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Psychiatry Year 3 Dundee > Addiction > Flashcards

Addiction Flashcards

1
Q

According to the ICD 10 to have a dependance on something you need….

A 
3 or more in that last year
Strong desire to take substance
Difficulties in controlling substance use
Physiological withdrawal state
Tolerance
Neglect alternative pleasure
Persistence despite evidence of harm
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2
Q

What is the ICD-11 definition of a Gaming Disorder?

A

Impaired control over gaming
Increased priority over other activities
Disregard of negative consequences
Significant impairment to function

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3
Q

CAGE - addiction

A

Cut down - felt need to cut down
Annoyed - at people criticising levels of usage
Guilty - about amount spent
Eye opener - first thing you do in the morning

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4
Q

What is Incentive Salience?

A

Cognitive attributing want to a substance

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5
Q

What pathway drives the Incentive Salience?

A

Mesolimbic pathway

Dopamine is a motivating and incentivising neurotransmitter

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6
Q

What do all addictive drugs act upon?

A

Dopaminergic activity

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7
Q

How does a craving develop?

A

Chronic overexposure to dopamine - reduced D2 receptor expression
Tolerance builds up as more and more dopamine needed to evoke same response.

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8
Q

Why do addicts usually find normality dull and unfulfilling?

A

Normal stimuli don’t trigger enough dopamine to be released.

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9
Q

What type of reinforcement is an acute addiction and why?

A

Positive reinforcement - to reach a high

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10
Q

What type of reinforcement is a chronic addiction and why?

A

Negative reinforcement - to prevent the negative affects of withdrawal - protective

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11
Q

How does the prefrontal cortex affect addiction?

A

Modulates the affects of reward pathway as ability to override mesolimbic pathway and resist the cravings.
Sets goals and focuses attention

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12
Q

What can be a predisposing factor to acquiring an addiction?

A

Underactivity or dysfunction of the prefrontal cortex

Unable to consciously override urges

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13
Q

Why does early age drug experimentation have an impact on addiction?

A

Due to the plasticity of the prefrontal cortex long exposure can lead to alterations to promote such urges

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14
Q

What is the function of the hippocampus and amygdala?

A

Consolidation and acquisition of memories and learning

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15
Q

How can the hippocampus and the amygdala have an affect on addiction?

A

Expression of drug stimulus learning, as a result learned associations can trigger urges.

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16
Q

What is the function of the Orbitofrontal cortex?

A

Collates stimuli and attaches importance to them

Key creator of motivation to act

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17
Q

How are addicts Orbitofrontal cortex wired?

A

Show increased activity when exposed to drug cues

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18
Q

What gene is linked to higher risk activities to gain a high?

A

Low DRD2 receptor expression

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19
Q

What is the affect of Acute stress on dopamine?

A

Dopamine release in neural reward pathway

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20
Q

What is the affect of Chronic stress on dopamine?

A

Dampening of dopaminergic pathways

Reduced reaction to normal - encourages to seek highly rewarding often dangerous behaviour.

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21
Q

AUDIT - what is it?

A

Quantifies level of hazardous drinking

Less sensitive to harmful drinking and dependance

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22
Q

What is hazardous drinking?

A

Pattern of consumption that increases their risk of physical mental and social consequences.

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23
Q

How many units would be classed as Hazardous drinking?

A

Between 14-35 units per week

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24
Q

Equation for Units

A

Units = (Strength ABV x volume (ml)) / 1000

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25
Q

What cancers have an increased incidence in those who drink over 14 units a week?

A 
Mouth
Upper throat
Larynx 
oesophagus
Breast
Liver
Bowel
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26
Q

What is the most important question in the Fast Alcohol Screening done in A and E?

A

How often have you had 6 units (Female) 8 units (Male) or more units on a single occasion in the past year?

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27
Q

If somoene has an audit score over 5 what do they require?

A

A brief intervetion

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28
Q

What is a Brief Intervention?

A 
5- 15 minutes FRAMES
Feedback review problems due to alcohol
Responsibility is down to patients
Advice factual is best
Menu provide options for change
Empathy 
Self Efficacy encourage optimism
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29
Q

Alcohol dependance syndrome

A 
3 or more of the following
Strong desire or compulsion
Difficulty in controlling - onset termination or level of use
Physiological withdrawal star
Evidence of tolerance
Progressive neglect
Persistence despite evidence of harm
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30
Q

What is alcohols affect on the CNS?

