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Psychiatry > Substance Abuse (Alcohol and Drug) > Flashcards

Substance Abuse (Alcohol and Drug) Flashcards

1
Q

state the spectrum of substnace use (4 stages)

A

recreational use-> acute intoxication-> harmful use-> Dependence syndrome

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2
Q

define acute intoxication

A

transietn condition follwoing use of alcohol or drugs

-closely related to dose and following which recovery is usually complete

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3
Q

define harmful substance use

-what does diagnosis of this need

*-what does not qualify for diagnosis

A

pattern of substnace use that causes damage to physical health, mental health or social circumstances

diagnosis requires damage to physical or mental health of use

*-social disapproval or adverse social consequences for example:
-ingestion of excessive amounts
-idosyncratic relations
-Iv adminsiosntr
-chronic use (considered misuse not harmful use)

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4
Q

define dependence syndrome

-what is a central characteristic

A

cluster of physiological behvaiourla and cognitive phenoma where a substance takes on much higher priority for a given individual than other behaviours that once had greater value

-strong, sometimes overpowering, desire to take psychoactive drugs, alcohol or tobacco

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5
Q

what is needed for a dependence syndroem diagnosis 6

A

3 or more of:
-strong desire or sense of compulsion
-diificulteis controlling substance taking behaviour
-physiological withdrawal state
-build up of tolerance
-neglect of alternative pleasures or interests
-persistent use of substance despite clear evidence of overtly harmful consequences

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6
Q

define a withdrawal state 4

A

group of syx of variabl clustering, severity and duration depending on substance

occurs on withdrawal or reduction of use

occurs after repeated use of a substance

indicates dependence

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7
Q

examples of withdrawal state syx from benzos

A

anxeity

agitation

irritability

diaphoresis

confusion

nauseas

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8
Q

examples of withdrawal state syx from opioids

A

rhinitis

lacrimation

yawning

dilated pupils

diaphoresis

insomia

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9
Q

how is delirium tremens characteristed 6

A

Hx of alochol

confusion-nocturnal worsening

hallucinations

illusisons( insects)

anxiety

fear

autonomic increase

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10
Q

define alcohol withdrawal syndrome

A

set of physical and psycholgoical syx occur following a reduction in alcohol intake after period of excessive use

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11
Q

when do alcohol withdrawal syndrome syx start

A

begin 6-8hrs afeer abrupt reduction in alcohol intake

can peak at 10-30hrs since last drink

can last 3-7days

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12
Q

mild to moderate syx of alcohol withdrawal syndrome 7

A

N+V

diarrhoea

tremoors- hands arms lefs

hyperacitivty,anxietym, agitatio

muslce pain

sweating

insomnia

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13
Q

severe syx of alcohol withdrawal syndrome 3

A

seizures

delirium tremenes

wernicks encephalopathy

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14
Q

management of alcohol withdrawal syndrome seizures 1

A

lorazepam IV

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15
Q

management of delirium trememns 2

A

chloridazepoxide (2-3 doses)

if no response

lorazepam

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16
Q

define Wernicke encephalopathy

A

acute neuropsychatric disorder resulting fom thiamine deficiency which develops rapidly or sub-acutely over a number of days

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17
Q

syx of delrium termenrs 6

A

24-72hrs after alchhol cessation

syx
-severe tremor
-delusions
-tachycarida
-pyrexia
-visual and auditory hallucaitons
-confusion

18
Q

inital managemnt of Wernicke encephalopathy 2

A

prophllyactilcaly give pabrinex
-after which give thiamine

-even of clinical suspsicion is low

19
Q

signs of Wernicke encephalopathy4

A

ataxia

opthalmoplegia

loss of memory

confusion

20
Q

signs of patient with a high risk of developing Wernicke encephalopathy 4

A

hypotension

hypothermia

malnourished

hyperglycaemia

21
Q

managemnt of alcohol withdrawal

A

benzos -chlordiazepoxide

22
Q

why is chlordiazepoxide used first line for alcohol withdrawal syndrome

A

more gradual onset

long half life

less risk of rebound syx

23
Q

when is diazepam used for alcohol withdrawal syndrome

A

in A&E
or if patient is unlieklyu to be admitted to hospital

24
Q

define korsakoof syndroem

A

memory disorder results from vit B1 deficiency

associated with alcholhil

25
Q

syx of korsakoff syndrome 3

A

problems learning new info

inability to rememebr recent events

long term memory gaps

26
Q

what pathway in the brain is implicit in drug use

A

mesolimbic dopamine rewarrd pathway

27
Q

aetiology of addiction

A

social learning model
-observing others and copying

disease model
-altered brain structure and functioning

genetic vulnerability
children of alcoholic 4x likely to themselves

28
Q

assessment of substance use disorders

A

use

problems

phsycial adaptaion

behvaioural dependence

medical harm

cognitive impairment

motivation to change

29
Q

psychosocial interventions in additviosn 8

A

motivational enhancement interviweing

brief interventions

relapse prevention (CBT)

12 step programmes (AA,NA,CA)

peer support

contingency management

therapeutic community/ residential rehab

30
Q

describe motivational interviewing 4

A

facilitatinf and engaging intrisinc motivation to change

collaborative

goal-orientated

client centres

31
Q

describe the FRAMES model

A

F- Feedback of risks
R- Responsibility Highlighted
A - Advice to abstain or cut down
M- Menu of alternative options and activities offered
E- Empathic Interviewing
S- Self efficacy enhanced

32
Q

main cause of drug related deaths in Scotland

A

> 80% assoc w opiods

> 50% assoc w benzos

33
Q

most abused type of opiods

A

Most abused substances are μ receptor agonists

34
Q

effects of μ opiods 5

A

mediate analgesia

respiratory depresion

europhia

drowsiness

consitpation

35
Q

managment of opiod addicts 2

A

either detox or maintenance presciption

lofexidine or buprenorphine for detox
-high relapse rates

methadone and buprenoprhine for maintenance

36
Q

issues with maintenance prescription for opiods addicts 4

A

respiraitory depresion in overdose

rapid loss of tolerance

high risk of OD if misse doses o& reinstated at usual dose

need for re-titration after 3 days

37
Q

syx of opiod overdose 3

A

respiratiory depresion

pinpoint pupils

decreased level of conscious es

38
Q

treatment of opioid overdose

A

naloxone -usualy IM

competitiev opiod antagonis
-reverses depression of CNS and respiratory syx

39
Q

MOA of benzos

A

enhance GABA at GABA (A) receptors

40
Q

effects of benzos 4

A

sedative

hypnotic

anxiolytic

muscle relaxant effects

41
Q

overdose of benzo syx (5) and managemnt 2

A

sedation

drowsiness

slurred pseech

coma

respiraoty depression

Mx-supportive, flumanzenil(watch use as can cause seizures)

42
Q

define ketamine bladder

A

affects of ket on bladder

erosion of urothelium
-inflam leads to revasculaition

30% of regular ket users

decreased bladder compliance and volume

detrusor overacititvu

painful haemturiatin

can cause bilateral hydronephrosis and renal papillary necorisi

on stopping use:
-1/3 recover
a third no change
a third deteriroitate

Psychiatry (21 decks)

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