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Psychiatry > 1: Addiction > Flashcards

1: Addiction Flashcards

1
Q

What is addiction

A

Maladaptive pattern of substance abuse leading to clinically significant distress

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2
Q

What is the DSM-5 criteria for addiction

A

Requires 3 of the following:

  1. Tolerance
  2. Using Large amounts or long time period
  3. Use despite knowledge of harm
  4. Craving
  5. Withdrawal
  6. Unsuccessful attempts at control
  7. Time spent in activities to obtain, use or recover
  8. Important activités given up
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3
Q

What are the 4 syndromes ICD-10 describe for addiction

A
  1. Acute intoxication
  2. Harmful Use
  3. Dependence Syndrome
  4. Withdrawal state
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4
Q

Define acute intoxication

A

Transient condition following administration of alcohol or substance causing disturbed consciousness or other psychophysiological functions

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5
Q

Define harmful use

A

Use of substance abuse that is damage to health. Can be physical or mental;

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6
Q

Define dependence syndrome

A

Cluster of physiological, behavioural and cognitive phenomenon in which use of a substance takes higher priority that other values that once had greater value

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7
Q

Define withdrawal state

A

Symptoms occurring on absolute or relative withdrawal of a substance

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8
Q

Define tolerance

A

Using more of a substance to achieve same effects

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9
Q

Define hazardous drinking

A

Binge drinking and consumption of:

  • 22-50 units in men
  • 15-35 units in females
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10
Q

What defines hazardous drinking in men

A

Consumption 22-50 units

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11
Q

What defines hazardous drinking in females

A

Consumption 15- 35 units in females

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12
Q

Define harmful drinking in males

A

Consumption >50 Units in males

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13
Q

Define harmful drinking in females

A

Consumption >35 Units in females

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14
Q

What is normal advice regarding alcohol

A
  • Do not consume more than 14-units per week
  • Try to spread alcohol consumption over 3-days
  • Do not drink if pregnant
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15
Q

What is used to measure drinks strength

A

ABV (Alcohol By Volume)

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16
Q

How is units calculated

A

(ABV x mL)/1000

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17
Q

What are 5 risk factors for alcohol misuse

A
  • Young
  • Male
  • FH
  • Low socio-economic group
  • Occupation - doctors
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18
Q

What are 5 features of alcohol mis-use disorder

A
  • Tolerance
  • Narrowing repotoir of drinks
  • Failure abstinence
  • Withdrawal symptoms
  • Maintaining intake is a priority
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19
Q

What can alcohol withdrawal lead to

A

Delirium tremens

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20
Q

When does delirium tremens usually occur

A

48-96h after

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21
Q

Define delirium tremens

A

State of impaired consciousness and sympathetic over-activity due to alcohol withdrawal

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22
Q

What are the symptoms of delirium tremens

A
  • Impaired consciousness
  • Generalised tonic-clonic seizures
  • Visual and tactile hallucinations - insects crawling
    over them
  • Hyper-reflexia
  • Intention tremor

Sympathetic Over-Activity:

  • Sweating
  • Tachycardia
  • HTN
  • Nausea
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23
Q

What is a common hallucination in delirium tremens

A

Insects crawling over them (tactile of visual)

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24
Q

What is wenicke’s Encephalopathy

A

Neuropsychiatric disorder caused by deficiency in thiamine

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25
Q

What is the triad of symptoms in Wernicke’s encephalopathy

A
  1. Ophthalmoplegia
  2. Confusion
  3. Ataxia
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26
Q

If untreated what does Wernicke’s encephalopathy progress to

A

Korsakoff syndrome

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27
Q

What is Korsakoff’s syndrome

A

Symptoms of Wernicke’s (ophthalmoplegia, confusion, ataxia) with:

  • Anterograde or retrograde amnesia
  • Confabulation
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28
Q

What are screening tests for alcohol misuse disorder

A
  • CAGE

- AUDIT

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29
Q

What is the CAGE questionnaire

A

Cut down
Annoyed at drinking
Guilty about drinking
Eye-opener

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30
Q

What score on CAGE indicates hazardous consumption

A

> 2/4

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31
Q

What score in AUDIT tool should indicate referral to specialist alcohol services

A

> 15

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32
Q

What does AUDIT stand for

A

Alcohol Use Disorder Identification Test

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33
Q

What is used in assessment for alcohol misuse disorder

A

Alcohol history and psychiatric assessment

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34
Q

What conservative measures are offered for alcohol mis-use disorder

A
  • SMART therapy
  • Motivational Interviewing
  • If wernicke-korsakoff’s offer supported living

Harmful drinking:

  • CBT
  • Behavioural Therapies
  • Social network and environment therapies
35
Q

What is used for acute alcohol withdrawal

A
  • Benzodiazepines
  • Pabrinex
  • 10% Glucose
36
Q

How much pabrinex is given

A

2 ampoules IV over 2-days

37
Q

If an alcoholic is hypoglycaemia what is given

A

Give pabrinex

Then give glucose

38
Q

What is given to treat alcohol-withdrawal seizures

A

Chlordiazepoxide or diazepam

39
Q

What is preferred if alcoholic has liver impairment

A

Lorazepam

40
Q

When is inpatient program for withdrawal indicated

A

> 30 SADQ
30 Units
Concurrent benzodiazepine withdrawal
History epilepsy

41
Q

Explain legal aspects of alcohol misuse disorder

A

Alcohol mis-use disorder is not classified under mental health act - so individuals cannot be detained