A

Suppression by acting on GABA A receptors

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31
Q

Why do you get withdrawal symptoms from alcohol?

A

Due to over activation of GABA receptors -brain unregulated Glutamate activity and down regulates expression of GABA receptors.
Withdrawal leads to massive imbalance - excessive glutamate is toxic to nerves - unregulated glutamate excitation.

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32
Q

Describe alcohol withdrawal syndromes course.

A

First symptoms generally occur within hours the peak is between 24-48 hours.
Generally resolved between 5-7 days

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33
Q

What are the common symptoms of Alcohol withdrawal syndrome?

A 
Restlessness 
Tremor
Sweating
Anxiety
N+V
Loss of appetite 
Insomnia
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34
Q

What are some of the more serious symptoms of Alcohol withdrawal syndrome?

A

Tachychardia
Systolic Hypertension
generalised seizures - <24hrs

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35
Q

What is a medical emergency in regards to alcohol withdrawal?

A

Delirium tremens

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36
Q

When and what proportion of withdrawals result in delirium tremens?

A

2 days post abstinences

5% of cases

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37
Q

Describe delirium tremens

A

Often insidious onset - night time confusion

Confusion , disorientation, agitation, hypertensive, fever, visual auditory hallucinations , paranoid ideations.

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38
Q

What is the mortality rate of delirium tremens?

A

2-5% - with medical intervention much higher without

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39
Q

What is it that kills you in Delirium Tremens?

A

Cardiovascular Collapse and infection

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40
Q

What should you never advice a dependant drinker to do?

A

Go cold turkey without support or observation

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41
Q

How do you manage a withdrawal?

A

General support advice and reassurance
BDZ - titrate against severity reduce over 7 days
Vitamin supplementation

42
Q

What BDZ are used in alcohol withdrawal ?

A

Diazepam

Chlordiazepoxide

43
Q

What vitamin is especially important in alcohol withdrawal management?

A

Thiamine prophylaxis to prevent Wernickes Encephalopathy

44
Q

When should an inpatient detox be undertaken?

A

Severe dependance AUDIT >30 or 30 units
History of seizures or Delirium Tremens
Cognitive impairment or poor physical health
Poor social support

45
Q

When should specialist services be involved?

A

Moderate to Severe dependance

Failed to benefit from brief or extended interventions

46
Q

What can be provided in inpatient detox that improve chances of going clean?

A

Adequate hydration
Analgaesia
Antiemetic
Treat infections and other physical conditions that might be driving them towards substance abuse

47
Q

What are some effective psychosocial therapies for relapse prevention?

A

CBT
motivational enhancement therapy
behavioural self control training
12 step facilitation therapy e.i AA

48
Q

When are BDZ used in alcohol dependance?

A

Only used acutely

49
Q

MOA of Disulfiram

A

Inhibits Acetaldehyde Dehydrogenase

Accumulation of acetaldehyde if ingested leads to unpleasant side effects

50
Q

What does a patient on Disulfiram experience if they ingest alcohol?

A 
Flushed skin
Tachycardia
N+V
Arrhythmias
Hypotension
51
Q

What medication can be used to prevent alcohol relapse?

A

Naltroxene - 1st line
Acamprosate
Disulfiram

52
Q

What is an issue with Disulfiram?

A

Efficacy is entirely dependance on compliance

Making someone take a drug that makes them feel horrendous in difficult

53
Q

Acamprosate MOA

A

Acts on glutamate and GABA
Reduces cravings needs to be started ASAP
Used alongside psychosocial interventiona

54
Q

Acamprosate sideffects

A

Headaches Diarrhoea Nausea

55
Q

Naltrexone

A

Opiod antagonist reduces reward gained from alcohol

56
Q

What are some natural Opiates?

A

Morphine

Codeine

57
Q

What are some semi-synthetic opiates?

A

Hydrocodone

Hydromorphone

58
Q

What are some fully synthetic opiates?

A

Methadone

Tramadol

59
Q

How do opiates work?

A

Induce dopamine release into the mesolimbic pathway.

60
Q

What is the definition of opioid replacement therapy?

A

Deliberate introduction of prescribed drugs in a controlled manner.

61
Q

What are the stages of opioid replacement therapy?

A

Induction
Optimization
Maintenance
Reduction

62
Q

What is optimisation?

