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Psychiatry - 3a CR > Addiction > Flashcards

Addiction Flashcards

1
Q

What questions might you want to include in a focused addiction history?

A 
What drugs do you use?
When did you start?
Why did you start?
Why have you continued?
How often do you use?
How much? Grams? Units? Money?
When do you have your first hit of the day?
How does it make you feel?
Do lots of your friends use as well?
Do you have friends outside of your habit?
Do you use on your own?
Have you ever thought about quitting?
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2
Q

What questionnaire might be used to access addiction? (Drugs or Alcohol)?
What additional questionnaire may be used to access alcohol addiction?

A

CAGE Questionnaire

AUDIT Screening Test

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3
Q

What questions are included in the CAGE questionnaire?

A

Has anyone ever told you you should CUT down?
Does it make you ANGRY when people suggest that you should stop?
Do you ever feel GUILTY about using?
Do you ever use in the morning as an EYE OPENER?

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4
Q

What are some of the consequences of addiction?

A

Occupational
Relationships
Forensic
Physical

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5
Q

What are the features of a dependence syndrome?

Would be enquired about in a dependence screen

A 
Dependence
Addiction
Tolerance
Craving
Compulsive Drug Seeking Behaviour
Withdrawal
Substance Misuse
Narrowing of Repertoire
Using to Relieve (withdrawal)
Awareness of Compulsion
Return after abstinence
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6
Q

What is dependence?

A

When an organism functions normally only in the presence of a drug, manifesting as a physical disturbance when the drug is withdrawn.

Feature of dependence syndrome

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7
Q

What is addiction?

A

Recurrent substance use
Resulting in failure to fulfil major role obligations
Causing social or interpersonal problems
In physically hazardous situations

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8
Q

What is tolerance?

A

When a higher dose of a substance is required to achieve the same effect

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9
Q

What is a craving?

A

A powerful desire for something.

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10
Q

What is compulsive drug seeking behaviour?

A

When an individual has lost control over their drug use and subconsciously, compulsively starts to use drugs as part of a stimulus-response habit established by Pavlovian conditioning rather than a goal-directed action.

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11
Q

What is withdrawal?

A

Abnormal physical or psychological features following abrupt discontinuation of a drug which has the capacity of producing physical dependence.

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12
Q

What is substance misuse?

A

Non-therapeutic ingestion of a substance in quantities or methods which harm the user or others.

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13
Q

What is narrowing of repertoire?

A

Reduction in the range of drinks/substances and development of a pattern to keep the level of substance in the system constant.

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14
Q

What is awareness of compulsion?

A

Persistent occupation of thoughts with desire for drink/drugs.

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15
Q

Give some examples of central nervous system depressants?

A

Barbiturates: pentobarbital
Benzodiazepines: diazepam (valium), lorazepam.
Sleeping medications.

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16
Q

What are the health impacts of CNSDs (Barbiturates and Benzos)?

A

Short-term: Drowsiness, slurred speech, poor concentration, confusion, dizziness, problems with movement and memory, lowered blood pressure, slowed breathing.
Barb withdrawal can cause seizures and mixing with alcohol can cause respiratory depression and death.

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17
Q

What is the treatment of CMDS (Barbs and Benzos) addiction?

A

No medication; gradual withdrawal from the drug over time with assistance of health care provider.

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18
Q

What are the health effects of Cocaine?

A

Short term: Narrowing of blood vessels, enlarged pupils, increased body temp, increased HR and BP, headache, euphoria, increased energy, alertness, insomnia, anxiety, panic attacks, paranoia, heart attack, arrhythmia, stroke, seizure, coma.
(Increased risk of heart issues if mixed with alcohol)

Long term: Loss of smell, nosebleeds, nasal damage, infection and death of bowel tissue, poor nutrition and weight loss.

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19
Q

What is the treatment of cocaine addiction?

A

No medication approved.

CBT, 12-step programme.

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20
Q

What is the treatment of cocaine overdose?

A

Benzodiazepine and physical cooling to treat hyperthermia chest pain and increased heart rate.
Nitro-oxide mediated vasodilators - nitroglycerine - lowering blood pressure.

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21
Q

What are the withdrawal symptoms of cocaine?

A

Depression, tiredness, increased appetite, insomnia, vivid unpleasant dreams, slowed thinking and movement, restlessness.

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22
Q

What are the health effects of Heroin (made from morphine)?

A

Short-term - Euphoria, dry mouth, itching, nausea, vomiting, slowed breathing and heart rate, constricted pupils.

Long-term: Collapsed veins, abscesses, multi-system problems.

With alcohol: respiratory depression.

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23
Q

What are the withdrawal symptoms of heroin?

A

Restlessness, muscle and bone pain, insomnia, diarrhoea, vomiting, cold flashes with goose bumps.

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24
Q

What is the treatment of heroin withdrawal?

A 
Methadone (substitute)
Buprenorphine
Naltrexone (short and long acting forms) (alcohol or opioid)

12-step facilitation therapy

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25
Q

What are the health effects of ketamine?

A

Dreamlike states, hallucinations, sedation, confusion, loss of memory, raised blood pressure, unconsiousness, dangerously slowed breathing.

