Substance abuse Flashcards
What are the questions you must ask if someone has had a fall due to substance abuse?
What were you doing at the time?
Were you alert during the fall?
Did anyone witness the fall?
Are you aware of a change of colour in your appearance after the fall i.e. looking blue?
Do you have video footage of the fall?
Was there any tongue biting? Incontinence?
Have you ever had a fall like this before?
Did you get a funny feeling or symptoms before the fall?
Did you get a funny feeling or symptoms after the fall?
How long did it take you to recover?
Did you hit your head or injure yourself anywhere specifically?
Tell me everything you remember about it
When you came around where were you?
What questions to ask about alcohol abuse?
What do you drink (narrowing of repertoire = serious)? Where?
How much do you drink? (quanitfy)
Why do you drink? (risk assess)
Do you find that you end up drinking for longer than you originally planned to?
Do you feel you need to drink more to feel the same effects? (TOLERANCE)
Do you ever start shaking if you’ve not had a drink yet that day/for a few hours? (WITHDRAWAL)
How’s your appetite? What do you eat in a day? (assess for neglect and harm)
Do you ever feel you can’t balance? Or have blurred vision? Or feel particularly confused? (WERNICKE’S)
CAGE questionnaire:
Do you feel in control of your drinking?
Does it annoy you when people tell you, you drink too much?
Do you feel guilty about your drinking?
Do you need an eye-opener drink in the morning?
What investigations would you like to do in a patient who you suspect abuses alcohol?
Bloods: FBC, U&Es, LFTs, glucose, alcohol levels, drug tox levels
Urine: dipstick, alcohol and drug tox
What management would you undergo for a patient with alcohol abuse?
Admit
Immediate: BIO: Oral chlordiazepoxide; Thiamine to prevent Wernicke’s encephalopathy -> Korsakoff’s psychosis
Involve seniors, Psychiatrist input
Long term: BIO: POST-DETOX: Disulfiram (inhibits acetaldehyde dehydrogenase CI in resp/cardio disease or if alcohol ingestion in last 12 hrs); Acamprosate (*Anti-craving*Increases GABA transmission)
PSYCHO: MOTIVATIONAL interviewing; CBT, group therapy, stages of change model to understand relapse behaviours
SOCIAL: Alcoholics Anonymous support group; Grief counselling; Social worker probation officer, civil advice authority
Alcoholics anonymous
Alcohol quitting programme
How would you acutely manage a patient if they presented with delirium tremens? (confused, sweaty, shaking, tachycardic and complaining of audio-visual hallucinations)
EMERGENCY - ABCDE - Obs
Identify any concurrent medical conditions -> treat the underlying cause
Large doses of benzodiazepines -> Chlordiazepoxide up to 400mg daily
Antipsychotics only for severe psychosis as they decrease the seizure threshold
IM/IV thiamine
Monitor Obs, U&Es, glucose
What is the long-term management for an opioid addict?
1) Methadone
2) Naltrexone (Blocks opioid receptors, prevents relapse) Buprenorphine (sublingual tablet, less sedating than methadone)
How may mental and behavioural disorders secondary to substance abuse be categorised according to ICD-10?
Acute intoxication
Harmful use (damage to health, either physical or mental)
Dependence syndrome
Withdrawal state
Withdrawal state with delirium
Psychotic disorder
Amnesic syndrome
Residual and late-onset psychotic disorder.
