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MB3 Psychiatry > Addiction > Flashcards

Addiction Flashcards

1
Q

what is the moral model of addiction?

A

addicts take drugs for themselves with no consideration for others or their actions

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2
Q

ICD-10 classification of dependence

A 
strong desire to take substance 
difficulties in controlling substance abuse 
physiological withdrawal state
tolerance 
neglecting alternative pleasures 
persistence despite evidence of harm
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3
Q

name a drug that may cause physical dependence but not psychological

A

opiates

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4
Q

name a drug that causes psychological dependence but not physical

A

cannabis

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5
Q

types of addiction?

A

Drug use

Pathological - gaming, gambling, eating, extreme sports, social media

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6
Q

describe the physical components of the mesolimbic pathway

A

ventral tegmental area connection to nucleus accumbens to ventral striatum
connections to prefrontal cortex, amygdala, hippocampus

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7
Q

describe the mechanism of action of addiction on the mesolimbic pathway

A

modulation of dopaminergic activity leading to raising of dopamine levels
leads to sense of reward and incentivises behaviour to repeat

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8
Q

describe the action addiction has on dopaminergic tolerance on the mesolimbic pathway

A

repeated stimulation leads to downregulation of D2 receptors leading to needing higher quantities of drug needed
normal life is impaired leading to it becoming boring

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9
Q

describe how tolerance leads to -ve reinforcement of addiction

A

initially drug taking is by +ve reinforcement due to dopamine reward
once tolerance develops +ve reinforcement stops and as life becomes boring -ve reinforcement removes dullness or unpleasant effects

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10
Q

reasons for lesser prefrontal cortex activity in those with addiction

A

ACEs
drug use during brain maturation
genetics

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11
Q

describe the function of amygdala and hippocampus in addiction

A

associated with consolidation and expression of drug stimulus learning
so drug association can lead to cravings in addiction ie pictures or seeing drug

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12
Q

function of orbitofrontal cortex in drug addiction

A

internal representation of events and assigns them to action
drug cues activate OFC and increases drug cravings

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13
Q

true/false - those with genetically more D2 have a higher level of addiction in their population

A

false - it is those with lower D2 as they seek reward more

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14
Q

how does stress lead to addiction

A

acute stress triggers dopamine reward

chronic stress downregulates D2 and encourages exposure to more rewarding behaviour and drug seeking

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15
Q

natural forms of opiate?

A

morphine, codeine

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16
Q

semi-synthetic forms of opiate

A

hydrocodone

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17
Q

synthetic forms of opiate

A

metadone

tramadol

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18
Q

who to treat for opiate or other drug addiction?

A 
>3 for >1m 
sense of compulsion 
craving 
physiological withdrawal 
evidence of tolerance 
preoccupation with substance use 
persistent despite consequence
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19
Q

what is included in an opiate safety bundle

A

drug diary, screening
opiate withdrawal scale
recovery care plan
risk assessment

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20
Q

true/false - opiate withdrawal is life threatening

A

false

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21
Q

true/false - opiate toxicity/overdose is life threatening

A

true - warrant for immediate administration of naloxone due to respiratory depression

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22
Q

what is the reason for ORT

A

substitute prescribing to control administration and introduce order and control into addicted individuals life

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23
Q

mechanism of action of methadone, metabolism, dose, means of taking

A

Mu receptor agonist and long half life
hepatic metabolism
30mg initially, 60-100mg
liquid

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24
Q

mechanism of action of buprenorphine, means of taking, dose

A

Mu partial agonist with low intrinsic activity and high affinity
sublingual tablet
12-24mg

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25
Q

considerations to make before which ORT to prescribe

A 
QTc 
ECG 
sedation 
combination therapy 
diversion
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26
Q

what is hazardous drinking

A

anyone drinking >14units alcohol weekly and <35

no alcohol related consequences

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27
Q

calculation of units in a drink

A

strength (ABV) x volume (ml)/1000

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28
Q

where may alcohol related cancers appear

A 
larynx 
mouth or URT 
oesophagus 
breast 
bowel 
liver
29
Q

brief intervention question to ask in emergency care about drinking?

A

how often have you had 6 (F) or 8 (M) units in one occasion in the last year
if weekly to almost daily then full AUDIT scoring needed

30
Q

AUDIT score - 0-5, what is the risk and what intervention needed

A

No action needed

ver low risk

31
Q

AUDIT score - 6-7, what is the risk and what intervention needed

A

Brief intervention

low risk

32
Q

AUDIT score - 8-15, what is the risk and what intervention needed

A

Brief intervention

Moderate risk

33
Q

AUDIT score - 16-19, what is the risk and what intervention needed

A

Brief intervention

High risk

34
Q

AUDIT score - >20, what is the risk and what intervention needed

A

Specialist referral

Very high risk

35
Q

What is brief intervention, what framework should it follow

A

5-15 min intervention by NHS or another service
FRAMES
motivational interviewing

36
Q

what is motivational interviewing

A

guiding change
collaborative conversation
respect autonomy

37
Q

what is the FRAMES framework?

