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YEAR 3 PSYCH > Addiction > Flashcards

Addiction Flashcards

1
Q

what is the ICD-10 criteria for dependence

A 
3 or more of:
a strong desire to take the substance
difficulties in controlling substance use 
physiological withdrawal
tolerance 
neglect of alternative pleasures
persistence despite evidence of harm
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2
Q

way to remember criteria of dependence

A

Catherine Never Takes Drugs Woo Hoo

C - controlling difficulties
N - Neglect of alternative pleasures
T - tolerance
D - Desire to take 
W - withdrawal
H - harm but persisting
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3
Q

what is the name of the 4 question process that aims to detect alcohol dependence and abuse

A 
CAGE
Cut down
Annoyed 
Guilty 
Eye opener
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4
Q

what is incentive salience

A

attributing want to a stimulus

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5
Q

what is the key neurotransmitter in the reward pathway

A

dopamine

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6
Q

what are the main areas of the brain involved in the reward pathway

A

mesolimbic and cortical areas

ventral tegmental area –> nucleus accumbens –> prefrontal cortex

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7
Q

dopamine release from a stimulus/activity motivates an individual to do what

A

repeat behaviour

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8
Q

what is meant by the term once use drugs

A

significant dopamine release causes the brain to seek out the substance to the point that normal things in life do not stimulate enough dopamine so ignore other things and only crave the substance

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9
Q

how does tolerance develop

A

overstimulate pathway –> dopamine receptors down regulate

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10
Q

what dopamine receptors are decreased by addiction

A

D2 receptors

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11
Q

what is meant by positive reinforcement

A

taking the drug gives a reward

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12
Q

what is meant by negative reinforcement

A

taking the drug alleviates feeling rubbish

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13
Q

the initial stages of drug taking are driven by ____ reinforcement

A

positive

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14
Q

eventually drug taking is driven by ____ reinforcement

A

negative

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15
Q

what part of the brain modulates the powerful effects of the reward pathway and keeps emotions and impulses under control

A

pre-frontal cortex

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16
Q

cortical maturation occurs in what direction

A

back to front

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17
Q

cortical maturation begins with what and ends with what

A

begins with primary motor cortex and ends with prefrontal cortex developing last (in 20s)

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18
Q

prefrontal cortex activity is _____ in substance misuse people

A

lower

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19
Q

true/false

the earlier the age at which drug experimentation starts the longer the relationship with drugs lasts

A

true

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20
Q

what 3 brain areas are critical in acquisition, consolidation and expression of drug stimulus learning - meaning that learned drug assoc. can que internal state of craving

A

hippocampus
amygdala
striatum

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21
Q

what part of the brain is the key creator of motivation to act

A

orbitofrontal cortex

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22
Q

addicts show _____ activity of the OFC when faced with drug ques

A

increased

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23
Q

what circuit decides whether you will do it or not

A

OFC

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24
Q

what circuit is involved in inhibitory control

A

anterior cingulate gyrus and prefrontal cortex

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25
Q

what circuit is involved in reward/salience

A

nucleus accumbens and ventral pallidum

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26
Q

what circuit is involved in motivation/drive

A

OFC and subcallosal cortex

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27
Q

if you have low D2 receptors are you lower or higher risk of drug addiction

A

higher - will seek out rewarding behaviours

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28
Q

acute stress triggers release of ____

A

dopamine

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29
Q

chronic stress leads to ______ of dopaminergic activity which _____ sensitivity to normal rewards

A

dampening through down regulation of D receptors

reduces

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30
Q

the ____ develops late and is vulnerable during development

A

PFC

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31
Q

the ____ puts the breaks on the reward system

A

PFC

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32
Q

what is conditioning

A

process of behaviour whereby an individual comes to assoc. a desired behaviour with a previous or unrelated stimulus

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33
Q

what are the 2 types of conditioning

A

classical (pavlovian) - a classic pavlova

operant (skinnerian)

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34
Q

what is classical conditioning

A

through repeated pairing with the cue a previously neutral stimulus will come to elicit the same response

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35
Q

what is operant conditioning

A

instrumental value - learning by connecting the consequences of an action with the preceding behaviour

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36
Q

reinforcement _____ frequency of behaviour

punishment _____ frequency of behaviour

A

reinforcement - increases

punishment - decreases

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37
Q

being shouted at by a partner is an example of _____ punishment

A

positive

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38
Q

losing a family member and home due to using is an example of _____ punishment

A

negative

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39
Q

what is a habit

A

an acquired behaviour pattern regularly followed until it becomes almost involuntary

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40
Q

name 5 thinking errors that lead to substance taking

A

permission giving “its just a treat”
minimisation “its only one
rationalisation “i havent used for a week”
denial “i can use and stay in control”
blaming “she made me so angry i had to use”

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41
Q

1 unit is how many mls of alcohol

A

10mls

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42
Q

how can you calculate no of units

A

% x volume / 10

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43
Q

what is higher risk drinking

A

regularly consuming over 35 units per week

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44
Q

what is increased risk drinking

A

regularly consuming between 15 and 35 units per week

45
Q

what is the recommended alcohol intake

A

no more than 14 units per week

spread over 3 days or more

46
Q

what is considered harmful use of alcohol

A

pattern of psychoactive substance use that is causing damage to health (physical or mental)

47
Q

what is considered binge drinking for males

A

> 8 units

48
Q

what is considered binge drinking for females

A

> 6 units

49
Q

what is AUDIT

A

alcohol user disorders identification test - 10 questions which aim to detect hazardous drinking

