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CP2 > 4 - PSY - Alcohol and substance misuse > Flashcards

4 - PSY - Alcohol and substance misuse Flashcards

1
Q

Acute intoxication

A

Transient physical and mental abnormalities
May causes disturbed consciousness, cognition, perception, affect, behaviours etc
Specific for each substance

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2
Q

Harmful use

A

Continuation of use despite damage to user’s physical/mental health or to social well-being - may be denied/minimised by user

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3
Q

Withdrawal

A

Due to cessation after physical dependence
Clinically significant withdrawals = alcohol, opiates, benzos, cocaine, amphetamines
Complicated by development of seizures, delirium or psychotic symptoms

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4
Q

Tolerance

A

More must be taken to achieve same intensity of effect

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5
Q

6 core features of dependence syndrome

A

Primacy - drug and getting it = priority in life
Continued use despite negative consequences
Loss of control of consumption
Narrowing of the repertoire
Rapid reinstatement of dependent use after abstinence
Tolerance and withdrawal

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6
Q

Substance induced psychotic disorder

A

Psychotic as direct result of substance neuro-toxicity
Psychotic features either during intoxication/withdrawal, or on background of chronic use
Can be difficult differentiating between this and primary psychotic illness

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7
Q

Most common cause of alcohol related death?

A

Alcoholic liver disease

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8
Q

Cost of alcohol to NHS?

A

Estimated as £3.5bn per year

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9
Q

One unit =

A

8g/10ml of pure ethanol

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10
Q

Guideline weekly drinking for men and women?

A

14 units

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11
Q

Biological alcohol misuse aetiology

A

Risk 7x if first degree relative is alcohol dependent
Alcohol dependent parents = increased risk (even if adopted!!)
No specific genes - although some determine metabolising capacity (SEAsian’s may not be able to metabolise -> unpleasant flushing reaction)

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12
Q

Psychological alcohol misuse aetiology

A

Mental illness increases risk
Stress, high social anxiety + low self esteem
Negative and Positive reinforcement models can be applied. E.G. - using alcohol to deal with stress, or using alcohol to be happy in social situations

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13
Q

Social/Occupational alcohol misuse

A 
Men>women - women increasing over last 20y
Mortality higher in lower socio-economic classes
Social isolation + loss of spouse = higher risk
Certain professions (bar-tending, farming)
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14
Q

Complications of Alcohol misuse - Neuro

A

CNS - cog and mem impaired, brain shrinks, Wernicke-Korsakoff syndrome, Cenral Pontine Myelinolysis, Cerebellar degeneration
PNS - alcoholic peripheral neuropathy and myopathy, optic atrophy and visual changes

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15
Q

Complications of Alcohol misuse - Resp

A

increases susceptibility to aspiration pneumonia and infections

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16
Q

Complications of Alcohol misuse - CV

A

Alcoholic cardiomyopathy
Arrhythmia - esp AF
HTN
Cerebrovascular events - esp haemm strokes

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17
Q

Complications of Alcohol misuse - Hepatic

A

Alcohol hepatitis
Fatty liver changes - vast majority changes reverse with abstinence
Cirrhosis at end stage of either of above - females increased risk of cirrhosis
Hepatocellular carcinoma

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18
Q

Complications of Alcohol misuse - renal

A

Cirrhosis can predispose to hepato-renal syndrome

HTN > CKD

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19
Q

Complications of Alcohol misuse - Pancreas

A

Commonest cause of chronic pancreatitis > malabsorption > DM

Also Acute pancreatitis

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20
Q

Complications of Alcohol misuse - Spleen

A

Splenomegaly secondary to cirrhosis and portal HTN

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21
Q

Complications of Alcohol misuse - S + L Bowel

A

Malabsorption
Chronic diarrhoea
Lower GI Ca risk factor

22
Q

Complications of Alcohol misuse - Gastro-oesophageal

A

Oesophageal - Mallory Weiss tears from vomiting, varices +/- haemorrhage, Barretts oesophagus and CA
Gastric - gastritis and gastric erosions, peptic ulcer +/_ haemorrhage, gastric CA

23
Q

Complications of Alcohol misuse - Sexual health

A

Women - sexual dysfunction, fertility problems risk, teratogenic
Men - ED + hypogonadism

24
Q

Complications of Alcohol misuse - Psychiatric

A

Alcoholic hallucinosis - occurs during clear consciousness (sober)
ARBrainDamage - 60% of chronic heavy drinkers - impaired memory and executive function
Pathological jealousy - Primary delusion that partner has/is being unfaithful
Other PSY co-morbidity - anxiety and depression, suicide, schizophrenia

25
Q

Risk factors for more severe alcohol withdrawal

A

Increased amount + time of heavy drinking
Intercurrent medical illness
Liver disease
Previous withdrawal episodes

