Alcohol abuse

Question 1

What is alcohol dependence?

Answer 1

Alcohol consumption high enough to cause substantial physical, psychological and social harm.

Risk: Low (under 21/14 units M/F), Hazardous (22-50/15-35 units/wk M/F) High (M>50, F>35).

Question 2

What is the aetiology of alcohol dependence?

Answer 2

Multifactoria, genetic basis with social drives. Assoc culture, religion, FHx, availability and price of alcohol, male.

Question 3

What is the epidemiology of alcohol dependence?

Answer 3

1% drink harmfully UK

Question 4

What would you find in the history and exam of people with alcohol dependence?

Answer 4

1. Strong desire or sense of compulsion
2. Difficulties in controlling substance taking – LACK OF CONTROL is key for diagnosis
3. Physiological withdrawal
4. Evidence of tolerance – need more to gets same effect
5. Progressive neglect of other aspects of life
6. Persisting use even after bad experiences

Question 5

What is the MSE for acute intoxication?

Answer 5

o App: Smell, oncoordination

o Speech: slurred

o Mood: variable, labile

o Thought: variable

o Perception: hallucinations

o Cognition: confused

o Insight: poor

Question 6

What is the MSE for delirium tremens?

Answer 6

o 48-72h of drinking cessation

o Appearance: agitated fearful

o Speech: Confused

o Mood: Labile/anxious

o Thought: Confused

o Perception: hallucination/delusion

o Cognition: confused

o Insight: poor

Question 7

What investigations would you do for alcohol dependence?

Answer 7

Blood: alcohol leve, FBC, LFT, Alb, clotting, glucose, B12 folate, Ues.

Question 8

What is the management of alcohol dependence?

Answer 8

Detoxification if needed : BZD (prevent seizures) rehydraton therapy

Vitamin supplements: B12 + Pabrinex.

Motivation and self help, social issues

Question 9

What are the complications and prognosis of alcohol dependence?

Answer 9

Mental: anxiety, depression, breakdown of relationships, self harm, suicide, dementia.

Physical: GI ulcers, gastritis, HTN, arrhythmias, cirrhosis, hepatitis, jaundice, neuropathy (B12), delirium tremens (withdrawal).

Wernickes encephaopathy: opthalmoplegia, confusion, nystagmus. This is followed by irreversible Kosakoffs -> confabulation + retrograde memory loss.

Relapsing and remitting, high suicide risk.