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5. Psychiatry > 3- Substance Abuse D/o > Flashcards

3- Substance Abuse D/o Flashcards

1
Q

What are the 4 features of alcoholism?

A
  1. Craving
  2. Impaired control
  3. Physical dependence
  4. Tolerance
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2
Q

Understanding alcoholism is based on what model?

A

Bio-psycho-social model

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3
Q

Neurally, alcoholism is due to a balance between what?

A

Drive/reinforcement (ventral tegmental area) vs. executive control (prefrontal cortex)

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4
Q

Genetic predisposition to alcoholism is a/w with what physiological change?

A

Mutated dopamine transporter

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5
Q

What is the addiction cycle?

A

Preoccupation/Anticipation => Binge/intoxication => Withdrawal/negative affect (repeat)

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6
Q

T or F: Drug use will occur faster/more frequently if there is a genetic predisposition?

A

TRUE

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7
Q

What is the 3-step clinical process for recovery?

A
  1. Screen
  2. Diagnose
  3. Treat
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8
Q

During the screening phase of recovery, where does this typically occur and what screening tools are used?

A

Primary care

Cage or AUDIT

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9
Q

During the diagnosis phase of recovery, where does this typically occur and what screening tools are used?

A

Psychiatry/Addiction medicine

MAST, DSM

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10
Q

During the treatment phase of recovery, where does this typically occur and what screening tools are used?

A

In-patient (detox/rehab)

Out-patient (rehab/follow up)

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11
Q

Who are “at risk users” (substance misuse)?

A

> 14 drinks/wk for men vs. >7 drinks/wk for women OR

> 4 drinks/occasion for M vs. >3 drinks/occasion for F/seniors

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12
Q

Who are “problem users” (substance abuse)?

A

Those that experience problems related to substance abuse (health, legal ,family, school, work)

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13
Q

Who are “dependent users” (~addiction)?

A

Increased loss of control, alcohol related consequences, physiological dependence

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14
Q

If pt admits to alcohol use during HPI, what screening tool can be used to get additional information?

A

CAGE (4 questions taken from MAST, if score of 1+ consider AUDIT)

  1. Have you ever felt like you should Cutdown your drinking?
  2. Have you Annoyed people w/ your drinking?
  3. Have you ever felt Guilty/bad about drinking?
  4. Have you ever had a drink 1st think in the morning (Eye opener) to steady nerves/get rid of hangover?
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15
Q

What screening tool is best for alcohol abuse, problem drinking and asks about frequency?

A

AUDIT (10 questions, high specificity/sensitivity, score of 8+ = harmful/hazardous drinking)

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16
Q

How does the DSM5 organize substance related d/o?

A
  1. Class: substance related d/o
    1. Group: Substance-use d/o
      1. Disorder: By substance and by severity
    2. Group: Substance-induced d/o
      1. Disorder: intoxication, withdrawal, delirium, dementia, amnesia, psychosis, mood d/o, anxiety, sexual dysfunction, sleep d/o
17
Q

What are the sx a/w substance use d/o? (11)

A
  1. Taking more/longer than intended
  2. Desire to cut down (or unsuccessful attempts)
  3. A lot of time devoted to acquiring, using, recovering
  4. Craving for drug/to use
  5. Failure to fulfill obligations
  6. Persistent use despite social harm
  7. Giving up important things/reducing them
  8. Use in physically hazardous situations
  9. Use despite physical/psychological harm
  10. Tolerance
  11. Withdrawal
18
Q

What is the DSM5 criteria for substance use d/o? Severity? Specifiers?

A
  1. 2+ w/in 12 months (*sx # from previous card)
    - impaired control (sx #1-4)
    - social impairment (sx #5-7)
    - risky use (sx #8-9)
    - pharmacological (sx #10-11)

Severity: Mild (2-3 sx), Mod (4-5 sx), sever (6+ sx)

Specifiers:

  • W/ or w/o physical dependence (sx #10-11)
  • TX Course (when, if in tx)
19
Q

What are 3 motivational techniques for getting a pt into tx?

A

One-on-one Confrontation (don’t argue, just state the facts, make unique to pt and get pt/family to agree to tx)
Showing empathy
Offering hope

20
Q

What is the disease model for alcoholism? (4)

A
  1. Alcoholism is a disease like any other medical condition
  2. Alcoholism has an “early stage”
  3. It is NOT the pts fault
  4. Can be tx w/ good prognosis
21
Q

Pts w/ alcoholism can seek treatment anywhere along the spectrum of abuse. When should a pt absolutely seek help?

A

Tolerance + dependence + compulsion

22
Q

What is the tx progression for substance use d/o

A
  1. Inpatient (detox in hospital, rehab 14-28 days)
  2. Out patient (rehab, 1/2 way house)
  3. Therapy (individual, group)
  4. Support from “inner circle”
23
Q

What is a “Dual diagnosis”?

A

Pt w/ substance use d/o AND comorbid psychiatric condition

24
Q

What strategies are used in individual therapy?

A

Motivation interviewing, CBT, behavior modification

25
Q

What strategies are used in group therapy?

A

12 step programs, specific support groups

26
Q

What meds are used to tx DTs in inpatient alcohol detox?

A

Diazepam
Lorazepam
Phenobarbital

27
Q

What nutritional needs should be considers for inpatient alcohol detox?

A

Thiamine

28
Q

What is included in for long term tx of substance use d/o? (4)

A

Disulfiram
Acamprostate
Naltrexone
Individual/group counseling (AA)

5. Psychiatry (19 decks)

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