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Psychiatry Year 3 Dundee > Addiction > Flashcards

Addiction Flashcards

(101 cards)

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1
Q

According to the ICD 10 to have a dependance on something you need….

A 
3 or more in that last year
Strong desire to take substance
Difficulties in controlling substance use
Physiological withdrawal state
Tolerance
Neglect alternative pleasure
Persistence despite evidence of harm
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2
Q

What is the ICD-11 definition of a Gaming Disorder?

A

Impaired control over gaming
Increased priority over other activities
Disregard of negative consequences
Significant impairment to function

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3
Q

CAGE - addiction

A

Cut down - felt need to cut down
Annoyed - at people criticising levels of usage
Guilty - about amount spent
Eye opener - first thing you do in the morning

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4
Q

What is Incentive Salience?

A

Cognitive attributing want to a substance

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5
Q

What pathway drives the Incentive Salience?

A

Mesolimbic pathway

Dopamine is a motivating and incentivising neurotransmitter

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6
Q

What do all addictive drugs act upon?

A

Dopaminergic activity

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7
Q

How does a craving develop?

A

Chronic overexposure to dopamine - reduced D2 receptor expression
Tolerance builds up as more and more dopamine needed to evoke same response.

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8
Q

Why do addicts usually find normality dull and unfulfilling?

A

Normal stimuli don’t trigger enough dopamine to be released.

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9
Q

What type of reinforcement is an acute addiction and why?

A

Positive reinforcement - to reach a high

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10
Q

What type of reinforcement is a chronic addiction and why?

A

Negative reinforcement - to prevent the negative affects of withdrawal - protective

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11
Q

How does the prefrontal cortex affect addiction?

A

Modulates the affects of reward pathway as ability to override mesolimbic pathway and resist the cravings.
Sets goals and focuses attention

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12
Q

What can be a predisposing factor to acquiring an addiction?

A

Underactivity or dysfunction of the prefrontal cortex

Unable to consciously override urges

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13
Q

Why does early age drug experimentation have an impact on addiction?

A

Due to the plasticity of the prefrontal cortex long exposure can lead to alterations to promote such urges

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14
Q

What is the function of the hippocampus and amygdala?

A

Consolidation and acquisition of memories and learning

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15
Q

How can the hippocampus and the amygdala have an affect on addiction?

A

Expression of drug stimulus learning, as a result learned associations can trigger urges.

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16
Q

What is the function of the Orbitofrontal cortex?

A

Collates stimuli and attaches importance to them

Key creator of motivation to act

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17
Q

How are addicts Orbitofrontal cortex wired?

A

Show increased activity when exposed to drug cues

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18
Q

What gene is linked to higher risk activities to gain a high?

A

Low DRD2 receptor expression

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19
Q

What is the affect of Acute stress on dopamine?

A

Dopamine release in neural reward pathway

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20
Q

What is the affect of Chronic stress on dopamine?

A

Dampening of dopaminergic pathways

Reduced reaction to normal - encourages to seek highly rewarding often dangerous behaviour.

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21
Q

AUDIT - what is it?

A

Quantifies level of hazardous drinking

Less sensitive to harmful drinking and dependance

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22
Q

What is hazardous drinking?

A

Pattern of consumption that increases their risk of physical mental and social consequences.

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23
Q

How many units would be classed as Hazardous drinking?

