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Psychiatry > Addiction / Alcohol use disorder > Flashcards

Addiction / Alcohol use disorder Flashcards

1
Q

1 unit of alcohol = how many mls & grams?

A

10mls / 8g

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2
Q

Female patient says they drink 5 glasses of wine a night. Is this over their weekly limit?

A

No, 6 glasses of wine = weekly limit of 14 units.

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3
Q

How much alcohol would a woman have to drink to be within the hazardous drinking category?

A

> 14 units/week
BUT
<35 / week

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4
Q

How many units would a man have to drink to be within the hazardous drinking category?

A

> 14 units/week
bUT
<50 / week

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5
Q

What is the category above hazardous drinking and what is a definition of this?

A

harmful drinking - a pattern of alcohol consumption that is causing mental or physical damage.

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6
Q

A woman who is a harmful drinking consumes how much alcohol/week?

A

35 or more units/week

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7
Q

A man who is harmful drinking consumes how much alcohol/week?

A

50 or more units/week

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8
Q

Describe alcohol dependence.

A

A cluster of behavioural, cognitive and physiological factors that typically include a strong desire to drink alcohol and difficulties in controlling its use.

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9
Q

What is tolerance?

A

the need to increase alcohol intake to achieve intoxication
or
a markedly diminished effect with continued use of the same amount of alcohol.

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10
Q

name the 6 elements of the FRAMES brief intervention.

A 
Feedback
Responsibility 
Advice
Menu
Empathy 
self-efficacy
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11
Q

Which drug can be used in medically assisted detoxification?

A

chlordiazepoxide

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12
Q

What is the major downside of medically assisted detoxification?

A

high rate of relapse after successful medicated withdrawal

cognitive impairment / cumulative neuronal damage

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13
Q

What is the kindling effect (seen in medically assisted detoxification)?

A

the severity of withdrawal symptoms tends to increase after each alcohol withdrawal

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14
Q

Which drug used in relapse prevention works on GABA and glutamate transmission?

A

acamprosate

corrects neurotransmission imbalance post-withdrawal and reduced craving

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15
Q

Which drug would you give a patient to prevent relapse and keep them completely abstinent?

A

acamprosate

poor compliance since multiple tablets/day

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16
Q

Which drug can be given to prevent relapse that blocks opioid receptors? What effect does it have?

A

naltrexone - reduced rewarding effect mediated by endorphin system.

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17
Q

Which drug can be given to prevent relapse but allows the patient to continue to drink?

A

nalmefene (selincro)

taken as needed

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18
Q

Which drug when given causes an unpleasant side effect when mixed with alcohol?

A

disulfiram

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19
Q

what is the basic early metabolic pathway of diamorphine?

A

diamorphine (diacetylmorphine) -> 6-mono-acetylmorphine -> morphine

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20
Q

How soon do withdrawal symptoms start after heroin is stopped?

A

6-8hrs

21
Q

What are some symptoms of heroin withdrawal?

A 
cravings
agitation
tachycardia &amp; hypertension
piloerection (goosebumps)
diarrhoea / N&amp;V
dilated pupils
joint pains
yawning 
runny nose &amp; watery eyes
22
Q

What is the basic idea of opiate substitution therapy (OST)?

A

replace a short-acting opiate (heroin) with a long-acting opiate

23
Q

What are the 2 long-acting opiates used in OST and what is the difference between them?

A

methadone & buprenorphine

methadone = long-acting full agonist (liquid used)
buprenorphine = long-acting partial agonist (tablet)
24
Q

Name 3 psychosocial interventions for substance misuse recommended by NICE.

A

contingency management
behavioural couples’ therapy
CBT & psychodynamic therapy

25
Q

Describe contingency management.

A

rewards positive behaviours in order to reduce illicit drug use ± promote engagement with service receiving methadone.

26
Q

Who is behavioural couples’ therapy for?

A

people who are in close contact with a non-drug misusing partner and who present for treatment of stimulant or opioid misuse.

27
Q

When is CBT & psychodynamic therapy indicated in opioid addiction?

A

for co-morbid anxiety and depression (not to treat the drug misuse)

28
Q

Model of addiction which sees addiction as violations of societal rules and a result of human weakness with the individual s the primary causal factor.
Who are the ‘agents of change’ in this model?

A

moral model

agents of change = church, law enforcement and courts.

29
Q

Model of addiction which says addiction is an irreversible disease but can be halted by total abstinence.

A

dispositional disease model

30
Q

Model of addiction that says that the roots of a patient’s addiction lie in their abnormal personality.
Who are the agents of change and which personality traits does this reference?

A

personality traits such as poor impulse control; low self-esteem; inability to cope with stress; egocentricity; manipulation; need for control & power and feeling of powerlessness.

agents of change = psychiatry

31
Q

Model of addiction which says that substance misuse is a learned behaviour and that the patient has gone through conditioning behaviour modification.

A

Behavioural models

32
Q

What is conditioning?

A

the process of behaviour modification whereby an individual comes to associate a desired behaviour with a previous unrelated stimulus.

33
Q

Describe classical (Pavlovian) conditioning.

A

Involve association - repeated pairing with the cue makes a previously neutral stimuli elicit the same response.

34
Q

Describe Operant (Skinnerian) conditioning.

A

Involves instrumental value - learnin. by connecting the consequences of an action with the preceding behaviour

35
Q

Which type of conditioning is this:
A bell is rung every time a dog receives food. When the bell is rung but no food presented the dog will go to its food bowl and expect its food.

A

Classical (pavlovian) conditioning

via associative learning

36
Q

Which type of conditioning is this:

Patient believes that if they do x then y will happen.

A

Operant (skinnerian) conditioning

via instrumental learning

37
Q

Give an example of positive reinforcement felt when a stimulus is present.

A

feeling more relaxed after using (increases frequency of behaviour)

38
Q

Give an example of negative reinforcement - when a stimulus is removed.

A

Getting rid of withdrawals

39
Q

Give an example of positive punishment.

A

Being shouted at by a partner for using.

40
Q

Give an example of negative punishment.

A

Losing a family member and home due to using.

41
Q

Model of addiction in which the central premise states that unconscious process, perception & thought influence emotion and behaviour. Changes in addictive behaviour occur due to changes in motivation, cognition and appraisal.

A

cognitive behavioural model

42
Q

Thinking errors:

It’s just a treat = ?

A

permission-giving

43
Q

Thinking errors:

It’s only one = ?

A

minimisation

44
Q

Thinking errors:

I haven’t used in a whole week, so why not?

A

rationalisation

45
Q

Thinking errors:

I can use and stay in control = ?

A

denial

46
Q

Thinking errors:

She made me angry, so I had to use =?

A

blaming

47
Q

What is incentive salience?

A

Attributing “want” to a stimulus

48
Q

What is the role of the pre-frontal cortex in addiction?

A

Helps intention-guide behaviour.
Modulates the powerful effects of the reward pathway.
Sets goals, focuses attention.
Makes sound decisions.
Keeps emotions and impulses under control to achieve long term goals.

49
Q

Which area of the brain is the ‘Key creator of motivation to act’?

A

orbito-frontal cortex

Psychiatry (6 decks)

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