Long term: Ulcers and pain in the bladder, kidney problems, stomach pain.

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26
Q

What are the health effects of LDS?

A

Short-term: Distortion of reality, raised blood pressure, heart rate, body temperature, enlarged pupils, tremors.

Long-term: Flashbacks (HPPD). Ongoing visual disturbances, mood swings, paranoia.

27
Q

What are the health effects of Marijuana?

A

Short term: Enhanced sensory perception and euphoria followed by drowsiness and relaxation. Slowed reaction time, increased heart rate and appetite. Problems with learning and memory.

Long term: Mental health problems, chronic cough.

28
Q

Withdrawal symptoms of cannabis?

A

Irritability, trouble sleeping, decreased appetite, anxiety.

29
Q

What are the health effects of MDMA?

A

Short term: Lowered inhibitions, increased heart rate and blood pressure, muscle tension, nausea, faintness, chills or sweating. Sharp rise in body temperature leading to kidney failure or death.

Long term: Confusion, depression, memory and sleep problems, anxiety.

30
Q

What is the treatment of a heroin overdose?

A

Naloxone - binds with opioid receptors, preventing heroin from binding to them.

31
Q

What are the health effects of Methamphetamine?

A

Increased wakefulness and physical activity, decreased appetite, increased breathing, heart rate, blood pressure.

Long term: Anxiety, confusion, insomnia, mood problems, hallucinations, itching and skin sores.

32
Q

What are the consequences of excess alcohol consumption?

A

Physical - Acute intoxication, coma, head injury, withdrawal, hangover.

Psychological - Elation (short term), Depression, Anxiety,

Social - Isolation, Antisocial decision making.

33
Q

What is the management of alcohol dependence?

A

Detoxification and Rehabilitation

Benzodiazepines - Chlordiazepoxide (longest half life) - Treat withdrawal by stimulating GABA receptors to depress synaptic transmission, reducing anxiety and convulsions.

Acamprosate - Reduces craving for alcohol

Disulfiram - Makes drinking unpleasant, extreme hangover

Nalmefene/Naltrexone - No reward from drinking.

34
Q

What are the some of the biological causes/risk factors of substance abuse?

A

Family history

Illness precipitating abuse

35
Q

What are the some of the psychological causes/risk factors of substance abuse?

A

Family attitudes, conflict, abuse
Poor parenting
Trauma
Grief

36
Q

What are the some of the social causes/risk factors of substance abuse?

A 
Low academic success
Behavioural problems at school
Community norms
Friends who use
Availability
Transition
Alienation
Isolation
37
Q

What are the biological addiction, acute and risk effects of heroin addiction?

A

Addiction - craving, tolerance, withdrawal
Acute - respiratory depression, cognitive depression, constipation, death in overdose
Risks - DVT, infective endocarditis, PE, septic arthritis, abscess, blood borne viruses.

38
Q

What questions would you ask about a persons drinking if you suspected alcoholism (none questionnaire)?

A

When did the symptoms start? Getting worse? Anything like this before? How much do you drink? How often? What do you drink? Drinking today? When was the last time? How do you feel if you don’t have a drink? Do you drink to get rid of that feeling? Do you drink alone? Do you prioritise alcohol over other things? Have you thought about quitting? What’s the longest you’ve gone without alcohol? What made you stat again?Have your drinking habits changes? Any consequences of your drinking?

39
Q

If you suspect alcoholism, how might you explore the level of dependence?

A

CAGE questionnaire
AUDIT screening test
Dependence Screen

40
Q

What is included in the AUDIT screening test? (Alcohol Use Disorders Identification Test)

A

How often do you have an alcoholic drink?
How many units of alcohol do you drink on a typical day when you are drinking?
How often have you had six (female) or eight (male) units or more on a single occasion in the last year?
How often during the last year have you found that you were not able to stop drinking once you had started?
How often during the last year have you failed to do what was normally expected from you because of your drinking?
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
How often during the last year have you felt of guilt and remorse after drinking?
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Have you or somebody else been injured as a result of your drinking?
Has a relative, friend or health worker been concerned about your drinking or suggested that you cut down?
0-7 low risk, 8-15 increased risk, 16-19 high risk, 20+ possible dependence

41
Q

What might you include in an alcohol dependence screen?

A 
More of the same drink, reduction in variety? - Narrowing of repetoire
More to achieve same effect - Tolerance
How feel if don't drink - Withdrawal
Drink to get rid - Withdrawal/dependence
Longest without drinking 
Drinking behaviour
42
Q

What are some of the risks of acute alcohol withdrawal?

A 
Mild - Autonomic hyperactivity
Moderate - Alcoholic Ketoacidosis
Severe - Delirium Tremens (severe autonomic hyperactivity)
Alcoholic hallucinations
Alcohol withdrawal seizures
Wernicke's Encephalopathy
Wernicke Korsakoff Syndrome
Beriberi
43
Q

Who is at increased risk of alcohol withdrawal symptoms?

A 
Elderly
Drinking daily >10 years
>2 weeks typical binge
Epilepsy
History of severe withdrawal
Cardiac, liver or kidney impairment
44
Q

What is involved in an alcohol detox?

