person weighs up pros & cons and considers if change is necessary

Decision

–Person decides to act (or not)

Action

–Person chooses strategy for change & pursues it

Maintenance

–Gains are maintained & consolidated

Relapse

–Return to previous pattern, but relapse may help learning

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10
Q

What’s the relationship between psychiatric illness and substance misuse?

A
  • ntoxication & / or dependence may lead to psychological symptoms and social difficulties
  • Substance misuse & / or withdrawal may cause psychiatric symptoms or illness & may trigger illness in those who are predisposed
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11
Q

Safe levels of alcohol intake

A

Men & Women now advised:

2-3 units / day

14 units / week

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12
Q

Harmful levels of alcohol intake

A

Harmful levels:

–Women > 6 units / day = >35 units / week

–Men > 8 units / day = >50 units / week

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13
Q

Aetiology of alcohol dependence

A
  • Gender → Males > females
  • Genetics → 25-50% of predisposition may be inherited
  • Occupation → Publicans, doctors, journalists, salesmen, actors, entertainers, seamen
  • Social → childhood difficulties / problems, parental separation, low educational achievement
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14
Q

Symptoms of alcohol intoxication

A
  • Relaxation & euphoria followed by disinhibition, various emotional states (irritable, weepy, morose), impulsive & irresponsible behaviour
  • Slurred speech, ataxia, sedation, confusion, flushed face, nystagmus, conjunctival injection
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15
Q

Symptoms of alcohol withdrawal with timeframe

A
  • symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
  • peak incidence of seizures at 36 hours
  • peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia
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16
Q

Mechanism of alcohol withdrawal

A
  • chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
  • alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)
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17
Q

Physical complications of alcohol abuse

A

Liver

–Hepatitis

–Cirrhosis in 10 – 20% of dependent persons

Gastrointestinal

–Pancreatitis

–Oesophageal varices

–Gastritis

–Peptic ulceration

Neurological

–Peripheral neuropathy

–Seizures

–Dementia

Cancer

–Bowel, breast, oesophageal & liver all associated

Cardiovascular

–Hypertension & cardiomyopathy

Head injury / accidents

–Risk increased while intoxicated

Foetal alcohol syndrome

–In infants born to those who drink during pregnancy

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18
Q

Management of alcohol withdrawal

A
  • patients with a history of complex withdrawals from alcohol (i.e. delirium tremens, seizures, blackouts) should be admitted to hospital for monitoring until withdrawals stabilised
  • firstline: benzodiazepines e.g. chlordiazepoxide.

Lorazepam may be preferable in patients with hepatic failure. Typically given as part of a reducing dose protocol

  • carbamazepine also effective in treatment of alcohol withdrawal
  • phenytoin* is said not to be as effective in the treatment of alcohol withdrawal seizures
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19
Q

Examples of one unit of alcohol

A
  • 25ml single measure of spirits (ABV 40%)
  • a third of a pint of beer (ABV 5 to 6%)
  • half a 175ml ‘standard’ glass of red wine (ABV 12%)
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20
Q
A
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21
Q

Psychological complications of alcohol dependence

A
  • Depression & Anxiety rates increased (also self medication can lead to dependence)
  • Self harm & suicide risk increased
  • Amnesia / blackouts (due to intoxication
  • Cognitive impairment

–Alcoholic dementia

–Korsakoff’s psychosis

  • Alcoholic hallucinations
  • Morbid Jealousy
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22
Q

How to calculate a number of units in a drink?

A

To calculate the number of units in a drink multiply the number of millilitres by the ABV and divide by 1,000. For example:

  • half a 175ml ‘standard’ glass of red wine = 87.5 * 12 / 1000 = 1.05 units
  • one bottle of wine = 750 * 12 / 1000 = 9 units
  • one pint of 5% beer or lager = 568 * 5 / 1000 = 2.8 units
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23
Q

Drugs used in detoxification

A

Detoxification

  • Benzodiazepines
  • Vitamins (Thiamine)
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24
Q

Relapse prevention

A
  • Psychological support (group, individual, AA)
  • Medical
  • Acamprosate – reduces craving
  • Disulfiram – induces flushing if alcohol taken
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25
Q

Medications used in relapse prevention (alcohol)

A
  • Acamprosate →reduces craving
  • Disulfiram → induces flushing if alcohol taken
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26
Q

MoA of Disulfiram

  • contraindications
A

disulfram → promotes abstinence - alcohol intake causes severe reaction due to inhibition of acetaldehyde dehydrogenase

Patients should be aware that even small amounts of alcohol (e.g. In perfumes, foods, mouthwashes) can produce severe symptoms.