50
Q

what is the screening tool used in pregnant women for alcohol problems

A 
TWEAK
tolerance
worries 
eye opener
kut down
51
Q

name 3 other screening tools for alcohol problems

A

MAST
FAST (abbreviated audit for A+E)
TACE

52
Q

what liver enzyme is raised in alcohol problems

A

GGT

AST

53
Q

carbohydrate deficient transferrin detects what

A

men drinking 5 or more units per day for 2 weeks

54
Q

an audit score of what would identify alcohol dependence syndrome

A

20

55
Q

over how many units daily would identify alcohol dependence syndrome

A

15

56
Q

alcoholism causes a _____ MCV

A

raised

57
Q

what is FRAMES

A

brief intervention model

  • feedback
  • responsibility
  • advice
  • menu
  • empathy
  • self-efficacy
58
Q

what is the feedback part of FRAMES looking at

A

identifying problems caused by alcohol

59
Q

what is detoxification

A

the process by which a patient becomes alcohol free

60
Q

what is relapse prevention

A

combination of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem free drinking following detox

61
Q

alcohol inhibits the action of what ion channels

A

excitatory NMDA-glutamate controlled ion channels

62
Q

chronic alcohol use leads to ______ of glutamate receptors

A

up-regulation

63
Q

alcohol potentiates the actions of what ion channels

A

inhibitory GABA type A controlled ion channels

64
Q

chronic alcohol use leads to _____ of GABA a receptors

A

down-regulation

65
Q

alcohol withdrawal leads to ______

A

excess glutamate activity

reduced GABA activity

66
Q

excess glutamate activity and reduced GABA activity in acute alcohol withdrawal leads to what

A

CNS excitability and neurotoxicity

67
Q

1st symptoms of alcohol withdrawal syndrome occur within how long of last drink and when do they peak

A

4-12 hours

peak 24-48 hours

68
Q

what are some s/s of alcohol withdrawal syndrome

A 
restlessness
tremor
sweating 
anxiety 
N+V
loss of appetite
insomnia
69
Q

what is the HR and BP like in alcohol withdrawal syndrome

A

tachycardia

systolic hypertension

70
Q

when does delirium tremens occur

A

within 2 days of abstinence

71
Q

how does delirium tremens present

A

often insidiously with night time confusion

confusion, disorientation, delirium, ataxia, course tremor, hallucinations, delusions, paranoid ideations

72
Q

what is the treatment of alcohol withdrawal syndrome

A

benzodiazepines - diazepam, chlordiazepoxide

reduce gradually over 7 days

73
Q

what vitamin supplementation should be given as prophylaxis against wernickes encephalopathy

A

thiamine

parenteral

74
Q

is wernickes reversible

A

yes

75
Q

what causes wernickes

A

thiamine deficiency –> lactic acidosis in brain

76
Q

what does wernickes look like

A

ataxia, abnormal eye movements

77
Q

is korsakoff’s syndrome reversible

A

no irreversible brain damage

78
Q

what causes korsakoff’s syndrome

A

thiamine deficiency

79
Q

what is seen in korsakoff’s syndrome

A

memory loss

confabulation

80
Q

what are some psychosocial interventions for relapse prevention

A

CBT
12 step
motivational enhancement therapy

81
Q

are benzos used in alcohol relapse prevention past detoxification period

A

no

82
Q

what is disulfiram

A

antabuse

83
Q

what happens if people taking disulfiram drink alcohol

A

flushed skin
tachycardia
N+V

84
Q

how does disulfiram work

A

inhibits acetyl dehydrogenase leading to accumulation of acetaldehyde if alcohol is ingested

85
Q

what is the downfall of using disulfiram

A

requires compliance

86
Q

what are 2 other drugs used in relapse prevention

A

acamprosate

naltrexone

87
Q

how does acamprosate work

A

acts centrally on glutamate and GABA systems to reduce craving

88
Q

how does naltrexone work

A

opioid antagonist and reduces reward from alcohol

89
Q

what is the first line agent for relapse prevention

A

naltrexone

90
Q

what makes heroin so addictive

A

rapid onset of action

short half life

91
Q

what is opium

A

mixture of alkaloids (codeine and morphine)

92
Q

what is diamorphine

A

heroin - addition of 2 acetyl rings to morphine

93
Q

codeine and heroin are broken down to what

A

morphine

94
Q

how can you tell the difference between heroin and morphine in a blood screen

A

heroin has a unique intermediate that sticks around for 6 hours

95
Q

what is the active metabolite of heroin

A

morphine

96
Q

what would the pupils of someone who had taken heroin look like

A

pin point

97
Q

opioid overdose does what to BP and HR

A

hypotension

bradycardia

98
Q

what is the treatment for opioid overdose

A

naloxone

99
Q

what happens in opioid withdrawal

A 
agitation
tachycardia
hypertension
diarrhoea
N+V
dilated pupils 
rhinorrhoea
watery eyes
100
Q

when does opioid withdrawal occur

A

within 6-8 hours

101
Q

why does opioid withdrawal occur

A

locus caerulus releases lots of NA

102
Q

what is opiate substitution therapy

A

replacement of a short acting opiate with a long acting opiate in a once daily oral dose

103
Q

name 2 long acting opiates

A

buprenorphine

methadone

104
Q

methadone is a

A

long acting full agonist

105
Q

buprenorphine is a

A

long acting partial agonist

106
Q

is OST taken under supervision

A

yes initialy

107
Q

why is methadone given as a liquid not as a tablet

A

tablets can be hidden and sold on

108
Q

what is opioid detoxification

A

achieve complete abstinence from all opiates - gradually taper dose until opioid free

109
Q

what are people who have completed outpatient detoxification at high risk of

A

relapse and overdose - take large dose they previously needed

YEAR 3 PSYCH (14 decks)

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