14. Clinical Approach to Substance Abuse Disorders Flashcards
What is a primary chronic disease of brain reward motivation, memory and related circuitry? Dysfunction in these circuits leads to characteristic biological, psychological and behavioral dysnfunction… *this is reflected in an individual pathologically pursuing reward and or relief by substance use and other behaviors…
Addiction
What syndrome is a result of dopamine system malfunction, which is complicit in vulnerability to addiction, and helps us understand the compulsive use that characterizes addiction versus physical dependency?
Reward Deficiency Syndrome
Regardless of the object of addiction, what circuitry of the nervous system is the ultimate common pathway for addictive behaviors?
Neurobiological Circuitry
Addictophrenia spectrum has a genetic history of addictive disorders, intractable mood disorders, personality disorder and habitual criminal behavior, along with a history of polysubstance use, trauma in the earlier life, chronic psychosocial stressors at young age and borderline?
personality disorder
Up to 50% of addicts have comorbid psychiatric disorder such as antisocial PD, depression, and suicide. What disorder is characterized by using larger amounts or for longer time than intended, persistent desire or unsuccessful attempts to cut down use, great deal of time obtaining, craving, fail to fulfill major roles and persistent social/interpersonal problems caused by the substance?
Substance Use Disorder
Substance Use Disorder severity depends on # of diagnostic criteria documented, mild is 2-3 symptoms, moderate is 4–5 symptoms and severe substance use disorder is?
6+ symptoms
Substance Use Disorder is also characterized by important social/occupational activities given up, use in physically hazardous situations, use despit of problems caused, tolerance along with?
Withdrawal (not after use of PCP, inhalants, hallucinogens)
Substance Use Disorder SPECIFIERS include: in early remission means no criteria for >3months (except craving), in sustained remission is no criteria for >12 months (except craving), in a controlled environment such as?
Jail- access to substance restricted
What mental disorder represents a clinically significany symptomatic presentation of a mental disorder, with evidence of the disorder developing during or within 1 month of substance intoxication or withdrawal or taking medication AND the involved substance/medication is capable of producing the mental disorder?
Substance-Induced Mental Disorder
What is a substance specific syndrome problematic behavioral change due to stopping or reducing prolonged use with physiological and cognitive components, causing significant distress in social, occupational or other areas of functioning, not due to medical/mental disorder…?
Withdrawal
What refers to underlying CNS changes that occur following repeated use such that person develops tolerance or withdrawal, pharmacokinetic-adaptation of metabolizing system, pharmacodynamic- ability of CNS to function despite high blood levels..?
Neuroadaption
What is the need to use an INCreased amount of substance in order to acheive the same desired effect or markedly diminished effect with continued use of the same amount of substance?
Tolerance
To tx withdrawal/addiction, hospitalization due to drug OD, or residential treatment unit, or even an outpatient program for a highly motivated person…Withdrawal specifically, what is something he pointed out in class as loving?
12 step facilitation (along with AA/NA/CBT)
Alcohol is a CNS depressant- with benzos can cause respiratory depression and death. Early alcohol withdrawal includes anxiety, irritability, tremor, HA, insomina, nausea, tachycardia, HTN, what is typically seen 24-48 hours and most often grand mal?
Seizures
What alcohol withdrawal stage is between 48-72 hours and causes altered mental status, hallucinations, marked autonominc instability and is life threatening?
Withdrawal Delirium (Delirium Tremens)
Delirium Tremens is the most severe manifestation of alcohol withdrawal and occurs 3-10 days after last drink, manifests as agitation, confusion, disorientation, hallucinations, *fever, HTN, diaphoresis, what is the hallmark of delirium tremens?
