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Alcohol and Substance Misuse Flashcards

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1
Q

State the seven ICD10 categories of Substance Misuse

A

1 - Acute Intoxication
2 - Harmful Use (but no dependence)
3 - Dependence Syndrome
4 - Withdrawal State
5 - Psychotic Disorder
6 - Amnesic Syndrome
7 - Residual Disorder (Personality disorder etc as a result of substance misuse)

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2
Q

Describe the Biological Aetiology behind Substance Misuse

A
  • Genetics (variations in enzymes that metabolise drugs)
  • Neurochemical Abnormalities
  • Mesolimbic Dopaminergic Reward Pathway - biological reinforcement
  • Psychosocial reinforcement from peers of pleasurable effects
  • peer pressure
  • life stressors
  • parental drug use
  • cultural acceptability
  • cost
  • availability
  • effect of drug
  • route

leads to dependence

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3
Q

Substance Dependence requires more than three of the following symptoms over a period of 1 month

A

Drug Problems Will Continue To Harm

strong Desire to consume substance

Preoccupation with substance

Withdrawal state when stopped/reduced

impaired ability to Control

Tolerance to substance requiring more consumption for desired effect

persisting with use despite clear Harm

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4
Q

Give 4 examples of Stimulant Drugs and their route

A
  • Cocaine (IN, IV, smoked)
  • Crack cocaine (IN, IV, smoked)
  • Ecstasy (PO)
  • Amphetamine (PO, IV, IN, smoked)
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5
Q

Describe the psychological effects of Stimulant Drugs

A

Euphoria

Increased Energy

Grandiose beliefs

Aggression

Arguemtative

Illusions

Hallucinations

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6
Q

Describe the physical effects of Stimulant Drugs

A
  • Tachycardia
  • Hypertension
  • Arrhythmias
  • N&V
  • Dilated pupils
  • psychomotor agitation
  • muscular weakness
  • chest pain
  • convulsions
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7
Q

Describe the withdrawal effects of Stimulant Drugs

A
  • Dysphoric mood - must be present
  • Lethargy
  • Psychomotor Agitation
  • Craving
  • Increased Appetite
  • Insomnia
  • Bizarre or unpleasant dreams
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8
Q

Name two Hallucinogens and their route

A

LSD

Magic Mushrooms

both PO

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9
Q

Describe the psychological effects of Hallucinogenic Drugs

A
  • Anxiety
  • Illusions
  • Hallucinations
  • Derealisation/Depersonalisation
  • Paranoid
  • Ideas of reference
  • Hyperactivity
  • Impulsivity
  • Inattention
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10
Q

Describe the physical effects of Hallucinogenic Drugs

A
  • Tachycardia
  • Palpitations
  • Sweating
  • Tremor
  • blurred vision
  • pupillary dilation
  • incoordination
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11
Q

Describe the psychological effects of Volatile Solvent Drugs (aerosols, paint, glue, petrol which are inhaled)

A
  • Apathy
  • lethargy
  • Aggression
  • Impaired attention and judgement
  • Psychomotor retardation
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12
Q

Describe the physical effects of Volatile Solvent Drugs

A
  • Unsteady Gait
  • Diplopia
  • Nystagmus
  • Decreased consciousness
  • Muscle weakness
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13
Q

Describe the psychological effects of Anabolic Steroids (testosterone, androstenedione, danazol which can all be taken PO and IM)

A
  • Euphoria
  • Depression
  • Aggression
  • Hyperactivity
  • Mood Swings
  • Hallucinations
  • Delusions
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14
Q

Describe the physical effects of Anabolic Steroids

A
  • Increased muscle mass
  • Reduced fat
  • Acne
  • Reduced sperm count
  • Male pattern baldness
  • Stunted growth
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15
Q

Describe psychological effects of opiates

A
  • Apathy
  • Disinhibition
  • Psychomotor retardation
  • Impaired judgement and attention
  • Drowsiness
  • Slurred speech
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16
Q

Describe physical effects of opiates

A
  • respiratory depression
  • hypoxia
  • decreased BP
  • hypothermia
  • low bp
  • coma
  • pupillary constriction
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17
Q

describe the withdrawl signs of opiates

A

craving

rhinorrhoea

lacrimation

myalgia

abdominal cramps

N&V

dirrhoea

dilated pupils

piloerection

raised heart rate and BP

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18
Q

describe the psychological effects of cannabis (cannabinoids)

