Deck 6 Flashcards
(101 cards)
1
Q
What’s the ICD-10 criteria for substance misuse?
A
- Acute intoxication. The acute, usually transient, effect of the substance.
- Harmful use. Recurrent misuse associated with physical, psychological and social consequences, but without dependence.
- Dependence syndrome. Prolonged, compulsive substance use leading to addiction, tolerance and the potential for withdrawal syndromes.
- Withdrawal state. Physical and/or psychological effects from complete (or partial) cessation of a substance after prolonged, repeated or high level use.
- Psychotic disorder. Onset of psychotic symptoms within 2 weeks of substance use. Must persist for more than 48 hours.
- Amnesic syndrome. Memory impairment in recent memory (impaired learning of new material) and ability to recall past experiences. Also defect in recall, clouding of consciousness and global intellectual decline.
- Residual disorder. Specific features (flashbacks, personality disorder, affective disorder, dementia, persisting cognitive impairment) subsequent to substance misuse.
2
Q
Give examples of opiates and the routes into the body
A
Morphine (PO, IV)
Diamorphine (IN, IV, smoked)
Codeine/methadone (PO)
3
Q
Do you need to do LFTs for lithium?
A
No, it is not metabolised by the liver
4
Q
Can you use a section 5(2) or 5(4) in the emergency department?
A
No
5
Q
If you lack capacity to make a medical decision can your spouse do it for you?
A
Only if they are the medical lasting power of attorney. If not the medical team will act in the patient’s best interest.
6
Q
If someone ODs can you use the mental health act to treat the overdose?
A
No, MHA can only be used to treat mental conditions. You must use the mental capacity act.
7
Q
What are the effects of opiates?
A
Psychological
- apathy
- disinhibition
- psychomotor retardation
- impaired judgement
- impaired attention
- drowsy
- slurred speach
Physical
- respiratory depression
- hypoxia
- dec BP
- hypothermia
- coma
- pupillary constricition
8
Q
What are the withdrawal signs of opiates?
A
- craving
- rhinorrhoea
- lacrimation
- myalgia
- abdominal cramps
- N+V
- diarrhoea
- pupillary dilation
- piloerection
- inc HR/BP
9
Q
What are the effects of cannabis?
A
Psychological
- euphoria
- disinhibition
- agitation
- paranoid ideation
- temporal slowing (time passes slowly)
- impaired judgement/attention/reaction time
- illusions
- hallucinations
Physical
- increased appetite
- dry mouth
- conjunctival injection
- inc HR
10
Q
What are the withdrawal signs of cannabis?
A
- anxiety
- irritability
- tremor of outstretched hands
- sweating
- myalgia
11
Q
Give examples of sedative-hypnotics. How can they be taken into the body?
A
Benzodiazepines
Barbiturates
PO, IV
12
Q
What are the effects of sedative-hypnotics?
A
Psychological
- euphoria
- disinhibition
- apathy
- aggression
- anterograde amnesia
- labile mood
Physical
- unsteady gait
- difficulty standing
- slurred speech
- nystagmus
- erythematous skin lesions
- dec BP
- hypothermia
- depression of gag reflex
- coma
13
Q
What are the withdrawal signs of benzos/barbiturates?
A
- tremor of hands
- tremor of tongue or eyelids
- N+V
- inc HR
- headache
- agitation
- malaise
- transient illusions/hallucinations
- paranoid ideation
- grand mal convulsions (tonic-clonic seizures)
14
Q
Give examples of stimulants and their routes into the body
A
Cocaine, crack cocaine (IN, IV, smoked)
Ecstasy (PO)
Amphetamine (PO, IV, IN, smoked)
15
Q
What are the effects of stimulants?
A
Psychological
- euphoria
- increased energy
- grandiose beliefs
- aggression
- argumentative
- illusions
- hallucinations
- paranoid ideation
- labile mood
Physical
- inc HR
- inc BP
- arrhythmias
- sweating
- N+V
- pupillary dilation
- psychomotor agitation
- musclar weakness
- chest pain
- convulsions
16
Q
Withdrawal state of stimulants
A
- dysphoric mood (must be present)
- lethargy
- psychomotor agitation
- craving
- increased appetite
- insomnia/hypersomnia
- bizarre/unpleasant dreams
17
Q
Give examples of hallucinogens and how are they taken?
A
LSD (lysergic acid diethylamide)
Magic mushrooms
PO
18
Q
What are the affects of hallucinogens?
A
Psychological
- anxiety
- illusions
- hallucinations,
- depersonalization
- derealization
- paranoia
- ideas of reference
- hyperactivity
- impulsivity
- inattention
Physical
- inc HR
- palpitations
- sweating
- tremor
- blurred vision
- pupillary dilatation
- incoordination
19
Q
The following are the effects of what?
Psychological
- apathy
- disinhibition
- psychomotor retardation
- impaired judgement
- impaired attention
- drowsy
- slurred speach
Physical
- respiratory depression
- hypoxia
- dec BP
- hypothermia
- coma
- pupillary constricition
A
Opiates
20
Q
What are the following effects of?
