substance misuse psychiatry

Question 1

benzodiazepine symptoms

Answer 1

extremely anxious
restless
visibly sweating
noticeable tremor

Question 1

managing benzo withdrawal?

Question 2

what is the use of benzodiazepines

Answer 2

sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant
* They should only be used for a short time (2-4 weeks) due to addictive potential

epilepsy

Question 3

benzodiazepine withdrawal can be lethal t/f?

Answer 3

true

Question 4

what do benzo target?

Answer 4

GABA- A

Question 5

gaba a targeting drugs?

Answer 5

alcohol
z drugs
benzos
GHB
baclofen

Question 6

withdrawal features of benzoz?

Answer 6

anxiety
irritibilitiy
tremor
sweating
insomnia
appetite
confusion

convulsion
psychosis

Question 7

benzodiazepine toxicity?

Answer 7

drowsy
ataxia
slurred speed
reduced consciousness

severe can lead to hypotension and bradycardia

overdose = resp depression

Question 8

how to manage benzo addiction?

Answer 8

manage by GP/addiction

convert to diazepam equivalent dose once daily

diazepam 40mgOD

reduce by no more than 10% every 2 weeks

Question 9

what can counteract benzos overdose?

Answer 9

flumazenil 200microgram

Question 10

psychoactive substance defn?

Answer 10

substance that has an effect on CNS

Question 11

substance dependence

Answer 11

continued misuse of a psychoactive substance

Question 12

ICD 10 diagnostic criteria

Answer 12

strong desire / compulsion
difficulties in controlling substance taking behaviour
physiological withdrawal state
tolerance
progressive neglect of alternative pleasures / interests

persisiting with substance

Question 13

ICD-11 dependence criteria

Answer 13

impaired control over substance use

increased precedence of substance use over toher aspects of life

physiological features indicating neuroadaptation

Question 14

stages of change model who was this made by?

Answer 14

prochaska and DiClemente

Question 15

Prochaska and DiClemente’s stages of change model

Answer 15

The five stages of change are precontemplation, contemplation, preparation, action, and maintenance.

can enter and renter again and again
So each relapse is a framework to learn!

Question 16

FRAMES

Answer 16

feedback
responsibility for change
advice - to change
menu- of alternative
empathic
self-efficacy

Question 17

screening tool for alcohol use

Answer 17

CAGE
audit
fast

Question 18

Ix for alcohol dependence?

Answer 18

Bloods: FBC, LFT, B12, folate, U&E, clotting screen, glucose
* Blood alcohol level or breathalyser
* Urine drug screen
* Rating scale (e.g. AUDIT, CIWA-Ar, APQ)
* Severity of Alcohol Dependence Questionnaire (SADQ)

Question 19

charity that can help with alcohol addiction?

Answer 19

AA
SMART recovery
change
grow

Question 20

therapy for alcohol addiction

Answer 20

Offer psychological intervention (e.g.CBT, behavioural therapy, social network and
environment-based) focused on alcohol-related cognitions

Question 21

DT

Answer 21

signs of altered mental status : hallucinations
persecutory auditory

confusion
delusions
severe agitation

Question 22

dt mx

Answer 22

short term

Question 23

Acamprosate

Answer 23

Acamprosate was thought to be slightly more effective at helping people with alcohol use disorder remain off alcohol

reduces craving

Question 24

Naltrexone

Answer 24

reduces dopamine release

Question 25

wernickes and korsakoff

Answer 25

vit b1 deficiency wernickes is reversible

Question 26

wernickes symptoms

Answer 26

triad confusion opthamoplegia ataxia

Question 27

korsakoff

Answer 27

excessive anterograde and retrograde amnesia frontal lobe dysfunction > confabulation psychotuc symptoms : may require institutionalisation

Question 28

Community-based assisted withdrawal (best option)

Answer 28

* This can be done through organisations like CGL (Change, Grow, Live) * Usually 2-4 meetings in the first week * If complex, may need up to 4-7 days per week over a 3-week period

Question 29

acute mx of opiate overdose?

Answer 29

abc approach airway and IV fluids IV nalozone > short acting antagonist prevents opiates binding

Question 30

opiate substitution therapy

Answer 30

buprenorphine methadone

Question 31

methadone

Answer 31

long acting half life 24 hours s/e lethargy

Question 32

buprenorphine

Answer 32

partial agonist long half life competes with opiates in brain risk of respiratory depression less sedating less euphoric less risk of respiratory depression

Question 33

opiate withdrawal is it lethal

Answer 33

no flu like tremor tachy and hypertension hot / cold gi: nausea, diarrhoea, vomiting dilated pupils joint pain anxiety goosebumps / piloerection

Question 34

recommended alcohol intake?

Answer 34

drink no more than 14 units of alcohol a week 6 medium glasses of wine 6 pints of beer across 3 days at least

Question 35

what is binge drinking?

Answer 35

5 or more drinks in 2 hours 4 or more in 2 hours >35 units per week