25. Alcohol use disorder

Question 1

Effects on parts of the brain

Answer 1

First it affects the forebrain: Assaults motor coordination and decision making. Then increased dosage –>
Mid brain: Lose control over emotions and increase chances of blackout. Then more intake –>
Brain stem: Controls homeostasis. Heart rate, body temp. appetite, consciousness. Dangerous and fatal condition.

Question 2

What happens?

Answer 2

Is water soluble and very quickly absorbed, reaches brain within 5 minutes.Cell membranes highly permeable to alcohol, so ends up in nearly every tissue. Affects neurotransmitters and receptors (endorphins, dopamine, serotonin, glutamine).
Travels from stomach to small intestine where absorbed quickly into blood. Amount and circumstances of consumption affect extent of intoxication.

Question 3

Long term effects

Answer 3

Strong action on biomedical balance. Effect on malnutrition. Effects certain chemicals that cause blood to change. Effect on antidiuretic hormone causing metabolic disorders –> liver disease and decreased function, skin and energy, stress on cells and organs. Oxidative stressors lead to cancer

Question 4

Long term effects of large consumption (signs and symptoms):

Answer 4

Brain: Impaired development, cravings, irritability, depression etc. ataxia, impaired vision and memory. Effects mouth, trachea and oesophagus (cancer). Anaemia, alcohol cardiomyopathy, hepatitis, cirrhosis, chronic gastritis, pancreatitis, increased risk of diabetes type 2.

Question 5

Co-occurring conditions:

Answer 5

Exacerbates: Skin diseases, linked to cancer, CVD, tobacco use, drug use, liver disease, depression, anxiety, bulimia, MENTAL HEALTH

Question 6

Aetiology:

Answer 6

Cause is unknown. Multifactorial: is genetic, psychological, social and environmental.
Develops when drink so much that chemical changes in brain occur, increasing pleasurable feelings when drinking alcohol, making them want to drink more often. Combines symptoms of impulse control disorders and compulsive disorders.

Question 7

Risk factors:

Answer 7

50% is considered genetic.
Psychoactive disorders.
Steady drinking over time, starting at early age, family history, depression and other mental health problems, history of trauma, social and cultural factors.

Question 8

Trajectory

Answer 8

Phases of repeated intoxication, withdrawal, abstinence, progression from impulsivity to compulsivity.
Brian undergoes long term adaptive changes in cell structure to the point where regular alcohol use is required to feel normal.

Question 9

Treatments:

Answer 9

Withdrawal management, pharmacotherapy, brief interventions, inpatient/outpatient rehab, specialised services (counselling), self-help groups, hypnosis.

Question 10

Diagnosis

Answer 10

fMRI: Darker colouring indicates depressed brain activity. less function, less control over behaviour, less ability to think.
Physical exam: History of alcohol use, complete psychosocial examination.
DSM-5

Question 11

Signs and symptoms:

Answer 11

Unable to limit amount of alcohol consumed, spending a lot of time drinking or recovering from drinking, strong urges or craving for alcohol, giving up or reducing social and work and productive commitments, experiencing withdrawal symptoms (nausea, sweating, shaking, craving)