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Psychiatry > Alcohol and Addiction > Flashcards

Alcohol and Addiction Flashcards

1
Q

Name a few conditions in which alcohol is a causative factor?

A
  • Mouth, throat, stomach, liver and breast cancers
  • High blood pressure
  • Liver cirrhosis
  • Depression
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2
Q

What is the maximum recommended units of alcohol per week for men and women?

A

14 units

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3
Q

What can be used to find out if a patient is drinking above the low risk guidelines?

A
  • Screening tools
  • FAST, Paddington alcohol test
  • Self disclosure
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4
Q

What are some low dose effects of alcohol?

A

Euphoria
Reduced anxiety
Relaxation
Sociability

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5
Q

What are some high dose effects of alcohol?

A

-intoxication
-Impaired attention/judgment
-Unsteadiness
-Nystagmus
-Mood instability
-Unconsciousness
etc

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6
Q

What is considered harmful use of alcohol?

A
  • Pattern of use causing damage to physical or mental health

- Use >1 month or repeatedly over 12 months

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7
Q

What classifies alcohol dependence?

A

3 or more of :

  • Cravings/compulsions to take
  • Difficulty controlling use
  • Primacy
  • Increased tolerance
  • Physiological withdrawal on reduction/cessation
  • Persistence despite harmful consequences
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8
Q

What is withdrawal state?

A

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

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9
Q

What condition is associated with withdrawal state of alcohol?

A

Delirium Tremens

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10
Q

What mental health problems may be associated with alcohol?

A
  • Anxiety
  • Depression
  • Sleep disruption
  • Morbid Jealousy
  • Alcoholic hallucinosis
  • Deliberate self-injury
  • Suicidal thoughts/acts
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11
Q

What difficulties can alcohol cause on relationships?

A
  • Aggression
  • Marital difficulties
  • Poor parenting/neglect
  • Loss of friendships and social supports
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12
Q

What screening tools can be used for alcohol use?

A

CAGE
AUDIT
FAST
PAT

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13
Q

What are the components of CAGE?

A

C - Cut down?
A - Annoyed?
G - Guilty?
E - Eye opener

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14
Q

What management is used in alcohol use?

A
  • Practical advice, education, harm reduction
  • Holistic/bio-psycho-social approach (Support for patient/family, Psych help, Social work input, Skills training, Community support, Inpatient/residential treatment, Medication)
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15
Q

List some of the functions of the liver

A
  • Carbohydrate metabolism
  • Fat metabolism
  • Protein metabolism
  • Storage
  • Synthesis
  • Kupffer cells
  • Production of bile
  • Drug and alcohol metabolism
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16
Q

What is alcohol converted into in the liver?

A

Alcohol -> Acetylaldehyde -> Acetate

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17
Q

What alcoholic liver condition is reversible?

A

Fatty liver (steatosis)

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18
Q

What are some indicators of chronic alcohol use?

A
  • Elevated GGT
  • Macrocytosis
  • Low platelets
  • Elevated ferritin
  • Enlarged smooth edged liver on AUSS
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19
Q

In a hepatic lobule, what vein are central veins a branch of?

A

Hepatic vein

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20
Q

In a hepatic lobule, what vein are interlobular veins a branch of?

A

Portal vein

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21
Q

What is the components of alcoholic hepatitis?

A
  • Infiltration with leucocytes

- Hepatic necrosis

22
Q

What may alcoholic hepatitis result in?

A
  • Hepatomegaly
  • Jaundice
  • Abdominal pain
  • Fever
  • Hepatic decompensation
23
Q

What scoring system is used for alcoholic hepatitis?

A

Glasgow Alcoholic Hepatitis Score

Age, markers of inflammation and liver function

24
Q

List some complications of cirrhosis

A
  • Variceal haemorrhage
  • Encephalopathy
  • Ascites
25
Q

What does abstinence do to prognosis in liver conditions?

A

Improves it!

26
Q

What is tolerance?

A

-Reduced responsiveness to a drug caused by previous administration

27
Q

List some drugs that may lead to tolerance

A
  • Opioids
  • Ethanol
  • Barbiturates
  • Benzodiazepines
28
Q

What are some mechanisms that may lead to dispositional tolerance (less drug reaching acitve site)?

A
  • Decreased rate of absorption
  • Increased rate of metabolism to inactive metabolites
  • Decreased rate of metabolism to active metabolites
  • Increased rate of excretion
29
Q

What are some mechanisms that may lead to pharmacodynamic tolerance (tissue or functional tolerance)?

