Addiction Psychiatry

Question 1

Management for alcohol addiction

Answer 1

Naltrexone
Disulfiram
Acamprosate - can be used in patients with liver disease

Psychological: Psychoeducation, CBT, motivational interviewing

Social: alcoholics anonymous, family counselling, rehab

Question 2

Treatment of alcohol withdrawal

Answer 2

Monitor withdrawal signs using CIWA scale
Benzos: Diazepam (if good liver function), Lorazepam/Oxazepam
Thiamine 300mf daily before glucose
Folic acid, multivitamins
Antipsychotics if severely agitation and hallucinations
Symptomatic mx
Correct electrolyte abnormalities, IV dextrose if hypoglycemic

Question 3

Delirium tremens when does it occur, how to treat, symptoms

Answer 3

48-96 hrs after last drink

Diazepam

Clouding of consciousness, visual hallucinations, marked tremor, fomication, high fever, autonomic instability, agitation, insomnia

Question 4

How long does opioid remain positive in blood

Answer 4

1-3 days

Question 5

Opioid intoxication symptoms

Answer 5

Pupillary constriction + one or more of the following:

• drowsiness/coma
• slurred speech
• impairment in attention/memory

Question 6

How to treat opioid overdose

Answer 6

Naloxone

Question 7

Treatment of opioid dependence

Answer 7

Methadone
Bruphenorphine
Naltrexone

psycho and social like alcohol

Question 8

Opioid withdrawal symptoms

Answer 8

3 or more of 
dyspeptic mood
lacrimation/rhinorrhoea
yawning
pupillary dilation/piloerection/sweating 
fever
insomnia
n&v
diarrhoea
muscle aches

Question 9

Tobacco withdrawal symptoms

Answer 9

4 or more of 
Irritability, frustration, anger
Anxiety 
Difficulty concentrating
Increased appetite 
Restlessness
Depressed mood  
Insomnia

Question 10

Investigations for tobacco use disorder

Answer 10

Heavy Smoking Index Test
Fagerstrom test
FBC, ESR/CRP, FBG, lipid, UEC, LFT, ECG, CXR, ABG, spirometer

Question 11

Treatment of tobacco use disorder

Answer 11

Nicotine replacement therapy
Varenicline
Bupropion

Psycho: 5A, motivational interviewing, behavioural support

Question 12

Cannabis intoxication feature

Answer 12

Conjunctival injection, dry mouth

Question 13

Stimulant intoxication feature:

Answer 13

Pupillary dilation

Question 14

PCP intoxication feature

Answer 14

Nystagmus

Question 15

Ketamine intoxication feature

Answer 15

Cystitis

Question 16

Cocaine intoxication feature

Answer 16

Fomication

Question 17

When will urine drug screen for stimulant be positive

Answer 17

2-4 days

Question 18

Treatment of stimulant withdrawal

Answer 18

Benzos for mild-mod agitation and anxiety
Antipsychotics for severe agitation or psychosis
Symptomatic support for hypertension and arrhythmias
Bupropion for maintenance after detox
Rehab

Question 19

When is weed detected in urine

Answer 19

Single use: 3 days

Heavy use: 4 weeks

Question 20

How long does benzo stay in urine and blood

Answer 20

Short acting: 5 days

Long acting: 30 days

Question 21

Treatment for benzo intoxication

Answer 21

Flumazenil in overdose

Question 22

Treatment for barbiturate intoxication

Answer 22

Sodium bicarbonate

Question 23

Feature of sedative/hypnotic/anxiolytic withdrawal

Answer 23

Grand mal seizures

Question 24

Alcohol/benzo intoxication symptoms

Answer 24

Slurred speech, incoordination, unsteady gait, nystagmus, impairment in memory/attention, stupor/coma

Question 25

Alcohol withdrawal symptoms

Answer 25

Autonomic hyperactivity 
increased hand tremor
insomnia
n&v
transient visual, tactile or auditory hallucinations or illusions 
Psychomotor agitation
Anxiety 
Generalised tonic-clonic seizures

Question 26

How long does drug test for opioid remain positive

Answer 26

1-3 days

Question 27

Alcohol misuse tests

Answer 27

FBC, UEC, LFT, coag, FBG, VBG, ECG, amylase/lipase, TFT

Question 28

Opioid overdose triad

Answer 28

Respiratory depression
Miosis
Altered mental status