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Psychiatry > Alcohol and Substance Misuse > Flashcards

Alcohol and Substance Misuse Flashcards

1
Q

State the seven ICD10 categories of Substance Misuse

A

1 - Acute Intoxication
2 - Harmful Use (but no dependence)
3 - Dependence Syndrome
4 - Withdrawal State
5 - Psychotic Disorder
6 - Amnesic Syndrome
7 - Residual Disorder (Personality disorder etc as a result of substance misuse)

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2
Q

Describe the Biological Aetiology behind Substance Misuse

A
  • Genetics (variations in enzymes that metabolise drugs)
  • Neurochemical Abnormalities
  • Mesolimbic Dopaminergic Reward Pathway - biological reinforcement
  • Psychosocial reinforcement from peers of pleasurable effects
  • peer pressure
  • life stressors
  • parental drug use
  • cultural acceptability
  • cost
  • availability
  • effect of drug
  • route

leads to dependence

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3
Q

Substance Dependence requires more than three of the following symptoms over a period of 1 month

A

Drug Problems Will Continue To Harm

strong Desire to consume substance

Preoccupation with substance

Withdrawal state when stopped/reduced

impaired ability to Control

Tolerance to substance requiring more consumption for desired effect

persisting with use despite clear Harm

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4
Q

Give 4 examples of Stimulant Drugs and their route

A
  • Cocaine (IN, IV, smoked)
  • Crack cocaine (IN, IV, smoked)
  • Ecstasy (PO)
  • Amphetamine (PO, IV, IN, smoked)
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5
Q

Describe the psychological effects of Stimulant Drugs

A

Euphoria

Increased Energy

Grandiose beliefs

Aggression

Arguemtative

Illusions

Hallucinations

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6
Q

Describe the physical effects of Stimulant Drugs

A
  • Tachycardia
  • Hypertension
  • Arrhythmias
  • N&V
  • Dilated pupils
  • psychomotor agitation
  • muscular weakness
  • chest pain
  • convulsions
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7
Q

Describe the withdrawal effects of Stimulant Drugs

A
  • Dysphoric mood - must be present
  • Lethargy
  • Psychomotor Agitation
  • Craving
  • Increased Appetite
  • Insomnia
  • Bizarre or unpleasant dreams
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8
Q

Name two Hallucinogens and their route

A

LSD

Magic Mushrooms

both PO

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9
Q

Describe the psychological effects of Hallucinogenic Drugs

A
  • Anxiety
  • Illusions
  • Hallucinations
  • Derealisation/Depersonalisation
  • Paranoid
  • Ideas of reference
  • Hyperactivity
  • Impulsivity
  • Inattention
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10
Q

Describe the physical effects of Hallucinogenic Drugs

A
  • Tachycardia
  • Palpitations
  • Sweating
  • Tremor
  • blurred vision
  • pupillary dilation
  • incoordination
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11
Q

Describe the psychological effects of Volatile Solvent Drugs (aerosols, paint, glue, petrol which are inhaled)

A
  • Apathy
  • lethargy
  • Aggression
  • Impaired attention and judgement
  • Psychomotor retardation
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12
Q

Describe the physical effects of Volatile Solvent Drugs

A
  • Unsteady Gait
  • Diplopia
  • Nystagmus
  • Decreased consciousness
  • Muscle weakness
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13
Q

Describe the psychological effects of Anabolic Steroids (testosterone, androstenedione, danazol which can all be taken PO and IM)

A
  • Euphoria
  • Depression
  • Aggression
  • Hyperactivity
  • Mood Swings
  • Hallucinations
  • Delusions
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14
Q

Describe the physical effects of Anabolic Steroids

A
  • Increased muscle mass
  • Reduced fat
  • Acne
  • Reduced sperm count
  • Male pattern baldness
  • Stunted growth
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15
Q

Describe psychological effects of opiates

A
  • Apathy
  • Disinhibition
  • Psychomotor retardation
  • Impaired judgement and attention
  • Drowsiness
  • Slurred speech
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16
Q

Describe physical effects of opiates

A
  • respiratory depression
  • hypoxia
  • decreased BP
  • hypothermia
  • low bp
  • coma
  • pupillary constriction
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17
Q

describe the withdrawl signs of opiates

A

craving

rhinorrhoea

lacrimation

myalgia

abdominal cramps

N&V

dirrhoea

dilated pupils

piloerection

raised heart rate and BP

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18
Q

describe the psychological effects of cannabis (cannabinoids)