A 
Medication:
Benzodiazepines
Antiepileptic
Barbituaties
Thiamine
Magnesium 
Folic Acid

Acamprosate + Disulfiram + Naltrexone (Long term prevention)

Rehabilitation:
Structured social activity
Therapy
Occurational Therapy

45
Q

How would you decide between community and inpatient care for someone with alcohol addiction?

A

Inpatient: Underlying condition requiring treatment - Delirium tremens or above - Moderate to severe withdrawal
Community: Mild withdrawal, no underlying conditions.

46
Q

What are the long term complications of alcohol dependence?

A

Cerebellar degeneration and atrophy
Epilepsy
Dementia
Central

47
Q

What are the long term complications of alcohol dependence?

A 
Cerebellar degeneration and atrophy
Epilepsy
Dementia
Central pontine myelinolysis
Hypertension
Stroke
Ischaemic Heart Disease
Fatty liver --> Alcoholic hepatitits --> Cirrhosis
Cancers
Pancreatitits
Sleep disorders and Depression
Peptic ulcers
Diabetes
Mallory-Weiss tears
Peripheral neuropathy
Foetal alcohol syndrome
48
Q

What is the immediate management plan for heroin overdose?

A 
Clinical diagnosis
ABCDE
Naloxone (IV infusion, IM, SC)
Dextrose
Thiamine
Intubation in severe hypoxia
49
Q

What investigations might you do in heroin overdose?

A

ECG - Abnormalities with co-ingestants
ABG - respiratory acidosis, could be metabolic in severe due to tissue hypoxia
Glucose - hypoglycaemia
LFT and Clotting - If suspected hepatitis
Ammonia - Suspected encephalopathy
U&E - Suspcted rhabdomyosis, shock, coma, sepsis, hypertension, renal failure
FBC - suspected infection, blood loss, immunodeficiency
CK - suspected rhabdomylosis, compartment syndrome, cardiac injury.
Chest X ray - if persistend hypoxia
Endochardiogram - suspected endocardidis
Toxicology
Urinalysis
Blood borne viruses

50
Q

Short term risks of IV drug use?

A 
Respiratory depression
Cognitive depression
Constipation
DVT
Infective endocarditis 
Pulmonary embolism
Osteomyelitis
Septic arthritis 
Abscess - brain, ect
Blood borne viruses 
Coma 
Death in overdose
51
Q

Long term risks of IV drug use?

A 
Withdrawal
Addiction
Dental problems
Gum inflammation
Chronic constipation
Immunosuppression
Sexual dysfunction
Memory and cognitive problems
Depression
Anorexia
52
Q

Risks of IV Drug use to self, others and healthcare professionals?

A

Risk to self
Physical
Psychological
Social

Risk to others
Transmission of blood borne viruses
Forensic risk

Risk to healthcare professionals
Transmission of blood borne viruses
Violence

53
Q

What might you want to screen for in an IV drug user?

A

STIs
Blood borne viruses
Physical examination

54
Q

What harm reduction measures might you implement for an IV drug user?

A

Needle exchange
Drug consumption rooms
Testing in clubs/at festivals
Information

55
Q

What are the pregnancy complications of substance abuse?

A 
Pregnancy complications
Miscarriage
Pre-term Birth
Placental abruption
Excessive bleeding
56
Q

What are the prognostic factors of how severely substance abuse will affect pregnancy?

A

Age

Frequency of use

57
Q

What is important in treating drug addiction?

A

‘One stop model’ of holistic care.

58
Q

What is the self-efficacy concept?

A

Believing in one’s capabilities to accomplish a goal in order to self manage life situations
Involved planning realistic goals and involving the patient

59
Q

What are the 6 sources of self-efficacy?

A

Distal: past life experiences
Proximal: present influential factors
Vicarious: modelling another’s successful performance
Imaginal: imagined future
Verbal persuasion: from extrinsic factors (can be provider)

An individual must believe in themselves in order to produce the desired outcome

60
Q

What is the role of CBT in treating addiction?

A

Focusing on thought processes and investigating beliefs.
Identifying traumatic events to detect source of emotional distress
Identify maladaptive beliefs about addiction, pregnancy and treatment
Self-perception develops in childhood, shapes perception of the world, core beliefs justify self-identity.

May also implement rational emotive behavioural therapy

61
Q

What are the gender differences in addiction?

A

Women are more prone to addiction as a consequence of trauma
Pregnancy and labour can be traumatic for women with addictions
Many women fear losing children due to substance abuse
Pregnant addicts have better outcomes - lower arrest rates, higher utilisation of services

62
Q

What are the consequences of substance abuse to the mother?

A 
Anxiety
Depression
Paranoid Delusions
Psychosis
Personality Change
Social Isolation
63
Q

What are the consequences of substance abuse to the foetus?

A

Withdrawal (neonatal abstinence syndrome) - Mental retardation
Poor feeding Growth restriction
Lethargy Low birth weight
Cardiac defects Cleft palate
Floppy infant syndrome Foetal death
Childhood respiratory illness Learning disability

Psychiatry - 3a CR (2 decks)

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