Alcoholism

Question 1

What is the current drinking guidelines in Scotland?

Answer 1

14 units of alcohol a week and at least 2/3 alcohol free days a week

Question 2

What are the effects of alcohol in low doses?

Answer 2

Euphoria

Reduced anxiety

Relaxation

Sociability

Question 3

What are the effects of alcohol in high doses?

Answer 3

Intoxication: Pathological state produced by a drug/poisoning

Impaired attention and judgement

Unsteadiness

Flushing: Peripheral vasodilation

Nystagmus

Mood instability

Disinhibition

Slurring

Stupor

Unconsciousness

Question 4

What are the 4 classes of alcohol related diagnoses?

Answer 4

Acute intoxication: High dose symptoms

Harmful use

Dependence

Withdrawal

Question 5

Define harmful use of alcohol

Answer 5

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

Question 6

What are the symptoms of alcohol dependence?

Answer 6

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

CDIPPP

Cravings/compulsions to take

Difficulty controlling use

Primacy: Where you rank alcohol in priorities

Increased tolerance

Physiological withdrawal on reduction/cessation

Persistence despite harmful consequences

Neglect of other interests

Question 7

What is alcohol withdrawl state?

Answer 7

group of symptoms variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance

Question 8

How does alcohol withdrawl present?

Answer 8

PAT SCWIND

Psychomotor agitation

Anxiety: THE FEAR

Tremor

Seizures

Confusion

Weakness

(Insomnia)

Nausea/Vomiting

Death

Question 9

What is delirium tremens?

Answer 9

Onset of profound confusion 2-3 days once drinking stops

Question 10

How does delirium tremens present?

Answer 10

HAPTID

Hallucinations

Agitation

Autonomic over-activity

Profound confusion

Tremor

Insomnia

Delusions

Death: cardiovascular collapse, infection, hyperthermia, seizures or self injury

Question 11

What is the mortality rate of delirium tremens?

Answer 11

5/10%

Question 12

Name some alcoholism screening tools

Answer 12

CAGE

AUDIT (Alcohol Use Disorders Identification Test)

FAST (4 questions), used in A&E as smaller version of AUDIT

PAT (Paddington Alcohol Test)

Question 13

What are the CAGE questions?

Answer 13

(2 or more = likely to be an alcohol problem)

Have you ever tried to Cut down?

Have you felt Annoyed by people criticising your drinking?

Have you felt Guilty about drinking?

Have you ever felt the need to have an Eye-opener?

Question 14

How can alcohol affect your mental health?

Answer 14

Anxiety: Helps in low levels, yet can become a cycle if drinking to help anxiety which is then causing the anxiety

Depression: Vicious cycle

Sleep disruption: Helps in initial insomnia yet does not promote REM sleep

Morbid jealousy (Othello’s syndrome): Delusion that partner may be cheating, breakdown of relationship

Alcoholic hallucinosis: Usually auditory hallucinations of derogatory nature

Deliberate self-injury: More likely to act on suicidal thoughts due to disinhibition

Question 15

How does alcohol affect your physical health?

Answer 15

Cerebral atrophy

Accidental injury

Violence

Cancer

• Mouth
• Oesophagus
• Liver
• Pancreatic

Neurological

• Brain damage
• Loss of memory
• Hallucinations
• Fits
• Dementia

Liver

• Cirrhosis
• Hepatitis
• Hepatocellular cancer

Cardiac

• Enlarged heart
• Hypertension
• Irregular pulse

GI

• Ulcers
• Gastritis
• Vomiting blood
• Oesophageal varices
• Pancreatitis

Poor control of diabetes

CVS

• High BP
• HF
• Arrythmia
• Dilated Cardiomyopathy
• Vascular
• Thrombosis

Immunosuppression

Question 16

What is Wernicke’s triad?

Answer 16

Confusion

Ataxia

Ophthalmoplegia/eye muscle paralysis causing Nystagmus

Question 17

Why is treatment of Wernicke’s encephalopathy essential?

Answer 17

can progress to Korsakoff’s psychosis.

Question 18

What is Korsakoff’s psychosis?

Answer 18

Chronic memory disorder characterised by prominent impairment of recent and remote memory (anterograde and retrograde)

Question 19

What causes Wernicke’s and Korsakoff’s?

Answer 19

thiamine deficiency (vitamin B1)

Question 20

Why does thiamine deficiency occur in alcoholics?

Answer 20

Poor intake and absorption due to GI damage by alcohol

Poor hepatic function

Increased requirement for alcohol metabolism (thiamine is required for alcohol metabolism)

Poor nutrition

Question 21

What are the psycho-social interventions for alcoholism?

Answer 21

Support for friends and family

CBT

Social work input: Benefits, housing, child protection

Skills training

Community support: AA, ADA (Alcohol and Drugs Action)

Inpatient or residential treatment

Question 22

What medication is given to manage alcohol withdrawls?

Answer 22

Benzodiazepines, commonly chlordiazepoxide, as act on same receptors as alcohol

Question 23

Give examples of anti-craving medication?

Answer 23

Acamprosate

Naltrexone

Nalmefene

Question 24

Name an aversion medication?

Answer 24

Disulfiram

Stops you from breaking alcohol down properly, giving a reaction to put you off drinking

Question 25

When do symptoms of alcohol withdrawl begin?

Answer 25

6-12 hours

Question 26

When is the peak incidence of seizures after alcohol withdrawl?

Answer 26

36 hours

Question 27

When is the peak incidence of delirium tremens?

Answer 27

48-72 hours

Question 28

When would chlordiazepoxide not be first line in alcohol withdrawl management?

Answer 28

Lorzepam may be preffered in patients with hepatic failure

Question 29

How can alcohol units be calculated?

Answer 29

Volume (ml) x alcohol by volume (%) /1000