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MB3 Psychiatry > Addiction > Flashcards

Addiction Flashcards

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1
Q

what is the moral model of addiction?

A

addicts take drugs for themselves with no consideration for others or their actions

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2
Q

ICD-10 classification of dependence

A 
strong desire to take substance 
difficulties in controlling substance abuse 
physiological withdrawal state
tolerance 
neglecting alternative pleasures 
persistence despite evidence of harm
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3
Q

name a drug that may cause physical dependence but not psychological

A

opiates

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4
Q

name a drug that causes psychological dependence but not physical

A

cannabis

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5
Q

types of addiction?

A

Drug use

Pathological - gaming, gambling, eating, extreme sports, social media

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6
Q

describe the physical components of the mesolimbic pathway

A

ventral tegmental area connection to nucleus accumbens to ventral striatum
connections to prefrontal cortex, amygdala, hippocampus

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7
Q

describe the mechanism of action of addiction on the mesolimbic pathway

A

modulation of dopaminergic activity leading to raising of dopamine levels
leads to sense of reward and incentivises behaviour to repeat

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8
Q

describe the action addiction has on dopaminergic tolerance on the mesolimbic pathway

A

repeated stimulation leads to downregulation of D2 receptors leading to needing higher quantities of drug needed
normal life is impaired leading to it becoming boring

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9
Q

describe how tolerance leads to -ve reinforcement of addiction

A

initially drug taking is by +ve reinforcement due to dopamine reward
once tolerance develops +ve reinforcement stops and as life becomes boring -ve reinforcement removes dullness or unpleasant effects

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10
Q

reasons for lesser prefrontal cortex activity in those with addiction

A

ACEs
drug use during brain maturation
genetics

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11
Q

describe the function of amygdala and hippocampus in addiction

A

associated with consolidation and expression of drug stimulus learning
so drug association can lead to cravings in addiction ie pictures or seeing drug

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12
Q

function of orbitofrontal cortex in drug addiction

A

internal representation of events and assigns them to action
drug cues activate OFC and increases drug cravings

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13
Q

true/false - those with genetically more D2 have a higher level of addiction in their population

A

false - it is those with lower D2 as they seek reward more

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14
Q

how does stress lead to addiction

A

acute stress triggers dopamine reward

chronic stress downregulates D2 and encourages exposure to more rewarding behaviour and drug seeking

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15
Q

natural forms of opiate?

A

morphine, codeine

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16
Q

semi-synthetic forms of opiate

A

hydrocodone

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17
Q

synthetic forms of opiate

A

metadone

tramadol

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18
Q

who to treat for opiate or other drug addiction?

A 
>3 for >1m 
sense of compulsion 
craving 
physiological withdrawal 
evidence of tolerance 
preoccupation with substance use 
persistent despite consequence
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19
Q

what is included in an opiate safety bundle

A

drug diary, screening
opiate withdrawal scale
recovery care plan
risk assessment

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20
Q

true/false - opiate withdrawal is life threatening

A

false

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21
Q

true/false - opiate toxicity/overdose is life threatening

A

true - warrant for immediate administration of naloxone due to respiratory depression

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22
Q

what is the reason for ORT

A

substitute prescribing to control administration and introduce order and control into addicted individuals life

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23
Q

mechanism of action of methadone, metabolism, dose, means of taking

A

Mu receptor agonist and long half life
hepatic metabolism
30mg initially, 60-100mg
liquid

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24
Q

mechanism of action of buprenorphine, means of taking, dose

A

Mu partial agonist with low intrinsic activity and high affinity
sublingual tablet
12-24mg

