Addiction Psychiatry

Question 1

which pathway in the brain is affected in addiction

Answer 1

mesolimbic - reward pathway

Question 2

what structures of the brain make up the mesolimbic pathway

Answer 2

ventral tegmental area
nucleus accumbent
pre-frontal cortex

Question 3

when a certain chemical is produced, its produces a motivating signal and you want that thing more, what chemical is produced

Answer 3

dopamine

Question 4

what is the function of the hippocampus, striatum and amygdala

Answer 4

learning and memory - responsible for habits and cues

Question 5

what is the function of the pre-frontal cortex

Answer 5

puts brakes on the reward pathway

Question 6

how does behaviour change in response to addiction

Answer 6

normally, dopamine is released with pleasurable experiences

in addiction, receptors downregulate and more of the substance is required to produce the same desired effect

Question 7

what 6 features must be present for a diagnosis of dependence

Answer 7

craving
tolerance
withdrawal - physical symptoms when stopping
loss of control
persistence despite harm
preoccupation - doesn’t enjoy other things

Question 8

what are the complications of IV drug use

Answer 8

infection - local, distant and systemic

DVT and PE

Question 9

describe the features associated with heroin use

Answer 9

euphoria
respiratory depression 
reduced consciousness 
bradycardia 
analgesia 
constipation 
hypotension

Question 10

what is the pupillary change seen in heroin use

Answer 10

pin point pupils

Question 11

describe the features associated with heroin withdrawal

Answer 11

approx 6 hours after use 
diarrhoea 
hypertension 
dilated pupils 
piloerection
agitation 
tachycardia 
nausea and vomiting
lacrimation and rhinorrhoea

Question 12

what is the main treatment for opiate misuse

Answer 12

opiate substitution therapy

Question 13

what is the first line opiate substitution and what is its mechanism

Answer 13

methadone - long acting full agonist

Question 14

what is the second line opiate substitution and what is its mechanism

Answer 14

buprenophine - long acting partial agonist

Question 15

what is the recommended limit for alcohol consumption for men and women

Answer 15

14 units per week spread across several days with some alcohol free days

Question 16

how do you calculate the number of units in a drink

Answer 16

(mls of drink x % of alcohol) / 1000

Question 17

define binge drinking

Answer 17

> 6 units in a sitting if female

>8 units in a sitting if male

Question 18

define hazardous drinking

Answer 18

audit score of 8-14, drinking more than recommended but not experiencing any alcohol related problems

Question 19

define harmful drinking

Answer 19

audit 15-19, drinking habits have resulted in physical or mental health complications

Question 20

define alcohol dependency

Answer 20

audit >20 or >15 with at least 3 features of dependency

Question 21

list some of the screening tools available for assessing alcohol use

Answer 21

AUDIT
CAGE
TWEAK
PAT and FAST

Question 22

describe the AUDIT

Answer 22

10 questions on hazardous drinking

Question 23

describe the CAGE

Answer 23

4 questions 
C - cut down 
A - annoyed 
G - guilt 
E - eye opener

Question 24

when are the PAT and FAST tools used

Answer 24

short screening tools for A&E that suggests if further assessment is required

Question 25

alcohol inhibits which neurotransmitter

Answer 25

NMDA glutamate controlled ion channels

Question 26

alcohol potentiates which ion channels

Answer 26

GABA controlled (inhibitory)

Question 27

withdrawal from alcohol causes what change in neurotransmitters

Answer 27

causes excess glutamate activity which is neurotoxic and reduces GABA activity - causes CNS excitability

Question 28

what are the clinical features of withdrawal

Answer 28

``` restless tremor sweating anxiety nausea/vomiting loss of appetite tachycardia generalised seizures ```

Question 29

what a severe complication of alcohol withdrawal

Answer 29

delirium tremens

Question 30

how does delirium tremens present

Answer 30

``` night time confusion disorientation agitation fever hallucinations paranoid ideation ```

Question 31

how long does delirium tremens typically last

Answer 31

5-7 days

Question 32

how is alcohol withdrawal managed

Answer 32

benzodiazepines - usually diazepam and gradually reduce dose over 7 days parenteral vitamin supplementation (thiamine as prophylaxis)

Question 33

what are the non-pharmacological methods for alcohol relapse prevention

Answer 33

CBT Alcoholics Anonymous family and couple therapy

Question 34

once someone has come out of withdrawal, which drug is started and how does it work

Answer 34

naltrexone - opioid antagonist and reduces reward from alcohol

Question 35

what is Antabuse

Answer 35

a medication used for alcohol detoxification, inhibits enzyme in breakdown causing flushed skin, tachycardia etc

Question 36

alcohol excess can cause which deficiency

Answer 36

B1 - thiamine

Question 37

thiamine deficiency can initially cause which syndrome

Answer 37

Wernicke's encephalopathy

Question 38

how does wernicke's encephalopathy present

Answer 38

ataxia confusion double vision and ptosis split into acute, acute-chronic and chronic

Question 39

what is Korsakoff's syndrome

Answer 39

chronic memory impairment associated with thiamine deficiency

Question 40

what are the main features of Korsakoff's syndrome

Answer 40

confabulations and anterograde amnesia