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Year 2 Psychiatry > Substance Use and Addictions > Flashcards

Substance Use and Addictions Flashcards

1
Q

Positive reinforcement?

A

Gain positive state:
-stay awake
-get high
-enjoy it
-escapism

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2
Q

Negative reinforcement?

A

Overcome adverse state:
-boredom
-reduce anxiety
-to get to sleep
-feel better

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3
Q

Course of addiction?

A

Like -> Want -> Need

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4
Q

Dependence syndrome ICD-10?

A

3 or more of following
1. Strong DESIRE or sense of compulsion to take substance
2. DIFFICULTIES CONTROLLING substance taking behaviour (onset, termination, levels)
3. Physiological WITHDRAWAL state when stopped or reduced
4. TOLERANCE
5. Progressive NEGLECT of alternative interests
6. PERSISTING with use despite evidence of harmful consequences

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5
Q

Addiction?

A

Continue using despite being harmful
Cannot stop using drug
Neglect of work, social, or family obligations
Tolerance and withdrawal

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6
Q

Dependence?

A

Body physically adapted to drug
-tolerance/withdrawal

can be dependent and not addicted

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7
Q

Behaviour addictions?

A

-gambling disorder
-internet gaming disorder

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8
Q

3 levels of addiction?

A
  1. Hazardous use (high quantity and frequency)
  2. Harmful use (consequences - physical, social, psychological)
  3. Dependence/addiction (tolerance, withdrawal)
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9
Q

Elements involved in alcohol/drug use and addiction?

A

-social, environmental factors
-drug factors (faster entry=more addictive)
-personal factors (genetic, personality)

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10
Q

Models of addiction?

A

-reward deficiency (positive reinforcement)
-overcoming adverse state (withdrawal, anxiety - negative reinforcement)
-impulsivity/compulsivity

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11
Q

Alcohol acute effects?

A

Blocks excitatory system (through NMDA receptor) - impaired memory, alcoholic blackouts

Boosts inhibitory system (through GABA-A receptor) - anxiolysis, sedation

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12
Q

Chronic alcohol exposure neuroadaptations?

A

Upregulation of excitatory system

Reduced function of inhibitory system (tolerance)

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13
Q

Upregulation of excitatory system from chronic alcohol?

A

Increased number of NMDA receptors - increase in calcium release which is toxic

calcium is toxic leading to hyper excitability (seizures) and cell death (atrophy)

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14
Q

Reduced function of inhibitory system from chronic alcohol?

A

GABA-A receptor - switch in subunits to make less sensitive to alcohol

TOLERANCE

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15
Q

To boost GABA function?

A

Treat with benzodiazepines

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16
Q

Ventral striatum

A

Natural rewards increase levels of dopamine in ventral striatum

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17
Q

Dopamine pathway?

A

Pleasure-reward-motivation system

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18
Q

Cocaine and amphetamine interaction with dopamine?

A

Block dopamine reuptake

amphetamines enhance release of dopamine

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19
Q

Alcohol and nicotine effect on dopamine?

A

Increase dopamine neurone firing in VTA (ventral tegmental area)

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20
Q

Reward system in abstinent addicts?

A

Blunted activation of reward system in abstinent addicts compared with controls

blunted response = more likely relapse (reward deficiency)

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21
Q

Amygdala?

A

Emotional processing
Involved dysregulation of stress system, increase in kappa/dynorphin opioid system, noradrenergic activity

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22
Q

Positive -> negative reinforcement?

A

As addiction/dependence develops

23
Q

Ventral -> dorsal migration

A

Fronto-striatal connections with reduced frontal ‘control’ or striatal activity
Move from ventral (limbic) to dorsal (habit) striatum as dependence develops

24
Q

Intoxication?

A

Transient, temporary state that disappears when drug is eliminated

25
Q

Withdrawal?

A

Signs + symptoms when dose is reduced or stopped

26
Q

Tolerance?

