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Psychiatry > Alcohol > Flashcards

Alcohol Flashcards

1
Q

What are the effects of alcohol at low doses?

A

1 - Euphoria

2 - Reduced anxiety

3 - Relaxation

4 - Sociability

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2
Q

What are the effects of alcohol at high doses?

A

1 - Impaired attention and judgement

2 - Unsteadiness

3 - Flushing

4 - Nystagmus

5 - Mood instability

6 - Disinhibition

7 - Slurring

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3
Q

What are signs of alcohol dependence?

A

1 - Increased tolerance

2 - Physiological withdrawal

3 - Neglecting other interests

4 - Difficulty controlling use

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4
Q

How is ‘harmful use’ of alcohol diagnosed?

A
  • A pattern of use causing damage to physical or mental health
  • Used alcohol > 1 month or repeatedly over 12 months
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5
Q

How is alcohol dependence diagnosed?

A

3 or more of the following for > 1 month or repeatedly over 12 months:

  • Cravings/compulsions to drink
  • Difficulty controlling use
  • Primacy (drinking before eating)
  • Increased tolerance
  • Physiological withdrawal on reduction/cessation
  • Peristent drinking despite harmful consequences
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6
Q

What is a withdrawal state relating to alcohol?

A

1 - Group of symptoms of variable clustering and severity caused by complete/relative withdrawal of a psychoactive substance

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7
Q

Which neurochemical is released when alcohol is consumed?

A

Opiate

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8
Q

What neurochemicals increase in volume during alcohol consumption?

A

GABA A

Glycine

Adenosine

Opioids

Endocannabinoids

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9
Q

What neurochemicals decrease in volume during alcohol consumption?

A

NMDA glutamate

Aspartate

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10
Q

What are the symptoms of an alcohol withdrawal state?

A

1 - Tremor

2 - Weakness

3 - Nausea

4 - Vomiting

5 - Anxiety

6 - Seizures

7 - Confusion

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11
Q

What is delirium tremens and what is it associated with?

A

Associated with alcohol withdrawal state

Symptoms of delirium tremens:

  • Profound confusion
  • Tremor
  • Agitation
  • Hallucinations
  • Delusions
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12
Q

How long after stopping alcohol does delirium tremens usually start?

A
  • Occurs 48-72 hours after alcohol stopped
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13
Q

What are the 4 L’s usually associated with alcohol problems?

A

1 - Liver

2 - Livelihood

3 - Lover

4 - Law

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14
Q

What are the mental health problems associated with alcohol abuse?

A
  • Anxiety
  • Depression
  • Sleep disruption
  • Morbid jealousy
  • Alcoholic hallucinosis
  • Deliberate self-injury
  • Suicidal thoughts
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15
Q

What are the physical health problems associated with alcohol abuse?

A
  • Brain damage
  • Poor control of diabetes
  • Loss of muscle
  • Chest infections
  • High blood pressure
  • Liver cirrhosis
  • Hepatitis
  • Pancreatitis
  • Trembling hands
  • Impotence
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16
Q

How does a moderate drinkers brain compare with an alcoholics brain?

A
  • Cerebral atrophy
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17
Q

What are the symptoms of wernicke’s encephalopathy?

A

1 - Confusion

2 - Ataxia

3 - Opthalmoplegia

4 - Nystagmus

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18
Q

What are the symptoms of korsakoff’s psychosis?

A

1 - Prominent impairment of recent and remote memory

2 - Immediate recall preserved

3 - Impaired learning and disorientation

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19
Q

What is the cause of both wernicke’s encephalopathy and korsakoff’s psychosis?

A

Thiamine (Vitamin B1) deficiency caused by:

  • Poor intake and absorption
  • Poor hepatic function
  • Increased requirement for alcohol metabolism
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20
Q

What effects can alcohol have on relationships?

A

1 - Verbal & physical aggression

2 - Marital difficulties (morbid jealousy)

3 - Poor parenting

4 - Loss of friendships and social supports

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21
Q

What are the screening tools that can be used to assess alcohol problems?

A

CAGE

AUDIT

FAST

PAT

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22
Q

What is the CAGE screening tool and how is it used?

A

Cut down (Have you tried?)

Annoyed (by people criticising your drinking?)

Guilty (about your drinking?)

Eye-opener (ever needed one?)

Answering Yes to 2 or more of the above questions = likely alcohol problem

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23
Q

What is the most appropriate treatment to commence in an inpatient who is at risk of alcohol withdrawal?

A

Chlordiazepoxide

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24
Q

How is wernicke-korsakoff syndrome prevented?

A

Give Thiamine

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25
Q

What medications are given to manage alcohol withdrawal?

A

1 - Benzodiazepines (Chlordiazepoxide)

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26
Q

What is the commonly used drug to help deter alcoholics from using alcohol?

A

Disulfiram - produces an acute sensitivity reaction to alcohol

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27
Q

What are some common anti-craving medications?

A

1 - Acamprosate

2 - Naltrexone

3 - Nalmefene

28
Q

What is the UK government low risk alcohol consumption guidance (2016)?

A

Men & woman should not regulalrly exceed 14 units/week

14 units =

  • 6 pints of beer (4% ABV)
  • 6 glasses of wine (13% ABV)
  • 14 shots of spirits
29
Q

How do you calculate the number of units of alcohol in your drink?

A

Units = ABV x volume of drink/1000

30
Q

What is the best way to tell if your patient is drinking above the low risk guidelines?

A

Use the screening tools (CAGE, FAST, Paddington etc.)

31
Q

When should patients be screened for their alcohol consumption levels?