A

Between 14-35 units per week

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24
Q

Equation for Units

A

Units = (Strength ABV x volume (ml)) / 1000

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25
What cancers have an increased incidence in those who drink over 14 units a week?
``` Mouth Upper throat Larynx oesophagus Breast Liver Bowel ```
26
What is the most important question in the Fast Alcohol Screening done in A and E?
How often have you had 6 units (Female) 8 units (Male) or more units on a single occasion in the past year?
27
If somoene has an audit score over 5 what do they require?
A brief intervetion
28
What is a Brief Intervention?
``` 5- 15 minutes FRAMES Feedback review problems due to alcohol Responsibility is down to patients Advice factual is best Menu provide options for change Empathy Self Efficacy encourage optimism ```
29
Alcohol dependance syndrome
``` 3 or more of the following Strong desire or compulsion Difficulty in controlling - onset termination or level of use Physiological withdrawal star Evidence of tolerance Progressive neglect Persistence despite evidence of harm ```
30
What is alcohols affect on the CNS?
Suppression by acting on GABA A receptors
31
Why do you get withdrawal symptoms from alcohol?
Due to over activation of GABA receptors -brain unregulated Glutamate activity and down regulates expression of GABA receptors. Withdrawal leads to massive imbalance - excessive glutamate is toxic to nerves - unregulated glutamate excitation.
32
Describe alcohol withdrawal syndromes course.
First symptoms generally occur within hours the peak is between 24-48 hours. Generally resolved between 5-7 days
33
What are the common symptoms of Alcohol withdrawal syndrome?
``` Restlessness Tremor Sweating Anxiety N+V Loss of appetite Insomnia ```
34
What are some of the more serious symptoms of Alcohol withdrawal syndrome?
Tachychardia Systolic Hypertension generalised seizures - <24hrs
35
What is a medical emergency in regards to alcohol withdrawal?
Delirium tremens
36
When and what proportion of withdrawals result in delirium tremens?
2 days post abstinences | 5% of cases
37
Describe delirium tremens
Often insidious onset - night time confusion | Confusion , disorientation, agitation, hypertensive, fever, visual auditory hallucinations , paranoid ideations.
38
What is the mortality rate of delirium tremens?
2-5% - with medical intervention much higher without
39
What is it that kills you in Delirium Tremens?
Cardiovascular Collapse and infection
40
What should you never advice a dependant drinker to do?
Go cold turkey without support or observation
41
How do you manage a withdrawal?
General support advice and reassurance BDZ - titrate against severity reduce over 7 days Vitamin supplementation
42
What BDZ are used in alcohol withdrawal ?
Diazepam | Chlordiazepoxide
43
What vitamin is especially important in alcohol withdrawal management?
Thiamine prophylaxis to prevent Wernickes Encephalopathy
44
When should an inpatient detox be undertaken?
Severe dependance AUDIT >30 or 30 units History of seizures or Delirium Tremens Cognitive impairment or poor physical health Poor social support
45
When should specialist services be involved?
Moderate to Severe dependance | Failed to benefit from brief or extended interventions
46
What can be provided in inpatient detox that improve chances of going clean?
Adequate hydration Analgaesia Antiemetic Treat infections and other physical conditions that might be driving them towards substance abuse
47
What are some effective psychosocial therapies for relapse prevention?
CBT motivational enhancement therapy behavioural self control training 12 step facilitation therapy e.i AA
48
When are BDZ used in alcohol dependance?
Only used acutely
49
MOA of Disulfiram
Inhibits Acetaldehyde Dehydrogenase | Accumulation of acetaldehyde if ingested leads to unpleasant side effects
50
What does a patient on Disulfiram experience if they ingest alcohol?
``` Flushed skin Tachycardia N+V Arrhythmias Hypotension ```
51
What medication can be used to prevent alcohol relapse?
Naltroxene - 1st line Acamprosate Disulfiram
52
What is an issue with Disulfiram?
Efficacy is entirely dependance on compliance | Making someone take a drug that makes them feel horrendous in difficult
53
Acamprosate MOA
Acts on glutamate and GABA Reduces cravings needs to be started ASAP Used alongside psychosocial interventiona
54
Acamprosate sideffects
Headaches Diarrhoea Nausea
55
Naltrexone
Opiod antagonist reduces reward gained from alcohol
56
What are some natural Opiates?
Morphine | Codeine
57
What are some semi-synthetic opiates?
