Alcoholism

Question 1

What’s the Impact of the Pandemic on Alcohol Consumption and Harm ?

Answer 1

Accelerated long established trend to home drinking. Consumer surveys show a polarisation with light drinkers drinking less and heavy drinkers drinking more.

Question 2

Describe the symptoms of intoxication?

Answer 2

impaired attention and judgement, unsteadiness,

flushing, nystagmus, mood instability, disinhibition, slurring, stupor, unconsciousness

Question 3

What is the definition of harmful use of alcohol?

Answer 3

pattern of use causing damage to physical
or mental health. Use >1 month or repeatedly over 12
months

Question 4

What is the definition of dependence on alcohol?

Answer 4

3 or more of the following for >1month or
repeatedly over 12 months:

– Cravings/compulsions to take – Difficulty controlling use – Primacy – Increased tolerance – Physiological withdrawal on reduction/cessation – Persistence despite harmful consequences

Question 5

What is the definition of the withdrawal state?

Answer 5

Group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance
Tremor, weakness, nausea, vomiting, anxiety,
seizures, confusion, agitation, death
– Delirium Tremens

Question 6

What is delirium Tremens?

Answer 6

• Profound confusion, tremor, agitation, hallucinations,
delusions, sleeplessness, autonomic over-activity • Mortality in DTs = 5% • Death: cardiovascular collapse, infection, hyperthermia,
seizures or self injury • Usually 48-72 hours after alcohol stopped

Question 7

What mental health issues are associated with alcoholism?

Answer 7

Anxiety, depression, sleep disturbance, morbid jealousy, alcoholic hallucinations, deliberate self-injury, suicidal thoughts

Question 8

What is korsakoff’s psychosis?

Answer 8

Prominent impairment of recent and remote memory,
preservation of immediate recall, no general cognitive impairment, retrograde and anterograde memory, impaired learning and disorientation, may exhibit nystagmus and ataxia

Question 9

What causes wernicke’s encephalopathy?

Answer 9

Caused by thiamine deficiency
– Poor intake and absorption, poor hepatic function,
increased requirement for alcohol metabolism

Question 10

What is the treatment of wernicke’s encephalopathy?

Answer 10

High potency parenteral B1 replacement: 3-7 days: Oral thiamine. Avoid carbohydrate load until thiamine replacement completed.

Question 11

Describe the CAGE screening tool.

Answer 11

CAGE (2 or more = likely alcohol problem)
– Have you tried to Cut down?
– Have you felt Annoyed by people criticising your drinking?
– Have you felt Guilty about drinking?
– Have you felt the need to have an Eye-opener?

Question 12

What medications are used in the management of alcohol withdrawal?

Answer 12

Benzodiazepines , commonly Chlordiazepoxide

Question 13

Name alcohol anitcraving medications.

Answer 13

– Acamprosate (Campral)
– Naltrexone
– Nalmefene
– (Baclofen)

Question 14

What percentage of drinkers with a fatty liver progress to cirrhosis?

Answer 14

20%

Question 15

What is a sign of late stage alcoholic hepatitis?

Answer 15

Jaundice

Question 16

What is the pathology of alcoholic hepatitis?

Answer 16

Response of liver to excess alcohol. Fatty change. Acute inflammation. Liver cell death, liver failure. Progresses to cirrhosis.

Question 17

Describe the mortality in alcoholic hepatitis with a GAHS >9.

Answer 17

30 day mortality
• Without steroids 48%
• With steroids        22%
84 day mortality
• Without steroids 62%
• With steroids       41%