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MRCPsych Part B > Addiction Psychiatry 1.3 > Flashcards

Addiction Psychiatry 1.3 Flashcards

1
Q

What was project MATCH?

A

Multisite (9) USA based RCT of 1726 patients testing the hypothesis that matching patient characteristics to specific treatments would improve alcohol dependence.

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2
Q

What did project MATCH find?

A

Patients with low support for drinking derived more benefit from motivational enhancement therapy.
Readiness to change and self-efficacy were the strongest predictors of long-term drinking outcomes.

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3
Q

What was the UKATT?

A

Multicentre (7) pragmatic effectiveness RCT of 742 patients comparing MET and Social Behaviour and Network therapy.

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4
Q

Results of UKATT

A

No difference in therapies used for alcohol dependence

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5
Q

Who did a meta-analysis into therapies for alcohol dependence

A

Slattery et al 2003

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6
Q

What do meta analyses of therapies for alcohol dependence show

A

No difference in therapies re efficacy

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7
Q

What happens in behavioural self-control training?

A

Placing limits on number of drinks
Self-monitoring
Using non-alcoholic spacers
Using food before/after drink
Assertiveness to refuse drink
Reward oneself for goals

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8
Q

What is the FRAMES approach to alcohol?

A

Feedback of risks
Responsibility highlighted
Advised to abstain or cut down
Menu of alternative options
Empathic interviewing
Self-efficacy enhanced

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9
Q

What is AA an example of

A

Twelve step facilitation programme (TSR)

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10
Q

What is the idea behind AA

A

Once someone becomes an alcohol, they remain to be so. This helps by being continuously vigilant and modifying lifestyle accordingly.

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11
Q

Twelve steps of AA

A

Accept powerlessness in front of alcoholism
Admit only a greater power can help
Make a decision to turn to care of god
Make a searching and fearless moral inventory
Admit wrongs done to others
Become ready for removal of defects
Ask him to help now
Be willing to make amends to all
Make direct amends where possible
Continue personal inventory
Prayer and meditation
Practice and preach

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12
Q

What model is motivational interviewing based on

A

Transtheoretical model of change

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13
Q

Aim of motivational interviewing

A

Help patients explore and resolve their ambivalence about behaviour change
Create dissonance in drinker until they are willing to consider alternatives

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14
Q

Principles of motivational interviewing

A

Empathy
Attitude-behaviour discrepancy
Roll with resistance w/o confrontation
Support self-efficacy for change

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15
Q

Aim of CBT for relapse prevention

A

Enhance capacity to maintain abstinence

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16
Q

Impact of CBT on relapse re alcohol

A

Reduces relapse
Reduces intensity of relapse

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17
Q

Describe the minnesota rehab model

A

Use of detox, psychoeducation and AA attendance with 4 weeks stay on the ward followed by aftercare at rehab residences

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18
Q

What is a concept house?

A

Works on a therapeutic community model
Slightly confrontational style, firm feedback given, responsibility emphasized.
Residents have a role in running the house.

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19
Q

Give an example of a concept house

A

Phoenix house

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20
Q

Px of naloxone for opioid OD

A

IV at 0.8mg per 70kg of body weight

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21
Q

Harm reduction advice in opioid use

A

Do not use opiates while alone
Not to use in combination with other routes
Avoid IV
Inject in direction of blood flow
Rotate injection sites
Avoid neck, groin
Ensure complete dissolution before injection - else emboli can occur
Use sterile needles and syringes on each occassion
Use sterile water
Avoid lemon juice - can cause candida endophthalmitis
Never share needles

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22
Q

Drugs available to treat opioid withdrawal

A

Methadone
Buprenorphine
Alpha 2 agonists

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23
Q

How to decide which drug to give for opioid withdrawal

A

Patient choice
Duration of treatment
Adverse effects
Withdrawal severity

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24
Q

Which drugs should be used in opioid withdrawal if short duration is desirable

A

Alpha 2 adrenergic agonists
Buprenorphine

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25
Q

What is Buspirone not helpful in opioid withdrawal?

A

Chronic pain syndrome

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26
Q

Why does Buspirone not cause withdrawal symptoms on abrupt discontinuation?

A

Partial agonist

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27
Q

When is methadone for opioid withdrawal more effective?

A

If carried out slowly or with linear dose reduction

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28
Q

How long can methadone suppress withdrawal for?

A

24-36 hours

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29
Q

When should alpha 2 agonists be avoided?

A

Concerns for bradycardia or hypotension

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30
Q

What dose of methadone reduces withdrawal sx?

A

40-60mg/day

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31
Q

What might high doses of Buprenorphine produce in a dependent patient?

A

Withdrawal sx as acts as antagonist at high doses

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32
Q

What is methadone effective at?

