Lecture 6 (Psych)- Exam 3 Flashcards

Question

ALCOHOL USE DISORDER * how many people drink occasionally * What is the gender prevalence * Race?

Answer 1

The **higher** the educational level, the more likely the current use of alcohol.

Answer 2

Legal intoxication (in Florida): blood alcohol content (BAC) 0.08

Answer 3

* Close family members of alcoholics have four-fold increased risk of being alcoholic * Adopted away children of alcoholic persons have a four-fold increased risk * Familial association is strongest for son of an alcohol-dependent father.

Answer 4

* Individuals of Jewish ethnicity and individuals of Asian descent have lower rates of alcohol dependence. * Many Asians show acute toxic effects after minimal consumption of alcohol

Answer 5

* Early in the drinking period, as blood alcohol levels rise, symptoms often include talkativeness, a sense of well-being, and a bright expansive mood * Later, particularly when levels are falling, the individuals likely become progressively more depressed, withdrawn, and cognitively impaired

Answer 6

At very high levels, a non-tolerant person falls asleep and enters a first stage of anesthesia. Higher blood levels can cause inhibition of respiration and pulse and even death

Answer 7

ANTEROGRADE AMNESIA = Blackouts * Appear as though alert and awake * Can perform complex tasks without no recollection * Individuals with brain damage more susceptible

Answer 8

* Occurs after ingestion of small amount of alcohol that for most people would not cause intoxication * Usually, individuals become aggressive * Individuals with brain damage more susceptible

Answer 9

* CUT: Have you felt you should cut down on your drinking? * ANNOYED: Have people annoyed you by criticizing your drinking? * GUILT: Have you ever felt guilty about your drinking? * EYE-opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?

Answer 10

* 90% absorbed through stomach->Rest through small intestines * Reaches peak concentration (distributed throughout the body) in 30- 90 minutes

Answer 11

* Intoxication is more pronounced when levels rising than when going down * 90% metabolized in liver by hepatic oxidation. Remainder excreted unchanged through liver and lung

Answer 12

* Research has established individual variation in alcohol metabolism is controlled by genetic factors and environmental factors. * Several pathways to metabolism – most common involves two enzymes; alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) * **ADH metabolizes alcohol to Acetaldehyde – highly toxic/carcinogen**

Answer 13

Disulfiram (Antabuse) inhibits the action of aldehyde dehydrogenase and produces toxic blood levels of acetaldehyde

Answer 14

Individuals of Asian descent have lower levels of both alcohol dehydrogenase and aldehyde dehydrogenase. * Metabolize alcohol more slowly. * Become intoxicated on lower amounts of alcohol than do Caucasians

Answer 15

* Alcohol is a depressant * Decreases neuronal activity (action like sedative-anxiolytics: benzodiazepines, barbiturates, and carbamates

Answer 16

* Activation of GABA * Opens chloride channels and depresses CNS * Releases opioid peptides and dopamine * Inhibits glutamate NMDA (N-methyl-D-Aspartate) receptors * Interacts with serotonin system

Answer 17

* Upregulation of excitatory glutamate NMDA receptors * Downregulation of inhibitory neuronal GABA receptors * Increased central norepinephrine activity

Answer 18

CNS hyperactivity. Due to a lack of opposition to an alcohol-induced excitatory state

Answer 19

* Flushing of face * Nausea * Rapid heart rate * Increased respiration rate

Answer 20

* Acne rosacea * Palmar Erythema * Hepatomegaly (fatty liver) * Cirrhosis * Jaundice * Ascites * Testicular Atrophy * Gynecomastia * Dupuytren’s contractures * Telangiactasia * Peripheral wasting * Peripheral neuropathy

Answer 21

* Elevated Transaminases * Elevated Mean Corpuscular Volume * Increased HDL and Decreased LDL * Elevated Triglycerides * Elevated Bilirubin * Low Platelets

Answer 22

Evidence of fractures

Answer 23

Complete history and physical CBC with diff Comprehensive blood chemistry panel: * Electrolytes- * Ca and Mg * LFT's * Bilirubin, Bun, creatinine, FBS prothrombin time, albumin, total protein

Answer 24

* Hepatitis type B surface antigen * Test for Hepatitis C * B Vitamins (especially B1- thiamine); and B 12 Folate * Serum amylase, * U/A and urine drug screen * EKG; Chest x-ray

Answer 25

**gamma-glutamyl transferase * It is elevated in 80% of patients with chronic alcoholism**

Answer 26

Panic Disorder

Answer 27

Begins several hours after consumption ends or when there is reduction in consumption if a person drinks heavily or for a *prolonged period of time. * Prolonged = days.