Profound Global Confusion, + sympathetic overdrive
***MEDICAL EMERGENCY w high mortality rate
The clinical institute withdrawal assessment for alcohol is used and assigns numerical values to orientation, N/V, tremor, sweating anxiety, agitation, and HA, VS checked but not recorder, a total score of > what indicates more severe withdrawal and based on severity or history or prev withdrawal seizures/DTs, med therapy can be scheduled or symtpom triggered?
score >10 = severe withdrawal
Alch Withdrawal tx inlcudes benzos which dec risk of seizure, along with anticonvulsants such as carbamazepine/ valproic acid, and what supplementation which can dec risk of wernicke korsakoff which is a med emergency?
Thiamine Supplementation
Other treatment for alch withdrawal includes outpatient AA, and medications such as disulfarim (never used), natrexone 50mgpoqd -opioid antagonist may cause heptotoxicity at high doses, what drug may be used w unknown MOA but stabilizes neuron excitation and inhibition-cleared renally?
Acamprosate 666mgpoTID
Benzos and barbs chornic use can cause alzheimers dementia, benzo withdrawal is similar to alcohol with anxiety, insomnia, fatigue, HA, tremor, sweating, poor concentration, and is treated with taper dosing with either diazepam, alprazolam, chlordiazepoxide, clonazepam, or?
lorazepam
The benzos used for tapering to get them off include temazepam, oxazepam and what, which are metabolized through only gluronidation in the liver and not affected by age/hepatic insufficiency? (note- chlordiazepoxide is long acting drug used in hepatic sufficient patients)
Lorazepam*
Opioid withdrawal is the worst- intoxication is seen at pinpoint pupils, sedation, constipation, bradycardia, hypotension and dec resp rate, withdrawal includes dilate pupils, lacrimation, goosebumps, n/v, diarrhea, myalgias arthralgias, dysphoria or agitation… Rx can help symptomatically with antiemeticc, antacid, antidiarrheal, nsaids clonidine and maybe?
Benzos
Opiate use disorder is treated with CD tx- support education, skills building, psych treatment and NA, meds include methadone (causes prolonged QTc and death via cardiac arrhythmia), naltrexone and?
Buprenorphine (partial u agonist)
Methadone maintenance is only availible through a certified medication assisted treatment program (MAT), an oral solution, high risk med*- can be deadly with benzo use, frequently causes QTc prolongation and is fatal, dangers increase when used with another?
CYP3A4 substrate
**dont give with benzos for pain
Stimulants- intoxication (acute) psychological and physical signs include euphoria, vigor, gregariousness, hyperactivity, restlessness, interpersonal sensitivity, anxiety, tension, anger, impaired judgement and paranoia. Chronic intoxication signs include affective blunting (no emotional response), fatigue, sadness, social withdrawal, hypotension, bradycardia and muscle weakness.. what is seen with severe paranoia?
Psychosis
withdrawal can cause severe and suicidal depression
Stimulant use disorder treatment options include NA, CD tx including support education and skills, no meds are approved, tx comorbid psychiatric disturbance and tx medical?
symptoms as appropriate
Tobacco induces CYP1A2 watch for interactions (ex: olanzapine), no intoxication, neuroadaption and tolerance forms, withdrawal include dysphoria, irritability, anxiety, dec concentration, insomnia and increased?
appetite
meds to tx include bupropion/varenicline
MDMA/XTC/Ecstacy intoxication includes illusions, hyperacusis, sensitivity of touch, taste and smell altered, tearfulness, euphoria, panic, paranoia, impaired judgement- **common short term problems includ tachycardia, sweating muscle spams and EXTREMELY»??
EXTREMELY HIGH FEVER (38.5-43C)
Adolsecent males who use cannabis regularly have a 7 fold increased risk of psychosis, frequently worsens comorbid psychiatric problems, withdrawal includes insomnia, irritability, anxiety, poor appetite, depression and physical?
discomfort
Phenacyclidine (PCP or ANGEL DUST) is a dissociative anesthetic like ketamine used in anesthesia, intoxication includes paranoid delusions, hallucinations, can be agitated/violent w dec awareness of pain, and there are cerebellar symptoms which include ataxia, dysarthia and?*****
Nystagmus: vertical and horizontal
