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Y3 - Psych > Addiction > Flashcards

Addiction Flashcards

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1
Q

How do addictive substances work to cause addiction?

A

Increase the amount of dopamine in the reward pathway
This increases activity in the orbito-frontal cortex and reduces activity of the pre-frontal cortex
This increases substance taking and seeking behaviour

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2
Q

What are the functions of the orbito-frontal cortex and the pre-frontal cortex?

A

Orbito-frontal cortex is involved in producing motivation to act
Pre-frontal cortex is involved in guiding behaviour and keeping impulses under control

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3
Q

What is tolerance?

A

When increasing amounts of a substance are needed to achieve the same effect

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4
Q

Why does tolerance occur?

A

Increased amount of dopamine in the reward pathway causes down-regulation of dopamine D2 receptors

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5
Q

What is intoxication?

A

The dose dependent direct physiological effects of a substance

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6
Q

What is classed as ‘harmful use’ of a substance?

A

A pattern of substance misuse that results in damage to either physical or mental health

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7
Q

What are the features of dependence syndrome?

A 
Cravings
Loss of control
Withdrawal
Tolerance
Preoccupation
Persistent use despite harm
Rapid reinstatement after period of abstinence
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8
Q

What are cravings?

A

The strong desire to take a substance

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9
Q

What is loss of control with regards to addiction?

A

A person is unable to control when or how much of a substance is taken

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10
Q

What is withdrawal in addiction?

A

Physical symptoms that occur during a period of abstinence with associated use to avoid such symptoms

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11
Q

What is preoccupation with regards to addiction?

A

Prioritisation of substance use, which results in neglect of other activities or interests

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12
Q

What is the recommended weekly intake of alcohol?

A

14 units spread evenly across the week with several alcohol free days

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13
Q

What is a calculation to determine the units in an amount of alcohol?

A

(Millilitres of drink x %alcohol) / 1000

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14
Q

What is classed as binge drinking?

A

Males: >8 units per sitting
Females: >6 units per sitting

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15
Q

What is classed as hazardous drinking?

A

Audit 8-14

Drinking over the recommended amount but currently not experiencing any alcohol related problems

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16
Q

What is classed as harmful drinking?

A

Audit 15-19
Current drinking habits have resulted in physical or mental health complications
>35 units per week

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17
Q

What is classed as dependency?

A

Audit >20
Consuming >15 units daily
High levels of alcohol use with at least 3 features of dependence syndrome

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18
Q

What are some complications of alcohol misuse?

A 
Malnutrition
Alcoholic liver disease, liver cirrhosis
Barrett's oesophagus
Mallory-Weiss tear
Peptic ulcer disease
HTN
AF
Stroke
Peripheral neuropathy
Wernicke's
Korsakoff's syndrome
Increased incidence of cancers
Gout
Psychiatric: depression, anxiety, suicidal ideation, delirium
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19
Q

When do symptoms of alcohol withdrawal occur, when do they peak and when do they resolve?

A

Occur 4-12 hours after last drink
Peak at 24-48 hours
(Most) resolve in 5-7 days

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20
Q

Why do alcohol withdrawal symptoms occur?

A

Due to chronic alcohol use causing an imbalance in neurotransmitters in the brain - increased GABA, decreased glutamate

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21
Q

What are the symptoms of alcohol withdrawal?

A 
Overwhelming desire to drink
Insomnia
Anxiety, agitation, restlessness
Shaking, sweating
Tachycardia
HTN
Pyrexia
Nausea ad vomiting
Generalised seizures
Delirium tremens
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22
Q

What is delirium tremens?

A

A severe, potentially fatal form of withdrawal seen in physical dependence

23
Q

How common is delirium tremens?

A

5% of withdrawal cases

24
Q

What is the onset of delirium tremens?

A

Within 2 days of abstinence

25
Q

What are the symptoms of delirium tremens?

A 
Same as withdrawal plus:
Delirium
Ataxia
Course tremor
Hallucinations and delusions
26
Q

What is Wernicke’s encephalitis?

A

Acute onset degenerative inflammation of the brain due to thiamine (B1) deficiency

27
Q

Why are alcoholics more susceptible to Wernicke’s encephalitis in withdrawal?

A

Due to the higher risk of malnutrition there is more risk of thiamine deficiency
In withdrawal metabolism increases but the body sometimes might not have the nutrient stores to support this

28
Q

What are the symptoms of Wernicke’s encephalitis?