(PO or smoked)

A
  • euphoria
  • disinhibition
  • agitation
  • paranoid ideation
  • temporal slowing
  • impaired judgement/attention/reaction time
  • illusions
  • hallucinations
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19
Q

describe the physical effects of cannabis

A

increased appetite

dry mouth

conjunctival injection

increased heart rate

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20
Q

describe the withdrawl signs of cannabis

A

anxiety

irritability

tremor of outstretched hands

sweating

myalgia

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21
Q

describe the psychological effects of sedative-hypnotics such as benzodiazepines and barbiturates (PO, IV)

A

euphoria

disinhibition

apathy

aggression

anterograde amnesia

labile mood

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22
Q

describe the physical effects of sedative-hypnotics

A
  • unsteady gait
  • difficulty standing
  • slurred speech
  • nystagmus
  • erythematous skin lesions
  • low bp
  • hypothermia
  • depression of gag reflex
  • coma
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23
Q

what are the withdrawl signs of sedative-hypnotics

A
  • tremor of hands
  • tongue or eyelids
  • N&V
  • increased heart rate
  • postural drop in BP
  • headache
  • agitation
  • malaise
  • transient illusions/hallucinations
  • paranoid ideation
  • grand mal convulsions
24
Q

Give 5 potential consequences of Substance Misuse

A

Endocarditis Drug Induced Psychosis DVT Crime Homelessness

25
Q

Give an example of a Class A drug and the subsequent UK law

A

Cocaine

7 years prison for possession, up to life for supply

26
Q

Give an example of a Class B drug and the subsequent UK law

A

Ketamine

5 years for possession, up to 14 years for supply

27
Q

Give an example of a Class C drug and the subsequent UK law

A

Benzodiazepines

Up to 2y possession and 14y for supply

28
Q

Name four investigations for a known substance abuser

A

Bloods - BBV (HIV, HEP B &C, LFTs, & clotting, U&Es, drug levels
Urinalysis - Drug Metabolites
ECG - Arrhythmias
Echo - Endocarditis

29
Q

Describe the management of Opioid Dependence

A

Detoxification and Maintenance- Methadone/Buprenorphine

Continued Abstinence (ie after detoxification) - Naltrexone

Overdose antidote = Naloxone

30
Q

Describe four psychosocial interventions for Substance Misuse

A
  • Keyworker with a therapeutic alliance for psychosocial support
  • Hep B immunization if risk
  • Motivational interviewing and CBT
  • Contingency Management (changing specific behaviours by offering incentives for positive behaviours)
  • Supportive help with finance/housing/employment
  • Narcotics Anonymous
  • Driving - DVLA guidelines
31
Q

whats the difference between detoxification and maintenance?

A

detoxification refers to a process in which the effects of the drug are eliminated in a safe manner (replacement drug) such that the withdrawl symptoms are avoided in an attempt to attain abstinence

maintenance therapy - aim is to minimise harm rather than abstain

32
Q

Define Alcohol Abuse

A

Consumption of alcohol at a level enough to cause physical psychiatric and social harm

33
Q

Define Binge Drinking

A

Drinking twice over recommended level of alcohol per day in one session
>8 units for males
>6 units for females

34
Q

Define Harmful Alcohol Use

A

Drinking above safe levels with evidence of alcohol related problems
>50 units per week for males and >35 units per week for females

35
Q

Describe the biological effects of alcohol

A

Affects GABA causing Anxiolytic and Sedative effects

Pleasurable and stimulant effect from dopaminergic pathway sensitises and leads to dependence

Long term decreases GABA and increases Glutamate = hyper-excitability of the CNS when alcohol is withdrawn

long term use often experince cravings which has been linked to dopaminergic, serotonergic, opioid systems that mediate positive reinforcement

36
Q

Describe the psychological theories behind alcohol dependence

A

Social Learning Theory
Operant Conditioning Therapy

37
Q

what are some risk factors for alcohol abuse?