A

1 - New patient registration

2 - As part of condition management

32
Q

What should be done if your patient is drinking more than the low risk guidance?

A

1 - Explain they have a chance to reduce their risk of health harm

2 - If alcohol dependence likely = refer to treatment services

3 - Assess how willing they are to change

33
Q

What are the societal vulnerability factors that can affect someones likelyhood of drinking excessively?

A

1 - Alcohol pricing, availability & regulation

2 - Drinking context

3 - Socio-economic status

4 - Culture

34
Q

What are the individual vulnerability factors that can lead someone to exceeding the minimum alcohol guidelines?

A

1 - Mental health

2 - Homelessness

3 - Gender

4 - Age

35
Q

What is the licensing act which regulates the sale of alcohol?

A

Licensing Act 2005

36
Q

During which times of the week and where do common and serious assaults mostly occur?

A
  • During weekend
  • In city centre
37
Q

What happens to your risk of commiting or becoming the victim of a crime when intoxicated with alcohol?

A

Increased

38
Q

What are the top 5 causes of hospital admissions due to alcohol?

A

1 - Unintentional injuries

2 - Mental ill health & benahioural disorders

3 - Heart conditions & strokes

4 - Liver disease & pancreatitis

5 - Cancer

39
Q

How is alcohol processed by the body?

A

In the liver

40
Q

What are the functions of the liver?

A

1 - Carbohydrate metabolism

2 - Fat metabolism

3 - Protein metabolism

4 - Storage of glucose, iron, copper, vitamins

5 - Production of fibrinogen & thrombopeitin

6 - Kupffer cells - collect bacteria and old cells

7 - Bile production (breaksdown fat in small intestine)

8 - Metabolism of drugs and alcohol

41
Q

Once alcohol arrives at the liver, what does it turn into?

A

1 - Alcohol

2 - Acetyaldehyde

3 - Acetate

42
Q

What enzymes does the liver use to process alcohol?

A

ADH - Alcohol dehydrogenase

ALDH - Acetyldehydrogenase

43
Q

Which component of the alcohol breakdown process is a harmful carcinogen?

A

Acetaldehyde

44
Q

Which cells of the liver are activated to produce cytokines & oxidants?

A

Kupffer cells

45
Q

Which cells of the liver are activated and injured by cytokines and oxidants?

A

Stellate cells - activated

Hepatocytes - injured

46
Q

Activation of stellate cells results in what?

A

Fibrosis of liver

47
Q

Which cofactors lead to a fatty liver due to chronic ethanol consumption?

A

NAD+

NADH

48
Q

What are the causes of Liver Cirrhosis?

A

1 - Alcohol related liver disease (majority)

2 - Fatty liver disease

3 - Hepatitis C

4 - Autoimmune dieases

49
Q

What is the disease progression of alcohol related liver disease?

A

1 - Normal liver

2 - Fatty liver (steatosis)

3 - Steatohepatitis

4 - Fibrosis

5 - Liver cirrhosis

50
Q

What is the pathophysiology of fatty liver disease?

A

1 - Alcohol ingestion

2 - Acetaldehyde produced by liver

3 - Acetate produced from acetaldehyde

4 - Defects in fatty acid metabolism lead to build up of lipids in liver

51
Q

What effect does abstaining from alcohol have on fatty liver disease?

A

Fatty liver disease is reversed and liver returns to normal

52
Q

What are the indicators of chronic alcohol use?

A

1 - Elevated Gamma GT (Liver enzyme)

2 - Macrocytosis (large red blood cells)

3 - Low platelets

4 - Elevated Ferritin

5 - Enlarged smooth edged liver on AUSS

53
Q

Which larger vein is the central vein a branch of?

A

Hepatic vein

54
Q

Which larger vein is the interlobular vein a branch of?

A

Portal vein

55
Q

What are the structures that make up the portal triad?

A

Interlobular:

  • Vein
  • Artery
  • Bile duct
56
Q

What is alcoholic hepatitis?

A

Fatty change within the liver

57
Q

What are the features of alcoholic hepatitis?

A

1 - Infiltration with leucocytes

2 - Hepatic necrosis

3 - Hepatomegaly

4 - Jaundice

5 - Abdo pain

6 - Fever

7 - Hepatic decompensation

58
Q

What system is used to score the severity of alcoholic hepatitis?

A

Glasgow alcoholic hepatitis score

59
Q

What are the components of the Glasgow alcoholic hepatitis score?

A

Age

WBC

Urea

Bilirubin

PT (Prothrombin time)

60
Q

What is the cut-off score used to decide whether a patient with alcoholic hepatitis has a good or poor chance of survival?

A

9

GAHS < 9 = 87% survival rate

GAHS > 9 = 46% survival rate

61
Q

How are patients with alcoholic hepatitis managed?

A

1 - Steroids

2 - Management of infection & nutrition

3 - Abstinence

62
Q

What are the features of Liver Fibrosis & Cirrhosis?

A

1 - Chronic Inflammation

2 - Activation of Stellate cells

3 - Collagen production between veins/tracts

4 - Loss of lobule structure

63
Q

What type of lobules are associated with Liver Cirrhosis?

A

Pan lobular - Pseudo lobules

64
Q

What are the complications of Liver Cirrhosis?

A

1 - Variceal Haemorrhage

2 - Encephalopathy

3 - Ascites

4 - Hepatocellular Carcinoma

65
Q

What effect does alcohol abstinence have on Liver Cirrhosis?

A

5 year survival if abstinent = 65%

5 year survival if ongoing alcohol consumption = 35%

Psychiatry (18 decks)

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