Psychological
- euphoria
- disinhibition
- agitation
- paranoid ideation
- temporal slowing (time passes slowly)
- impaired judgement/attention/reaction time
- illusions
- hallucinations
Physical
- increased appetite
- dry mouth
- conjunctival injection
- inc HR
A
Cannabinoids
21
Q
What are the following effects of?
Psychological
- euphoria
- disinhibition
- apathy
- aggression
- anterograde amnesia
- labile mood
Physical
- unsteady gait
- difficulty standing
- slurred speech
- nystagmus
- erythematous skin lesions
- dec BP
- hypothermia
- depression of gag reflex
- coma
A
Sedative-hypnotics
22
Q
What are the following effects of?
Psychological
- euphoria
- increased energy
- grandiose beliefs
- aggression
- argumentative
- illusions
- hallucinations
- paranoid ideation
- labile mood
Physical
- inc HR
- inc BP
- arrhythmias
- sweating
- N+V
- pupillary dilation
- psychomotor agitation
- musclar weakness
- chest pain
- convulsions
A
Stimulants
23
Q
What are the following effects of?
Psychological
- anxiety
- illusions
- hallucinations,
- depersonalization
- derealization
- paranoia
- ideas of reference
- hyperactivity
- impulsivity
- inattention
Physical
- inc HR
- palpitations
- sweating
- tremor
- blurred vision
- pupillary dilatation
- incoordination
A
Hallucinogens
24
Q
What’s the criteria for substance dependence?
A
Drug Problems Will Continue To Harm
3 or more of the following must have occurred over 1 month
- Strong Desire (compulsion to consume substance)
- Preoccupation with substance use
- Withdrawal state when substance ingestion is reduced or stopped
- Impaired ability to Control stubtance-taking behaviour
- Tolerance to substance, requiring more consumption for desired effect
- Persisting with use, despite clear evidence to the Harmful effects
25
What else do you need to know if someone is using substances?
- TRAP (type, route, amount, pattern)
- signs of dependency
- possible triggers
- past use
- physical, psychological and social complications of drug abuse
- coping strategies
26
Investigations for substance misuse
```
Bloods
- HIV, Hep B/C
- U&Es to check renal function
- LFTs and clotting to check hepatic function
- drug levels
Urinalysis for drug metabolites
ECG for arrhythmias
ECHO if endocarditis suspected (needle sharing)
```
27
DDx for substance misuse
Psychiatric disorders
- psychosis
- mood disorders
- anxiety disorders
- delirium
Organic disorders
- hyperthyroidism
- CVA
- intracranial haemorrhage
- neurological disorders
28
Management for substance misuse
- a keyworker with a therapeutic alliance is best placed to offer psychosocial support
- Hep B immunization if at risk
- Motivational interviewing
- CBT if comorbid depression/anxiety
- contingency management (abstinence for reward)
- supportive help housing, finance and employment
- help with co-existing alcohol misuse or smoking cessation should be offered
- self help groups e.g narcotic anonymous
- RISK ASSESS- especially driving
29
Treatment for opiate dependence
Methadone
30
What's used for detox and maintenance from opioids?
Buprenorphine
31
What is recommended for those who were formerly opioid-dependent but have stopped and are motivated to continue abstinence?
Naltrexone (opioid receptor antagonist)
32
Used after opioid averdose
IV naloxone
33
What's the theory the states positive or negative reinforcement from the effects of drinking will either perpetuate or deter habits?
Operant conditioning
34
What's binge drinking?
Over 8 units for men and over 6 units for women
35
What is harmful alcohol use?
Drinking above the safe levels with evidence of alcohol related problems (>50 units/week for men and >35 units/week for women)
36
Risk factors for alcohol abuse
- male
- middle aged
- genetic
- premorbid antisocial behaviour
- lack of facial flushing
- life stressors (marital, financial)
37
What's the Edward and Gross criteria for alcohol dependence?
SAW DRINk
- subjective awareness of compulsion to drink
- avoidance or relief of withdrawal symptoms by further drinking
- withdrawal symptoms
- drink-seeking behaviour predominates
- reinstatement of drinking after attempted abstinence
- increased tolerance to alcohol
- narrowing of drinking repertoire
38
What's the treatment for DT?
- chlordiazepoxide
- haloperidol for psychotic features
- IV pabrinex
39
Give examples of peripheral stigmata of chronic liver disease
- palmar erythema
- dupuytrens contracture
- spider naevi
- gynaecomastia
- clubbing
- caput medusa
- oesophageal varices
40
Investigations for alcohol problems
- blood alcohol concentration
- FBC, MCV (raised with chronic use)
- U+Es (dehydration, decrease urea)
- carbohydrate deficient transferrin (sensitivity 75%, specificity 90%)
- LFTs and urate (raised in 50%)
- GGT (raised in 80% with alcohol problems)
- amylase
```
CT head (if head injury is suspected)
ECG for arrhythmias
```
41
DDx for alcohol abuse
Medical
- head injury
- cerebral tumour
- stroke
Psychiatric disorders
- psychosis
- mood disorders
- anxiety disorders
- delirium
42
What pharmacological therapies for alcohol dependence?
