Substance misuse psych Flashcards
What drugs can be used for opiate detoxification?
- methadone maintainance is used as an alternative which is safer to addict (oral not IV) and society (prescribed so reduced crime rates)
- however cocaine use on methadone is a problem, disulfiram often has a role here
- burprenorphine is often used as a partial u opioid agonist
- naltrexone is opioid antagonist which can be used
what drug is used to smooth withdrawal from benzos?
diazepam- convert to equivelant dose of diazepam and gradually reduce dose. prescribe weekly supply and withdraw by 2mg/ week. warn to expect withdrawl symptoms
Which drugs are used for alcohol withdrawal?
Long acting benzodiazepines (chlordiazepoxide) for withdrawal symptoms and reduced seizures and tremors
Short acting benzo like lorazepam can be given for seizures and delerium tremens.
Pabrinex (B vitamines) given IV to prevent wernickes
What are the symptoms of benzo withdrawl?
- anxiety or psychtoic symptoms 1-2 weeks after withdrawal
- insomnia, panic, depression, irritability, feelings of unreality and depersonalisation may follow
- diplopia, paraesthesia, fasiculation and ataxia may also occur
- Gi symptoms inc D+v, abdo pain and dysphagia
- palpitations, flushings and hyperventilation may also occur
How and when does discontinuation syndrome (after stopping antidepressants) present?
- onset within 5 days
- SSRI (paroxetine- short ½ life): flu like symptoms, headaches, nasty shock sensations, dizziness, insomnia, tears, irritability, vivid dreams
- MAOIs (tranylcypromine): aggression, irritability, ataxia, movement disorders, insomnia, reduced cognition, altered speech
- TCAs (imipramine): flu like symptoms, insomnia
- usually mild and self limiting but can be severe
How long should anti depressants be withdrawn over?
- 4 weeks
- longer if fluoxetine as longer half life
what are the criteria for diagnosis of a dependence syndrome?
3 or more of:
- A strong desire or sense of compulsion to take the substance (craving)
- Difficulty in controlling substance use (onset, termination, level of use)
- A physiological withdrawal state when reducing or ceasing substance use
- Tolerance: increased doses are required to produce the original effect
- Progressive neglect of alternative pleasures or interests
- Persisting use despite clear evidence of harmful consequences
- narrowing of repetoire
- reinstatement after abstinance
- primarcy/ salience (obtaining and using becomes so important that other interests are neglected)
How do drug induced psychosis tend to present?
- usually non auditory hallucinations
- (most auditory hallucinations not associated w/ falling asleep or waking are from schizophrenia or depression)
- usually within 4 weeks of drug abuse starting
- severity not correlated with amount of drugs taken
- drug seeking behaviour
- physical exam: needle marks, cellulitis, spider naevi, palmer erythema etc
- bloods: increased MCV, increased gamma GT if alcohol abuse
- imaging: CNS imaging if pt elderly
- they respond to the hallucinations/ delusions as if they were real (substance intoxification/ withdrawal recognises the hallucinatory nature of the experience)
what is hallucinogen persisting perception disorder
Condition presents episodically up to 5 years after exposure to an hallucinogen, with flashback hallucinogens.
May be self-induced or triggered by darkness, stress or fatigue
what does alcohol addiction imply?
- increased tolerance
- narrowing of drinking repitoire
- difficulty or failure of abstinence
- withdrawal symptoms when stop
- priority to maintain alcohol intake
- often away of compulsion to drink
what are the CAGE questions?
- has anyone felt you should cut down on your drinking
- have people annoyed you by critising your drinking
- have you ever felt bad or guilty about your drinking
- have you ever had a drink first thing in the morning (eye opener)
2 or more is clinically significant
Describe the TWEAK assessment tool for alcohol use
Q1: 2points if >6 drinks. Q2: 2 points if yes. An answer of >6 for Q1 or a total of 3 denotes a problem.
- Tolerance: how many drinks can you hold?
- Worried: have close friends/ family worried or complained about your drinking?
- Eye- opener: do you take a drink in the morning when you get up?
- Amnesia: has someone ever told you about things you said or did while you were drinking, and you can’t remember?
- Cut down: do you sometimes feel the need to cut down on your drinking
How should alcohol abuse be managed as an out pt?
- MOTIVATIONAL INTERVIEWING
- CBT, problem solving psychotherapy
- acamprosate is anti craving
- disulphiram can be used if these not appropriate
- self help groups and AA groups
- social: get job, up skill, move house, traning courses, residential programmes
List 5 complications of alcohol abuse
- fatty liver disease, cirrhosis, liver cancer
- cerebral atrophy, poor memory, retrobulbar neuropathy, WE
- peptic ulcer disease, varices, pancreatitis
- arrhythmias, htn, cardiomyopathy
- oesteoporosis
- decreased fertility
- anaemia (macrocytic)
- peripheral neuropathy
- cancer: liver, bowel, oesphagus
- anxiety, depression, amnesia, cognitive impairment, alcoholic hallucinations, morbid jealousy
- social: unemployment, divorce, child abuse, domestic violence, law breaking
describe the symptoms of wernickes encephalopathy
- confusion
- wide gait ataxia, reduced tendon reflexes
- opthalmoplegia (nystagmus, conjugate gaze, bilateral lateral rectus palsy)
- clouding of consciousness, memory disturbance, peripheral neuropathy, hypotension, hypothermia, ptosis, vomiting
