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9. PSYCHIATRY > Addiction > Flashcards

Addiction Flashcards

1
Q

Define alcohol abuse and binge drinking

A

Alcohol abuse: consumption of alcohol to cause physical, psychiatric and/or social harm

Binge drinking: drinking over twice the amount recommended level of alcohol per day in one session

Guidance: no more than 14 units per week (for males and females

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2
Q

ICD-10 alcohol intoxication?

A

General criteria for acute intoxication

• Clear evidence of psychoactive substance use at high dose
• Disturbed consciousness, cognition, perception or behaviour
• Not accounted for by mental or medical disorder
Evidence of dysfunctional behaviour
• Disinhibition, argumentativeness, aggression, labile mood, impaired concentration/attention
• One of the following signs: unsteady gait, slurred speech, nystagmus, flushing, reduced consciousness, conjunctival injection

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3
Q

ICD-10 alcohol withdrawal?

A

General criteria
• Clear evidence of recent cessation or reduction of substance after prolonged/high level usage
• Not accounted for by medical or mental disorder
• Any 3 of the following: tremor, sweating, nausea/vomiting, tachycardia/HTN, headache, psychomotor agitation, insomnia, malaise, transient hallucinations, grand mal convulsions

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4
Q

Symptoms of alcohol intoxication?

Symptoms of alcohol dependence?

A
  • Slurred speech
  • Loss of balance; poor coordination
  • Impaired judgement
  • Severe: hypoglycaemia, coma
Alcohol dependence
• Compulsion to drink
• Withdrawal symptoms relieved by further drinking
• Increased tolerance to alcohol
• Drink seeking behaviour predominates
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5
Q

What is Wernicke’s encephalopathy?

A
  • Acute encephalopathy due to thiamine deficiency
  • Presentation: delirium, nystagmus, ophthalmoplegia, hypothermia and ataxia
  • Can progress to Korsakoff’s psychosis
  • Tx: parenteral thiamine
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6
Q

What is Korsakoff’s psychosis?

A
  • Irreversible short term memory loss
  • With confabulation (filling in empty gaps in memories with imaginary events)
  • Disorientation to time
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7
Q

What is alcohol withdrawal?

A

Alcohol withdrawal

6-12 hours after abstinence
•	Malaise
•	Tremor 
•	Insomnia 
•	Transient hallucinations
•	Autonomic hyperactivity

Around 36 hours
• Seizures

Around 72 hours
• Delirium tremens (severe)

Withdrawal mediation – GABA, glutamatergic and NA systems

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8
Q

What is delirium tremens?

A

Develops between 24 hours and 1 week

Predisposing factor: physical illness

Characteristics:

  • Cognitive impairment
  • Visual abnormalities (hallucinations and/or delusions)
  • Paranoid delusions
  • Marked tremor
  • Autonomic arousal (tachycardia, fever, pupil dilatation, increased sweating)

Medical treatment: high dose of benzodiazepines; psychotic features: haloperidol

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9
Q

Aetiology of alcohol dependence?

A

Stimulant effects of alcohol are mediated by the dopaminergic pathway
Repeated alcohol ingestion sensitises pathway > dependence

Long term exposure: down-regulation of GABA and up-regulation of glutamate (so when alcohol is withdrawn, it results in CNS hyper-excitability)

Positive reinforcement mediation – dopaminergic, serotonergic and opioid systems

Social learning theory – drinking behaviour is based on imitation of social circle

Operant conditioning – positive or negative reinforcements will either perpetuate or deter drinking habits respectively

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10
Q

Risk factors for alcohol dependence?

A

Males – increased alcohol metabolism > consume more alcohol

Younger adults

Genetics

Antisocial behaviour

Lack of facial flushing – flushing is caused by a mutation in the aldehyde dehydrogenase gene that metabolises acetaldehyde more slowly

Life stressors - financial problems, marital stress etc.

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11
Q

Investigations for alcohol dependence?

A

CAGE questionnaire: felt you should cut down? felt annoyed by people commenting? guilty about drinking? eye opener in mornings?

AUDIT questionnaire >8 suggests harmful

Collateral Hx is important

Bloods:
FBC
U+Es (dehydration)
LFTs
Blood alcohol concentration
MCV (raised; macrocytosis)
Vit B12/folate/TFTs (identify alternative causes of macrocytosis)
Glucose (hypoglycaemia)
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12
Q

Treatment of alcohol withdrawal?

A

High dose benzodiazepine (1st line) – e.g. chlordiazepoxide

Thiamine – to prevent Wernicke’s encephalopathy (oral or IV)

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13
Q

Tx of alcohol dependence?

