Alcohol Abuse Flashcards
How many A&E admissions are alcohol related?
1 in 3
How much does alcohol abuse cost the NHS annually?
£3.8 billion
What are the stages of change in the ‘Stages of Change’ model?
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse (or lapse)
What happens during ‘pre-contemplation’ in the stages of change?
The individual is not concerned about their behaviour, even if other people are
The benefits of their actions far outweigh the drawbacks in their opinion
What happens during ‘contemplation’ in the stages of change?
The individual still enjoys their behaviour, however they are beginning to note some of the negatives of the behaviour more often
What happens during ‘preparation’ in the stages of change?
This is when the drawbacks outweigh the benefits in the individuals perspective and they feel ready to make a change
What happens during ‘action’ in the stages of change?
They have begun to make changes to their behaviour
What happens during ‘maintenance’ in the stages of change?
They have been in the action stage for a prolonged period and the change is easier now and more of habit
What happens during ‘relapse’ in the stages of change?
When the individual returns to the behaviour they had changed
What happens during ‘lapse’ in the stages of change?
A lapse is a slip up, where by the behaviour is resumed very shortly but is not always a relapse
List some of the symptoms of alcohol withdrawal
- Headaches
- Nausea
- Breathing difficulties
- Anxiety
- Depression
- Delirium tremens
What are the symptoms of mania (DIG FAST)?
D - distractibility I - Irritability G - Grandiosity F - Flight of Ideas A - Activity Increase S - Sleep deficit T - Talkativeness
What are the symptoms of Delirium Tremens?
- Delirium (consciousness disturbances)
- Autonomic hyperactivity
- Tachycardia
- Fever
- Insomnia
- Anxiety
- Hypertension
- Perceptual distortions
- Visual or tactile hallucinations (formication)
- Fluctuating motor activity
What medications do we give to a patient with alcohol withdrawal to prevent seizures?
Benzodiazepine e.g. i. Diazepam ii Lorazepam iii. Chlordiazepoxide iv. Oxazepam
What medications do we give IV to patients presenting with alcohol withdrawal?
IV pabrinex and fluids
What is the purpose of giving patients who are withdrawing from alcohol IV fluids and pabrinex?
To prevent Wernicke’s encephalopathy
What is the triad of Wernicke’s encephalopathy?
Ophthalmoparesis with;
i. Nystagmus
ii. Ataxia
iii. Confusion
What causes Wernicke’s encephalopathy?
Thiamine deficiency (B12)
What is Korsakoff syndrome?
A neuropsychiatric disorder associate with memory disturbance with anterograde and retrograde memory deficits.
What is retrograde amnesia?
Amnesia where the individual cannot recall memories that were formed before the event that caused the amnesia, it usually affects recently stored past memories not memories from a long time ago.
What is anterograde amnesia?
Amnesia where an individual cannot form new memories after an event that causes amnesia. This is the most common form of amnesia.
How long after stopping alcohol does Delirium tremens occur?
72 hours
Which medication is used in acute mania?
Olanzapine
What is a common maintenance medication used in bipolar disorder?
Lithium
What is Bipolar disorder?
Extreme highs (mania or hypomania) and extreme lows over a period of days-weeks.
What is bipolar-1 disorder?
Depression and mania
What is bipolar-2?
Depression and hypomania
What is cyclothymia?
Cyclical periods of mild highs and lows over a period of 2 years
How much more likely is an individual to develop bipolar disorder if a family member suffers from it?
x10 more likely than control population
What is the ICD-10 criteria for substance dependence?
Must have 3< present in the last year;
i. Compulsion to take
ii. Loss of control
iii. Withdrawal state
iv. Tolerance
v. Neglect of alternative interests
vi. Taking despite being aware of harm
What is the name of the gold standard tool for identifying alcohol dependence specifically?
AUDIT tool
Which benzodiazepine is most commonly used to treat the alcohol withdrawal state?
Chlordiazepoxide
What is the name of the scale that is used for a patient to self-assess/rate their withdrawal state?
CIWA scale
What medication regime is given to inpatients at the alcohol withdrawal centre?
- IM/IV Pabrinex
- QDS Chlordiazepoxide
Name the 3 medications that can be used long term to aid alcohol avoidance
- Disulfiram
- Acamprosate
- Naltrexone
What are the 2 treatment options to help someone withdrawing off opioids?
- Methadone
- Buprenorphine
What are the NICE guidelines for opioid detox?
- Treatment should be readily available to anyone requiring help
- Methadone or buprenorphine is first line
- NEVER offer rapid detox