42
Q

What are 3 medications that help long-term with withdrawal

A

Disulfram
Acamprosate
Naltrexone

43
Q

What is the MOA of acamprosate

A

NMDA antagonist. Reduces Craving

44
Q

What is the MOA of naltrexone

A

Opioid receptor antagonist - reduces reward of drinking

45
Q

What needs to be checked prior to starting disulfram

A

U+E, LFT

46
Q

What is MOA of disulfram

A

Acetaldehyde dehydrogenase - which causes accumulation of acetaldehyde

47
Q

What can vitamin B12 deficiency cause

A

Microcytic anaemia

Subacute combined degeneration of spinal cord

48
Q

What is alcohol ketoacidosis

A

Raised anion gap metabolic acidosis - due to impaired glucose metabolism (alcohol, malnutrition)

49
Q

How does alcoholic ketoacidosis present

A

Abdominal pain
Nausea and vomiting
Tachypneoa

50
Q

What are 5 features of foetal alcohol syndrome

A
  • Hypoplastic upper lip
  • Smooth philtrum
  • Microcephaly
  • VSD
  • Down-slanting palpabrae fissures
51
Q

What are the 5 ICD-10 criteria to define nicotine dependence

A
  1. Tolerance
  2. Withdrawal
  3. Impaired Control
  4. Ongoing use despite risks
  5. Social adverse effects
52
Q

What do NICE recommend for assessing nicotine dependence

A

Nicotine dependence should be assessed at each appointment using pack years, then very brief advice should be use

53
Q

How are pack years calculated

A

(Number Packs Smoked Per Day x Years)/ 20

54
Q

How are pack years calculated

A

(Number Packs Smoked Per Day x Years Smoked)/ 20

55
Q

What are the two questions to assess nicotine dependence

A
  • How many cigarettes smoker per day

- How soon after waking up do you smoke

56
Q

What are 4 conservative manages to stop smoking

A
  1. Refer to stop smoking services
  2. Behavioural support
  3. Set a quite date
  4. Advice
57
Q

What advice is given to stop smoking

A
  • Not a puff rule
  • Discuss methods to stop cravings
  • Avoid people smoking
  • Discuss barriers
58
Q

What are three medications for smoking cessation

A

Varencline
Buproprion
NRT

59
Q

What nicotine replacement therapy should be used

A

Use long-acting such as nicotine patch and short-acting such as gum to treat cravings

60
Q

What is the MOA of varencline

A

Partial nicotine receptor agonist

61
Q

How do you remember the MOA of varencline

A

V(arencline) is V similar to nicotine

62
Q

What is the brand name of varnecline

A

Champix

63
Q

What is the MOA of buproprion

A

Dopamine and Noradrenaline re-uptake inhibitor

64
Q

Explain NICE recommendation on smoking in pregnancy

A
  • Test with CO detector

- Any women who stopped smoking, stopped in 2W or CO >7 refer to stop smoking services

65
Q

What medications are CI in pregnancy for smoking cessation

A

Varencline

Buproprion

66
Q

What is experimental use of drugs

A

Using drugs to try effects

67
Q

What is situational drug use

A

Using drugs in certain situations

68
Q

What is recreational drug use

A

Regular, non-dependent use

69
Q

What is dependent use

A

Fits criteria for dependence syndrome

70
Q

What opioid is usually abused

A

Heroine

71
Q

What is clinical presentation of opioids

A

Euphoria

Relaxation

72
Q

What are side effects of opioids

A

N+V
Constipation
Injection has risk of abscess, cellulitus, HIV, Hep B and Hep C

73
Q

What are 4 symptoms of OD in opioids

A
  • Pin point pupils
  • Resp distress
  • Bradycardia
  • Hypotension
74
Q

How will pupils present in opioid over-dose

A

Pin-point

75
Q

What symptoms does withdrawal of opioids cause

A
  • Sweating
  • Rhinorrhoea
  • Anxiety
  • Cold sweats
  • Severe muscle pain
  • Diarrhoea
76
Q

What is a key symptoms of opioid withdrawal

A

Severe muscle pain

77
Q

Describe symptom-onset in opioid withdrawal

A

Symptoms onset 6-24h

Persist 5-7d

78
Q

Explain harm-reduction for opioid abuse

A

Describes methods to ensure users take opioids in safer way

79
Q

What are 5 methods of harm-reduction in opioid abuse

A
  1. Needle Program
  2. Safe Injecting Advice: sterile water, rotate sites, avoid neck and groin
  3. Methadone - come to clinic to take
  4. Naloxone - give rescue naloxone incase they OD
80
Q

What are two medications that can be used to aid withdrawal of opioids

A

Methadone

Buprenorphine

81
Q

What is the mechanism of methadone in opioid withdrawal

A

Methadone is a long-acting opioid, is saturates opioid receptors causing no additional benefit to injecting

82
Q

What is the mechanism of action of buprenorphine

A

Partial opioid receptor agonist

83
Q

What can be given to treat OD of opioids

A

Naloxone

Psychiatry (13 decks)

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