problem drinking osce Flashcards
(15 cards)
what things should you ask for symptom analysis?
- pattern of drinking
- CAGE questions
- dependence and tolerance
how can you asses complications of problem drinking?
- asses psychological implications:
1. how has your mood been?
2. how has it affected your relationships?
3. do you feel safe at home?
physical: - weight-loss appetite diet memory
things to look out for in past medical history
do you have any psychiatric conditions?
things to look out for in drug history?
have you ever tried any treatments/detox for alcohol?
things to look out for in the family history?
does anyone in you family suffer from drug or alcohol use?
what examinations would you consider doing?
BP, nutritional status, tremor, palpate for hepatomegaly
what investigations would you do?
AUDIT questionnaire. Drinking diary
FBC (MCV), LFT (including GGT). Consider TFT, vitamin B12 + folic acid
what are the CAGE questions?
Have you ever felt you should Cut down on your drinking
Do people Annoy you by criticising your drinking
Do you feel Guilty about your drinking
Do you need an Eye-opener first thing in the morning
how can you assess dependence and tolerance?
Do you have to drink more to get the same effect you used to?
What happens if you don’t drink? Shakes or sweats?
Do you get cravings for alcohol?
Has drinking become your main priority in life?
how to asses the pattern of drinking?
Can you tell me about your drinking?
When did all of this start? How have things progressed since then?
Starting first thing in the morning, talk me through what you drink in a normal day (what, how much, when, where)
Binging or continuous?
how quickly should you follow up the patient?
FU in 1-2 weeks to monitor progress
how would you treat someone with an audit score of 1-7?
Low-risk drinking: score of 1–7. Feedback positively.
Don’t drink more than 14 units a week (6 pints of beer or 6 standard size glasses of wine. Bottle = 10 units). Have 2 alcohol free days per week
how would you treat someone with an audit score of 8-15?
Hazardous drinking: score of 8–15. Brief advise
I - leaflet (eg down your drink) and support groups (eg AA)
L - alternative coping strategies eg exercise
S
Set goals. Cut down on alcohol but don’t stop completely
Practical advise
Recognizing and avoiding high-risk situations for drinking (eg pub)
Recognizing personal cues for drinking (eg stress and being alone)
Trying alternative activities to drinking (eg exercise or reading)
Drinking a soft drink for every alcoholic drink and eating before drinking
W - consider whether safe to drive/work
P - if poor diet, take a multi-vitamin with vitamin B (thiamine is B1)
R - may self refer to substance misuse team
how would you treat someone with an audit score of 16-19?
Harmful drinking: score of 16–19. Extend brief intervention + assessment for medically assisted withdrawal (detox)
Self-referral to substance misuse team for both (called Pavilions in Brighton). May require CBT or behavioural therapy. Detox likely to be in community
Oral thiamine to harmful or dependent drinkers if they are malnourished or detoxing
how to treat someone with an audit score >20
Possible alcohol dependence: score of 20 or more. Refer to specialist services + medically assisted withdrawal (detox)
Self-referral to substance misuse team. Detox likely to be as an in-patient
Oral thiamine to harmful or dependent drinkers if they are malnourished or detoxing
If Sx of withdrawal or suspected Wernicke’s encephalopathy, refer for urgent admission and detox
If chronic medical problem (eg liver disease) refer to appropriate secondary care
If chronic psychiatric problem (eg depression), abstinence may improve Sx. Re-assess after 4 weeks and consider treatment if Sx persist
