Addictive Behaviour Flashcards
What areas are involved in addiction
Ventral tegmental area
Nucleus accumbens
Define “acute intoxication”
Transient condition following the administration of alcohol/psychoactive substances
Results in disturbed levels of consciousness, cognition, perception, affect, or behaviour
Define “harmful use”
A pattern of psychoactive substance use that is causing damage to health
Damage may be physical or mental
Define “dependence”
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
Define “tolerance”
Diminished response to a substance over the course of prolonged or repeated exposure
Define “withdrawal”
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
Symptoms of alcohol withdrawal
4-12hrs after alcohol
Tremor, nausea, sweating, mood disturbance
Outline delirium tremens
Acute confusional state secondary to alcohol withdrawal
48hrs after alcohol
Medical emergency
5-10% mortality
Symptoms of delirium tremens
Confusion, markedly fluctuating
Marked psychomotor agitation
Visual, auditory and tactile hallucinations
Sweating, paranoia, high temperature
Outline Wernicke’s encephalopathy
Triad: confusion, ataxia, ophthalmoplegia (6th CN)
Reversible
Give thiamine + magnesium
Outline Korsakoff’s syndrome
Anterograde and retrograde amnesia
Poor short-term memory
Confabulation
Minimal content in conversation
Lack of insight
Irreversible
Pharmacology of alcohol
Enhances GABA-A response (anxiolytic)
Promotes release of dopamine
Inhibits glutaminergic response at NMDA receptors (amnesic)
Harmful effects of alcohol
physical, mental, social
Physical:
Fatty liver, cirrhosis, CBD, stroke, hypertension, cancer
Mental:
Depressive disorder, anxiety, suicide, psychosis,
Social:
Unemployment, domestic violence, crime
Symptoms of opiate withdrawal
Sweating Piloerection Malaise and anxiety Yawning and sneezing Tears, rhinorrhoea, diarrhoea Insomnia Nausea and vomiting Severe muscle/joint cramps and aches Fever, hypertension, hyperventilation
Pharmacodynamics of alcohol
Opens GABA chloride channels
Pharmacodynamics of GHB/GBL
Release DA and GABA agonist
Pharmacodynamics of amphetamine
Releases DA and NA/5HT
Pharmacodynamics of cocaine
Reduces DA uptake
Pharmacodynamics of MDMA
Releases 5HT and DA
Pharmacodynamics of heroin
μR agonist
Pharmacodynamics of ketamine
NMDA antagonist and μRs agonist; enhances MA transmission
Investigations in drug/alcohol toxicity
Physical exam (track marks) Breathalyse Mouth swab Hair sample Urine drug screen History
Treatment of alcohol dependence
Don’t suddenly stop (risk of seizures/delirium tremens)
Cravings:
Acamprosate (enhances GABA and inhibits glutamate actvity)
Naltrexone (opioid antagonist)
Nalmefene
Treatment of alcohol withdrawal seizures
PR diazepam or IV lorazepam