Contraindications: ischaemic heart disease and psychosis

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27
Q

MoA of Acamprosate

A

Acamprosate:

  • reduces craving, known to be a weak antagonist of NMDA receptors
  • improves abstinence in placebo controlled trials
28
Q

Delirium Tremens

  • when does it start
  • symptoms
  • treatment
A

Delirium Tremens

  • Onset in 48h after abstinence
  • Confusion, hallucinations & illusions, agitation, sweating, tachycardia, tremor, seizures
  • Treat with reducing benzodiazepine regime & parenteral B vitamins (Pabrinex) - to avoid Wernicke – Korsakoff Syndrome
29
Q

Wernicke’s Encephalopathy

  • classic triad
  • cause
  • treatment
A

Wernicke’s Encephalopathy

Classic triad: of confusion, ataxia & ophthalmoplegia

Cause: Acute thiamine (vitamin B1) deficiency

Treatment: a course of parenteral B vitamins (Pabrinex) given IV or IM

*if untreated leads to Korsakoff’s Psychosis (IRREVERSIBLE anterograde amnesia with confabulation)

30
Q

Amphetamines

  • class
  • unofficial names
  • routes of administration
  • effects
A

Amphetamines

Class: stimulant

Names: “speed”, “whizz”

Routes of administration: Snorted, injected, eaten / put on gum

Physical & Psychological Effects:

–Cardiovascular strain

–Enlarged pupils

–Talkative, agitated, full of energy, irritable

  • Psychosis (schizophreniform)
31
Q

‘Illegal’ Benzodiazepines

  • what effect they produce?
A
  • Diazepam, Lorazepam, Temazepam
  • Prescribed or bought (often online)
  • Usually ingested orally, can be prepared for injection

Effects: sedation, euphoria, disinhibition, lability of mood, anterograde amnesia, unsteady gait, slurred speech, nystagmus, reduced consciousness, respiratory depression

32
Q

Withdrawal of benzodiazepines

  • what can happen
  • treatment
A

Withdrawal can cause: delirium tremens – like presentation with psychotic symptoms and seizures

Treatment: convert to diazepam equivalent dose & withdraw gradually over 8 + weeks

33
Q

Cocaine

  • class
  • effects it produces
A

Cocaine → Stimulant

  • Alert, confident, strong, disinhibited
  • Short- acting → need to repeat dose
  • “come down” – fatigue, depression / dysphoria, paranoid ideation, depersonalisation
34
Q

Two forms of cocaine

A

Two forms:

1. Powder (hydrochloride)

  • Sniff / snort / inject
    2. Crack (alkaloid)
  • Heated & inhaled through pipe
  • Quick acting with fast high
  • Can be injected if added to acid (vit C) – often with heroin (‘speedball’)
35
Q

What’s ‘speedball’?

A

Cocaine that can be injected if added to acid (vit C) – often with heroin (‘speedball’)

  • very fast effect of high
36
Q

Management of Cocaine abuse

A
  • Intense craving is a major problem
  • No replacement therapy available
  • Acute Psychotic episodes → antipsychotic & benzodiazepines (short term) for symptom control
  • Self help and support groups available (Cocaine Anonymous)
37
Q

Mechanism of action of cocaine

A

cocaine blocks the uptake of dopamine, noradrenaline and serotonin

38
Q

Side effects of cocaine abuse

A

Cardiovascular effects

  • myocardial infarction
  • both tachycardia and bradycardia may occur
  • hypertension
  • QRS widening and QT prolongation
  • aortic dissection

Neurological effects

  • seizures
  • mydriasis
  • hypertonia
  • hyperreflexia

Psychiatric effects

  • agitation
  • psychosis
  • hallucinations

Others

  • ischaemic colitis is recognised in patients following cocaine ingestion. This should be considered if patients complain of abdominal pain or rectal bleeding
  • hyperthermia
  • metabolic acidosis
  • rhabdomyolysis
39
Q

Management of cocaine toxicity

A

Management of cocaine toxicity

  • benzodiazepines are generally first-line for most cocaine-related problems
  • chest pain: benzodiazepines + glyceryl trinitrate. If myocardial infarction develops then primary percutaneous coronary intervention
  • hypertension: benzodiazepines + sodium nitroprusside
40
Q

Cannabis

  • routes of administration
  • active substance
  • other name
A

Administration: dried vegetative state or resin → eat or smoke

Active substance tetrahydrocannabinol → 75% of available cannabis is “Skunk” (genetically engineered to have more THC)

41
Q

SEs of cannabis

A

Produces “high”

SEs:

  • can exaggerate previous mood state, anxiety, “paranoia”, distortion of time, mild hallucinogen
  • conjunctival injection, dry mouth, tachycardia, respiratory tract symptoms
  • Association with schizophrenia
42
Q

Ecstasy

  • class
  • route of administration
A

MDMA → 3,4 methylenedioxymethylamphetamine

Sold in tablet (usually) or powder form

43
Q

Effects and SEs of ecstasy use

A

• increased energy, hyperaesthesias, increased feeling of wellbeing and love

SEs:

  • panic
  • dysphoria
  • depression

•Has been associated with raised temp, dehydration, tachycardia & DIC (disseminated intravascular coagulation)

44
Q

Heroin

  • class
  • other (informal) names
A

Class: opiate derivative → highly addictive

Names: “brown”, “smack”, “gear”

45
Q

Routes of administration of Heroin

A

•Injected

–If combined with crack cocaine is called “speedballing”

•Smoked

–By heating on tinfoil and inhaling the smoke

–“chasing the dragon”