(PO or smoked)

A
  • euphoria
  • disinhibition
  • agitation
  • paranoid ideation
  • temporal slowing
  • impaired judgement/attention/reaction time
  • illusions
  • hallucinations
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19
Q

describe the physical effects of cannabis

A

increased appetite

dry mouth

conjunctival injection

increased heart rate

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20
Q

describe the withdrawl signs of cannabis

A

anxiety

irritability

tremor of outstretched hands

sweating

myalgia

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21
Q

describe the psychological effects of sedative-hypnotics such as benzodiazepines and barbiturates (PO, IV)

A

euphoria

disinhibition

apathy

aggression

anterograde amnesia

labile mood

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22
Q

describe the physical effects of sedative-hypnotics

A
  • unsteady gait
  • difficulty standing
  • slurred speech
  • nystagmus
  • erythematous skin lesions
  • low bp
  • hypothermia
  • depression of gag reflex
  • coma
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23
Q

what are the withdrawl signs of sedative-hypnotics

Study These Flashcards
A
  • tremor of hands
  • tongue or eyelids
  • N&V
  • increased heart rate
  • postural drop in BP
  • headache
  • agitation
  • malaise
  • transient illusions/hallucinations
  • paranoid ideation
  • grand mal convulsions
24
Q

Give 5 potential consequences of Substance Misuse

Study These Flashcards
A

Endocarditis Drug Induced Psychosis DVT Crime Homelessness

25
Give an example of a Class A drug and the subsequent UK law
Cocaine 7 years prison for possession, up to life for supply
26
Give an example of a Class B drug and the subsequent UK law
Ketamine 5 years for possession, up to 14 years for supply
27
Give an example of a Class C drug and the subsequent UK law
Benzodiazepines Up to 2y possession and 14y for supply
28
Name four investigations for a known substance abuser
Bloods - BBV (HIV, HEP B &C, LFTs, & clotting, U&Es, drug levels Urinalysis - Drug Metabolites ECG - Arrhythmias Echo - Endocarditis
29
Describe the management of Opioid Dependence
Detoxification and Maintenance- Methadone/Buprenorphine Continued Abstinence (ie after detoxification) - Naltrexone Overdose antidote = Naloxone
30
Describe four psychosocial interventions for Substance Misuse
* Keyworker with a therapeutic alliance for psychosocial support * Hep B immunization if risk * Motivational interviewing and CBT * Contingency Management (changing specific behaviours by offering incentives for positive behaviours) * Supportive help with finance/housing/employment * Narcotics Anonymous * Driving - DVLA guidelines
31
whats the difference between **detoxification** and **maintenance**?
detoxification refers to a process in which the effects of the drug are eliminated in a safe manner (replacement drug) such that the withdrawl symptoms are avoided in an attempt to attain abstinence maintenance therapy - aim is to minimise harm rather than abstain
32
Define Alcohol Abuse
Consumption of alcohol at a level enough to cause physical psychiatric and social harm
33
Define Binge Drinking
Drinking twice over recommended level of alcohol per day in one session \>8 units for males \>6 units for females
34
Define Harmful Alcohol Use
Drinking above safe levels with evidence of alcohol related problems \>50 units per week for males and \>35 units per week for females
35
Describe the biological effects of alcohol
Affects GABA causing Anxiolytic and Sedative effects Pleasurable and stimulant effect from dopaminergic pathway sensitises and leads to dependence Long term decreases GABA and increases Glutamate = hyper-excitability of the CNS when alcohol is withdrawn long term use often experince cravings which has been linked to dopaminergic, serotonergic, opioid systems that mediate positive reinforcement
36
Describe the psychological theories behind alcohol dependence
Social Learning Theory Operant Conditioning Therapy
37
what are some risk factors for alcohol abuse?
male young adults genetics antisocial behaviour lack of facial flushing life stressors