A

male

young adults

genetics

antisocial behaviour

lack of facial flushing

life stressors

38
Q

Describe the ICD10 criteria for Alcohol Intoxication

A

A - Clear evidence of psychoactive substance, Disturbance in consciousness/cognition/behaviour, Not accounted for by mental/medical disorder
B - Evidence of dysfunctional behaviour, and one of unsteady gait/slurred speech/nystagmus/flushing

39
Q

Describe the clinical features of Alcohol Dependence (SAW DRINk)

A
  • *S**ubjective awareness of compulsion
  • *A**voidance of withdrawal symptoms by drinking
  • *W**ithdrawal symptoms
  • *D**rink seeking behaviour predominates
  • *R**einstatement if drinking after failed abstinence
  • *I**ncrease tolerance
  • *N**arrowing of drinking repertoire (fixed times)

k

40
Q

Describe the ICD10 criteria for Alcohol Withdrawal

A

A) General criteria for withdrawal state met (not accounted for by mental/medical disorders)
B) 3 of Tremor/Sweating/N and V/ Tachycardia/ Headache/Insomnia/Transient Hallucinations

Occurs 6-12hrs after abstinence

41
Q

Give 5 long term manifestations of Alcoholism

A

Cirrhosis
HCC
Peptic Ulcers
Pancreatitis
Wernickes and Korsakoff

42
Q

What is the CAGE questionnaire for Alcohol Abuse?

A

C - Have you ever felt you should CUT down on your drinking
A- Have people ANNOYED you by criticising your drinking
G - Have you ever felt GUILTY about your drinking
E - Do you ever have a drink EARLY in the morning

43
Q

Describe the expected MSE for an Alcohol Intoxicated patient

A

Appearance - Poor coordination, alcohol smell
Speech - Slurred
Mood - Elevated or depressed
Thought - Variable
Perception- Normal
Cognition - Impaired judgement, reduced concentration
Insight - Poor

44
Q

Describe the expected MSE for an Alcohol Withdrawn patient

A

Appearance - Agitated, Sweaty
Speech - Confused
Mood - Anxious
Thoughts - Paranoid Delusions
Perception - Visual Hallucinations, Illusions
Cognition - Delirium, Inattention
Insight - Poor

45
Q

what blood tests would you do in excess alcohol consumption

A

blood alcohol level

FBC (anaemia)

U&Es (dehydration, low urea)

LFTs including gamma GT (may be raised)

blood alcohol concentration, MCV (macrocytosis)

vitamin B12/folate/TFTs (alternative causes of raised MCV)

amylase (pancreatitis)

hepatitis serology

glucose (hypoglycaemia).

46
Q

Name three questionnaires for Alcohol Abuse

A

AUDIT (Alcohol Use Disorders Identification Test)
SADQ (Severity of Alcohol Dependence Questionnaire)
FAST screening tool

47
Q

Describe the biological management of Alcohol withdrawal

A

High Dose Benzodiazepines (clordiazepoxide) used and tapered over 5-9 days
Thiamine Orally or IV as Pabrinex

48
Q

Describe the long term Biological management of Alcohol Dependence

A

Disulfiram
Acamprosate (reduces craving by enhancing GABA)
Naltrexone

49
Q

Describe the Psychological management of Alcohol Abuse

A

Motivational Interviewing
CBT
Environment based therapy

50
Q

Motivational interviewing uses the Stages Of Change Model, describe it

A

1) Precontemplation
2) Contemplation
3) Determination
4) Action
5) Maintenance
6) Relapse

51
Q

Describe the social management of Alcohol abuse

A

Alcoholics Anonymous (AA)

52
Q

How do you calculate alcohol units?

how many ml in 1 unit of alcohol

A

10ml (8g) of ethanol

strengths x ml / 1000

53
Q

bio-psychosocial approach to management of alcohol abuse

A
54
Q

what is Karsakoff’s psychosis

A

profound irreversible short term memory loss with confabulation (the unconscious filling of gaps in memory with imaginary events) and disorientation of time

55
Q

what is Wernicke’s encephalopathy

A

acute encephalopathy due to thiamine deficiency, presenting with delirium, nystagmus, ophthalmoplegia, hypothermia and ataxia

urgent treatment - as may progress to Karsakoff’s psychosis

treat with parenteral thiamine

56
Q

what is the triad of Wernicke’s encephalopathy?

A

altered mental state

ataxia

ophthalmoplegia

57
Q

what is delirium tremens?

A

withdrawl delirium develops between 24 hours and 1 week after alcohol cessation

peak at 72 hours

cognitive impairment, vivid perceptual abnormalities, paranoid delusion, marked tremor, autonomic arousal

treated with benzodiazepines, haloperidol for psychotic features and iv Pabrinex

Psychiatry (18 decks)

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