3. Alcohol dependence

Question 1

How common is it?

Answer 1

Common

5.9% estimation

Question 2

Who does it affect?

Answer 2

M>F

Question 3

What causes it?

Answer 3

No single causal factor
Associated with many mental health problems
Social issues eg neglect, violence

Question 4

What risk factors are there?

Answer 4

FH
Psychological factors
Psychiatric comorbidities
Adverse life events
Environmental factors

Question 5

How does it present?

Answer 5

CAGE (Compulsion to drink, Angry when someone challenges you, Guilt for drinking too much, Eye-opener)
Worrying about where next drink is coming from
Difficulty stopping drinking once started
Withdrawal symptoms eg sweating, nausea, rigors

Question 6

What signs may the patient have on examination?

Answer 6

Withdrawal symptoms
High bp
May present with complications eg liver disease, anaemia

Question 7

What other conditions might present similarly?

Answer 7

Other mental health issues
Other drug dependence
NASH
Hypoglycaemia
Acute head injury

Question 8

How would you investigate?

Answer 8

Blood alcohol levels
Breathalyzer test
FBC, TFTs, LFTs

Question 9

What treatments are there?

Answer 9

Symptom management of withdrawal (chlordiazepoxide)
Talking therapies
Medication

Question 10

What complications are there?

Answer 10

Alcoholic liver disease
Hepatic encephalopathy
Psychiatric disturbances
Worsening CHD
Foetal alcohol syndrome
Anaemia / B12 deficiency