Answer 28

* Symptoms usually peak in intensity during the second day of abstinence and usually improve significantly by the fourth or fifth day * Symptoms of anxiety, insomnia, and autonomic dysfunction may continue for up to 3-6 months (less intensity) * Fewer than 10% individuals who develop alcohol withdrawal develop dramatic sxs (e.g., severe autonomic hyperactivity, tremors, withdrawal delirium)

Answer 29

Usually in severe, heavy users who are medically compromised with long hx of dependence * Delirium tremens ( DT's) * Paranoid delusions, visual hallucinations of insects or small animals and tactile hallucinations ## Footnote Occurs in 1-3% dependent drinkers

Answer 30

Rates the following on a scale from 1-7 (not present to extremely severe) * Nausea and vomiting * Paroxysmal sweats * Anxiety * Agitation * Tremor

Answer 31

* The CIWA should be used to monitor patients in severe withdrawal and receiving IV benzodiazepines every 10-15 minutes * Time between assessments increases as symptoms improve * For patients receiving PO benzodiazepines, monitor every four to six hours * Vital signs, tremor, and mental status

Answer 32

* Check vital signs q 4-6 hrs * Correct electrolyte imbalances etc. * Treat with Benzos (Ativan, Librium or Serax) if BP/pulse rising * Treat severe withdrawal with anti-seizure medication and/or IV Benzodiazipines * May treat hallucinations with antipsychotics. But be careful. It could precipitate seizures

Answer 33

* Thiamine i.m. initially and then orally: 100 mg one to three times/day * Folic acid: 1 mg orally daily * Multivitamin daily * Provide medication for adequate sleep

Answer 34

* Wernicke’s encephalopathy * Korsakoff’s Syndrome

Answer 35

* An ACUTE syndrome caused by thiamine deficiency * Nystagmus; abducens and conjugate gaze palsies * Ataxia; global confusion; confabulation; lethargy; indifference, mild delirium, anxious insomnia, * Fear of dark

Answer 36

* Treat with thiamine 100 mg im followed by 100 – 300 mg po qd. until opthalmoplegia resolves. * May need to give magnesium- a cofactor in thiamine metabolism * With treatment, most sxs resolve except ataxia, nystagmus, and sometimes peripheral neuropathy. * Sxs may clear in a few days or weeks or -> Korsakoff's Syndrome

Answer 37

* Related to alcohol dependence * Also known as Korsakoff's Psychosis * Usually when person’s major caloric intake for years has been alcohol * Caused by thiamine deficiency (Vitamin B-1) because of inadequate nutrition

Answer 38

* Anterograde and retrograde amnesia * Confabulation; disorientation * Polyneuritis * Often co-exists with alcohol related dementia * Recovery rate 20-50%- therefore tends to be chronic

Answer 39

* ANTERIOR GRADE AMNESIA =Amnesia for events that occur after a point in time * RETROGRADE AMNESIA=Amnesia for events occurring before a point in time

Answer 40

* Clonidine (Catapres) or Propranalol (Inderal) might be helpful * Full recovery- 25% * Rate of partial recovery with long term treatment with thiamine- 50- 100 mg daily: 50%

Answer 41

Salvation Army was found to be the most effective followed by AA.

