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Psychiatry > Addictive Behaviour > Flashcards

Addictive Behaviour Flashcards

1
Q

What areas are involved in addiction

A

Ventral tegmental area

Nucleus accumbens

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2
Q

Define “acute intoxication”

A

Transient condition following the administration of alcohol/psychoactive substances

Results in disturbed levels of consciousness, cognition, perception, affect, or behaviour

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3
Q

Define “harmful use”

A

A pattern of psychoactive substance use that is causing damage to health

Damage may be physical or mental

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4
Q

Define “dependence”

A

3 or more of the following, which should have occurred together for at least 1 month:

Compulsion

Aware of harm but continues to consume

Neglect of alternative pleasures/interests

Tolerance

Stopping causes withdrawal

Time - pre-occupied in use

Out of control

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5
Q

Define “tolerance”

A

Diminished response to a substance over the course of prolonged or repeated exposure

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6
Q

Define “withdrawal”

A

A group of physical and psychological symptoms that occur on absolute or relative withdrawal of a substance after repeated/prolonged/high-dose use of that substance

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7
Q

Symptoms of alcohol withdrawal

A

4-12hrs after alcohol

Tremor, nausea, sweating, mood disturbance

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8
Q

Outline delirium tremens

A

Acute confusional state secondary to alcohol withdrawal

48hrs after alcohol

Medical emergency

5-10% mortality

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9
Q

Symptoms of delirium tremens

A

Confusion, markedly fluctuating

Marked psychomotor agitation

Visual, auditory and tactile hallucinations

Sweating, paranoia, high temperature

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10
Q

Outline Wernicke’s encephalopathy

A

Triad: confusion, ataxia, ophthalmoplegia (6th CN)

Reversible

Give thiamine + magnesium

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11
Q

Outline Korsakoff’s syndrome

A

Anterograde and retrograde amnesia

Poor short-term memory

Confabulation

Minimal content in conversation

Lack of insight

Irreversible

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12
Q

Pharmacology of alcohol

A

Enhances GABA-A response (anxiolytic)

Promotes release of dopamine

Inhibits glutaminergic response at NMDA receptors (amnesic)

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13
Q

Harmful effects of alcohol

physical, mental, social

A

Physical:
Fatty liver, cirrhosis, CBD, stroke, hypertension, cancer

Mental:
Depressive disorder, anxiety, suicide, psychosis,

Social:
Unemployment, domestic violence, crime

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14
Q

Symptoms of opiate withdrawal

A 
Sweating
Piloerection
Malaise and anxiety
Yawning and sneezing
Tears, rhinorrhoea, diarrhoea
Insomnia
Nausea and vomiting
Severe muscle/joint cramps and aches
Fever, hypertension, hyperventilation
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15
Q

Pharmacodynamics of alcohol

A

Opens GABA chloride channels

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16
Q

Pharmacodynamics of GHB/GBL

A

Release DA and GABA agonist

17
Q

Pharmacodynamics of amphetamine

A

Releases DA and NA/5HT

18
Q

Pharmacodynamics of cocaine

A

Reduces DA uptake

19
Q

Pharmacodynamics of MDMA

A

Releases 5HT and DA

20
Q

Pharmacodynamics of heroin

A

μR agonist

21
Q

Pharmacodynamics of ketamine

A

NMDA antagonist and μRs agonist; enhances MA transmission

22
Q

Investigations in drug/alcohol toxicity

A 
Physical exam (track marks)
Breathalyse
Mouth swab
Hair sample
Urine drug screen
History
23
Q

Treatment of alcohol dependence

A

Don’t suddenly stop (risk of seizures/delirium tremens)

Cravings:
Acamprosate (enhances GABA and inhibits glutamate actvity)
Naltrexone (opioid antagonist)
Nalmefene

24
Q

Treatment of alcohol withdrawal seizures

A

PR diazepam or IV lorazepam

25
Q

When to consider inpatient treatment for alcohol dependence

A

Failed home detoxification

Co-existing physical/mental illness

Poly-substance misuse

Social isolation

26
Q

Treatment of cannabis dependence

A

Education

Gradually reduce

Mix more tobacco

No skunk

Relaxation techniques

Family therapy

27
Q

Treatment of opioid addiction

A

Substitution:
Methadone
Buprenorphine
Diamorphine

Post-Detox:
Naltrexone

28
Q

Psychosocial treatment of opiate addiction

A

Harm reduction

Day centres

Group therapy

CBT

Residential rehabilitation

29
Q

Outline alcoholics & narcotics anonymous

A

Self-help group (self-refer)

Based on “12 steps”

No records kept of meetings

Peer led support and camaraderie

New social connections & structure

30
Q

Social and vocational interventions for addiction

A

Housing

Financial support

Employment advice

Basic education and vocation training

Family therapy

Psychiatry (15 decks)

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