Flashcards in Alcohol Dependence Disorders Deck (30)
What is harmful use of alcohol defined as?
A pattern of use that is causing damage to health (physical or mental).
What guidelines would you use in the diagnosis of alcohol dependence disorders?
ICD-10 classification of mental and behavioural disorders by the WHO. F-10 part is for alcohol.
What are the diagnostic criteria for harmful use?
1. Clear evidence that substance was responsible for physical or psychological harm.
2. Nature of harm should be clearly identifiable.
3. Persisted for at least 1 month or occurred repeatedly.
4. Does not meet criteria for any other disorder.
What are the criteria for alcohol dependence syndrome?
3 or more of:
1. Strong desire or compulsion to take alcohol.
2. Difficulties in controlling use.
3. Persistent use despite clear evidence of harm.
4. Preoccuption with substance use.
5. Increased tolerance.
6. Psychological withdrawal state.
What are the stages of change?
What is a screening tool for hazardous drinking?
Fast alcohol screening test (FAST).
What is a more in depth screening tool for hazardous drinking?
What vitamins can you give people with hazardous drinking?
Oral thiamine if low risk.
IM/IV Pabrinex for high risk.
What supportive measures can you give people with hazardous drinking?
Nutrition, hydration, anti-emetics and anti-diarrhoeals.
What should you do if a patient has an audit score of 20+ (possible dependence)?
If in community refer to TSMS.
If inpatient monitor and manage them then refer to TSMS.
What are the complications of alcohol dependence?
Withdrawals (4-12 hours).
Withdrawal seizures (60%).
Delirium tremens (3-10 days).
What is withdrawal state with delirium/delirium tremens?
Severe form of alcohol withdrawal that included sudden and severe mental and/or nervous system changes. MEDICAL EMERGENCY.
When do symptoms of delirium tremens tend to occur?
72 to 96 hours after the last drink.
How long can delirium tremens last for?
From 1 week to 1 month.
What is the mortality form delirium tremens?
When is the risk for delirium tremens increased?
In severe dependence, co-morbid infection, liver damage.
What are the symptoms of DT?
Confusion, hallucination in every modality, autonomic hyperactivity (tachycardia, sweating, HTN, pyrexia), body tremors (shaking), seizures.
What is the management of delirium tremens?
Inpatient detox (use of common law/mental health act).
Benzodiazepine and pabrinex.
Supportive measures - anticonvulsants, antipsychotics, antiemetics, fluids etc.
What is the triad for Wernicke's encephalopathy?
Ophthalmoplegia, ataxia, confusion (10%).
Don't be fooled as alcohol and BZD cause ataxia and nystagmus.
What causes Wernicke's encephalopahty?
Lack of thiamine.
What is alcoholic hallucinosis?
Acoustic hallucinations, delusions, mood distrubances during or shortly after periods of heavy drinking.
Who normally gets alcoholic hallucinosis?
Does alcoholic hallucinosis occur when a person has clear consciousness or not?
What is an indicator of better prognosis in alcoholic hallucinosis?
Full recovery between episodes.
For relapse prevention what are the first and second line drugs?
1st line - acamprosate and naltrexone.
2nd line - disulfiram.
What are the psychological methods of relapse prevention?
Brief interventions, trauma focused therapies, 12 steps programme (AA).
What are the social rehabilitation methods of relapse prevention?
Skills training, employment, housing/relationships/finances.
What does acamprosate do?
Stabilises chemical signalling in the brain that is disrupted by alcohol withdrawal.
What does naltrexone do?
Decreases positive reinforcement of alcohol drinking.