A

Reducing heroin use, injecting and sharing equipment

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33
Q

At what doses is methadone effective as maintenance treatment?

A

60-120mg

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34
Q

Doses of buprenorphine for maintenance treatment

A

8-16mg

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35
Q

Drugs for relapse prevention with maintenance treatment in opioid misuse

A

Methadone
Buprenorphine
LAAM
Suboxone

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36
Q

What is LAAM?

A

Long-acting congener of methadone

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37
Q

How long does LAAM suppress withdrawal for?

A

48-72 hours

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38
Q

Advantage of LAAM over methadone

A

Less frequent clinic visits as suppresses withdrawal for longer

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39
Q

Why is LAAM no longer used?

A

Prolonged QT and Torsades de Pointes

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40
Q

What does Suboxone contain

A

Buprenorphine
Naloxone

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41
Q

Advantage of Naloxone in Suboxone?

A

Deters abuse of tablets by IV injection

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42
Q

What does of buspirone and naloxone produces unpleasant withdrawal sx if taken IV?

A

4:1

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43
Q

What is naltrexone used for?

A

To nullify effects of heroin if relapse occurs

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44
Q

How long does naltrexone last for

A

72 hours

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45
Q

Who is Naltrexone suitable for?

A

Adjuvant therapy
Highly motivated patients
Those who fear consequences if they do not stop opioid use

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46
Q

What forms of Naltrexone need to be tested

A

Implants
Depot

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47
Q

SEs of Naltrexone

A

Insomnia
Dysphoria
Abdominal pain
Nausea/vomiting
Joint and muscle pain
Headaches

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48
Q

What must services do if an opioid dependent patient requests to become abstinent

A

Offer detox
Provide information
Offer community based approach
Offer first line treatment

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49
Q

What information must services provide to opioid dependent patients wishing to become abstinent?

A

Withdrawal experience
Management approaches
Loss of opioid tolerance on successful detox and so risk of intoxication rises

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50
Q

When should community based detox for opioid use not be ffered

A

Previous failure of community detox
Significant additional physical/MH problems
Polydrug detox
Considerable social problems

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51
Q

What is first line treatment for opioid withdrawal

A

Buprenorphine
Methadone

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52
Q

When should Lofexidine be considered in opioid withdrawal?

A

Those with mild or uncertain dependence

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53
Q

What must opioid dependent patients be warned about if given Lofexidine?

A

Need for adjuvant medications to manage nausea, vomiting and shivering

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54
Q

What psychosocial interventions should be offered to opioid withdrawal patients?

A

Self-help groups
Drug misuse services
Contingency management
Urine tests

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55
Q

Who with opioid dependence should be offered opportunistic brief interventions?

A

People with limited contact with services

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56
Q

What is contingency management

A

Incentives e.g. vouchers if clean urine test

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57
Q

How often to do urine tests in those who are in opioid withdrawal

A

Three tests a week for first three weeks
Two tests a week for next three weeks
Once weekly until stability achieved

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58
Q

Recommendation for treatment of amphetamine dependence

A

CBT and Contingency management

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59
Q

What pharmacological agents reduce intensity of cocaine withdrawal?

A

None

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60
Q

What is the fish bowl procedure?

A

Allowing patients to draw a voucher from a bowel after each negative drug test

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61
Q

Evidence for contingency management in cocaine use?

A

Evidence supporting its use

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62
Q

What do NICE guidelines recommend contingency management should be used for?

A

Treatment of primary stimulant misuse and illcit drug use in methadone maintenance treatment

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63
Q

Which psychosocial intervention has the most evidence for cocaine users?

A

Contingency management

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64
Q

Problem with contingency management

A

Reduction or loss of response when reinforcement is stopped

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65
Q

Acceptable outcome of smoking cessation in trials?

A

6 months or longer

66
Q

Relapse rates of smoking after 6 months?

A

8%

67
Q

How many smokers quit without assistance?

A

5-10%

68
Q

How long is nicotine replacement therapy (NRT) given for?

A

2 weeks

69
Q

How many patients are compliant with patch NRT?

A

82%

70
Q

How many patients are compliant with gum NRT?

A

38%

71
Q

How many patients are compliant with nasal spray NRT?

A

15%

72
Q

How many patients are compliant with inhaler NRT?

A

11%

73
Q

Over how long does the transdermal patch NRT deliver nicotine?

A

16-24 hours

74
Q

Which NRT method delivers nicotine fastest?

A

Nasal spray - 5-10 minutes

75
Q

How quickly does nicotine reach blood when NRT gum or inhaler is used?

A

20 minutes

76
Q

Which NRT method delivers nicotine faster than smoking?

