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PSYCHIATRY > Alcohol Abuse > Flashcards

Alcohol Abuse Flashcards

1
Q

What is hazardous drinking?

What is harmful drinking?

What sex is it more common in?

A

Consumption that increases the risk of harm

Drinking that adversely affects physical or mental health

Men

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2
Q

Presentation:

Liver - how does it progress?

GI effects:

  • General - 2
  • Stomach and duodenum - 1
  • Oesophagus - 2
  • Biliary system - 1
A

D&V
Cancer

PUD

Varices, presenting with haematemesis and/or melena
Oesophageal erosions

Pancreatitis

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3
Q

Presentation:

Neurological

A 
Memory and cognitive impairments 
Peripheral neuropathy 
Seizures 
Falls 
Wernicke's encephalopathy
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4
Q

Presentation:

Psychological - 2

What is alcoholic hallucinosis?

A

Psychosis
Morbid jealously e.g. delusions that their partner is unfaithful

In chronic alcoholism, the hallucinations are auditory, while in withdrawal they are often visual or tactile.

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5
Q

Presentation:

CVD - 3

A

Arrhythmia
HTN
Cardiomyopathy

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6
Q

Other presentations of alcohol abuse?

A 
Anaemia 
Osteoporosis 
Reduced fertility 
Breast cancer 
Accidents 
Social problems
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7
Q

Investigations:

What tool can be used in any routine care?

Further assessment:

AUDIT - what does it stand for? what does it assess?
SADQ - what does it stand for? what does it assess?
APQ - what does it stand for? what does it assess?

A

CAGE alcohol questionnaire
FAST screening tool - UK

Alcohol Use Disorders Identification Test - assess pattern and severity

The Severity of Alcohol Dependence - to assess severity

Alcohol Problems Questionnaire - to assess secondary problems

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8
Q

Q’s to ask in history

What shouldn’t be forgotten?

A

Current and historical Hx

Typical day
Frequency
Volume

Psych - ask about mood and other psych symptoms - hallucinations for example

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9
Q

Social effects of alcohol:

Relationships

Work

Criminal behaviour

Social disintegration

A

Domestic violence
Divorse
Child neglect and abuse

Unemployment
Absent
Under-performance

Drunkenness 
Drunk and disorderly
Drink driving 
Criminal damage 
Theft 
Bulglary 
Violence

Financial difficulties
Homelessness

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10
Q

How may units are in the following:

Regular pint - beer/lager/cider

Can of lager

Glass of wine

1 Shot

A bottle of wine

LOOK AT PRESENTATION

A

2

1.5

2

1

9

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11
Q

Investigations:

Why do you do FBC?

Why do you do LFT’s?

What can be used to diagnose cirrhosis in all persistent heavy drinkers?

A

Macrocytic anaemia

Raised GGT, AST and ALT

FibroScan

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12
Q

Management - Assisted withdrawal:

> How many units should the patient be drinking before this is offered?

A combo of drugs and individual, group or self-help psychotherapy is offered:

> How many weeks of community-based Rx is given for most people?

> How many meetings per wk does someone with moderate dependence need?

> What can be used to people with severe dependence?

A

> 15 units/day

3 wks

2-4 per week

Intensive day programmes for most of the wk

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13
Q

Management - Biological:

During withdrawal:

What drug is used?

What is given to prevent neurological complications?

A

Benzodiazepines - chlordiazepoxide or diazepam

Thiamine - Pabrinex

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14
Q

Management - Biological:

Maintenance:

What drugs are used for maintenance? - A, N

What can be used if the top 2 aren’t suitable? - D

What tests need to be done to establish baseline?

A

Acamprosate - reduces craving
Naltrexone - reduces pleasure as opioid receptor

Disulfiram

U&E, LFTs

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15
Q

Management - Psychological:

When is psychological Rx needed?

1st

What type of interviewing can be done?

What CBT’s are available? - 3

A

For mild dependence
Combination with pharmacotherapy for withdrawal and relapse prevention

Motivational interviewing

Individual, group or behavioural couples therapy

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16
Q

Management - Social:

Who needs to be contacted?

What else should you think about apart from the person?

What can be offered to the homeless

A

DVLA if they drive
Won’t be allowed to drive until 1 yr alcohol-free.

Safeguarding issues e.g. child neglect, domestic abuse

3 months of residential rehabilitation - try and find long-term housing before discharge.

17
Q

Disulfiram:

MOA?

Side effects?

Contraindications? - don’t forget a AB!!

A

It prevents conversion to a chemical that causes hangover-like symptoms.

Headache and blurring of vision
N&V
Chest pain 
Anxiety and confusion
Sweating 
---------
Severe CVD
Pregnancy 
Psychosis 
Metronidazole
18
Q

Alcohol Withdrawal:

How long after their last drink does it begin?

Physical signs - 3

Psychological signs - 3

A

6-24 hrs

Tremor
Sweats
Nausea

Insomnia
Altered mood
Alcoholic hallucinosis

19
Q

Alcohol Withdrawal:

What type of seizure do they tend to get?

How long after their last drink could a seizure begin?

A

Generalised tonic-clonic seizure

12-48 hrs

20
Q

Alcohol Withdrawal:

Alcoholic hallucinosis:

What types of auditory, visual, and tactile hallucinations do they have?

How long does it take for this to present?

When does it resolve?

What other symptoms do they get?

A

Auditory - e.g. hostile voices

Visual - e.g. Lilliputian - things and people seem tiny

Tactile - e.g. formication - insects crawling on/under skin

12-24 hrs

48 hrs

Headaches
Dizziness
Irritability

21
Q

Alcohol Withdrawal:

Delirium tremens:

How many days after the last drink does it present?

2 physical symptoms
2 psychological symptoms

OBS??

A

3-7 days

Tremor and seizures

Delirium and confusion

High HR and low BP

22
Q

Alcohol Withdrawal - Management:

What needs to be done as always?

How are symptoms monitored?

What drug is given orally for seizures and sedation?

What alternative can be used if there is liver impairment? - O

What drug can be given if the seizures continue? - L

What nutritional support needs to be given?

A

ABCDE

CIWA-Ar - Clinical Institute Withdrawal Assessment for Alcohol Scale

Benzodiazepines - chlordiazepoxide or diazepam

Oxazepam

Lorazepam

Thiamine 
Folate 
Correction of any deficiencies in glucose 
Potassium
Magnesium
Phosphate
23
Q

Alcohol misuse results in reduced thiamine (Vit B1) intake from poor nutrition and impaired GI absorption. What 2 things does it cause?

A

Wernicke’s encephalopathy and Korsakoff’s syndrome

24
Q

Wernicke’s encephalopathy:

What is the classic triad:

  • Eyes
  • Gait
  • Mind

CAN BE MISTAKEN FOR INTOXICATION!!

A

Ophthalmoplegia - nystagmus, lateral rectus palsy

Ataxia with wide-gait

Confusion

25
Q

Korsakoff’s syndrome:

What is it?

Define:

  • anterograde amnesia
  • retrograde amnesia
  • confabulation
A

The chronic manifestation of thiamine deficiency.

Can’t form new memories

Can’t remember the past - RETRO 80’S PAST

False memories - believed to the true - to fill the memory blanks

26
Q

Wernicke’s encephalopathy and Korsakoff’s syndrome:

Management

Why do you have to be careful with glucose for correcting hypoglycaemia?

A

Thiamine replacement - IM or IV as an inpatient
THEN PO long term

Thiamine must be given if glucose is given as glucose depletes remaining thiamine.

PSYCHIATRY (20 decks)

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