A

Completely eliminating illicit drug use

63
Q

What medication can be used in opioid replacement therapy?

A

Methadone

Buprenophine

64
Q

What is Methadone?

A

A Mu receptor agonist

Long half life peak plasma at 4 hrs

65
Q

Describe the course of Methadone.

A

1x daily

Steady state is achieved by day 5

66
Q

What dosage of methadone is given?

A

Start at 30ml and titrate up

60-100ml is normal effective dose

67
Q

What metabolism does methadone undergo?

A

CY3P4 in liver

68
Q

When is Methadone contraindicated?

A

Prolongs QT

Anyone with a cardiac history or in combination with others drugs which prolong QT

69
Q

What risks are associated with methadone?

A

Sedative

Diversion- sell their methadone onto others

70
Q

What is Buprenophine?

A

Mu partial agonist

Low intrinsic activity but high affinity for receptor

71
Q

When are peak plasma levels of buprenophine reached?

A

1.5-2.5 hours

72
Q

What is the effective dosage of Buprenophine?

A

12-24mg

73
Q

How is Buprenophine delivered and what could the possible benefits of this be?

A

Sublingually

Pharmacist is able to observe it being taken

74
Q

What models of addiction are there?

A 
Moral
Dispositional
Personality
Biological 
Behavioural 
Cognitive
75
Q

Moral model of addiction.

A

Wilful violation of societal rules due to human weakness

Individual is primary causative factor

76
Q

According to the moral model how is someone treated for addiction?

A

Moral persuasion
Imprisonment
Spiritual guidance

77
Q

Dispositional disease model of addiction.

A

Primary cause is the individual

78
Q

According to the dispositional model how is someone treated for addiction?

A

Addiction is irreversible only total abstinence is the cure.

79
Q

Personality model

A

Abnormal individual with poor impulse control and unable to deal with stress and low self esteem

80
Q

Biological medical model.

A

Emphasis on genetic and physiological process - individual is still the cause.

81
Q

What region of the brain is associated with binge or intoxication?

A

Ventral striatum

82
Q

What region of the brain is associated with withdrawal ?

A

Amgydala

83
Q

What region of the brain is associated with preoccupation anticipation?

A

Cortex
Hippocampus
Cingulate gyrus

84
Q

What is the basis behind the behaviour model?

A

Addiction is the result of well rehearsed over learned repertoires.
Actions are influenced by the associations we make between our behaviour and environment.

85
Q

What two doctrines define the behavioural model?

A

Pavlovs Associative learning

Operant (instrumental) conditioning

86
Q

Pavlovs Associative learning

A

Through repeated pairing a previously neutral stimuli will come too illicit a response.

87
Q

Give an example of pavlovs associative learning.

A

Sensory stimuli e.g. clinking of glasses results in cravings

88
Q

Operant (Instrumental) Learning

A

Learning by connecting the consequences of an action with the preceding behaviour.
e.g entering pub = good time

89
Q

Operant (Instrumental) Learning - Positive

A

Applies the stimuli

90
Q

Operant Instrumental Learning - Negative

A

Removes the stimuli

91
Q

Operant Instrumental Learning - Reinforces

A

Increases the frequency of the behaviour

92
Q

Operant Instrumental Learning - Punishment

A

Decreases the frequency of the behaviour

93
Q

What is an example of positive reinforcement?

A

You are more relaxed after use

94
Q

What is an example of negative reinforcement?

A

Removes the withdrawal symptoms

95
Q

What is an example of Positive Punishment?

A

Shouted at by partner for using

96
Q

What is an example of negative punishment?

A

Losing family and home for using

97
Q

What is habit formation?

A

Acquired behaviour due to repetition of action until involuntary

98
Q

Cognitive theory

A

Addiction recruits and influences through
Attention bias Memory bias
Selective recall and implicit bias

99
Q

How can cognitive processing help addiction?

A

Slow down to prevent autonomic responses which allow biases to creep in.

100
Q

What are some common thinking errors?

A 
Its just a treat - permission giving
Its only one - Minimisation
She made me angry I had to - Blaming
I can use and stay in control - Denial
Ive been good all week - Rationalisation
101
Q

What is the best treatment for addiction?

A

Biopsychosocial - Medication + psychology + social work

Psychiatry Year 3 Dundee (21 decks)

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