A

None

77
Q

Drugs used for smoking cessatino

A

NRT
Bupropion
Nortiptyline
Clonidine
Varenicline

78
Q

Who is Bupropion not licensed for in smoking cessation?

A

Adolescents
Pregnant women

79
Q

Contraindications for Bupropion?

A

Hx of seizures or ED

80
Q

Dose of starting Bupropion for smoking cessation

A

150mg OD for six days
Then increased to 300mg OD

81
Q

By what stage should a smoker on Bupropion stop smoking?

A

Day 8 of treatment

82
Q

How many weeks of treatment required on Bupropion for smoking cessatino?

A

8

83
Q

What does NICE recommend if a smokers attempt to quit is unsuccessful?

A

Do not px NRT or Bupropion within 6 months

84
Q

What was pathological gambling classified as in DSM IV?

A

Impulse Control disorder

85
Q

Where is pathological gambling in DSM V?

A

Alongside substance use disorder

86
Q

How many patients with pathological gambling have comorbid substance misuse?

A

30-50%

87
Q

What is associated with pathological gambling?

A

Genetic markers influencing dopamine transmission
Impulsivity

88
Q

What drugs reduce gambling frequency

A

Naltrexone
Fluvoxamine
CItalopram
Sertraline
Lithium

89
Q

Who first described internet addiction?

A

Young - 1998

90
Q

Which classification has internet addiction?

A

Neither

91
Q

Categories of internet addiction

A

Cybersexual
Syberrelationship
Net compulsion (gambling/shopping)
Information overload
Computer addiction (gaming)

92
Q

Which countries is internet addiction more common?

A

China
Taiwan
Southeast Asia

93
Q

What is oniomania?

A

Compulsive buying

94
Q

Which classificatinos have compulsive buying?

A

Neither

95
Q

Definition of compulsive buying

A

Uncontrollable
Distressing, time-consuming and resulting in family, social, vocational and/or financial difficulties
Not occurring in context of hypomania or mania

96
Q

Prevalence of compulsive buying

A

2-8%

97
Q

Gender ratio of compulsive buying

A

> 80% are females

98
Q

Medications used for compulsive buying

A

High-dose citalopram
Escitalopram

99
Q

Therapies used for compulsive buying

A

CBT with self-monitoring

100
Q

What is an ergogenic agent?

A

One used to enhance performance

101
Q

What does ICD 10 classify steroids as?

A

Non-psychoactive substance

102
Q

Where does ICD 10 classify steroid abuse?

A

F50.xx - disorders of physiology

103
Q

How many fitness users use anabolic steroids?

A

13%

104
Q

How are steroids taken?

A

PO
IM

105
Q

What do steroids do when misused?

A

Support frequency and intensity of workouts
Enhance muscle bulk
Enhance strength and endurance
Speed up healing from sports injuries

106
Q

Doses of steroids when misused

A

10-100 times greater than therapeutic doses

107
Q

Patterns of steroid abuse

A

Cycling
Stacking
Pyramiding

108
Q

What is cycling abuse of steroids?

A

Use for 4-12 weeks in cyclical fashion

109
Q

What is stacking misuse of steroids?

A

Regular use of multiple preparations

110
Q

What is pyramiding abuse of steroids?

A

Gradually building the dose to a peak and then tapering

111
Q

What are anabolic steroid uses associated with?

A

Aggression
Violence
Psychosis
Mania
Depression
Endocrine abnormalities

112
Q

Endocrine abnormalities associated with steroid abuse

A

Acne - 50%
Testicular atrophy - 33%
Gynaecomastia

113
Q

How many young people in Europe have taken legal highs in the past year?

A

5-10%

114
Q

How much is the cost to test the harm of a psychoactive substance?

A

£1 million

115
Q

How long does it take to test the harm of a psychoactive substance?

A

1 year

116
Q

How do stimulant legal highs work?

A

Act via monoamine reuptake transporter - SERT, DAT or NAT blockade

117
Q

Primary stimulant legal high

A

Mephedrone (meow moew)

