Addictions Psychiatry

Question 1

What is reinforcement in addictions?

Answer 1

Response to a stimulus after exposure.

Positive when get a good feeling eg after drinking/using drugs leads to taking the substance again

Question 2

What is tolerance?

Answer 2

Decreased response to the same level of stimulus after repeated exposure to the stimulus

Question 3

What are the 2 main mechanisms of tolerance?

Answer 3

• Receptor deregulation (usually by down-regulation)

- Increased metabolism of stimulus (eg with alcohol)

Question 4

What is substance dependence?

Answer 4

Where the substance is required to maintain normal homeostasis

Question 5

What is substance withdrawal?

Answer 5

The symptoms that a pt experiences when a substance is suspended that they are dependant on

Question 6

Which is the main neurotransmitter that is unregulated in addiction?

Answer 6

Dopamine

Question 7

Name some social factors implicated in addictions

Answer 7

Peer pressure
Fashion
Ritual/tribal culture

Question 8

Name some behavioural factors implicated in addictions

Answer 8

Reponse and reward of taking drugs

Response and reward of coming out of withdrawal

Question 9

What is the theory that links childhood to addictions?

Answer 9

Attachment theory - neglect leads to reduced opiate response in brain so drugs are substitute

Question 10

How do we take an addictions hx?

Answer 10

The same as any other - SQITARS can be useful.

Question 11

What kind of questions do we ask in an addictions hx?

Answer 11

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?

Question 12

How many UK adults are thought to drink more than the recommended weekly amount of alcohol?

Answer 12

9 Million

Question 13

What are the top causes of death associated with alcohol?

Answer 13

Fights and Falls

Question 14

What other ways can alcohol cause mortality?

Answer 14

Liver failure
Pancreatitis
Overdose
Withdrawal
Wernickes Encephalopathy

Question 15

What is Wernickes encephalopathy?

Answer 15

The presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine

Question 16

What are the symptoms of wernickes encephalopathy?

Answer 16

Acute confusion
Delirium
Ataxia
Ophthalmoplegia
Memory disturbance
Hypothermia with hypotension
Delirium tremens

Question 17

What can substance misuse cause an episode of?

Answer 17

Psychosis
Schizophrenia
Mood disorder
Anxiety disorders
Delerium

Question 18

What is the recommended weekly intake of alcohol maximum?

Answer 18

14 units

Question 19

What % of serious alcoholics will get cirrhosis?

Answer 19

one third

Question 20

What neurotransmitter does alcohol mimic?

Answer 20

GABA - it is a GABA agonist

Question 21

What are the symptoms of withdrawal from alcohol due to?

Answer 21

Overactivity of the nervous system

Question 22

What does frequent alcohol detoxing increase the risk of?

Answer 22

Epilepsy

Question 23

What does drug and alcohol abuse come under?

Answer 23

Externalising disorders

Question 24

What is it important to distinguish dependance from?

Answer 24

Misuse - many people misuse, but are not dependant

Question 25

What is the rate of alcohol dependance in the UK, roughly?

Answer 25

3.6%

Question 26

What % of psychiatry admissions are due to alcohol?

Answer 26

20%

Question 27

Which occupations are at the highest risk for alcohol/drug abuse?

Answer 27

Journalists
Publican
Wine merchant
Armed forces
Entertainer
Doctor

Question 28

How do we help a person control high alcohol intake?

Answer 28

Methods to moderate their drinking, i.e. controlled drinking, self help material, counselling etc.

Question 29

How is alcohol dependance best treated?

Answer 29

Total abstinence, alongside supportive treatment and medical management

Question 30

What supportive treatment can we give for alcohol dependance?

Answer 30

Fluid replacement

Thiamine and other vitamin suppliments

Question 31

What medical treatment can we give to support someone through alcohol dependance?

Answer 31

Thiamine and other vitamin suppliments
Disulfiram
Benzo for sedation and anticonvulsant effect

Question 32

What is motivational interviewing?

Answer 32

Using techniques to push the pt gently from one step in the cycle of change to another to encourage them to change their ways

Question 33

What is a good way to talk to a pt in this setting?

Answer 33

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.

Question 34

What is delerium tremens?

Answer 34

3-4 days after withdrawal, the pt experiences restlessness, fear, paranoia, confusion, ataxia, tremor, and hallucinations.