27 - addictive behaviour

Question 1

What is addiction

Answer 1

Addiction is a strong uncontrollable desire to consume a particular substance or engage in a certain behaviour

Question 2

which groups is addiction more common in?

Answer 2

men, young people, people with other psychiatric problems, certain jobs.

Question 3

What is dependence syndrome?

Answer 3

behaviours such as: hoarding, binging, craving, withdrawal, ignoring negative consequences, rituals, tolerance, seeking behaviours, loss of control, rituals of consumption and narrowing of repertoire and putting primacy in obtaining.

Question 4

Which receptors involved in reward? other pathway involved in addiction?

Answer 4

Dopamine receptors: reward systems.

Mesolimbic pathway: increase in dopamine release
Stimuli reinforced by this release, reward sensitization

Question 5

Short term / long term risks of alcohol dependence?

Answer 5

Short term risks of arrhythmia, hypoglycaemia, violence, decreased libido, blackout,

Long term risks of IHD, CVA and stroke, oesophageal varices, Wernicke’s and Korsakoff’s, pancreatitis, infertility, depression, fatty liver disease,

Question 6

Mx of alcohol dependence?

Answer 6

Total abstinence is recommended.

Disulfiram - inhibits acetaldehyde dehydrogenase.
Pabrinex – replace B vitamin deficiencies

Psychotherapy and programmes such as 12 step are recommended for motivation.
May need treatment for other problems: liver disease needing a transplant etc.

Question 7

Stages of change

LAMMEEEEE

Answer 7

Pre contemplation 
contemplation 
preparation 
action 
maintenance 
relapse

Question 8

Stages of alcohol withdrawal?

Answer 8

Short term: sweating, tremor, nausea, agitation, tachycardia, hypertension.

Followed by: delusions, confusion, auditory hallucinations, seizures, diarrhoea

May produce delirium tremens: Lilliputian hallucinations, panic attacks, diaphoresis, ataxia, confusion and death,

Question 9

Mx of alcohol withdrawal?

Answer 9

Treat with chlordiazepoxide (benzodiazepine) for sedation and as an anticonvulsant.

Fluid and electrolyte replacement are essential (incl. dextrose).

Thiamine

Consider long term therapy as with alcohol dependence.

Question 10

triad of wernickes

Answer 10

nystagmus
ataxia
confusion

give thiamine

Question 11

Define obsession and compulsion

Answer 11

Obsession = a preoccupying idea

Compulsion = an irresistible urge to behave in a certain way.

Question 12

What do you need for OCD

Answer 12

Obsessions or compulsions must be present on most days for a period of two weeks. The patient must acknowledge their internal presence, they must be regarded as unpleasant and difficult to resist.

Question 13

Mx of OCD

Answer 13

CBT -> SSRI