118
Q

Other stimulant legal highs

A

Benzylpiperazine
Naphyrone
NBOMe-series 2C-series
Benzo fury
Ivory Wave

119
Q

Desired effects of stimulant legal highs

A

Euphoria
Disinhibition

120
Q

Adverse effects of stimulant legal highs

A

Serotonin syndrome
Psychosis
Mania
Hyperthermia
Cardiovascular sx

121
Q

How do psychedelic-like legal highs work

A

Act via 5HT1A, 2A and 2C receptors

122
Q

Name some psychedelic legal highs

A

DMT
Bromo DragonFLY
5-MeO-DAlt
NBOMe-series
2C series
Salvia

123
Q

Desired effects of psychedelic legal highs

A

Perceptual alterations
Feelings of being boundless

124
Q

Name some cannabis-like legal highs

A

JWH-018, 081, 122
AM-2201
UR-144
XLR-11

125
Q

Desired efefcts of cannabis legal highs

A

Relaxation
Pain and anxiety reduction
Sedation
Euphoria

126
Q

Adverse effects of cannabis legal highs

A

Paranoia
Psychosis
Anxiety
Seizures

127
Q

Name some benzomimetic legal highs

A

Pyrazolam
Flubromazepam
Phenazepam

128
Q

Desired effects of benzomimetic legal highs

A

Relaxation
Anxiety reduction
Sedation

129
Q

Adverse effects of benzomimetic legal highs

A

Respiratory depression
Withdrawal seizures

130
Q

How do dissociative anaesthetic legal highs work?

A

NMDA antagonism

131
Q

Name some dissociative anaesthetic legal highs

A

Mexxy
MXE
Diphenidine
3 or 4-MeO-PCP
N-EK
2-MK

132
Q

Desired effects of dissociative anaesthetic legal highs

A

Dissociative state
Pain reduction
Weightlessness

133
Q

Adverse effects of dissociative anaesthetic legal highs

A

Headache
Psychosis
GI sx
Cognitive impairment

134
Q

What is the commonest non-genetic cause of learning disability?

A

Fetal alcohol syndrome

135
Q

Sx in fetal alcohol syndrome

A

Intellectual impairment
Dysmorphic facial features
Disruptive behaviour

136
Q

Guidelines for alcohol use in pregnant women

A

None
Maximum one a day

137
Q

Treatment of alcohol use in preganncy

A

Psychosocial interventinos

138
Q

Medication use for alcohol use in pregnancy

A

Avoid

139
Q

Risk to the baby in opioid use in pregnancy

A

Injections: infection, drug-induced stillbirth, premature birth, antenatal complications,
Low birth weight
Microcephaly
Neonatal withdrawal

140
Q

Mean reduction of baby in patients who use heroin during pregnancy

A

500grams

141
Q

Principles of managing pregnant opioid user

A

Therapeutic alliance
Reduce risk taking behaviours
Stabilise on non-injectable alternatives
Close liaison with obstetric, midwifery and paediatric teams
HIV and hepatitis screening

142
Q

When should detox for opioid use be used in pregnant women?

A

Middle trimester
If done in first trimester - abortion risk
Laster trimester - possible premature birth

143
Q

Initial aim of treating pregnant opioid user

A

Stabilise on oral substitute

144
Q

What needs to be done if a woman starts pregnancy while on methadone

A

Reduce 1mg every 3 days
Fetal monitoring

145
Q

What dose of methadone is advocated during maintenance while pregnant

A

15mg

146
Q

How much more likely is methadone to induce neonatal withdrawal than heroin?

A

60-80%

147
Q

Impact of cocaine use in pregnancy on the baby?

A

Small for gestational age
Microcephalu

148
Q

Impact of cannabis use during pregnancy on the baby

A

Affects neurodevelopment
2 fold risk of low birth weight

149
Q

Mean weight reduction in babes of mothers who used cannabis during pregnancy

A

275grams

150
Q

When is alcohol withdrawal seen in neonates

A

3-12 hours of delivery

151
Q

Signs of alcohol withdrawal in the neonate

A

Hyperactivity
Poor sucking
Tremors
Seizures
Hyperphagia
Poor sleeping pattern
Diaphoresis

152
Q

Signs of barbituate withdrawal in the neonate

A

Severe tremors
Hyperacusis
Excessive crying
Vasomotor instability
Diarrhoea
Increased tone
Hyperphagia
Vomiting
Disturbed sleep

153
Q

Signs of marijuana withdrawal in neonates

A

Fine tremors
Hyperacusis
Prominent Monro reflex

154
Q

Signs of nicotine withdrawal in the neonate

A

Fine tremors
Variations in tone
Poor self-regulation

155
Q

When does opiate withdrawal begin in the neonate?

A

24-48 hours after birth

156
Q

When do signs of opiate withdrawal show in the neonate?

A

3-4 days after birth

157
Q

Signs of opiate withdrawal in the neonate

A

Hyperirritability
GI dysfunction
Respiratory dystress
High-pitched cry
Jittery movements
Increased muscle tone

158
Q

When do methadone withdrawal sx begin in neonates?

A

48-72 hours
May not start until 3 weeks

159
Q

Signs shown in neonates when antidepressants are used in pregnant mothers

A

Jittery
Respiratory distress

160
Q

What type of antidepressants lead to signs in the neonate?

A

Short-acting SSRIs like Paroxetine

MRCPsych Part B (64 decks)

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