Answer 42

Antabuse (Disulfiram) * Enforces sobriety by causing unpleasant (or worse) symptoms even with small amounts of alcohol * Inhibits aldehyde dehydrogenase * May see flushing, sweating, anxiety, confusion, headache, low blood pressure, difficulty breathing

Answer 43

* Antabuse contraindicated with patients who have pre-existing heart disease, cerebral thrombosis, diabetes. * Can cause fatal reaction ## Footnote Not a permanent treatment

Answer 44

ReVia (Naltrexone)- Decreases craving by blocking release of endogenous opioids * Blocks the high Acamprosate (Campral)- decreases cravings in abstinent patients Topamax may help with cravings- off label possibility

Answer 45

Al-Anon for families

Answer 46

* Low body weight * Poor coordination * Hyperactive behavior * Poor memory * Difficulty in school (math issues predominate) * Learning disabilities * Speech/language delays * Low IQ * Poor reasoning and judgement skills * Sleep problems as a baby * Vision/hearing deficits * Short stature, small head

Answer 47

* Affected infant may show signs of withdrawal * May have early stage of liver disease * Mental retardation common->44% had IQ of 79 or lower * 17% stillborn or die shortly after birth * 20% have birth defects. 32% show full sxs

Answer 48

* Nausea * Muscle tension * Vomiting * tachypnea * Shock * Palpitations * Agitation * Tremor

Answer 49

* Regular users of cannabis can develop all the general diagnostic features of a substance abuse disorder * Frequently occurs along with use of other substances- alcohol, cocaine, and opioids

Answer 50

* Nausea and vomiting due to chemotherapy * Anorexia and weight loss in individuals with HIV * Glaucoma * Arthritis * Chronic pain * Epilepsy * PTSD

Answer 51

* Early onset of use (prior to 15 years) is a robust predictor of development of cannabis use disorder and other types of substance use disorders and metal disorders during young adulthood * Cannabinoids are fat soluble * Persist in bodily fluids for extended periods of time * Excreted slowly

Answer 52

* Long term use causes AMOTIVATIONAL SYNDROME * Mixed with formaldehyde it is called “Illy” or “Wet” * Often mixed with PCP (“laced joint”)

Answer 53

LANCET study found at least 50% of individuals who used cannabis in their lifetime exhibited psychosis. It might manifest early on or could be delayed until midlife (or anytime, for that matter)

Answer 54

A 2021 systematic review found that past-year cannabis vaping nearly doubled from 2017 to 2020 in adolescents - jumping from 7.2 percent to 13.2 percent. A more recent study in five northeastern U.S. states found that 12.8 percent of adolescents vaped cannabis in the past 30 days, a narrower time frame that suggests potential increases in use. In addition, a 2020 study found that one-third of adolescents who vape do so with cannabis concentrates.

Answer 55

This has unintended neurodevelopmental implications given the increased use of cannabis and the potent levels of 9-tetrahydrocannabinol today being consumed by pregnant women, young mothers and teens.

Answer 56

Bara et al. found impaired synaptic plasticity as characteristic of developmental exposure and the important contribution of epigenetic reprogramming that maintains the long-term impact into adulthood and across generations.

Answer 57

Cannabis withdrawal is included in the DSM-5, and the diagnostic criteria include stopping cannabis use that has been heavy and prolonged (typically daily or almost daily for at least a few months).

Answer 58

* irritability * anger * aggression * nervousness or anxiety * difficulty sleeping * decreased appetite * restlessness * depressed mood

Answer 59

Generally sold over the counter in head shops Usually labeled as bath salts or herbal incense Often labels say * “not for human consumption” (bypasses FDA regs) * Herbal blends * Marketed as “natural” substances

Answer 60

* Bath salts and herbal incense abused for their psychogenic, hallucinogenic , and mood-altering effects * Attempts to mimic cocaine or methamphetamine * Sometimes marketed as substitute for methylphenidate- to sharpen concentration or to use as aphrodisiac

Answer 61

Methcathinones * Common components either * Mephedrone (Similar to methamphetamine) * 3,4-methylenedioxypyrovalerone (MDPV) * Methylone (Similar to MDMA-Ecstacy) Powerful stimulants Create similar effects as methamphetamines

Answer 62

* Mephedrone chemically similar to cathinone- active ingredient of African Khat plant * MDPV inhibits reuptake of dopamine and norepinephrine * Sold under names as White Lightning, Cloud 9, Ivory Wave

Answer 63

* May be inhaled, injected, snorted, swallowed, inserted into rectum or vagina * Works quickly- in 10-20 minutes * Desired effects typically last 2-4 hours * Adverse effects may last 8 hours or more * “Bumping”: Larger loading dose with several smaller doses q 2-3 hrs to maintain high