26
Q

When to prophylactically treat AWS

A
  • known alcohol dependence
  • Hx of alcohol withdrawal
  • consumed >10 units for >10 days
  • current withdrawal symptoms
27
Q

Mild/uncomplicated alcohol withdrawal

A

Occurs 4-12 hours after the last alcoholic drink
Features: coarse tremor, sweating, insomnia, tachycardia, nausea and vomiting, psychomotor agitation, anxiety
The patient may occasionally experience transient hallucinations
Intense cravings for alcohol
Typically lasts 2-5 days

28
Q

Seizures in AWS

A

5-15% of cases
6-48 hours after the last drink
Risk factors for seizures include: heavy, prolonged alcohol consumption, previous withdrawal seizures, idiopathic epilepsy and history of head injury

29
Q

Delirium Tremens - background

A

medical emergency
1-7 days after last drink
5% of AWS patients
40% mortality if untreated

30
Q

Delirium Tremens - symptoms

A 
clouded consciousness 
time, place, person disorientation
amnesia
hallucinations and delusions
severe psychomotor agitation and tremor
Fever
Autonomic disturbances and E imbalances
31
Q

AWS Key management

A

Benzos for Sx relief
Nutritional and Vitamin supplementation (thiamine)
Close physical and psychiatric complication monitoring

32
Q

Thiamine deficiency - alcoholic causes

A

-drinkers dietary habits
Chronic alcohol reduces thiamine absorption from gut
Drinkers>liver disease - capacity for thiamine storage is reduced

33
Q

How is Wernicke’s encephalopathy caused?

A

Secondary to Thiamine (Vit B1) deficiency

34
Q

Wernicke’s symptom triad ?

A

Ataxic gait, Ocular motor signs, Acute confusional state

35
Q

Wernicke’s treatment

A

ALL PT’s with symptoms/high risk of WE -> parenteral vitamin replacement
High potency Thiamine replacement
Glucose rehydration AFTER thiamine - glucose makes worse

36
Q

Wernicke’s Prognosis

A

untreated - 80% to Korsakoff’s

15% mortality if untreated

37
Q

Korsakoff’s Syndrome aetiological features

A

usually results from thiamine deficiency
Rare causes - head injury, CO poisoning, encephalitis
Can present w/o WE and in chronic form

38
Q

Korsakoffs - Clinical features

A

Anterograde amnesia ( can’t lay down new memories)
(Less marked) retrograde amnesia
Confabulaiton (false memories covering amnesia
Apathy

39
Q

Korsakoffs Treatment

A

aggressively treat preceding WE
Oral thiamine and vitamins for 2 years
Pyschosocial interventions for cog imp

40
Q

Alcoholic History - In depth areas:

A
  • Lifetime pattern of alcohol consumption
  • Current consumption
  • Signs of dependence
  • Social/occupational problems
  • Previous treatment attempts
  • Physical and mental health
41
Q

Alcoholic Investigations

A

MCV - high specificity - raised 3-6 months after abstinence (life of RBC)
GGT - alcohol related liver inflammation
Liver US if indicated

42
Q

Heroin - route? harmful effects?

A
  • most commonly smoked - many progress to IV use
  • Acute -N+V, constipation, resp depression + lost consciousness
  • IV use - Hep B C + HIV, abscesses, cellulitis, septicaemia
43
Q

Cocaine - harmful effects

A

Acute - ^HR, HTN, Vasoconstriction —- increasing risk fo CVA, MI and Arrhythmias —- acute anxiety, panic, impulsivity, impaired judgement
Chronic - Nasal septum ad sinus necrosis, CKD 2ndary to HTN, Panic disorder, GAD, Psychosis

44
Q

Harm reduction strategy examples…

A
  • needle distribution + education
  • Take home naloxone
  • Substitute prescribing
  • treat co-morbidities
  • safe sex education
45
Q

6 stages of change?

A

— Pre-contemplation (no intention of changing) — contemplation (aware of problem) — Preparation (intent to take action) — Action — Maintenance (sustained change) — Relapse —

46
Q

4 principles of motivational interviewing

A

Develop discrepancy (between behaviour and personal goals)
Roll with resistance
Express empathy with reflective listening
Support self efficacy (improve pt confidence in ability to change)

47
Q

Disulfiram

A

deterrent to alcohol abuse - unpleasant symptoms of flushing, headache, tachycardia,N+V if you drink

48
Q

Acamprosate

A

to reduce cravings of alcohol - by enhancing GABA transmission in brain

49
Q

Lofexidine

A

alpha agonist - reduces opiate withdrawal symptoms

50
Q

Loperamide or Metoclopramide - why?

A

to treaet diarrhoea and N+V commonly seen in withdrawal

51
Q

Substitute prescribing

- 2 drugs

A

Methadone - 24h half life - suitable for once daily dosing - orally - long acting synthetic opioid
Buprenorphine - partial mu agonist - once daily sublingual preparation

Both have street value

CP2 (339 decks)

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