Flashcards in Mental Health Deck (20)
What is alcohol dependence?
Characterised by 3 or more of:
- Withdrawal on cessation of alcohol
- Compulsion to drink, difficulty controlling termination or the levels of use
- Persistent desire to cut down or control use
- Time is spent obtaining, using, or recovering from alcohol
- Neglect of other interests (social, occupational or recreational)
- Continues use despite physical and psychological problems
What is the aetiology of alcohol dependence?
- Genetic factors suggests by twin studies and family history
- Environmental factors include cultural, parental and peer group influences, availability of alcohol, occupation (e.g. increased risk in publicans, doctors, lawyers)
- Pts with depressive and anxiety states are at risk
What is alcohol withdrawal?
- Alcohol enhances inhibitory GABA inactivity and inhibits excitatory glutamate neurotransmission
- Chronic alcohol exposure results in a compensatory reduction in GABA receptor function and upregulation of the glutamate NMDA receptors
- Abrupt alcohol cessation leads to overactivation of the excitatory NMDA system relative to the GABA system
What is the epidemiology of alcohol dependence?
The prevalence of alcohol dependence in primary care populations in the United States was reported as 2–9 % in 2004.
What should be noted when taking an alcohol history?
Record how much, what, when and with whom alcohol is taken
- Evaluate for associated comorbidities including smoking, other substance abuse, depression, anxiety and panic attacks
What are the CAGE screening questions for alcohol dependence?
- Cut down: '...felt that you should cut down on intake?'
- Annoyed: '...felt annoyed by criticism of your drinking
- Guilt: '...felt guilty about how much you drink?'
- Eye-opener: '... feel that you need a drink when you wake up?'
What are the presenting symptoms of acute alcohol intoxication?
What are the symptoms of alcohol withdrawal?
- Sweating and tremor
- Visual hallucination
What are the signs of alcohol dependence on examination?
- Signs suggestive of chronic alcohol misuse: Dupuytren's contracture, palmar erythema, bruising, spider naevi, telangiectasia, facial mooning, bilateral parotid enlargement, gynaeocomastia, smell of alcohol
- Signs of complications
What are the investigations for alcohol dependence?
- Blood: Raised MCV, GGT, Transaminases. Raised uric acids and triglycerides or markers of end organ damage (e.g. bilirubin, albumin, PT in liver)
- Acute overdose: Blood alcohol, glucose, ABG (risk of ketoacidosis or lactic acidosis), U&E, toxic screen (e.g. barbiturates, paracetamol)
What is a generalised anxiety disorder?
-Common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment
- At least 3 key symptoms required to make diagnosis: nervousness/restlessness, easy fatiguability, poor concentration, irritability, muscle tension or sleep disturbance
What is a social anxiety disorder?
- Excess fear of social and performance situations where individual is afraid of being embarrassed or negatively evaluated by others
What is the epidemiology of anxiety disorders?
- 4-6% of primary care pts
What is the aetiology of anxiety disorder?
- Increased in minor life stressors, presence of physical or emotional trauma and genetic factors
- Risk factors: Having another mental disorder, female, FHx
What are the signs of symptoms of anxiety disorders?
Nervousness/restlessness, easy fatiguability, poor concentration, irritability, muscle tension or sleep disturbance
What are the investigations for anxiety disorders?
What is a depressive disorder?
Chronic depression in which depressive symptoms are present for more than a 2 year period
What is the aetiology of a depressive disorder?
Risk factors: Having another mental disorder, female, FHx
What are the presenting symptoms of a depressive disorder?
- Presence of risk factors
- Depressed mood
- Functional impairment
- Weight change
- Libido changes
- Sleep disturbance
- Psychomotor problems
- Low energy
- Excessive guilt
- Poor concentration
- Suicidal idealation