Answer 64

* Intranasal rout produces more potent high and greater addictive potential than ingestion * MDPV may be 10X addictive than methanphetamine

Answer 65

May mimic psychiatric disorder Most common signs of toxicity * Dilated pupils with prominent nystagmus * Lockjaw and teeth grinding * Rapid, inappropriate, incoherent speech * Emotionally, verbally, and physically abusive

Answer 66

* Cannot be detected with standard urine drug tox screens * Specialized labs use chromatography-mass spectometry * Components very and often changes by manufacturers to avoid detection

Answer 67

benzodiazepines

Answer 68

Antipsychotics second-line choice * Lower seizure threshold * Potential for worsening hyperthermia gy triggering malignant neuroleptic syndrome

Answer 69

* After resolution of psychosis, many experience depression and suicidal thoughts * Patients who have underlying psychiatric conditions are at the greatest risk for severe psychiatric reactions

Answer 70

* Myocardial infarction * Stroke * Cerebral edema * Coma * Cardiovascular collapse * Death * Effects vary with route of admin-swallowed, snorted, injected, per rectum or vagina

Answer 71

* Known as K2; incense; spice * Not from cannabis * 1- year prevalence among 12th graders: 11.4%->2nd behind marijuana * Inhaled * Synthesized in labs and formulated to interact with endogenous cannabinoid receptors

Answer 72

* Decrease GABA levels * Increase glutamate and dopamine levels * Increases serotonin release * Carry a higher risk of causing psychosis

Answer 73

* Hypertension * Tachycardia * Anticholinergic manifestations * Nausea * Seizures

Answer 74

* Agitation * Alteration of time perception * Amnesia * Anxiety * Dysphoria * Apathy * Terrifying hallucinations * Paranoia/psychosis * Self-destructive and violent behavior

Answer 75

Symptoms typically last up to 6 hours

Answer 76

Can be detected by commercial lab BUT * Formulations change often * Tests quickly become obsolete Suspect spice intoxication in any patient presenting with bizarre behavior, anxiety, agitation, and/or psychosis who has no known psych history.

Answer 77

IV benzodiazepines most used to treat agitation and seizures

Answer 78

* Possible 3X increased risk of causing psychosis * Recurrence or exacerbation of pre-existing psychotic symptoms * Persistent depression and suicidal ideation * Reduced volume in hippocampus and amygdala * Alterations in emotional processing and cognitive functioning

Answer 79

* Benzodiazepines and alcohol- cross tolerance * Any benzo can be abused and result in dependence * All are agonists of gamma-aminobutyric acid A- (GABAA) receptors * Most prescribed medication

Answer 80

* Need to progressively increase dose to maintain desired effect (tolerance) * “Doctor Shopping” or using multiple providers to obtain the drug * Frequently “runs out” of prescription before he/she should * Frequently “loses” the prescription

Answer 81

* Much like Alcohol Withdrawal * Short acting Benzo withdrawal is more likely to produce symptoms (e.g. Xanax = alprazolam)

Answer 82

* Easier to withdraw patients if switch to longer acting benzodiazepine before the taper * Some patients develop withdrawal after regular use.

Answer 83

GHB (liquid ecstacy) * A naturally occurring brain transmitter that is related to sleep regulation->Increases dopamine in brain * A CNS depressant. Affects endogenous opioid system * Used to induce anesthesia->Unpredictable duration of action limits use * Recently studied to treat alcohol, opioid withdrawal and narcolepsy

Answer 84

* Rapidly absorbed * Onset of action within 15 minutes after ingestion * Effects last 1.5-2 hours * Surreptitious sedation facilitates rape ## Footnote * Until 1990, GHB sold in US health food stores. * Body builders used it as steroid alternative

Answer 85

* Nausea, vomiting respiratory problems, * Seizures, coma, death * Some reports- abuse linked to syndrome similar to Wernicke-Korsakoff syndrome

Answer 86

Signs and symptoms reflect compulsive prolonged self-administration of opioid substances for no legitimate purpose, or more than amount needed to treat pain symptoms.

