Substance misuse

Question 1

alcohol abuse risk factors

Answer 1

male
longer duration of problems
single, divorced, widowed
multiple substance abuse

Question 2

substance abuse and deliberate self harm

Answer 2

40-75% male
12-50% female

Question 3

tolerance

Answer 3

require more drug to have same effect
downregulate no of post synaptic membranes, with same no of drug concentration
alcohol - more enzymes - increases breakdown

Question 4

reinforcement

Answer 4

effect of drug negative or positive reinforces increased usage

Question 5

addiction why

Answer 5

genetic
neurobiological - dopamine
social
behavioural
attachment

Question 6

hx substance misuse

Answer 6

which drug/s
how long
how much
when did first try
when do you feel became a problem
money
how often
withdrawal
previous tx episodes
complications
overdose - find out what t
PMHx
SHx - housing and support

Question 7

alcohol prevalence

Answer 7

9 million afults over recommended limits

Question 8

alcohol mortality causes

Answer 8

fights and falls
liver failure - usually from varices
sudden/long slow
pancreatitis
overdose
withdrawal
wernicke’s encephalopathy

Question 9

how to calculate unit

Answer 9

percent x volume

Question 10

sx alcohol misuse

Answer 10

head injury
confusion
shaking/seizures
hallucinations
vomit blood
severe abdo pain
sudden yellow

Question 11

early alcohol withdrawal sx

Answer 11

tremor
sweating
nausea
anxiety
tachycardia

Question 12

late alcohol withdrawal sx

Answer 12

delirium tremens
disorientation
hallucination
tremor
BP, pulse, fever, motor incoordination

Question 13

wernicke’s encephalopathy

Answer 13

deficient thiamine
ataxia
nystagmus
opthalmogplegia
vomiting, altered level of cosnciousness, hypothermia, ptosis and abnormal pupillary reflexes
tx with parenteral thiamine

Question 14

korsakoff’s

Answer 14

results from repeated episodes of wernicke’s
long term dementia
impaired ability to learn new things
immediate recall preserved

Question 15

opiates misuse

Answer 15

pin point pupils
decreased consciousness
slow breathing
death

Question 16

opiate overdose tx

Answer 16

o2
naloxone IM
recovery position

Question 17

opiate withdrawal sx

Answer 17

sweaty clammy hands, persistent yawning, rhinorrhoea, tachycardia, restless, dilated pupils, lacrimation, goosebumps
days later -
N+V, diarrhoea, insomnia, cramps, muscle pains

Question 18

methadose use

Answer 18

in opiate addiction as less addictive

Question 19

buprenorphine uses

Answer 19

partial agonist for heroin
has to go into withdrawal first. once in withdrawal, gets them out of
easiest to withdrawal off

Question 20

benzo risks

Answer 20

withdrawal
overdose
dependency
disinhibiting with alcohol

Question 21

benzo tx

Answer 21

reduce on own supply
one off reduction only
pregabalin

Question 22

stimulants types

Answer 22

amphetamine
cocaine

Question 23

stimulants effects

Answer 23

acute heart attacks and strokes as increased BP
coke + alcohol - lasts longer - depressive agent in body….bad behaviour
effect on liver
psychosis - similar to schizophrenia

Question 24

hallucinogens examples

Answer 24

magic mushrooms
LSD
Ket

Question 25

Novel psychiatric substances types

Answer 25

mamba and spice

Question 26

NPS risks

Answer 26

psychosis
fits
incoordination

Question 27

cannabis increases

Answer 27

prevalence of schizophrenia

Question 28

mechanism of alcohol withdrawal

Answer 28

chronic alcohol consumption enhances GABA mediated inhibition in the CNS (similar to benzodiazepines) and inhibits NMDA-type glutamate receptors
alcohol withdrawal is thought to be lead to the opposite (decreased inhibitory GABA and increased NMDA glutamate transmission)

Question 29

1st line tx for alcohol withdrawal

Answer 29

long acting benzo - diazepam
or can give carbamezepine