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Psychiatry > Addiction > Flashcards

Addiction Flashcards

1
Q

What is the moral model of addiction

A

The idea that addicts use drugs through choice with no regard for the consequences of the drug use
This model leads to the criminal justice approach to management of drug addiction through prisons etc.
The individual is the cause

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2
Q

What is the medical model of addiction

A

The idea that being addicted to drugs and repeatedly taking them causes neurobiological changes in the brain which decrease the persons ability to exercise free choice
This leads to more compassionate care and better treatment

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3
Q

What are the symptoms of substance dependence

A 
A strong desire to take the substance
Difficulties in controlling substance use
A physiological withdrawal state 
Tolerance
Neglect of alternative pleasures 
Persistence despite evidence of harm
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4
Q

Which NT is the motivating signal in the reward pathway

A

Dopamine

The more that is released, the more a person is incentivised to perform that behaviour

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5
Q

How do drugs trigger the reward pathway

A

They all cause dopamine release by acting on a variety of targets in the nucleus accumbens
Cocaine and amphetamines act on dopamine receptors which is why they have such significant effects

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6
Q

What is meant by tolerance to reward

A

The dopamine pathway is overstimulated (by drug use) and is downregulated
This means that normal pleasure activities will no longer be enough to trigger the pathway
This leads to continued drug use to cause pleasure

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7
Q

How long does tolerance to reward last

A

The changes in the dopamine pathway will persist for an extend period even with prolonged abstinence
This leads to high relapse rates

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8
Q

What drives drug addiction

A

Initially it is driven by the reward pathway - positive reinforcement
Then it becomes a thirst - negative reinforcement

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9
Q

What is the function of the prefrontal cortex

A

It’s involved in executive function - making sound decisions and keeping emotions and impulses under control
Last part of the brain to develop - still developing into 20s

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10
Q

How is the prefrontal cortex involved in addiction

A

It is often much less developed in those who are addicted
Could be genetic or caused by substance use before it is developed
Makes it harder to stop drugs in the long term - less executive functioning

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11
Q

How is the hippocampus involved in drug behaviour

A

It is important in memory and learning
Learned drug/substance associated such as rolling a cigarette will cue a state of craving by stimulating the dopamine pathway

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12
Q

How is the orbito-frontal cortex involved in drug use

A

It is the key creator of motivation to act

Highly associated with cravings

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13
Q

Does substance use have a genetic component

A

Yes = 40-60% of risk is due to genetics

May affect how the body responds to drugs, the dopamine response and behavioural traits

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14
Q

How does stress affect the dopamine pathway

A

Acute stress leads to dopamine release within the neural reward pathways
Chronic stress leads to downregulation of the receptors which reduces sensitivity to normal rewards - this encourages exposure to highly rewarding behaviour such as drug taking

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15
Q

What is incentive salience

A

When you attribute want to a stimulus

The reward pathway is involved

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16
Q

Describe the current trend in drug deaths

A

Numbers are rising

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17
Q

List the effects of heroin (and other opiates)

A 
Euphoria 
Analgesia
Constipation 
Reduced conscious level Respiratory depression 
Hypotension and bradycardia 
Pupillary constriction 
Tolerance develops with repeated use
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18
Q

How long does it take for withdrawal to start

A

Typically occurs within 6-8 hours

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19
Q

Describe drug tolerance

A

As you contribute to use drugs you become tolerant to that dose
Usual dose no longer has an effect and so the person takes more - cycle

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20
Q

What often causes a drug death

A

People try to come off the drug and their tolerance drops

If they re-take their usual dose which is now far too high

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21
Q

Describe the symptoms of opiate withdrawal

A 
Dysphoria and cravings
Agitation
Tachycardia and hypertension
Piloerection
Diarrhoea, nausea and vomiting
Dilated pupils
Joint pains
Yawning (constant) 
Runny nose (rhinorrhoea) and watery eyes (Lacrimation)
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22
Q

Which route of administration of heroin gives a stronger affect

A

Injecting it

Stronger effect and often cheaper

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23
Q

What infections can be caused by IV drug use

A

Local: cellulitis, abscess, thrombophlebitis, necrotising fasciitis
Distant: e.g. infective endocarditis,
Systemic: Hep B, HIV, Hep C

24
Q

Do opioids cause psychosis

A

No

Cannabis, hallucinogens and alcohol are much more likely to do this

25
Q

What psychiatric issues are common in opioid misuse

A

Anxiety and depression

26
Q

Which drugs are used for opioid replacement therapy

A

Methadone or buprenorphine

27
Q

Which drugs are used for opioid detox

A

Methadone
Buprenorphine
Lofexidine

28
Q

Which drugs are used as opioid antagonist

A

Naloxone
Naltrexone
Used to treat an overdose
Recommended to all that use opiates and their families