Answer 87

**Pupillary constriction** with drowsiness or coma; slurred speech; impairment of attention or memory; and pulmonary edema from central respiratory depression

Answer 88

Disorientation, confusion,dysphoric mood, vertical nystagmus, increased muscle tone, **dilated pupils**, increased blood pressure and heart rate, marked diaphoresis, piloerection, lacrimation (or rhinorrhea), salivation, nausea or vomiting, yawning, fever, insomnia

Answer 89

* May be precipitated by opioid antagonist, such as naltrexone, after period of opioid use (May be used to treat opioid use disorder) * Withdrawal may begin within 6-12 hours after last dose of short-acting drug such as heroin but within 2-4 days in case of longer-acting drugs such as methadone

Answer 90

* A partial opioid mu-receptor agonist and weak kappa antagonist offers safety. Similar efficacy as methadone. * At high doses, its clinical effect plateaus and it acts more like an agonist, reducing the risk of overdose, respiratory depression and diversion to other opioid type substances

Answer 91

* Used for withdrawal and maintenance * Comes in patch and sublingual form as well as im and iv * Also sold as Suboxone which is buprenorphine plus naloxone

Answer 92

Methadone is a sort of surrogate that replaces heroin * Keeps addict from going into withdrawal * Its gradual and mild onset of action keeps addict from getting high * Other treatment use: Can give relief from chronic pain Methadone Maintenance * This program may be abused

Answer 93

* hallucinations and /or psychosis * It is a synthetic dextro-isomer of codeine * Exerts anti-tussigenic effect via the sigma opioid receptor BUT lacks other opioid activity

Answer 94

* In patients 12 yrs or older tolerated when take 60- 120 mg (in cold meds) * Benign reactions- drowsiness, dizziness, upset stomach, nervousness and restlessness

Answer 95

* Hallucinogenic effects at 160 to 300 + mgs. * Psychosis often occurs at greater than 600 mg * Non-suicidal use of 3600 mg been described

Answer 96

Individuals who are extensive metabolizers of CYP-450 2D6 show higher blood dextromethorphan and increased potential to abuse it for its dissociative and hallucinogenic effects * Of importance for individuals on SSRIs and SNRIs, even for normal metabolizers

Answer 97

* Cocaine in powder form may be snorted, injected, smoked or rubbed on mucosa * Referred to as coke, crack, blow, or freebase. * Crack is rock based form * “Freebase” is much more expensive form than “Crack cocaine.” Both are smoked. * Cocaine mixed with Heroin is “speedball”

Answer 98

A competitive blocker of dopamine . It inhibits dopamine reuptake and increases activation of dopaminergic pathways = dopamine agonist

Answer 99

* Mental: Euphoria, hypervigilance, agitation or psychomotor retardation, hallucinations * Cardiac: Tachycardia, bradycardia, high or low blood pressure, arrhythmia * Other: Pupillary dilation; perspiration or chills, nausea, or vomiting

Answer 100

****See dilated pupils with Cocaine, Opioid withdrawal, LSD use, Amphetamine intoxication

Answer 101

* Constricts coronary arteries * Cocaine withdrawal is not life threatening * Metabolite of cocaine-benzoylecognine-typically remains in urine 1-3days after single dose use * May be present for 7-12 days if repeated high doses used * There are no neurobiological markers of diagnostic utility

Answer 102

* Occurs within hours to days after heavy cocaine use. * Most common sign of withdrawal, desire to use again- craving

Answer 103

* Dysphoria, increased appetite, fatigue, psychomotor retardation or agitation, and sleep abnormalities ( vivid, unpleasant dreams, insomnia, or hypersomnia) * Some have used desipramine to treat psychological withdrawal. Some trials using propranolol show promise

Answer 104

* Violence- suicide and homicide * Psychopathology: Chronic use depletes all neurotransmitters. Risk of dependence could occur after one use

Answer 105

depression, fatigue, poor self-care, low self- esteem, low libido, mild parkinsonism. Psychosis, attention deficit sx and stereotypies may result from continued use.

Answer 106

* Can lead to death * Even in recreational low dose users * Route of consumption does not change risk * More serious acute complications- myocardial infarction, subarachnoid hemorrhage, metabolic and respiratory acidosis, arrhythmia, grand mal seizures, and respiratory arrest

Answer 107

nasoseptal defects and dental neglect because of cocaine's anesthetic properties.