A

Biological: chlordiazepoxide for wihdrawal

Disulfiram, Acamprosate, Naltrexone

Tx medical and psychiatric complications

Psychological: motivational interviewing and CBT

Social: AA, social support including family involvement

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14
Q

ICD-10 Substance misuse - define:

Alcohol intoxication
Harmful use
Dependence syndrome

A

Alcohol intoxication: acute, transient effect of the substance

Harmful use: recurrent misuse associated with physical, psychological and social consequences, but without dependence

Dependence syndrome: prolonged, compulsive substance use leading to addiction, tolerance and potential for withdrawal syndromes

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15
Q

ICD-10 Substance misuse - define:

Withdrawal state
Psychotic disorder
Amnesic syndrome
Residual disorder

A

Withdrawal state: physical and/or psychological effects from complete/partial cessation of a substance after prolonged, repeated or high levels of use

Psychotic disorder: onset of psychotic symptoms within 2 weeks of substance use

Amnesic syndrome: memory impairment in recent memory and ability to recall past experiences. Defect in recall, clouding of consciousness and global intellectual decline

Residual disorder: specific features (flashback, PD, affective disorder, dementia, persisting cognitive impairment) subsequent to substance misuse

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16
Q

Opiates - examples, psychological and physiological effects?

A

Morphine, codeine, heroine, methadone

Apathy, disinhibition, impaired judgement, drowsiness, slurred speech

Respiratory depression, hypoxia, hypotension, coma, hypothermia, pupillary constriction

17
Q

Cannabinoids - examples, psychological and physiological effects?

A

Cannabis

Acts on cannabinoid receptors (most commonly THC)

Euphoria, disinhibition, agitation, paranoid ideation, temporal slowing, illusions and hallucinations

Increased appetite, dry mouth, tachycardia, conjunctival injection

18
Q

Sedatives (hypnotics)- examples, psychological and physiological effects?

A

Benzodiazepines, barbituates

Benzodiazepines enhance GABA by increasing the frequency of chloride channels

Euphoria, disinhibition, apathy aggression, labile mood

Unsteady gait, slurred speech nystagmus, hypotension, hypothermia, erythematous skin lesions, depression of gag reflex, coma

19
Q

Stimulants - examples, psychological and physiological effects?

A

Cocaine, ecstasy (MDMA), amphetamine

Euphoria, increased energy grandiose beliefs, aggression, argumentative, illusions, hallucinations, paranoid ideation, labile mood

Tachycardia, HTN, arrhythmias, sweating, N+V, pupillary dilatation, muscular weakness, convulsions

20
Q

Hallucinogens - examples, psychological and physiological effects?

A

LSD, mushrooms

Anxiety, illusions, hallucinations, depersonalisation, derealisation, paranoia, hyperactivity, impulsivity, inattention

Tachycardia, palpitations, sweating, tremor, blurred vision, pupillary dilatation

21
Q

What is addiction?

Key theories?

A

Impaired control over a reward seeking behaviour from which harm ensues

Learning theories of addiction – classical and operant

Social learning theories
o Self regulation – e.g. goal setting behaviours and motivation
o Vicarious learning (modelling) – through implicit (non-conscious) and explicit (conscious) processes
o Self efficacy – the belief in how successful one would be in engaging in a behaviour/achieving a goal
o Outcome expectancies – “If-then” associations/beliefs; e.g. “If I drink alcohol I will be more sociable”; “If I do this I won’t feel pain”

Self-medication hypothesis
o Using self substances to self soothe during times of stress – e.g. cannabis (anxiety), alcohol (stress, social anxiety), benzodiazepines (depression), heroine, amphetamines (schizophrenia)
o Often linked top problematic childhood relationships and/or trauma
o Substance of choice is based on compensatory effect of the psychoactive properties
o E.g.
 Severe trauma involving violence/aggression – heroin and opiates
 Constricted emotions – alcohol
 Low mood and poor self confidence - stimulants

• Impulse and self-control theories
o Energy, Cognitive and Skill models (Baumesiter 2003)
 Energy: dual processing of the brain:
• System 1 – older part of brain, faster response
• System 2 – reasoning and processing, slower
• When we are low on energy, we end up processing more things through system
o Inhibitory Dysregulation Theory – damage to the reward pathways resulting in reduced ability to inhibit behaviours that are rewarding

Treatment
Alcohol
• SADQ – severity of alcohol dependence questionnaire (score out of 60, anything above 30 is severe)
o Other uses: anxiety, panic attacks, IBS, insomnia

9. PSYCHIATRY (10 decks)

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