Disulfiram
Acamprosate
Naltrexone
43
How does disulfiram work?
aka Antabuse
Disulfiram works by inhibiting the enzyme acetaldehyde dehydrogenase, which means that many of the effects of a "hangover" are felt immediately after alcohol is consumed.
44
How does acamprosate work?
Reduces craving by enhancing GABA transmission.
45
How does naltrexone work?
Blocks opioid receptors (antagonists) in the body, thus reducing the pleasurable effects of alcohol
46
How do you manage alcohol dependence?
Motivational interviewing- most effective during the pre-contemplation and contemplation phases
CBT
AA
Pharmacological therapies
Risk! Driving
47
What are the stages of change?
```
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
```
48
When does DT normally occur?
1 to 7 days post withdrawal. Peak 72 hours.
49
When does alzheimers commonly present?
8th/9th decade
50
Do typical or atypical antipsychotics have more extrapyramidal side effects?
Typical
51
Are typical or atypical antipsychotics more tolerated?
Atypical
52
Do typical or atypical antipsychotics have a better efficacy against depressive and cognitive symptoms?
Atypical
53
Which antipsychotics are more likely to cause metabolic syndrome?
Atypicals
54
Are typical or atypical antipsychotics more likely to cause weight gain and type 2 diabetes?
Atypicals
55
Are typical or atypical antipsychotics more likley to cause stroke in the elderly?
Typicals
56
Are typical or atypical antipsychotics more likely to cause high prolactin levels?
Typicals
57
Give examples of typical antipsychotics
```
Haloperidol
Chlorpromazine
Flupentixol
Fluphenazine
Sulpiride
Zuclopenthixol
```
58
What is Reboxetine?
Noradrenaline reuptake inhibitor
59
What is Trazodone?
Serotonin antagonist and reuptake inhibitor (SARI)
60
What is selective abstraction?
Focusing on one minor aspect rather than the bigger picture. e.g I have failed that exam because I got one question wrong
61
Which drug is associated with a rash?
Valproate
62
Which drug can cause BP variations?
Venlafaxine
63
Give an example of a RIMA (reversible inhibitor of monoamine oxidase)
Moclobomide
64
Which are the most sedating antipsychotics?
Olanzapine
Quetapine
Chlorpromazine
Clozapine
65
Which are the less sedating antipsychotics?
Haloperidol
Aripiprazole
Amisulpide
Risperidone
66
What's in Pabrinex?
```
vitamins:
C (ascorbic acid)
B1 (thiamine)
B2 (riboflavin)
B3 (nicotinamide)
B6 (pyridoxine)
```
67
Cortisol level are raised in what proportion of moderate to severely depressed patients?
50%
68
Prolonged depression is associated with atrophy of which structure?
Hippocampus
69
What's the frequency of eating disorders in women compared to men?
10x more common
70
Are sleep problems a side effect of SSRIs?
Yes
71
Is nausea more common is SSRIs or TCAs?
SSRIs
72
What drug should you avoid in combination with others?
Clomipramine
73
How effective is CBT for depression?
Effective in 80-85% of cases
74
Is it necessary to induce a seizure as part of ECT?
Yes!
75
How long does PTSD last?
Tends to resolve within a few months
76
Are mood stabilisers prescribed after mania?
Only after 2 episodes
77
What proportion of people with autism are male?
80%
78
What proportion of autistic people have epilepsy?
25%
79
What proportion of autistic people are mentally retarded?
75%
80
What drugs can cause depression?
Amphetamines
Digoxin
L-DOPA
Diuretics
81
What's another name for fluoxetine?
Prozac
82
Suicide occurs in what proportion of mood disorders?
1 in 8
83
What proportion of people with unexplained symptoms meet the criteria for depression?
At least 50%
84
What's the most common psychiatric disorder in childhood?
Conduct disorder
85
By what age is conduct disorder usually diagnosed?
7 years
86
What proportion of children with conduct disorder progress to dissocial PD?
50%
87
Which disorientation is characteristic of delirium?
Time
88
Delirium occurs in what proportion of medical in patients?
10%
89
What's the first line treatment for delirium?
low dose antipsychotics (except DT)
90
Which of the following are psychotic disorders?
```
Hypochondriasis
Paranoid PD
Somatoform disorder
Korsakoff's syndrome
Erotomania
```
Korsakoff
| Erotomania
91
What proportion of people who complete suicide are suffering from major depression?
70%
92
What proportion of those that self harm will go on to complete suicide?
5%
93
What proportion of suicide victims have a history of alcohol abuse or dependence?
50%
94
Is heritability calculated using twin or adoption studies?
Twin
95
What's the heritability of schizophrenia?
80%
96
What's the heritability of depression?
40%
97
What's the heritability of anxiety?
30%
98
Give some facts about complex partial epilepsy
- olfactory hallucinations are characteristic
- schizophrenia is more common that expected
- is associated with a several fold increase in suicide
- the seizure focus is normally in the temporal lobe
99
Is LSD addictive?
no
100
For how long can cannabis be detected in the urine?
Several weeks
101
How does phencyclidine (PCP) work?
Blocks NMDA receptors
