Alcohol and Health

Question 1

What are the effects of alcohol in both low doses and high doses?

Answer 1

Low Doses

• euphoria
• reduced anxiety
• relaxation
• sociability

High Doses

• Intoxication - pathological state produced by a drug, serum, alcohol, or any toxic substance; poisoning
  
  • impaired attention and judgement
  • unsteadiness
  • flushing
  • nystagmus
  • mood instability
  • disinhibition
  • slurring
  • stupor
  • unconsciousness

Question 2

What are some of the diagnostic criteria of alcohol dependence according to the ICD 10?

Answer 2

• Increased tolerance
• Physical withdrawal
• Neglect of other interests
• Difficulty controlling use

Question 3

What are the various ways in which alcohol dependence can be seen?

Answer 3

• Acute intoxication
• Harmful use
• Dependence
• Withdrawal State

Question 4

What is “harmful use” of alcohol?

Answer 4

• Pattern of alcohol use causing damage to physical or mental health
  
  • Use >1 month or repeatedly over 12 months.

Question 5

What is “alcohol dependence”?

Answer 5

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

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

Question 6

What is the “withdrawal state”?

Answer 6

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

Question 7

What impact does alcohol have on the neurochemistry within the brain?

Answer 7

• Alcohol is a depressant
• Alcohol enhances inhibitory GABA, glycine and adenosine.
• Alcohol reduces excitatory NMDA glutamate and aspartate.
• Alcohol promotes endogenous opioid release and endocannabinoid release.

Question 8

What S/S occur during the alcohol withdrawal state?

Answer 8

• Tremor
• Weakness
• Nausea
• Vomiting
• Anxiety
• Seizures
• Confusion
• Agitation
• Death

Question 9

What is a type of withdrawal that occurs 48-72hrs after last bevvy?

Answer 9

Delirium tremens

Question 10

What is delirium tremens?

Answer 10

• Profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness, autonomic over-activity.
• Mortality - 5%
• Death: CVS collapse, infection. hyperthermia, seizures and self-injury.
• Usually 48-72 hours after alcohol stopped.

[what that geezer in india had]

^aw what im george ive been to india

aw what im marty from londonderry

Question 11

What are “the 4 Ls of alcohol abuse”?

Answer 11

Liver

Lover

Life

Law

Question 12

Slide 12 about pathological jealousy???

Answer 12

…

Question 13

What mental health issues are liked with alcohol use?

Answer 13

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

Question 14

What implications can alcohol have on physical health?

Answer 14

See pic.

Also

• Accident injury/violence
• cancer (mouth, oesophagus, liver)
• neurological (fits, confusional state, Korsakoff’s/Wernickes)

Question 15

What is Wernicke’s Encephalopathy?

Answer 15

Presence of neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particula,r thiamine (vitamin B1).

• Confusion
• Ataxia
• Opthalmoplegia
• Nystagmus

Caused by thiamine deficiency

• Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism

Question 16

WHat is Korasakoff’s Psycosis?

Answer 16

• 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.
• Related to alcohol abuse.

Caused by thiamine deficiency

• Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism

Question 17

What impact can alcohol have on relationships?

What other aspects of life does it impact?

Answer 17

• Aggression
  
  • Verbal
  • Physical
• Marital difficulties
  
  • Morbid jealousy
• Poor parenting/neglect +/- loss of parenting rights
• Loss of friendships and social supports

Employment, Financial and Legal

Question 18

What screening tools are used in alcohol abuse?

Answer 18

• CAGE (2 or more = likely alcohol problem)
  
  • Have you tried to Cut down?
  • Have you felt Annoyed by people criticising your drinking?
  • Have you felt Guilty about drinking?
  • Have you felt the need to have an Eye-opener?
• AUDIT (Alcohol Use Disorders Identification Test)
• FAST (4 questions)
• PAT (Paddington Alcohol Test; used in A&Es)

Question 19

How can those with alcohol problems be managed?

Answer 19

• Practical advice, education, harm reduction
• Holistic/bio-psycho-social approach
  
  • Support for patient and family
  • Psychological help (e.g. CBT, group therapy)
  • Social work input (benefits, housing, child protection)
  • Skills training
  • Community Support (eg AA, ADA)
  • Inpatient or residential treatment
  • Medication

Question 20

What medication is given to those for prevention of wenicke-korsakoff syndrome?

Answer 20

• Prevention of Wernicke-Korsakoff Syndrome
  
  • Thiamine

Question 21

What meds for alcohol withdrawal?

Answer 21

Management of alcohol withdrawal

• Benzodiazepines , commonly Chlordiazepoxide

Question 22

What meds are used for aversion/deterrent?

Answer 22

Aversion/deterrent medication

• Disulfiram (Antabuse)

Question 23

What anti-craving medications can be given?

Answer 23

Anti-craving medication

• Acamprosate (Campral)
• Naltrexone
• Nalmefene
• (Baclofen)