A

Drug produces decreased effect after repeated use

27
Q

Harmful use? ICD-10

A

-pattern of substance that causes damage to health
-physical or mental damage
-adverse social consequences
-harmful use including bingeing (doesn’t include hangover alone)
-does not fulfil any other diagnosis within substance use (e.g dependence)

cannot be harmful use and dependence

28
Q

ICD-11 similarities? (Dependence and harmful use)

A

Distinction between dependence and harmful use is preserved

29
Q

ICD-11 differences (harmful use)?

A

Single episodes of harmful use differentiated from pattern of harmful use
harmful use now also include harm to health of others

30
Q

ICD-11 differences (dependence)?

A

former 6 criteria bundled into 3 pairs - 1 criteria sufficient
1. IMPAIRED CONTROL over substance use
2. INCREASING PRECEDENCE of substance over other aspects of life
3. NEUROADAPTATION to substance

usually over 12 months but diagnosis can be made after 3 months continuous

31
Q

DSM-5 classification differences? Addiction

A

Remained opioid use disorder and alcohol use disorder
Single continuum of mild, moderate, severe
No longer uses terms abuse or dependence

32
Q

Alcohol excretion rate?

A

1 unit per hour

33
Q

Recommended intake units?

A

14 per week for men and women
Spread over 3 or more days

34
Q

CAGE?

A

Cut down
Angry
Guilty
Eye opener

35
Q

Absorption pharmacology alcohol?

A

60 mins for maximum blood concentration

36
Q

Alcohol pharmacodynamics?

A

Enhances neurotransmission at GABA-A receptors (causing anxiolysis)
Inhibits NMDA mediated glutamate release (amnesic)

37
Q

Alcohol metabolism?

A

Ethanol oxidised by alcohol dehydrogenase to acetaldehyde
Acetaldehyde dehydrogenase turns acetaldehyde to CO2 and water

38
Q

Alcohol assessment? Physical examination

A

Examination - jaundice, bruising, clubbing, oedema, ascites, spider naevi

39
Q

Wernicke’s encephalopathy triad?

A

Ataxia
Confusion
Opthalmoplegia

40
Q

Alcohol withdrawal stages?

A

6-12 hours - minor withdrawal symptoms (tremulousness, anxiety, nausea…)
12-24 - alcoholic hallucinosis (usually accusatory or derogatory voices)
12-48 - withdrawal seizures
48-72 - delirium tremens

41
Q

Delirium tremens?

A

Medical emergency
Hallucinations, confusion and disorientation, hypertension, agitation, tachycardia, fever, severe tremor

42
Q

Alcohol withdrawal management?

A

Benzodiazepines

43
Q

Opioid effects?

A
  1. Relieve pain - analgesic
  2. Euphoria
    endogenous (endorphins) regulate pain and mood
44
Q

Opioid receptors?

A

Mu, delta, kappa - affected by heroin, codeine

45
Q

Opioid assessment examination?

A

Collapsed veins, track marks
endocarditis
Hep. B, HIV
Pneumonia

46
Q

Opioid withdrawal scale?

A

COWS
Clinical opiate withdrawal scale

47
Q

Opiate overdose treatment?

A

Naloxone

48
Q

Opiate overdose signs?

A

Not moving, can’t be woken, slow or no breathing
Choking or gurgling sounds, snoring
Tiny pupils
Clammy or cold skin
Blue nails

49
Q

Opioid addiction symptoms?

A

Tachycardia, snotty, achy, worry

50
Q

All diagnostic criteria similar features?

A

-loss of control
-functional impairment
-neuroadaptation

51
Q

Addiction history taking?

A

Triggers, method, withdrawal, previous treatment
Willing to change?

52
Q

Alcohol assessment? Neurological

A

Neurological - Wernicke’s encephalopathy, Korsakoff’s syndrome

53
Q

Alcohol abstinence drug and effect?

A

Acamprosate - increases GABA, NMDA antagonist

54
Q

Detox drug?

A

Benzodiazepines
Chlordiazepine
Thiamine, folate

Year 2 Psychiatry (7 decks)

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