Addiction psychiatry

Question 1

What are the 2 distinct mechanism which drive substance misuse?

Answer 1

Tolerance

Reward centre

Question 2

What is tolerance?

Answer 2

Reduced responsiveness to a drug caused by previous administration

Question 3

What causes dispositional tolerance?

Answer 3

Less drug reaches the active site
Less drug absorbed
Drug metabolised faster
More drug excreted

Question 4

What causes pharmacodynamic tolerance?

Answer 4

Drug has less action at the active site
Fewer drug receptors
Less efficient drug receptors

Question 5

Why does tolerance sometimes lead to dependence?

Answer 5

Development of tolerance may lead to withdrawal symptoms

Question 6

What are the acute and withdrawal effects of opioids?

Answer 6

Constipation

Diarrhoea

Question 7

What is the reward pathway?

Answer 7

Neurones project from the ventral tegmental area to the nucleus accumbens & prefrontal cortex

Question 8

What is released when VTA neurones are stimulated?

Answer 8

Dopamine

Question 9

How does drug abuse relate to reward centres?

Answer 9

Some drugs of abuse tap into the reward pathway and increase dopamine levels
This produces the psychological component of addiction

Question 10

How does heroin affect reward centres?

Answer 10

Increase firing rate of dopaminergic neurones

Question 11

How does amphetamine affect reward centres?

Answer 11

Increased dopamine release

Question 12

How does cocaine affect reward centres?

Answer 12

Inhibits dopamine uptake

Question 13

Which is the most potent natural stimulant?

Answer 13

Cocaine

Question 14

How quickly does cocaine take effect?

Answer 14

Smoking - almost immediate
Injecting - 15 to 30 secs
Snorting - 3 to 5 mins

Question 15

What are the effects of cocaine?

Answer 15

Stimulant/euphoriant
Alertness
Energy
Confidence
Impaired judgement
Lessens appetite and desire for sleep

Question 16

What are some adverse effects of cocaine?

Answer 16

Damage to nose and airways
Convulsions with respiratory failure
Cardiac arrhythmia's and MI
Hypertension and CVA
Toxic confusion
Paranoid psychosis

Question 17

What are some withdrawal effects of cocaine?

Answer 17

Depression 
Irritability
Agitation
Craving
Hyperphagia
Hypersomnia

Question 18

Does amphetamine last longer or shorter than cocaine?

Answer 18

Longer

Question 19

What are some commonly abused opiates?

Answer 19

Opium
Morphine
Heroin
Methadone
Codeine
Dihydrocodeine

Question 20

What does the phrase “chasing the dragon refer to?”?

Answer 20

Smoking heroin

Question 21

What are some adverse effects of heroin use?

Answer 21

Respiratory arrest with a pulse
Pinpoint pupils Unreactive to light
Snoring giving way to shallow respiration
Bradycardia
Hypotension
Reduced consciousness/coma

Question 22

What are some adverse effect of opiates?

Answer 22

Nausea
Vomiting
Headache
Phlebitis
Anorexia
Constipation
Tolerance
Withdrawal
Social

Question 23

What are some characteristics of opiate withdrawal syndrome?

Answer 23

Craving
Insomnia
Yawning
Muscle pain and cramps
Increased salivary and nasal secretions
Dilated pupils
Piloerection

Question 24

Almost half of all eccies contain no MDMA. What else do they contain?

Answer 24

Nil active
LSD
Amphetamine
Ketamine

Question 25

What are some common effects of MDMA?

Answer 25

Euphoria followed by feeling of calm Increased sociability Inability to distinguish between what is and isn’t desirable

Question 26

What are some adverse side effects of MDMA?

Answer 26

``` Nausea Dry mouth/dehydration Increased BP and temp Anxiety Panic Psychosis ```

Question 27

What is another name for Novel Psychoactive Substances (NPS)?

Answer 27

Legal highs

Question 28

When might anabolic (androgenic) steroids be legitimately prescribed?

Answer 28

Hypogonadism Muscular dystrophy Various anaemias Wasting in AIDS

Question 29

Muscle hypertrophy from steroid use is particularly marked in which areas?

Answer 29

Pectoralis Deltoid Trapezius Biceps

Question 30

What are some skin effects of steroid use?

Answer 30

Acne Stretch marks Baldness

Question 31

How might steroid use adversely affect males?

Answer 31

Feminisation Hypogonadism Gynaecomastia

Question 32

How might steroid use adversely affect women?

Answer 32

``` Virilisation Hirsutism Deep voice Clitoral enlargement Menstrual irregularities Hair thinning ```

Question 33

How does steroid use affect the CVS?

Answer 33

Increased cholesterol | Hypertension

Question 34

How does steroid use affect growth?

Answer 34

Growth deficits due to premature closure of epiphyses

Question 35

How does steroid use affect the liver?

Answer 35

Cholestatic jaundice | Liver tumours

Question 36

What are some psych side effects of steroid use?

Answer 36

Irritability Hypomania/mania Depression on withdrawal

Question 37

How is naloxone used?

Answer 37

Opiate antagonist | Reverses effect of opiates