A

Delirium
Ataxia
Nysagmus
Ophthalmoplegia

29
Q

What is Korsakoff’s syndrome?

A

Chronic memory impairment associated with thiamine deficiency and Wernicke’s

30
Q

What are the symptoms Korsakoff’s syndrome?

A

Confabulations
Anterograde amnesia - they have short term memory loss which is compensated for by making up stories that they believe are true

31
Q

What should be included in a history for alcohol dependence?

A 
Current alcohol use
Dependency screen
Past alcohol history
Consequences
Insight and motivation
32
Q

What are examples of assessments of a person’s drinking habits?

A

CAGE
AUDIT
FAST
Comprehensive assessment: severity of alcohol dependence questionnaire (SADQ, MMSE, full medical and psych history)

33
Q

What is involved in brief intervention - and when is it given?

A 
For hazardous or harmful drinking
Feedback (of problems due to alcohol)
Responsibility (patient for change)
Advice 
Menu (options for change)
Empathy
Self-efficacy (encourage optimism)
34
Q

What motivational interviewing - and when is it done?

A

For harmful drinking
Assessment of how motivated a patient is for making a change
Encouragement towards the realisation that they need to change their drinking habits

35
Q

When is medically assisted withdrawal done?

A

For dependency

36
Q

When is medically assisted withdrawal done inpatient?

A

Severe dependence
History of delirium tremens or withdrawal seizures
History of failed community detoxifications
Poor social support
Psychotic co-morbidity
Poor physical health

37
Q

When is specialist treatment given for medically assisted withdrawal?

A

Moderate or severe dependence
If brief advice and motivational interviewing haven’t worked and they want further help
If severe alcohol-related impairment or related co-morbid condition

38
Q

What does specialist treatment for medically assisted withdrawal involve?

A

Detoxification and relapse prevention using prescription medications

39
Q

Which benzodiazepines are used in medically assisted withdrawal?

A

Diazepam

Chlordiazepoxidine

40
Q

How are benzodiazepines used in medically assisted withdrawal?

A

Reduce gradually over 7 days or more

Titrate against severity of withdrawal symptoms

41
Q

How do benzodiazepines help in medically assisted withdrawal?

A

Sedate patient and make physical and psychiatric symptoms less traumatic

42
Q

Why are B12 and other vitamins given in medically assisted withdrawal and how are they given?

A

Reduces likelihood of Wernicke’s encephalopathy

Need to be given IV due to malnutrition being associated with villous atrophy and reduced absorption

43
Q

What are the pharmacological options for relapse prevention - and which is first line?

A

Naltrexone - first line
Disulfiram
Acamprosate

44
Q

What is naltrexone and how does it help relapse prevention?

A

Opioid agonist

Reduces reward from alcohol

45
Q

What are some physical risks in opiate misuse?

A 
Skin infection 
DVT 
Blood-borne viruses
Damage to nasal mucosa 
Physical dependence
Anxiety, depression, psychosis
Benzodiazepines - seizures
46
Q

What are signs of an acute overdose?

A 
Pinpoint pupils 
Decreased GCS
Respiratory depression 
Hypotension
Bradycardia
47
Q

What is the management of an acute opiate overdose ?

A

Naloxone

Respiratory support

48
Q

What are symptoms of withdrawal from opiates?

A 
Goosebumps
Dilated pupils
Tachycardia
Hypertension
Agitation
Sweating
Abdominal pain
Diarrhoea
49
Q

What are the management options for relapse prevention of opiate addiction?

A

Opioid replacement therapy

Psychosocial intervention, counselling and input from other agencies

50
Q

What is opioid replacement therapy?

A

Deliberate prescribing of opioid drugs in a controlled manner to introduce some order and control into lifestyle

51
Q

What is the process of opioid replacement therapy?

A

Induction
Optimisation
Maintenance
Dose reduction

52
Q

What drugs are options for opioid replacement therapy?

A

Methadone
Buprenorphine
Clonidine/Lofexidine

53
Q

What are the features of methadone?

A 
Opioid agonist
Long half life
Can prolong QT interval
Can cause sedation
High dependence and low lethal dose
54
Q

What is the treatment for overdose of methadone?

A

Narcan

Y3 - Psych (12 decks)

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