Addiction Psychiatry

Question 1

Addictive substances are uppers or downers or?

Answer 1

-Coffee, crystal meth, speed, amphetamine
-alcohol, opioids, benzodiazepine groups which sedatives, anxiolytic
- OR hallucinogens.

Question 2

dual diagnosis is common

Answer 2

primary psychiatric condition which the individual treats with drugs.
Addictions could lead to secondary disorders such as anxiety, depression

Question 3

behavioural addictions

Answer 3

-gambling, gaming, tech.
-recent behavioural addiction research shows that the neurobiology is similar to substance addictions. withdrawal symptoms, anxiety and craving also develops

Question 4

the term addiction

Answer 4

• should not be used loosely as strictly it refers to a substance into a body, and this has a reaction in the brain that causes tolerance, person loses control and has withdrawal symptoms

Question 5

What makes a substance addictive? (nicotine vs caffeine as stimulants)

Answer 5

-half life is important.
-this is how quickly the substance gets to the brain. liver breaks it down and it increases in system gradually increases in the blood. with tobacco, you get a short half life therefore it hits quicker. anything inhaled has a short half life and this is what causes addiction. it also has to do something when it reaches the brain; GABAnergic, dopamine and serotonin as well as opioid system (hijacking).

Question 6

What is Addiction?

Answer 6

• Not merely a habit; significant implications for legal defense compared to mental illness.
• The substance hijacks the brain. If core of the brain, grows further out the brain then the brain becomes more advanced. So, prefrontal cortex becomes overdeveloped (as in all primates).
  -Addiction causes executive dysfunction. Prefrontal cortex does not work, so individual does not think of consequences of their action. Withdrawal symptoms can occur at great levels.

Question 7

what is addiction considered a disease of?

Answer 7

disease of brain (Volkow)
-Significant changes occur in the brain often irreversible.

Question 8

Legal Context:

Answer 8

Mental Health Act 1983 (and amendments in 2007)

Question 9

Addiction is associated with….

Answer 9

harm: physical, psychological or social.

Question 10

how does alcohol work?

Answer 10

Alcohol activates the GABAnergic system, initially it causes drowiness. because of tolerance there is compensation and glutamatergic system balances the GABA. It becomes more active to establish eqm. If you take away alcohol = agitation, seizure.

Question 11

Heroin withdrawal symptoms

Answer 11

sweating, erection of body hair, yawning, nose, eyes are runny. Most characteristic symptom is pain in the joint, abdomen and back.

Question 12

Core Components of addiction (DSM-5)

Answer 12

• Tolerance: Increased amounts needed for the same effect.
• Withdrawal: Physical and psychological symptoms when substance use is reduced or stopped.
• Behavioral Patterns: Unsuccessful efforts to cut down, a lot of time spent in obtaining, using, or recovering from the substance.
• Continued Use: Despite knowledge of harm.

Question 13

how does addiction affect the Reward System?

Answer 13

• Role of the Mesolimbic system and specific brain regions like the Anterior Cingulate and Orbito-Frontal Cortex in craving and impulse control. Nucelus accumbens is the main reward centre of the brain.
• Addictive systems gives artificial pleasure by hijacking reward systems. Addicts rely on the immediate reward.

Question 14

evidence from studies

Answer 14

• Studies done on mice, where they take drug consistently and neglect eating and other things- same in humans.

Question 15

Alcohol and Drug Dependence:

Answer 15

Balance between GABAnergic and Glutamatergic is important in alcohol addiction. Down regulation and up regulation, respectively. Detoxing programmes, boosts GABAnergic system, so glutamatergic system calms down.

Question 16

Genetic factors

Answer 16

50% heritability for substance use disorders

Question 17

Environmental and personality factors

Answer 17

play significant roles. Biopsychosocial model is important here. Previous abuse, neglect is predeterminant of addiction.

Question 18

Decreased D2 Receptors:

Answer 18

• The role of D2 receptors. Fewer of them means more likely to use drugs (genetic). There is down regulation of D2 receptors with stimulant use.
• Studies showing changes in brain activity in cocaine addicts.

Question 19

absence models

Answer 19

are important in drug addictions. There is only partial recovery of D2 receptors. Addicts can relapse quickly so cannot become social or recreational users solely.

Question 20

Heroin causes….

Answer 20

extreme euphoria

Question 21

Heroin Withdrawal Symptoms:

Answer 21

• includes sweating, malaise, anxiety, insomnia, nausea, muscle/joint cramps, fever, hypertension.
• To prevent heroin overdose, naloxone injected by relatives.

Question 22

Treatments for Addiction

Answer 22

1. Opioid Substitution Treatment: Methadone (agonist), Buprenorphine, and considerations for detoxification vs. maintenance.
2. Medications for Alcohol Dependency: - Approaches for managing seizures, delirium tremens, and post-detox support.
   - PR diazepam or librium for seizures and detox.
   - BZDA and Pabrinex for Delirium Tremens/Wernicke’s (related to thiamine). Many addicts are malnourished, so pabrinex must be given parenterally; IV or IM.
   - Acamprosate (psycho-social work) and naltrexone (opioid antagonist) are used post-detox. Disulfiram (blocks ADH; accumulation of acetaldehyde) too but no longer used.
3. Harm Minimization for Cannabis Users: THC is addictive and psychotic, - CBD is relaxing and sedating. Anxilytic properties
   - Skunk- very potent (up to 20% THC which is very addictive) with contaminants
4. Behavioral and Rehabilitation Approaches: Relapse preventions, psychoeducation and social support

Question 23

Social and Policy Implications

Answer 23

decrease accessibility and increase price
-> alcohol and tobacco most harmful ranked but still accessible