Addictions Psychiatry Flashcards
What is reinforcement in addictions?
Response to a stimulus after exposure.
Positive when get a good feeling eg after drinking/using drugs leads to taking the substance again
What is tolerance?
Decreased response to the same level of stimulus after repeated exposure to the stimulus
What are the 2 main mechanisms of tolerance?
- Receptor deregulation (usually by down-regulation)
- Increased metabolism of stimulus (eg with alcohol)
What is substance dependence?
Where the substance is required to maintain normal homeostasis
What is substance withdrawal?
The symptoms that a pt experiences when a substance is suspended that they are dependant on
Which is the main neurotransmitter that is unregulated in addiction?
Dopamine
Name some social factors implicated in addictions
Peer pressure
Fashion
Ritual/tribal culture
Name some behavioural factors implicated in addictions
Reponse and reward of taking drugs
Response and reward of coming out of withdrawal
What is the theory that links childhood to addictions?
Attachment theory - neglect leads to reduced opiate response in brain so drugs are substitute
How do we take an addictions hx?
The same as any other - SQITARS can be useful.
What kind of questions do we ask in an addictions hx?
What drug? When did they start? How long? How much do they take? How much do they spend a week on their addiction? How often? When did it become a problem? What do they experience in withdrawal? Previous treatment? Complications? Overdose? BBVs?
How many UK adults are thought to drink more than the recommended weekly amount of alcohol?
9 Million
What are the top causes of death associated with alcohol?
Fights and Falls
What other ways can alcohol cause mortality?
Liver failure Pancreatitis Overdose Withdrawal Wernickes Encephalopathy
What is Wernickes encephalopathy?
The presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine
What are the symptoms of wernickes encephalopathy?
Acute confusion Delirium Ataxia Ophthalmoplegia Memory disturbance Hypothermia with hypotension Delirium tremens
What can substance misuse cause an episode of?
Psychosis Schizophrenia Mood disorder Anxiety disorders Delerium
What is the recommended weekly intake of alcohol maximum?
14 units
What % of serious alcoholics will get cirrhosis?
one third
What neurotransmitter does alcohol mimic?
GABA - it is a GABA agonist
What are the symptoms of withdrawal from alcohol due to?
Overactivity of the nervous system
What does frequent alcohol detoxing increase the risk of?
Epilepsy
What does drug and alcohol abuse come under?
Externalising disorders
What is it important to distinguish dependance from?
Misuse - many people misuse, but are not dependant
What is the rate of alcohol dependance in the UK, roughly?
3.6%
What % of psychiatry admissions are due to alcohol?
20%
Which occupations are at the highest risk for alcohol/drug abuse?
Journalists Publican Wine merchant Armed forces Entertainer Doctor
How do we help a person control high alcohol intake?
Methods to moderate their drinking, i.e. controlled drinking, self help material, counselling etc.
How is alcohol dependance best treated?
Total abstinence, alongside supportive treatment and medical management
What supportive treatment can we give for alcohol dependance?
Fluid replacement
Thiamine and other vitamin suppliments
What medical treatment can we give to support someone through alcohol dependance?
Thiamine and other vitamin suppliments
Disulfiram
Benzo for sedation and anticonvulsant effect
What is motivational interviewing?
Using techniques to push the pt gently from one step in the cycle of change to another to encourage them to change their ways
What is a good way to talk to a pt in this setting?
Allow them to talk about their issues.
If they bring something up that you see as an issue but they don’t reflect that back to them.
What is delerium tremens?
3-4 days after withdrawal, the pt experiences restlessness, fear, paranoia, confusion, ataxia, tremor, and hallucinations.