38
Describe the ICD10 criteria for Alcohol Intoxication
A - Clear evidence of psychoactive substance, Disturbance in consciousness/cognition/behaviour, Not accounted for by mental/medical disorder B - Evidence of dysfunctional behaviour, and one of unsteady gait/slurred speech/nystagmus/flushing
39
Describe the clinical features of Alcohol Dependence (SAW DRINk)
* *S**ubjective awareness of compulsion * *A**voidance of withdrawal symptoms by drinking * *W**ithdrawal symptoms * *D**rink seeking behaviour predominates * *R**einstatement if drinking after failed abstinence * *I**ncrease tolerance * *N**arrowing of drinking repertoire (fixed times) k
40
Describe the ICD10 criteria for Alcohol Withdrawal
A) General criteria for withdrawal state met (not accounted for by mental/medical disorders) B) 3 of Tremor/Sweating/N and V/ Tachycardia/ Headache/Insomnia/Transient Hallucinations Occurs 6-12hrs after abstinence
41
Give 5 long term manifestations of Alcoholism
Cirrhosis HCC Peptic Ulcers Pancreatitis Wernickes and Korsakoff
42
What is the CAGE questionnaire for Alcohol Abuse?
C - Have you ever felt you should **CUT** down on your drinking A- Have people **ANNOYED** you by criticising your drinking G - Have you ever felt **GUILTY** about your drinking E - Do you ever have a drink **EARLY** in the morning
43
Describe the expected MSE for an Alcohol Intoxicated patient
Appearance - Poor coordination, alcohol smell Speech - Slurred Mood - Elevated or depressed Thought - Variable Perception- Normal Cognition - Impaired judgement, reduced concentration Insight - Poor
44
Describe the expected MSE for an Alcohol Withdrawn patient
Appearance - Agitated, Sweaty Speech - Confused Mood - Anxious Thoughts - Paranoid Delusions Perception - Visual Hallucinations, Illusions Cognition - Delirium, Inattention Insight - Poor
45
what blood tests would you do in excess alcohol consumption
**blood alcohol level** **FBC** (anaemia) **U&Es** (dehydration, low urea) **LFTs** including **gamma GT** (may be raised) **blood alcohol concentration**, **MCV** (macrocytosis) **vitamin B12/folate/TFTs** (alternative causes of raised MCV) **amylase** (pancreatitis) **hepatitis serology** **glucose** (hypoglycaemia).
46
Name three questionnaires for Alcohol Abuse
AUDIT (Alcohol Use Disorders Identification Test) SADQ (Severity of Alcohol Dependence Questionnaire) FAST screening tool
47
Describe the biological management of Alcohol withdrawal
High Dose Benzodiazepines (clordiazepoxide) used and tapered over 5-9 days Thiamine Orally or IV as Pabrinex
48
Describe the long term Biological management of Alcohol Dependence
Disulfiram Acamprosate (reduces craving by enhancing GABA) Naltrexone
49
Describe the Psychological management of Alcohol Abuse
Motivational Interviewing CBT Environment based therapy
50
Motivational interviewing uses the Stages Of Change Model, describe it
1) Precontemplation 2) Contemplation 3) Determination 4) Action 5) Maintenance 6) Relapse
51
Describe the social management of Alcohol abuse
Alcoholics Anonymous (AA)
52
How do you calculate alcohol units? how many ml in 1 unit of alcohol
10ml (8g) of ethanol strengths x ml / 1000
53
bio-psychosocial approach to management of alcohol abuse
54
what is Karsakoff's psychosis
profound irreversible short term memory loss with confabulation (the unconscious filling of gaps in memory with imaginary events) and disorientation of time
55
what is Wernicke's encephalopathy
acute encephalopathy due to thiamine deficiency, presenting with delirium, nystagmus, ophthalmoplegia, hypothermia and ataxia urgent treatment - as may progress to Karsakoff's psychosis treat with parenteral thiamine
56
what is the triad of Wernicke's encephalopathy?
altered mental state ataxia ophthalmoplegia
57
what is delirium tremens?
withdrawl delirium develops between 24 hours and 1 week after alcohol cessation peak at 72 hours cognitive impairment, vivid perceptual abnormalities, paranoid delusion, marked tremor, autonomic arousal treated with benzodiazepines, haloperidol for psychotic features and iv Pabrinex

Psychiatry (18 decks)

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