Hydrocodone | Hydromorphone
58
What are some fully synthetic opiates?
Methadone | Tramadol
59
How do opiates work?
Induce dopamine release into the mesolimbic pathway.
60
What is the definition of opioid replacement therapy?
Deliberate introduction of prescribed drugs in a controlled manner.
61
What are the stages of opioid replacement therapy?
Induction Optimization Maintenance Reduction
62
What is optimisation?
Completely eliminating illicit drug use
63
What medication can be used in opioid replacement therapy?
Methadone | Buprenophine
64
What is Methadone?
A Mu receptor agonist | Long half life peak plasma at 4 hrs
65
Describe the course of Methadone.
1x daily | Steady state is achieved by day 5
66
What dosage of methadone is given?
Start at 30ml and titrate up | 60-100ml is normal effective dose
67
What metabolism does methadone undergo?
CY3P4 in liver
68
When is Methadone contraindicated?
Prolongs QT | Anyone with a cardiac history or in combination with others drugs which prolong QT
69
What risks are associated with methadone?
Sedative | Diversion- sell their methadone onto others
70
What is Buprenophine?
Mu partial agonist | Low intrinsic activity but high affinity for receptor
71
When are peak plasma levels of buprenophine reached?
1.5-2.5 hours
72
What is the effective dosage of Buprenophine?
12-24mg
73
How is Buprenophine delivered and what could the possible benefits of this be?
Sublingually | Pharmacist is able to observe it being taken
74
What models of addiction are there?
``` Moral Dispositional Personality Biological Behavioural Cognitive ```
75
Moral model of addiction.
Wilful violation of societal rules due to human weakness | Individual is primary causative factor
76
According to the moral model how is someone treated for addiction?
Moral persuasion Imprisonment Spiritual guidance
77
Dispositional disease model of addiction.
Primary cause is the individual
78
According to the dispositional model how is someone treated for addiction?
Addiction is irreversible only total abstinence is the cure.
79
Personality model
Abnormal individual with poor impulse control and unable to deal with stress and low self esteem
80
Biological medical model.
Emphasis on genetic and physiological process - individual is still the cause.
81
What region of the brain is associated with binge or intoxication?
Ventral striatum
82
What region of the brain is associated with withdrawal ?
Amgydala
83
What region of the brain is associated with preoccupation anticipation?
Cortex Hippocampus Cingulate gyrus
84
What is the basis behind the behaviour model?
Addiction is the result of well rehearsed over learned repertoires. Actions are influenced by the associations we make between our behaviour and environment.
85
What two doctrines define the behavioural model?
Pavlovs Associative learning | Operant (instrumental) conditioning
86
Pavlovs Associative learning
Through repeated pairing a previously neutral stimuli will come too illicit a response.
87
Give an example of pavlovs associative learning.
Sensory stimuli e.g. clinking of glasses results in cravings
88
Operant (Instrumental) Learning
Learning by connecting the consequences of an action with the preceding behaviour. e.g entering pub = good time
89
Operant (Instrumental) Learning - Positive
Applies the stimuli
90
Operant Instrumental Learning - Negative
Removes the stimuli
91
Operant Instrumental Learning - Reinforces
Increases the frequency of the behaviour
92
Operant Instrumental Learning - Punishment
Decreases the frequency of the behaviour
93
What is an example of positive reinforcement?
You are more relaxed after use
94
What is an example of negative reinforcement?
Removes the withdrawal symptoms
95
What is an example of Positive Punishment?
Shouted at by partner for using
96
What is an example of negative punishment?
Losing family and home for using
97
What is habit formation?
Acquired behaviour due to repetition of action until involuntary
98
Cognitive theory
Addiction recruits and influences through Attention bias Memory bias Selective recall and implicit bias
99
How can cognitive processing help addiction?
Slow down to prevent autonomic responses which allow biases to creep in.
100
What are some common thinking errors?
``` Its just a treat - permission giving Its only one - Minimisation She made me angry I had to - Blaming I can use and stay in control - Denial Ive been good all week - Rationalisation ```
101
What is the best treatment for addiction?
Biopsychosocial - Medication + psychology + social work

Psychiatry Year 3 Dundee (21 decks)

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