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25
considerations to make before which ORT to prescribe
``` QTc ECG sedation combination therapy diversion ```
26
what is hazardous drinking
anyone drinking >14units alcohol weekly and <35 | no alcohol related consequences
27
calculation of units in a drink
strength (ABV) x volume (ml)/1000
28
where may alcohol related cancers appear
``` larynx mouth or URT oesophagus breast bowel liver ```
29
brief intervention question to ask in emergency care about drinking?
how often have you had 6 (F) or 8 (M) units in one occasion in the last year if weekly to almost daily then full AUDIT scoring needed
30
AUDIT score - 0-5, what is the risk and what intervention needed
No action needed | ver low risk
31
AUDIT score - 6-7, what is the risk and what intervention needed
Brief intervention | low risk
32
AUDIT score - 8-15, what is the risk and what intervention needed
Brief intervention | Moderate risk
33
AUDIT score - 16-19, what is the risk and what intervention needed
Brief intervention | High risk
34
AUDIT score - >20, what is the risk and what intervention needed
Specialist referral | Very high risk
35
What is brief intervention, what framework should it follow
5-15 min intervention by NHS or another service FRAMES motivational interviewing
36
what is motivational interviewing
guiding change collaborative conversation respect autonomy
37
what is the FRAMES framework?
``` Feedback on problems Responsibility on pt Advice Menu to change Empathy Self-efficacy and optimism ```
38
Diagnosis of alcohol dependence syndrome
``` >3 for >1m sense of compulsion difficulty controlling substance withdrawal state tolerance neglect of other interests/pleasures persistence despite evidence of harm ```
39
mechanism of action of alcohol withdrawal
Adapted chronic CNS depression reduces GABA leads to upregulation of glutamate when stopping alcohol there is unopposed glutamate so unopposed excitation
40
features of alcohol withdrawal
restless, tremor, sweating, N&V, anorexia, insomnia, tachy, systolic HTN passes in 5 days but can have seizure in 24hr
41
what may alcohol withdrawal progress to
delirium tremens
42
features of delirium tremens
peak 2 days night time confusion, disorientation, agitation, HTN, fever, hallucination cardiovascualr collapse or infection
43
best way to prevent delirium tremens
do not allow dependent drinkers stop abruptly without support
44
management of alcohol withdrawal
BZD cross titrated and reduction over 7 days pavbrinex vitamins thiamine
45
when would you detox a patient in hospital rather than community
``` >30 units or AUDIT >30 severe dependence hx delirium tremens poor support cognitive impairment poor health psychiatric comorbidity ```
46
when to refer to specialist intervention for alcohol dependence
failed to benefit from brief intervejntion, extended intervention co-morbidity AUDIT >20
47
non-pharmacological relapse prevention?
``` CBT motivational therapy 12 step facility self control training family/couple therapy ```
48
true/false - give BZD as a pharm intervention for relapse prevention
false - only during detox
49
what medications can be given for alcohol rehabilitation and which is first line
naltrexone - first line acamprosate disulfiram
50
mechanism of action of naltrexone
opiate antagonist so reduces reward pathway
51
mechanism of action of acamprosate, what to prescribe with and side effects
acts on glutamate and GABA to reduce craving psychosocial intervention headache, diarrhoea and nausea
52
mechanism of action of disulfiram, caution and side effects
inhibits acetaldehyde dehydrogenase so accumulation of acetaldehyde leads to flushed skin, hypotension, N&V, tachy, arrhythmia needs compliance as can lead to severe side effects
53
core features of addictive behaviour
``` salience mood modification tolerance withdrawal conflict relapse ```
54
describe the moral model of addiction
addiction seen as violation of societal rules, weakness | individuals fault and law enforcement and courts are agents of change
55
describe the dispositional disease model of addiction
primary cause individual, loss of control and restraint | no cure for addiction besides abstinence
56
what is the personality model of addiction
roots of addiction lie within individuals personality | poor impulse control, low self esteem, cant cope woth stress, manipulation
57
what is the biological model of addiction
gene and physiological precess determine addiction in individual identify biological conditions that contribute to addiction agent of change is medical establishment to support
58
what are the limitations to the medical model of addiction
medical tx reduces harm but not always abstinence medical tx doesnt exist for many addictions but there is recovery behavioural addiction?
59
what is the behavioural model of addiction
learning through action influenced by behaviour, environment and consequences engagement is underpinned by reinforcement
60
what is conditioning
through repeated pairings, previously neutral stimuli will elicit a response with something paired with it ie going to parties as alcoholic conditions response to crave alcohol
61
what is the conditioned compensatory response theory
in overdoses, those who are conditioned to the substance are more likely to survive eg rats heroin experiment
62
what is operant conditioning
learning by connecting consequences of action woith behaviour
63
what is +ve reinforcement
encourages addictive behaviour by reward
64
what is -ve reinforcement
removal of stimuli to increase behaviour frequency
65
what is +ve punishment
use of stimulus to decrease frequency
66
what is -ve punishment
loss of stimulus to decrease frequency
67
what is the biopsychosocial model to addiction
interaction of biological, physical and social factors contribute to addiction and no one factor is dominant over another holistic
68
what is the cognitive behavioural model of addiction
patient vulnerable from genetic factors exposure to social factors or availability of psychoactive substance lead to cognitive and behavioural processes become increasingly automatic

MB3 Psychiatry (16 decks)

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