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Psychiatry > Addiction - Alcohol > Flashcards

Addiction - Alcohol Flashcards

1
Q

What are some high risk occupations for alcoholism?

A

Itinerant workers, bartenders and professionals

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2
Q

1 unit = how much alcohol?

A

10mls

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3
Q

How can you calculate the number of units in an alcoholic drink?

A

(Percentage x volume) / 10

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4
Q

What is the definition of high risk drinking?

A

Regularly consuming 35+ units of alcohol per week

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5
Q

What is the definition of increased risk drinking?

A

Regularly consuming 15-35 units of alcohol per week

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6
Q

Explain the drinking regulations for men and women?

A

Men and women should both not exceed 14 units per week, ideally spread over at least 3 days

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7
Q

What is the definition of the harmful use of alcohol?

A

A pattern of use which is causing damage to health - this can be physical or mental

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8
Q

What are the defining factors of alcohol dependence?

A

A strong desire to take the substance / difficulty controlling the use of the substance / physiological withdrawal state / tolerance / neglect of other pleasurable activities / persistence despite evidence of harm

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9
Q

What is the most common tool used to screen for alcohol dependence in Scotland?

A

AUDIT

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10
Q

What is the pro and con of using CAGE screening for alcohol use?

A

Good for detecting dependence but not good at detecting evidence of harm

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11
Q

Describe the process of stopping alcohol if a person is mildly dependent?

A

It is mostly possible to stop, there may be a few withdrawal symptoms but they will be transient

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12
Q

If a person is any more than mildly dependent on alcohol, what is the management for stopping and why?

A

Medication - to avoid severe withdrawal

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13
Q

When would hospital admission for stopping alcohol be required?

A

If there are lots of medical co-morbidities or an SADQ test result of 30+

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14
Q

What is the role of lab testing in alcohol misuse?

A

Not good for detecting alcohol related problems, but may play a role in monitoring response to therapy

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15
Q

GGT is an indicator of what?

A

Liver injury

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16
Q

Carbohydrate deficient transferrin is able to identify what?

A

Men drinking 5+ units per day for 2+ weeks

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17
Q

Why is MCV a useful test in the investigation of alcoholism?

A

Alcohol is the most common cause of a raised MCV

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18
Q

Who is the target audience for brief interventions related to alcohol?

A

Adults who have been identified by screening as drinking hazardous or harmful amounts of alcohol, and those attending NHS or NHS commissioned services

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19
Q

How long should a brief intervention last? What should you ask them to consider?

A

5-15 minutes, ask them to consider alternative behaviours

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20
Q

Brief interventions are very useful at decreasing alcohol consumption in who?

A

Adults who are not dependent

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21
Q

When should you consider referring patients for specialist alcohol withdrawal treatment?

A

If they have moderate-severe dependence or a severe alcohol related impairment OR if they have failed to benefit from brief advice but want further help

22
Q

What is detoxification?

A

The process by which patients become alcohol free

23
Q

What is relapse prevention?

A

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

24
Q

What type of neurotransmitter is a) NMDA-glutamate? and b) GABA?

A

a) excitatory b) inhibitory

25
Q

What effect does alcohol have on NMDA-glutamate controlled ion channels? Chronic use leads to what?

A

Inhibition / upregulation of receptors

26
Q

What effect does alcohol have on GABA controlled ion channels? Chronic use leads to what?

A

Stimulation / downregulation of receptors

27
Q

Overall, what effect does chronic alcohol use have on glutamate and GABA activity?

A

Excess glutamate activity and reduced GABA activity

28
Q

What is the effect of excess glutamate activity?

A

Nerve cell toxicity

29
Q

How long after stopping drinking do the first symptoms of alcohol withdrawal occur? When do they peak?

A

Within hours / 24-48 hours

30
Q

What are the main features of alcohol withdrawal?

A

Restlessness, tremor, sweating, anxiety, N+V, loss of appetite and insomnia

31
Q

What are some evident signs of alcohol withdrawal?

A

Tachycardia and systolic hypertension

32
Q

When can generalised seizures occur as a result of alcohol withdrawal?

A

The first 3-5 days

33
Q

What is delirium tremens? When can it start to occur following alcohol withdrawal? When does it peak?

A

An acute confusional state / 24 hours / 2 days

34
Q

In most people, symptoms of alcohol withdrawal resolve within how long?

A

5-7 days

35
Q

In what % of cases of alcohol withdrawal is DT seen? How does it present?

A

5% / Insidiously, with nighttime confusion

36
Q

What are some features of DT?

A

Confusion and disorientation, agitation, hallucinations and paranoia

37
Q

DT has a 2-5% mortality rate - what is this associated with?

A

CV collapse or infection

38
Q

How should DT be managed?

A

In a medical ward with IV fluids and antibiotics

39
Q

What are the 3 key factors in managing alcohol withdrawal?

A

General support, benzodiazepines and vitamin supplementation

40
Q

How do benzodiazepines work in alcohol withdrawal?

A

They are cross tolerant to the alcohol as they act on GABA-A receptors

41
Q

Which benzodiazepines could be used for alcohol withdrawal? Why are these used?

A

Diazepam or chlordiazepoxide / they are long-acting

42
Q

Benzodiazepines used for alcohol withdrawal should be reduced how?

A

Gradually over 7 days or more

43
Q

What vitamin supplementation must be given in alcohol withdrawal? How? Why?

A

Parenteral thiamine / prophylaxis against Wernicke’s encephalopathy

44
Q

Why do people who drink alcohol need thiamine supplements?

A

They don’t eat enough food containing it and also don’t absorb it

45
Q

What are some psychosocial interventions that can be used for alcohol relapse prevention?

A

CBT, motivational enhancement therapy, 12 step facilitation therapy, behavioural training, couples/family therapy

46
Q

What is the first line pharmacological agent for relapse prevention? How does it work?

A

Naltrexone - opioid antagonist works to reduce the reward from alcohol

47
Q

How does acamprosate work?

A

Acts centrally on GABA and NMDA receptors to reduce cravings for alcohol

48
Q

When should acamprosate be started if you are going to use it? Should it be continued through a relapse?

A

Straight away after detoxification / yes

49
Q

What are some side effects of acamprosate?

A

Headache, diarrhoea and nausea

50
Q

How does disulfiram (antabuse) work?

A

Inhibits acetaldehyde dehydrogenase leading to an accumulation of acetaldehyde when alcohol is consumed, making the effects of drinking unpleasant

51
Q

If you are taking disulfiram and ingest alcohol, what kind of symptoms does this cause?

A

Flushing, tachycardia, N+V, arrhythmias

Psychiatry (20 decks)

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