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Mental Health > Alcohol > Flashcards

Alcohol Flashcards

1
Q

What is the ICD-10 criteria for addiction?

A

3 of the following symptoms, present together at some time during the previous year or constantly for 1 month:

  • Strong desire for substance
  • Difficulties in controlling substance taking behaviour in terms of its onset, termination or levels of use
  • Evidence of tolerance, have to take higher levels for same effect
  • Withdrawal symptoms when stopping usage
  • Salience over other things in their life
  • Continuous use even though they know it’s harmful
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2
Q

What are alcohol withdrawal symptoms?

A
  • Symptoms start at 6-12hr: tremor, sweating, tachycardia, anxiety, tachypnoea
  • Peak incidence of seizures at 36hrs
  • Peak incidence of delirium tremens at 48-72hrs
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3
Q

What are the symptoms of delirium tremens?

A
  • Autonomic hyperactivity
  • Tachycardia
  • Fever
  • Insomnia
  • Anxiety
  • Hypertension
  • Perceptual distorsions
  • Visual or tactile and auditory hallucinations (formication)
  • Fluctuating motor activity (hyperactivity to lethargy)
  • Coarse tremor
  • Delusions
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4
Q

What is the pharmacological management of alcohol withdrawal?

A
  • 1st line: long acting benzodiazepines e.g. chlordiazepoxide (Librium) or diazepam
  • Lorazepam may be preferred in hepatic failure
  • Carbamazepine also effective in treatment of alcohol withdrawal
  • Rehydration with IV fluids and pabrinex to reduce risk of Wernicke’s encephalopathy
  • Always include thiamine Vit B1
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5
Q

What are the symptoms of Wernicke’s encephalopathy?

A
  • Clinical triad: opthalmoplegia (weakness of eye muscles) with nystagmus, ataxia and confusion
  • Peripheral sensory neuropathy, altered GCS
    Life threatening illness due to thiamine deficiency
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6
Q

What are the investigations and treatment for Wernicke’s encephalopathy?

A
  • Investigations: decreased red cell transketolase (detects thiamine deficiency), MRI
  • Treatment: high dose thiamine
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7
Q

What is Korsakoff’s syndrome?

A
  • Wernicke’s, if untreated, can develop into Korsikoff’s syndrome
  • Neuropsychiatric disorder associated with memory disturbances in which there are significant deficits in anterograde and retrograde memory
  • Immediate memory is maintained but short term memory is diminished with intact sensorium
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8
Q

What are features of Korsikoff’s syndrome?

A
  • Associated with patients fabricating stories in the setting of clear consciousness. Confabulations can be spontaneous or provoked (former in acute Wernicke’s state and latter in chronic Korsikoff’s).
  • Anterograde/retrograde amnesia
  • Apathy
  • Lack of insight
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9
Q

What are the current UK guidelines for alcohol consumption?

A
  • 14 units/wk
  • 6 pints of 4% beer, 7 175ml glass of wine a week
  • Units = strength (ABV) x volume (ml) / 1000
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10
Q

What are the mental and behavioural disorders due to psychoactive substance use?

A
  • Acute intoxication
  • Dependence syndrome
  • Harmful use
  • Withdrawal state
  • Pyschiatric disorder
  • Amnesic syndrome
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11
Q

What is the ICD-10 diagnosis of substance dependence?

A
  1. Physical:
    - Experiencing withdrawal symptoms if not used
    - Use of substance to relieve withdrawal symptoms
  2. Psychological:
    - Intense desire to use (craving)
    - Difficulty in controlling the onset, termination and amount used
    - Tolerance (need to escalate dose over time to achieve same effect)
  3. Social
    - Salience (neglecting alternate forms of leisure or pleasure in life)
    - The narrowing personal repertoire of substance use

At least 3 in past 12 months.

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12
Q

What are the physical health risks of using alcohol?

A
  • Cardiovascular: Cardiomyopathies, Arrhythmias (during withdrawal), high BP, increased risk of stroke
  • GI: cancer of mouth, oesophagus, liver, throat, larynx; Oesophagitis, gastritis; liver cirrhosis
  • Females: reduced fertility, breast cancer, harm to unborn babies
  • Psychological: depression and anxiety
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13
Q

What are the psychological health risks of alcohol use?

A
  • Disinhibition (linked to intoxication and binge drinking)
  • Depression (direct depressive effect plus reduces effectiveness of antidepressants)
  • Anxiety (may be linked to low level withdrawal)
  • Memory impairment (Korsikoff’s, alcohol related brain damage, dementia)
  • Self harm/suicide (often linked to social losses and isolation)
  • Psychosis: (rare form of chronic auditory hallucinations, repeat experience of DTs)
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14
Q

What are short term the social consequences of alcohol use?

A
  • Accidents or injuries
  • Aggression to others
  • Victim of violence
  • Unprotected sex
  • Loss of possessions
  • Alcohol possessions
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15
Q

What are the long term social consequences of alcohol use?

A
  • Unemployment
  • Domestic violence
  • Divorce
  • Homelessness
  • Financial impact
  • Driving convictions
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16
Q

What are the screening tools for alcohol dependence and harmful drinking?

A
  • CAGE questionnaire
  • AUDIT (indicates level of dependence)
  • SADQ: mild - =15, moderate - 15-30, severe >/=31
  • Leeds Dependence Questionnaire: low dependence <10, medium 10-22 + high >22
  • FAST used by emergency department to assess alcohol state
17
Q

How do you start an alcohol history?

A

Open questions:
- Could you tell me about your usual drinking habits?
- Could you take me through a typical day of drinking for you?
- When did you first start drinking? What did you drink then?
- How have things changed since you first started drinking?
Move to specifics re quantity and circumstances of current drinking
- Time of first drink, any days off, alone or socially, efforts to control

18
Q

What questions in the history do you want to ask about alcohol dependence?

A
  • Do you find it difficult at times to control the amount you drink?
  • Do you find you need to drink much more to achieve similar effects as in the past?
  • How do you feel before the first drink of the day?
  • Explore physical withdrawal symptoms
  • Would you say that alcohol has taken priority for you? OR do you prefer to have a drink than do other things?
  • Do you start drinking first thing in the morning?
  • Have you ever tried to stop drinking? What happened then?
19
Q

What are the stages of the CIWA score?

A
  1. <9 absent - mild withdrawal, typically no medications
  2. 9-19 moderate withdraw, medicated to treat
  3. > 20 severe withdrawal, inpatient withdrawal
20
Q

What is involved in the alcohol withdrawal regimes?

A
  • Can be done in community from alcohol services
  • Dangerous for patients to suddenly stop at home
  • May need to wait for detox to be organised - advice to continue drinking reduced amount rather than stop suddenly whilst waiting
  • Likely to need residential or hospital detox if: <30 units/day, hx of epilepsy or previous DTs, comorbid substance misuse/physical or mental health
21
Q

What medications are used to help alcohol cravings?

A
  • Acamprosate

- Naltrexone

22
Q

What are the psychological and social approaches for treating alcohol disorders?

A
  • Psychological: motivational interviewing, CBT, group programme
  • Social: 12 steps programme, AA, rehab programme

Mental Health (12 decks)

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