Clinical Assessment and Management of Substance Use Disorder Flashcards Preview

Adult Years > Clinical Assessment and Management of Substance Use Disorder > Flashcards

Flashcards in Clinical Assessment and Management of Substance Use Disorder Deck (28)
Loading flashcards...
1
Q

What is the definition of a drug?

A
  • Any psychoactive substance that affects the CNS and causes alteration in mood, behaviour, perception and conscioussness.
  • Any substance other than those required to maintain normal health, that can modify the individual’s functions.
2
Q

What is the definition of acute intoxication?

A

The pattern of reversible physical and mental abnormalities caused by direct effects of the substance.

3
Q

What is the definition of ‘at risk use’?

A
  • A pattern of substance use where the person is at increased risk of harming their physical or mental health.
  • Not a discrete point but shades into normal consumption and harmful use.
  • Not only absolute amounts but also situations e.g. driving.
4
Q

What is the definition of harmful use?

A
  • Continuation of the substance use despite evidence of damage to the user’s physical and mental health or to their social, occupational and familial wellbeing.
5
Q

What is the definition of dependence?

A
  • A state, psychological or physical resulting from use of psychoactive substance characterised by compulsion to continuously seek adn take the substance, to experience psychic effects or avoid discomfort of its absence.
6
Q

What is the definition of physical dependence?

A

A state of physical disturbance when the drug is withdrawn.

7
Q

What is the definition of tolerance?

A

A state of reduced responsiveness to the effects of the drug caused by its previous administration.

8
Q

What is the definition of withdrawl?

A
  • Physical withdrawls - can be fatal particularly in alcohol, seizures, death.
  • Psychological withdrawl state of anhedonia characterised by dysphoria, irritability, emotional distress.
9
Q

What are the functions of the dopamine pathway?

A
  • Reward (motivation)
  • Pleasure, euphoria
  • Motor function (fine tuning)
  • Compulsion
  • Perseveration
10
Q

What are the functions of the serotonin pathways?

A
  • Mood
  • Memory processing
  • Sleep
  • Cognition
11
Q

What are the components of the assessment of addiction?

A
  • Making a diagnosis
    • History taking
    • Collateral
  • Biopsychosocial
  • Formulation
  • Screening tools
  • Investigations
  • Risk assessment
  • Short term
  • Long term recovery
12
Q

What are the different disorders caused by substance use and addictive behaviours?

A
13
Q

What are the core features of addictive behaviour?

A
  • Salience (importance, dominance)
  • Mood modification (rush and escape)
  • Tolerance (escalation for effect, increasing intensity, recklessness, destructiveness).
  • Withdrawl (unpleasant emotional / physical effects when engagement is prevented).
  • Conflict (interpersonal, intrapsychic, loss of control)
  • Relapse (repeated reversions to excess)
14
Q

What are the 4 groups of the DSMV diagnostic criteria for substance use disorders?

A
  • Impaired cotrol
  • Risky use of substance
  • Social impairment
  • Pharmacological criteria
15
Q

Describe the features of impaired control.

A
  • Substance is often taken in larger amounts or over a longer period than was intended.
  • There is a persistent desire or unsuccessful efforts to cut down or control substance use.
  • A great deal of time is spent in activities necessary to obtain the substance, use the substance or recover from its effects.
  • Craving, or a strong desire or urge to use the substance.
16
Q

What are the features of risky use of substance?

A
  • Recurren substance use in situations in which it is physically hazardous.
  • Substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused by or exacerbated by the substance.
17
Q

What are the features of social impairment associated with substance use?

A
  • Recurrent substance use resulting in a failure to fulfil major role obligations at work, school or home.
  • Continues substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance.
  • Important social, occupational, or recreational activities are given up or reduced because of substance use.
18
Q

What are the pharmacological criteria for diagnosis of addiction?

A
  • Tolerance, as defined by either: a need for markedly increased amounts of the substance to achieve intoxication or desired effect OR markedly diminished effect with continued use of the same amount of the substance.
  • Withdrawl, as manifested by either: the characteristic withdrawl syndrome for the substance OR the substance (or a closely related substance) is taken to relieve or avoid withdrawl symptoms.
19
Q

What are the 10 classes of drugs encompassed in DSMV?

A
20
Q

What are the substances in the ICD10 classification?

A
21
Q

Describe the formulation model of addiction.

A
  • Predisposing
  • Precipitating
  • Perpetuating
  • Presenting
  • Protective
22
Q

Describe the components of the management of addiction.

A
  • Risk assessment
    • Do you have any statutory duties (children involved)?
  • Short term, medium term, long term
  • Guidance
  • Biopsychosocial
    • Pharmacological
    • Psychological
    • Social support systems
23
Q

What are the areas of risk which are pertinent to substance use?

A
  • To self
    • Self neglect
    • Self harm and suicide
  • To others
    • Violence
    • GBA/GBV
  • Exploitation
    • Perpetrator
    • Offending behaviour
    • Financial
24
Q

What are the pharmacological interventions for opioid dependency disorder?

A
  • Methadone
  • Buprenorphine
  • HAT
25
Q

What are the pharmacological interventions for alcohol dependency disorder?

A
  • Medically assisted withdrawl from alcohol
    • Benzodiazepines and vitamins
  • Relapse prevention
    • Naltrexone
    • Disulfiram
    • Acamprosate
26
Q

What are the stages of change in a patient with addiction?

A
  • Precontemplation (unaware / unready)
    • Intervention unlikely to succeed, give information about risks.
  • Contemplation (aware / ambivalent)
    • Offer advice and / or motivational work to move patient along.
  • Preparation (planning)
    • Set date, make plans, be specific, anticipate difficulties.
  • Action (ready to go)
    • Encourage, support, offer to follow-up.
  • Maintenance (keeping it up)
    • Reinforce success, advise on managing slips / relapse prevention.
27
Q

Describe the frames and oars approach.

A
  • Feedback
  • Responsibility
  • Advice
  • Menu of options
  • Empathic style
  • Self efficacy
  • Open questions
  • Affirmation
  • Reflective listening
  • Summary
28
Q

What should you encourage patients with addiction to keep in a diary?

A
  • When
  • Where
  • With whom
  • How much
  • Cost
  • Feelings before
  • Feelings after