A
  • Down regulation or internalisation of drug receptors
  • Reduced signalling down stream of drug receptors
  • Other compensatory mechanisms
30
Q

What is closely linked with tolerance?

A

Dependence (and subsequent withdrawal effect)

31
Q

What is the acute effect and withdrawal effect of opioids?

A

Acute Effect - Constipation

Withdrawal - Diarrhoea

32
Q

What is the acute effect and withdrawal effect of barbituates?

A

Acute Effect - Anticonvulsant

Withdrawal - Convulsions

33
Q

What neurotransmitter is released in reward pathways?

A

Dopamine

34
Q

Which drugs of abuse tap into the reward pathway?

A

Heroin
Amphetamine
Cocaine
Alcohol

35
Q

What are the two components of drug dependance?

A
  • Physical dependence

- Psychological craving

36
Q

Where does the reward pathway begin?

A

Ventral tegmental area (VTA)

Also involves nucleus accumbens and prefrontal cortex

37
Q

List some illegal stimulant drugs

A

Cocaine

Amphetamine

38
Q

What are the effects of cocaine?

A
  • Stimulant and euphoriant
  • Increased alertness and energy
  • Increased confidence and impaired judgement
  • Lessens appetite and desire for sleep
39
Q

What are the negative effects of cocaine?

A
  • Damage to upper respiratory tract
  • Convulsions with respiratory failure
  • Cardiac arrythmias and MI
  • Hypertension and CVA
  • Toxic confusion
  • Paranoid psychosis
40
Q

List some of the withdrawal effects of cocaine

A
  • Depression
  • Irritability
  • Agitation
  • Craving
  • Hyperphagia
  • Hypersomnia
41
Q

List some of the effects of amphetamine

A
  • Effects similar to cocaine but longer lasting
  • Toxic confusion occasionally with convulsions and death
  • Amphetamine psychosis in heavy chronic use
42
Q

List some opiate drugs

A
  • Opium
  • Morphine
  • Heroin
  • Methadone
  • Codeine and dihydrocodeine
43
Q

List some of the effects of heroin?

A 
Analgesia
Drowsiness and sleep
Mood change (euphoria, intense pleasure)
Respiratory depression
Cough reflex depression
Sensitisation of labyrinth with nausea and vomiting
Decreased sympathetic outflow (Bradycardia and hypotension)
Lowering of body temp
Pupillary constriction
Constipation
44
Q

List some of the side-effects of opiate use

A

First time - N+V, Headache

Medium term - Phlebitis, Anorexia, Constipation

Long term - Tolerance, Withdrawal, Social + Health problems

45
Q

List some of the withdrawal effects of opiates

A
  • Cravings
  • Insomnia
  • Yawning
  • Muscle pain and cramps
  • Increased salivary, nasal and lacrimal secretions
  • Dilated pupils
  • Piloerection
46
Q

What is the purpose of methadone maintenance?

A
  • Decriminalises drug use
  • Allows normalisation of lifestyle
  • Reduces iv misuse
47
Q

What are the effects of ecstasy?

A
  • Euphoria followed by feeling of calm
  • Increased sociability
  • Inability to distinguish between what is and isn’t desirable
48
Q

List some of the side-effects of ecstasy use

A
  • Nausea and dry mouth
  • Increased BP and temperature
  • Dehydration risk
  • Large doses can cause anxiety and panic
  • Drug induced psychosis
49
Q

What are the psychological effects of cannabis?

A
  • Relaxing/stimulating, euphoriant
  • Increases sociability and hilarity
  • Increases appetite
  • Changes in time perception
  • Synaesthesia

In higher dose - anxiety, panic, persecutory ideation, hallucinatory activity

50
Q

List some of the side-effects of cannabis use

A
  • Respiratory problems as with tobacco
  • Toxic confusion
  • Exacerbation of major mental illness
  • ?Cannabis psychosis
51
Q

List some of the side-effects of steroid use

A
  • Skin - acne, stretch marks, baldness
  • Feminisation in males - hypogonadism, gynaecomastia
  • Virilisation in women - hirsutism etc
  • Cardiovascular -^Cholesterol and hypertension
  • Growth deficits
  • Liver Disease
  • Irritability and anger
  • Hypomania, mania
  • Depression and suicidality on withdrawal

Psychiatry (15 decks)

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