substance related and addictive disorders

Question 1

Abuse

Answer 1

use that is inconsistent with sociality use patterns

Question 2

Intoxication

Answer 2

reversible syndrome caused by a specific substance affecting memory, judgment, behavior, or social or occupational functioning

Question 3

withdrawal

Answer 3

substance-specific symptoms that occur after stopping or reducing use

Question 4

psychodynamic theory of substance abuse

Answer 4

Based in oral stage fixation

Seeks gratification through oral behaviors

Regressive behaviors can be overloaded, fixed, and reinforced through dysfunctional family patterns

Sociocultural factors explain population based differences

Question 5

biological theory of substance abuse

Answer 5

Genetic
Gender
Ethnic differences

Two neurological processes
1. Reinforcement.
-Positive and negative rewards physiologically linked to memory function
-Brain base changes
-Positive rewards result in social rewards mediated by dopamine pathways
-Negative rewards like increased anxiety mediated by GABA
-Reward center in the ventral tegmental area
-repeated use causes dopamine system to become increasingly sensitized
-eventually, even pictures of drug use can cause dopamine release

2. Neuro adaptation.
   -brain based changes lead to tolerance and withdrawal
   -alterations in normal level and function of NTs
   -changes significant when person tries to stop
   -this is the basis for withdrawal
   -changes can endure for years, increasing potential relapse

Question 6

Psychiatric and substance comorbidity

Answer 6

50% of those in the US with a psychiatric disorder have a comorbid substance use disorder

Schizophrenics are four times more likely

Bipolar affective disorder are five times more likely

Question 7

CAGE and how to calculate

Answer 7

Cut down
Annoyed
Guilt
Eye-opener

2+ is mild to moderate risk
3 to 4 are high risk

Question 8

other SUD screening

Answer 8

AUDIT
CRAFFT
COWS

Question 9

getting a history during an assessment for substance use disorder

Answer 9

Normal stuff like HPI, social history, medication use

Try to validate history with a family member

Identify category of drug abused

Assessing the presence of substance abuse:
-maladaptive pattern, at least 12 months, repeated failure to fulfill obligations, use and situation that presents as physically hazardous, problems related like legal, interpersonal, social

3+ of tolerance, withdrawal, larger amounts than intended, persistent, craving, unsuccessful attempt to cut down, time spent obtaining, activities, decreased/given up, use despite consequences

Question 10

diagnostic criteria for substance withdrawal

Answer 10

Sensation/reduction that has been heavy or prolonged

2+ sx within hours/days of reduction/sensation
–tremor, insomnia, autonomic, hyperactivity, nausea/vomiting, hallucinations, psychomotor, agitation, anxiety, seizures

Question 11

physical findings, related to alcohol use disorder

Answer 11

Brain: mood changes, behavior changes

HEENT: poor oral health

Cardiovascular: hypertension, cardiomyopathy, tachycardia

Gastrointestinal: liver disease, cirrhosis, peptic ulcer, esophageal malignancies

Neurologic: tremor, cognitive deficits, peripheral neuropathy, Wernicke-Korsakoff syndrome

Metabolic: hyperlipidemia

Question 12

CIWA

Answer 12

Clinical Institute withdrawal assessment for alcohol

Likelihood of withdrawal and DT’s, which usually occur within the first 24 to 72 hours after cessation

10 common withdrawal symptoms
Nausea and vomiting
Tremors
Paroxysmal sweats
Anxiety
Agitation
Tactile disturbances
Auditory disturbance
Visual disturbances
Headaches
Altered sensorium

sx graded 0-7 with some exception

Question 13

clinical management of acute withdrawal

Answer 13

Detox agents as slow taping
–multiple daily doses of benzodiazepines
–poly therapy is a newer approach like using SSRI, naltrexone, NMDA
–anti Sz rx to decrease potential
–adrenergic medication to decrease blood pressure and pulse
–aversion treatment like Dilsulfuram/antabuse which need alcohol free 12 hours minimum

Question 14

citalopram to treat cravings and maintenance

Answer 14

Decreased desire

Question 15

disulfiram to treat cravings and maintenance

Answer 15

aversion therapy

Question 16

naloxone to treat cravings and maintenance

Answer 16

Blocks effects of opioids

Question 17

buprenorphine to treat cravings and maintenance

Answer 17

Agonist and antagonist, decreased cravings

Question 18

buprenorphine, and dioxide to treat cravings and maintenance

Answer 18

Opioid agonist/antagonist

Question 19

methadone to treat cravings and maintenance

Answer 19

Suppress withdrawal

Question 20

Nalmefene/revex to treat cravings and maintenance

Answer 20

Increases abstinence

Same for IM (Revia/vivitrol)

Question 21

Acamprosate to treat cravings and maintenance

Answer 21

Decreases cravings

Question 22

what to monitor when using disulfiram

Answer 22

LFT

Question 23

Antabuse and psychiatric disorder

Answer 23

May induce mania and people with bipolar

Question 24

indications for inpatient alcohol detoxification

Answer 24

History of severe withdrawal symptoms
Seizure
DTs
Multiple past detox
Additional medical or psychiatric illness
Recent significant alcohol consumption
Lack of reliable support system
Pregnancy