Addictions Psychiatry

Question 1

The two distinct mechanisms of substance misuse

Answer 1

Tolerance and reward centre

Question 2

Define Tolerance

Answer 2

Reduced responsiveness to a drug caused by previous administration

Question 3

Tolerance develops in response to which drugs

Answer 3

Opioids, ethanol, barbiturates, benzodiazepines

Question 4

Dispositional Tolerance

Answer 4

less drug reaches the active site, eg
decreased rate of absorption
increased rate of metabolism to inactive metabolites
decreased rate of metabolism to active metabolites
increased rate of excretion

Question 5

Pharmacodynamic Tolerance

Answer 5

site of action is less affected by the drug, eg
down-regulation or internalisation of drug receptors
reduced signalling down stream of drug receptors
some other compensatory mechanism

Question 6

Withdrawal Phenomena

Answer 6

The reverse of the acute effect, it is closely linked to tolerance. Development of tolerance may lead to physical dependence in order to avoid the withdrawal effects

Question 7

Opioid withdrawal

Answer 7

Acute effect is constipation and the withdrawal effect is diarrhoea

Question 8

Barbiturate withdrawal

Answer 8

Acute effects are anticonvulsants and the withdrawal effect is convulsions

Question 9

The reward pathway

Answer 9

Neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex
When VTA neurones are stimulated they release dopamine is released
This causes a sensation of pleasure/reward

Question 10

Why has the reward pathway evolved

Answer 10

The reward pathway is normally activated by eating, drinking and sex
It therefore encourages those “healthy” behaviours that lead to propagation of your genes

Question 11

How do drugs affect the reward centres

Answer 11

They tap into the reward pathways and increase dopamine levels.

heroin increases firing rate of dopaminergic neurones

amphetamine increases dopamine release

cocaine inhibits dopamine uptake

alcohol

THIS PRODUCES THE PSYCHOLOGICAL COMPONENT OF ADDICTION - CRAVING

Question 12

Stimulant Drugs

Answer 12

Cocaine and Amphetamine

Question 13

How is cocaine used

Answer 13

The leaves are chewed or brewed. Cocaine hydrochloride is snorted or injected. Cocaine freebase or crack cocaine is smoked.

Question 14

The effects of Cocaine (good)

Answer 14

Stimulant and Euphoriant
Increased alertness and energy
Increased confidence and impaired judgement
Lessens appetite and desire for sleep

Question 15

Dangerous effects of Cocaine

Answer 15

damage to nose and airways

convulsions with respiratory failure

cardiac arrhythmia’s and MI

hypertension and CVA

toxic confusion

paranoid psychosis

Question 16

Cocaine Withdrawal Effects

Answer 16

Depression 
Irritability
Agitation
Craving
Hyperphagia
Hypersomnia

Question 17

Amphetamine is usually

Answer 17

Amphetamine Sulphate

Question 18

How is Amphetamine used

Answer 18

Sniffed, swallowed or injected

Question 19

Effects of amphetamine

Answer 19

similar to cocaine but longer lasting

Question 20

Dangers of amphetamine use

Answer 20

Toxic confusion occasionally with convulsions and death

Amphetamine psychosis in heavy chronic use

Question 21

Opiates

Answer 21

Opium
Morphine
Heroin (diamorphine)
Methadone
Codeine and dihydrocodeine

Question 22

Heroine

Answer 22

Diamorphine or as diamorphine hydrochloride

Question 23

Heroine is also known as

Answer 23

H, gear, smack or brown

Question 24

How can heroine be taken

Answer 24

Snorting
Smoking
Injection

Question 25

Effects of Heroine

Answer 25

``` Analgesia, Drowsiness and sleep, Mood change Respiratory depression Cough reflex depression Sensitisation of the labyrinth with nausea and vomiting Decreased sympathetic outflow Lowering of body temperature Pupillary Constriction Constipation ```

Question 26

Dangers of Heroine

Answer 26

``` Respiratory arrest wtih a pulse Pinpoint pupils unreactive to light Snoring giving way to shallow respiration Bradycardia and hypotension Reduced consciousness ```

Question 27

First time side effects of Opiates

Answer 27

Nausea, vomiting and headache

Question 28

Medium term side effects of opiates

Answer 28

Phlebitis, anorexia, constipation

Question 29

Longer term side effects of opiates

Answer 29

tolerance, withdrawal and social and health problems

Question 30

Opiate Withdrawal Syndrome

Answer 30

``` craving insomnia yawning muscle pain and cramps increased salivary, nasal and lacrimal secretions dilated pupils piloerection (hence ‘cold turkey’) ```

Question 31

Methadone Maintenance

Answer 31

This is given to patients with opiate dependency. It decriminalises heroine use and allows normalisation of the lifestyle. It helps by reduces IV misuse and therefore reduces the consequences of doing so.

Question 32

Ecstasy

Answer 32

3,4-methylenedioxymethamphetamine

Question 33

Effects of ecstasy

Answer 33

relaxed euphoric state without hallucinations euphoria followed by feeling of calm increased sociability inability to distinguish between what is and isn’t desirable effects after 20 mins lasting 2-4 hours

Question 34

Side effects of Ecstasy

Answer 34

``` Nausea and dry mouth increased blood pressure and temperature in clubs users risk dehydration large doses can cause anxiety and panic drug induced psychosis ? liver and brain cell damage ```

Question 35

Psychoactive agent in cannabis

Answer 35

tetrahydrocannabinol

Question 36

Psychological Effects of Cannabis

Answer 36

relaxing or stimulating, euphoriant , increases sociability and hilarity, increases appetite, changes in time perception, synaesthesia anxiety , panic , persecutory ideation, hallucinatory activity

Question 37

Ill effects of cannabis

Answer 37

respiratory problems as with tobacco toxic confusion exacerbation of major mental illness cannabis psychosis