–can also be snorted (less common)

46
Q

Heroin

  • effects
  • withdrawal symptoms
A

Effects: gives strong sense / rush of relaxation / wellbeing

Withdrawal symptoms:

–Vomiting, diarrhoea, cramps, sweats, dysphoria

47
Q

Physical effects of Heroin

A
  • Pin point pupils
  • “Track marks” → injection sites
  • Constipation
  • Poor nutrition
  • Poor dental state (reduced salivary flow)
  • Respiratory depressant
  • Blood borne viruses (injecting patients)

–Hepatitis C

–Hepatitis B

–HIV

48
Q

Education for Heroin users

A

Harm Reduction

–Needle exchange, stop sharing gear / works

–Encourage smoke rather than inject

–Raise awareness of overdose & how to manage it, especially if been abstinent (some areas give naloxone packs)

-Narcotics Anonymous

49
Q

Pharmacological management of Heroin abuse (3)

A

Opioid Substitution Treatment (OST)

Methadone

  • Full agonist, prolongs QT interval (monitor ECG 6 monthly)
  • Cheap, large evidence base

Buprenorphine (Subutex)

•Partial agonist, less sedative, less risk of OD

Others

  • Dihydrocodiene (short term stop-gap only)
  • Patient Choice of aim of OST

–Maintenance

  • Detoxification
50
Q

What’s Khat?

A
  • Plant grown in East African regions
  • Has to be taken fresh
  • Recently made illegal
  • Usually consumed by Somali and other East African and Arab communities
  • Produces a stimulant like effect
  • Has been known to precipitate psychosis
  • Is used to make miaow-miaow
51
Q

Ketamine

  • class
  • routes of administration
A

Ketamine

  • an anaesthetic agent
  • commonly in powder or tablet form
52
Q

Ketamine

  • effects
  • side effects
A

Effects: produces hallucinations, reduced pain sensation, drowsiness, sedation, respiratory depression

SEs: Prolonged use can cause “ketamine bladder” – haematuria, scarring and severe pain – severe cases have necessitated removal of the bladder

53
Q

LSD

  • administration method
  • effects
  • SEs
A

LSD

Administration: taken as a “tab” on a tiny square of paper

Effects: hyperaesthesias, hallucinations, and other altered perceptions & experiences aka “trip”

*trips can be pleasant or unpleasant & frightening “bad trip”

SEs: Flashbacks can occur days / months later, can precipitate mental health problems in people with predisposition

54
Q

Novel Psychoactive Substances

  • names
A
  • previously known as “legal highs’’

Brand names include “Clockwork Orange”, “Bliss” and “Mary Jane’’

55
Q

Forms in which Novel Psychoactive Substances come in

A

Come in different forms - powders, pills, smoking mixtures, liquids, capsules, or on perforated tabs.

56
Q

Novel Psychoactive Substances

  • stimulants - names, eddects
A

Stimulants - e.g. mephedrone, naphyrone

Act like amphetamines, cocaine, or ecstasy.

Make you feel energised, physically active, fast-thinking, very chatty and euphoric.

57
Q

Novel Psychoactive Substances

  • downers/ sedatives - names, effects
A

Downers or sedatives - e.g. GBH / GBL.

Act like benzodiazepines. Make you feel euphoric, relaxed, sleepy.

58
Q

Novel Psychoactive Substances

  • Hallucinogens
A

Hallucinogens or psychedelics

Act like LSD, magic mushrooms, ketamine

59
Q

Synthetic cannabinoids

  • names
  • effects
A

Synthetic cannabinoids - novel psychoactive substnces

Names: e.g. “Spice”, “Black Mamba.”

Act similar to cannabis

Effects: relaxation, altered consciousness, disinhibition, feeling energised and euphoria

60
Q

Spice

  • what’s that
  • class
A

Spice

  • synthetic cannabinoid
  • more potent than natural cannabis.
  • usually smoked
  • Class B drug.
61
Q

Effects of Spice

A

Typical effects:

  • Feeling happy, euphoric, relaxed
  • Some people get “the giggles”, feel hunger pangs and become very talkative, others become drowsy
  • Mood and perception can change and concentration and co-ordination may become difficult
  • More likely to be associated with hallucinations than natural cannabis

*Some people have bad reactions, e.g. paranoia, panic attacks, forgetfulness.

Can make users “freeze.”

62
Q

What’s drug classification (in general)

A

Defined by the government and changes from time to time

  • Class A
  • Class B
  • Class C
  • Different classes carry different penalties & usually (but not always) reflect potential level of harm
63
Q

Class A drugs

  • the length of penalty
A

Class A

–Possession

•7 years & unlimited fine

–Possession with intent to supply

•Life & unlimited fine

64
Q

Class B drugs

  • the length of penalty
A

Class B

–Possession

•5 years & unlimited fine

–Possession with intent to supply

•14 years & unlimited fine

65
Q

Class C drugs

  • length of penalty
A

Class C

–Possession

•2 Years & unlimited fine

–Possession with intent to supply

•14 years & unlimited fine

Y4 CBLs (32 decks)

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