A 
Feedback on problems 
Responsibility on pt
Advice 
Menu to change 
Empathy 
Self-efficacy and optimism
38
Q

Diagnosis of alcohol dependence syndrome

A 
>3 for >1m 
sense of compulsion 
difficulty controlling substance 
withdrawal state 
tolerance 
neglect of other interests/pleasures 
persistence despite evidence of harm
39
Q

mechanism of action of alcohol withdrawal

A

Adapted chronic CNS depression reduces GABA leads to upregulation of glutamate
when stopping alcohol there is unopposed glutamate so unopposed excitation

40
Q

features of alcohol withdrawal

A

restless, tremor, sweating, N&V, anorexia, insomnia, tachy, systolic HTN
passes in 5 days but can have seizure in 24hr

41
Q

what may alcohol withdrawal progress to

A

delirium tremens

42
Q

features of delirium tremens

A

peak 2 days
night time confusion, disorientation, agitation, HTN, fever, hallucination
cardiovascualr collapse or infection

43
Q

best way to prevent delirium tremens

A

do not allow dependent drinkers stop abruptly without support

44
Q

management of alcohol withdrawal

A

BZD cross titrated and reduction over 7 days
pavbrinex
vitamins
thiamine

45
Q

when would you detox a patient in hospital rather than community

A 
>30 units or AUDIT >30 
severe dependence 
hx delirium tremens 
poor support 
cognitive impairment 
poor health 
psychiatric comorbidity
46
Q

when to refer to specialist intervention for alcohol dependence

A

failed to benefit from brief intervejntion, extended intervention
co-morbidity
AUDIT >20

47
Q

non-pharmacological relapse prevention?

A 
CBT 
motivational therapy 
12 step facility 
self control training 
family/couple therapy
48
Q

true/false - give BZD as a pharm intervention for relapse prevention

A

false - only during detox

49
Q

what medications can be given for alcohol rehabilitation and which is first line

A

naltrexone - first line
acamprosate
disulfiram

50
Q

mechanism of action of naltrexone

A

opiate antagonist so reduces reward pathway

51
Q

mechanism of action of acamprosate, what to prescribe with and side effects

A

acts on glutamate and GABA to reduce craving
psychosocial intervention
headache, diarrhoea and nausea

52
Q

mechanism of action of disulfiram, caution and side effects

A

inhibits acetaldehyde dehydrogenase so accumulation of acetaldehyde
leads to flushed skin, hypotension, N&V, tachy, arrhythmia
needs compliance as can lead to severe side effects

53
Q

core features of addictive behaviour

A 
salience 
mood modification 
tolerance 
withdrawal 
conflict
relapse
54
Q

describe the moral model of addiction

A

addiction seen as violation of societal rules, weakness

individuals fault and law enforcement and courts are agents of change

55
Q

describe the dispositional disease model of addiction

A

primary cause individual, loss of control and restraint

no cure for addiction besides abstinence

56
Q

what is the personality model of addiction

A

roots of addiction lie within individuals personality

poor impulse control, low self esteem, cant cope woth stress, manipulation

57
Q

what is the biological model of addiction

A

gene and physiological precess determine addiction in individual
identify biological conditions that contribute to addiction
agent of change is medical establishment to support

58
Q

what are the limitations to the medical model of addiction

A

medical tx reduces harm but not always abstinence
medical tx doesnt exist for many addictions but there is recovery
behavioural addiction?

59
Q

what is the behavioural model of addiction

A

learning through action
influenced by behaviour, environment and consequences
engagement is underpinned by reinforcement

60
Q

what is conditioning

A

through repeated pairings, previously neutral stimuli will elicit a response with something paired with it
ie going to parties as alcoholic conditions response to crave alcohol

61
Q

what is the conditioned compensatory response theory

A

in overdoses, those who are conditioned to the substance are more likely to survive
eg rats heroin experiment

62
Q

what is operant conditioning

A

learning by connecting consequences of action woith behaviour

63
Q

what is +ve reinforcement

A

encourages addictive behaviour by reward

64
Q

what is -ve reinforcement

A

removal of stimuli to increase behaviour frequency

65
Q

what is +ve punishment

A

use of stimulus to decrease frequency

66
Q

what is -ve punishment

A

loss of stimulus to decrease frequency

67
Q

what is the biopsychosocial model to addiction

A

interaction of biological, physical and social factors contribute to addiction and no one factor is dominant over another
holistic

68
Q

what is the cognitive behavioural model of addiction

A

patient vulnerable from genetic factors
exposure to social factors or availability of psychoactive substance lead to cognitive and behavioural processes
become increasingly automatic

MB3 Psychiatry (16 decks)

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