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Psychiatry > Alcohol and Addiction > Flashcards

Alcohol and Addiction Flashcards

1
Q

Functions of the liver

A 
carbohydrate metabolism 
fat metabolism 
protein metabolism 
storage of glucose, iron, copper and vitamins
synthesis - fibrinogen and thrombopoietin 
kuppfer cells - rubbish collectors
production of bile
metabolism of drugs and alcohol
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2
Q

How much alcohol does a healthy liver process?

A

1 unit of alcohol per hour

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3
Q

What is the breakdown product of alcohol which is a carcinogen?

A

Acetaldehyde

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4
Q

How many units of alcohol is recommended per week?

A

<14 units

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5
Q

When would some people have more damage to their liver than others?

A

poor dietary status - nutritional deficiencies
simultaneous exposure to other drugs (affects metabolism)
genetic variations/polymorphisms of enzymes
female gender more vulnerable
coexisting viruses e.g. Hep C

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6
Q

Causes of cirrhosis (highest to lowest)

A 
Alcohol related liver disease 
fatty liver disease
hepatitis C virus 
Other 
autoimmune causes
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7
Q

Progression of alcohol liver disease

A
  1. normal liver
  2. fatty liver (steatosis)
    - REVERSIBLE or can go straight to fibrosis
  3. steatohepatitis
  4. fibrosis
  5. liver cirrhosis
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8
Q

Indicators of chronic alcohol use

A 
elevated gamma GT 
macrocytosis (large RBCs)
Low platelets 
Elevated ferritin 
enlarged smooth edged liver on AUSS 
History
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9
Q

What is alcoholic hepatitis?

A

Fatty change within the liver and an inflammatory process

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10
Q

Pathology of alcoholic hepatitis

A

infiltration of leucocytes

hepatic necrosis

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11
Q

Results of alcoholic hepatitis

A 
hepatomegaly 
jaundice 
abdominal pain 
fever
hepatic decompensation
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12
Q

Treatment of alcoholic hepatitis

A

ABSTINENCE
steroids
management of infection and nutrition
renal impairment and coagulopathy

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13
Q

Pathology of liver fibrosis

A

Chronic inflammation
activation of stellate cells
Collagen production -> starts to produce scarring
fibrosis/cirrhosis

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14
Q

The 3 complications of cirrhosis

A

variceal haemorrhage
ascites
encephalopathy

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15
Q

effects of alcohol in low doses

A

euphoria
reduced anxiety
relaxation
sociability

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16
Q

effects of alcohol in higher doses

A 
intoxication 
impaired attention and judgement 
unsteadiness
flushing
nystagmus 
mood instability
disinhibition 
slurring 
stupor
unconsciousness
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17
Q

diagnostic criteria of alcohol dependence by ICD-10

A

Increased tolerance
Physiological withdrawal
neglect of other interests
difficulty controlling use

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18
Q

Definition of intoxication

A

the pathological state produced by a drug, serum, alcohol or any other toxic substance; poisoning

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19
Q

symptoms of dependence

A

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

  • cravings / compulsions to take
  • difficulty controlling use
  • primacy
  • increased tolerance
  • physiological withdrawal on reduction/cessation
  • persistence despite harmful consequences
  • neglect
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20
Q

Definition of withdrawal state

A

group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance

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21
Q

Symptoms of alcohol withdrawal state

A 
tremor
weakness
nausea/vomiting
anxiety
seizures
confusion 
agitation 
palpitations
death 
sweating
delirium tremens
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22
Q

Symptoms of delirium tremens

A 
profound confusion 
tremor
agitation 
hallucinations
delusions 
sleeplessness 
autonomic overactivity
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23
Q

alcohol problems

A 
physical health 
mental health 
relationships
employment 
financial 
legal
24
Q

What is Othello’s syndrome?

A

delusional jealously or morbid jealously

25
Q

How long of abstinence can it take until the long term effects of alcohol subside?

A

3 months

26
Q

Impacts of alcohol on mental health

A 
anxiety
depression 
sleep disturbance - drink to sleep 
morbid jealously
alcoholic hallucinations 
deliberate self injury 
suicidal thoughts/acts
27
Q

impacts of alcohol on physical health

A 
brain damage 
memory loss 
hallucinations
fits
dementia
risk of chest infections 
swollen liver 
hepatitis/cirrhosis 
tremor
tingling nerves/numbess 
risk of STIs and HIV/AIDs
loss of muscle
enlagrened heart
high BP / irregular pulse 
ulcers
gastritis/pancreatitis
vomiting blood
impotence/infertility
accidental injury / violence
cancer (mouth, oesophagus, liver)
fits/confused state
wernickes encephalopathy 
koraskoffs psychosis
28
Q

symptoms of wernickes encephalopathy

A

confusion
ataxia
opthalmoplegia
nystagmus

29
Q

symptoms of koraskoffs psychosis

A 
prominent impairment of recent and remote memory 
preservation of immediate recall 
no general cognitive impairment 
retrograde and anterograde memory 
impaired learning and disorientation 
may exhibit nystagmus and ataxia
30
Q

Screening tools for alcoholism

A

CAGE (2 or more = likely alcohol problem)
AUDIT
FAST (4 Qs)
PAT (used in A and E)

31
Q

The 4 CAGE questions

A

Have you ever tried to Cut down?
Have you felt Annoyed by people critising your drinking?
Have you felt Guilty about your drinking?
Have you ever felt the need for an Eye opener?

