14. Clinical Approach to Substance Abuse Disorders

Question 1

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…

Answer 1

Addiction

Question 2

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?

Answer 2

Reward Deficiency Syndrome

Question 3

Regardless of the object of addiction, what circuitry of the nervous system is the ultimate common pathway for addictive behaviors?

Answer 3

Neurobiological Circuitry

Question 4

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?

Answer 4

personality disorder

Question 5

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?

Answer 5

Substance Use Disorder

Question 6

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?

Answer 6

6+ symptoms

Question 7

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?

Answer 7

Withdrawal (not after use of PCP, inhalants, hallucinogens)

Question 8

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?

Answer 8

Jail- access to substance restricted

Question 9

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?

Answer 9

Substance-Induced Mental Disorder

Question 10

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…?

Answer 10

Withdrawal

Question 11

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..?

Answer 11

Neuroadaption

Question 12

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?

Answer 12

Tolerance

Question 13

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?

Answer 13

12 step facilitation (along with AA/NA/CBT)

Question 14

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?

Answer 14

Seizures

Question 15

What alcohol withdrawal stage is between 48-72 hours and causes altered mental status, hallucinations, marked autonominc instability and is life threatening?

Answer 15

Withdrawal Delirium (Delirium Tremens)

Question 16

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?

Answer 16

Profound Global Confusion, + sympathetic overdrive

***MEDICAL EMERGENCY w high mortality rate

Question 17

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?

Answer 17

score >10 = severe withdrawal

Question 18

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?

Answer 18

Thiamine Supplementation

Question 19

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?

Answer 19

Acamprosate 666mgpoTID

Question 20

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?

Answer 20

lorazepam

Question 21

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)

Answer 21

Lorazepam*

Question 22

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?

Answer 22

Benzos

Question 23

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?

Answer 23

Buprenorphine (partial u agonist)

Question 24

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?

Answer 24

CYP3A4 substrate

**dont give with benzos for pain

Question 25

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?

Answer 25

Psychosis

withdrawal can cause severe and suicidal depression

Question 26

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?

Answer 26

symptoms as appropriate

Question 27

Tobacco induces CYP1A2 watch for interactions (ex: olanzapine), no intoxication, neuroadaption and tolerance forms, withdrawal include dysphoria, irritability, anxiety, dec concentration, insomnia and increased?

Answer 27

appetite

meds to tx include bupropion/varenicline

Question 28

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»??

Answer 28

EXTREMELY HIGH FEVER (38.5-43C)

Question 29

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?

Answer 29

discomfort

Question 30

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?*****

Answer 30

Nystagmus: vertical and horizontal