Answer 108

Pathologic gambling among cocaine dependent users 5 times > general population

Answer 109

Release catecholamines (mainly dopamine) from presynaptic stores (in the reward pathway from ventral tegmentum to cortex

Answer 110

ADHD Narcolepsy Methylphenidate- * Sometimes depression * More commonly in depressed bipolar patients (off-label use)

Answer 111

Methylphenidate does not act on dopamine neurons so thought to be less addictive than amphetamines

Answer 112

Ice or crystal- pure form of methamphetamine * Of all the club drugs, the most often cause for admission to ED

Answer 113

* Clinical syndromes similar to cocaine abuse * Oral route of admin produces less rapid euphoria and less addiction * Can induce paranoid psychosis similar to schizophrenia, paranoid type

Answer 114

* “Khat”: Canthinone from a bush which is chewed * “Crank”: Methcanthinone synthesized from ephedrine or pseudoephedrine (Sudafed)

Answer 115

* Long term sequelae of amphetamine abuse mimic those of cocaine abuse * Chronic use can cause a syndrome resembling Dysthymic Disorder.

Answer 116

Desire for sex increased but ability to achieve arousal and orgasm greatly diminished in both men and women * Called sensual drug as opposed to sexual Prescription drugs such as sildenafil (Viagra) sometimes taken in order to counteract diminished sexual performance

Answer 117

* Has been long known to damage brain serotonin (5HT) neurons in laboratory animals * MDMA can cause loss of serotonergic neurons

Answer 118

Damage to the brain may be permanent and is dependent on overall amount of MDMA consumed over time

Answer 119

* Acute dangers rare but can be serious and usually involve dehydration that could cause coma or death * SEIZURES the most common reason for admission to ED

Answer 120

* Produce amphetamine like effects * Hypertension and/or hyperthermia * Rhabdomyolysis, hyponatremia, cerebral infarction, disseminated intravascular coagulopathy, cardiac arrhythmias, hepatic and renal failure * Must treat hyperthermia and complications. Rapid cooling and dantrolene (Dantrium), a skeletal muscle relaxant, may be life saving

Answer 121

* Anorexia * Trismus * Impaired concentrating * Impaired balance * Perceptual and behavioral side effects->Users found to have higher levels of paranoid ideation, psychotic syndromes, somatization, obsessions, anxiety, hostility, phobic anxiety

Answer 122

* Depression, anxiety, panic, increased impulsiveness, and sleep disturbances –these sxs significantly higher in people who have used MDMA, even when abstinent and when last use was long time ago * Memory deficits * Attention problems * Most common- psychosis, anxiety, panic disorder and depression

Answer 123

* No significant withdrawal symptoms * Mechanism of action: Partial agonist at postsynaptic serotonin receptor

Answer 124

PCP (usually laced with marijuana or nicotine to be smoked) * Can also be eaten, injected or inhaled nasally * “Special K”: Ketamine or Ketalar Both are anesthetics and hallucinogenic

Answer 125

* Ketamine IV been extremely effective treating resistant depression * Intranasal ketamine being used in trials with children who have bipolar illness and specific fearful phenotype- Dimitri Papolos MD, NIH grant

Answer 126

* "Magic Mushrooms,, "Shrooms" * Natural psychedelic * Psychoactive properties come from psilocybin, an indole hallucinogen similar to LSD but with a shorter duration of action: 4-6 hours

Answer 127

* COMPASS Pathways is a biotech company that has conducted a phase IIb clinical trial of COMP360 psilocybin therapy for treatment-resistant depression. * associated with a highly statistically significant reduction in depressive symptoms after three weeks, with a rapid and durable response for up to 12 weeks.

Answer 128

study run by COMPASS Pathways and published in the New England Journal of Medicine found that a third of patients with treatment-resistant depression who took the highest dose of psilocybin saw their symptoms diminish.

Answer 129

* Distortions in thinking (e.g., denial, superstitions, a sense of power and control over the outcome of chance events, overconfidence) * Belief that money is cause and solution of and to problems * UP to 50% individuals in treatment for gambling disorder have suicidal ideation, and about 17% have attempted suicide