29
Q

What are the characteristics of an ideal substitution treatment

A

Safe and well tolerated
Stop withdrawal symptoms
Should not be addictive
Have a long affect

30
Q

Which of the opioid replacement drugs has the strongest effect

A

Methadone - it is a pure opioid agonist

Buprenorphine is a partial agonist so is less potent

31
Q

If someone is on very high doses of heroin which opioid replacement drug is the better choice

A

Methadone

It has the stronger effect

32
Q

Which of the opioid replacement drugs is safer

A

Buprenorphine
Less risk of overdose
It is less sedative
Has a blocking effect so reduces effect of using on top of it
Has a longer effect and quicker titration
Easier to detox from

33
Q

How long does it take to titrate up buprenorphine

A

2-3 days

34
Q

How long does it take to titrate up methadone

A

Weeks to months

This is due to the high risk of overdose

35
Q

Why is buprenorphine not indicated for patients who use high doses of opiates

A

There is a risk of induced withdrawal as it has a lower effect
It can be misused - injected or snorted
It is less sedative

36
Q

What is the correct maintenance dose (in general)

A

The dose where the patient stops using and is not getting cravings
This can be much higher than the dose that would stop withdrawal symptoms

37
Q

What is the starting dose of methadone

A

10-30mgs

38
Q

What is the starting dose of buprenorphine

A

4-8mgs

39
Q

How do you titrate up methadone

A

Start on 10-30mgs
First week – increase by maximum 10mgs per day and max 30mgs per week
Takes 5 days to reach steady state which means that on one dose the blood level and effect will rise for 5 days
No maximum dose

40
Q

How is opioid replacement administered

A

• Supervised consumption – there is daily pick up from the pharmacy and the pharmacist will observe the patient taking their dose

41
Q

Describe the dispositional disease model

A

Individual is still considered the ‘problem’ but they have lost control of their impulses
The addiction is seen as irreversible but you can manage it with total abstinence

42
Q

What is the role of the amygdala in drug use

A

It is responsible for the withdrawal affect

It makes the person feel like their body is in danger without the substance

43
Q

Can addiction affect the connections in the brain

A

YES - It can actually change them
It triggers the reward pathways
Also get a lot of anticipation of using

44
Q

What is the primary disorder in addiction

A

It is a behaviour disorder primarily - impulse to use

45
Q

What is conditioning

A

The process of behaviour modification whereby an individual comes to associate a desired behaviour with a previous unrelated stimuli
Substance misuse is a learned behaviour

46
Q

What is the difference between positive and negative punishment

A

Psoiitve is when something is being ‘added’ - such as stimulus of being shouted at
Negative punishment is when something is taken away - home or family etc

47
Q

What are the intended outcomes of reinforcement and punishment

A

Reinforcement aims to increase the frequency of a behaviour

Punishment aims to decrease frequency

48
Q

What is the definition of a habit

A

An acquired behaviour pattern regularly followed until it becomes almost involuntary
More we do something, the more it becomes a habit
Acquired by learning mechanisms

49
Q

What is attention bias and how does it affect drug addicts

A

Attention is drawn to specific things

Addicts are more likely to notice stimuli related to their addiction (e.g. others smoking)

50
Q

How are addicts affected by memory bias

A

When presented with substance, the brain only recalls the positives of using and forgets the negatives
Can encourage addictive behaviour

51
Q

Describe slow cognitive processing

A

Deliberate and conscious process

Under the persons control and requires cognitive effort

52
Q

Describe fast cognitive processing

A

Unintentional and automatic process
Usually occurs out of the persons awareness
No effort required

53
Q

What are the functions of substance misuse (why do people do it)

A

People often use substances to block out unpleasant memories or to feel numb
Escape overwhelming thoughts/feelings
Substance can also provide a good feeling - more of something
Commonly used in social or celebratory situations

54
Q

What is the biopsychosocial model

A

Concerned with the interaction of biological factors (physical health, genetics), psychological factors and social
Look at all aspects of a persons life - no factor is dominant

55
Q

List biological/physical factors which can affect substance misuse

A 
Current non-prescribed drug use
Current prescribed drug use
Physical dependency 
Use and treatment history 
Injecting behaviour 
Physical health - BBV
56
Q

List psychological factors which can affect substance misuse

A

Personal history -family, social etc
Coping skills and cognitive functioning
Current/past psych problems

57
Q

List social factors that can affect substance misuse

A 
Significant relationships
Housing
Employment
Financial
Legal

Psychiatry (14 decks)

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