32
Q

Treatment/management of alcohol dependency

A 
Hollistic approach 
- support
- psychological help (CBT, Groups)
- social work 
- skills training
- community support (AA, ADA)
- in patient/ residential treatment 
inpatient at risk of alcohol withdrawal 
- cholordiazepoxide (a benzodiazepine) 
prevention of Wernicke-Korsakoff syndrome
- thiamine 
management of alcohol withdrawal 
- benzodiazepines, commonly chlordiazepoxide 
Aversion/deterrent medication 
- disulfiram (Antabuse)
Anti-craving medication 
- Acamprosate (campral)
- naltrexone
33
Q

Offences of the licencing (Scotland) act 2005

A

not allowed to buy < 18
attempt to enter a liscensed premises while drunk
sell to a drunk person or try to obtain for a drunk person
disruption of the peace when drunk
refusal to leave
low level disposal

34
Q

Vulnerability through intoxication

A

increased risk of committing a crime, becoming the victim of a crime of misadventure
Actions and decisions affected by alcohol
Adverse incidents - reactive measure

35
Q

Two distinct mechanisms of the misuse of drugs

A
  1. Tolerance- the basis of physiological dependence

2. Reward centre - the basis of physiological craving due to stimulation of reward pathways in the brain

36
Q

What is tolerance the basis of?

A

Physical dependence

37
Q

What is the reward centre the basis of?

A

Physiological craving due to the stimulation of reward pathways in the brain

38
Q

What is tolerance?

A

Reduced responsiveness to a drug caused by previous administration

39
Q

What kind of drugs cause tolerance?

A

opioids
ethanol
barbituates
benzodiazepines

40
Q

Mechanisms of tolerance

A
  1. DRUG IN - LESS DRUG REACHES THE ACTIVE SITE = dispositional tolerance
    - less drug absorped
    - drug metabolised faster
    - more drug excreted
  2. DRUG ACTION = DRUG HAS LESS ACTION AT ACTIVE SITE = pharmacodynamic tolerance
    - fewer drug receptors
    - down regulation/ internalisation of drug receptors
    - reduced signalling down stream of drug receptors
    - less efficient drug receptors
41
Q

What is tolerance closely linked to and how?

A

Dependence
imbalance of drug affect and adaptive response
- more drug effect means that the body develops a tolerance to bring the body back to its normal state
- if stop taking the drug = still increased adaptivity with loads of receptors and increased sensitivity to receptors and therefore get body withdrawal responses. Therefore the body has become dependent

42
Q

What is a withdrawal effect?

A

The reverse of the acute effect

43
Q

How does the reward pathway work?

A
  1. when VTA neurones are stimulated, they release DOPAMINE
  2. this causes a sensation of pleasure/reward
    Therefore encourages those “healthy” behaviours that lead to propagation of your genes
44
Q

What is the reward pathway stimulated by?

A

Eating
drinking
sex
some drugs

45
Q

How do drugs become craved and give some examples

A

Some drugs abuse tap into the reward pathway and increase dopamine levels

  • heroin increases firing rate of dopaminergic neurones
  • amphetamine increases dopamine release
  • cocaine inhibits dopamine uptake so there is more around for longer
  • alcohol indirectly
46
Q

What is the psychological component of addiction?

A

Craving

47
Q

How to calculate alcohol units

A

% x ml / 1000

48
Q

What is the alcohol limit for men and women per week?

A

14 in BOTH

49
Q

Treatment of alcohol craving

A

Disufram
Acamprosate
Naltrexone
Baclofen

50
Q

What does disufram do?

A

Makes the body unable to break down the alcohol so makes the patient very unwell when they take alcohol (have to pick patients very specifically for this)

51
Q

What symptoms do you get on alcohol withdrawal at 6 - 12 hours?

A

Alcohol withdrawal symptoms

52
Q

What symptoms do you get on alcohol withdrawal at 36 hours?

A

Seizures

53
Q

What symptoms do you get on alcohol withdrawal at 72 hours?

A

Delerim tremens

54
Q

What scale is looked at to assess alcohol withdrawal severity?

A

Clinical Institute Withdrawal Assessment for Alcohol (CIWA)

55
Q

Treatment of delirium tremens

A

Benzodiazepines

Psychiatry (18 decks)

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