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Yr4 - Psych > Alcohol and Substance Misuse > Flashcards

Alcohol and Substance Misuse Flashcards

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1
Q

ICD-10 criteria for substance misuse for acute intoxication

A

Acute, usually transient, effects of the substance

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2
Q

ICD-10 criteria for substance misuse for harmful use

A

Recurrent misuse associated with physical, psychological and social consequences
- but without dependence

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3
Q

ICD-10 criteria for substance misuse for dependence syndrome

A

Prolonged, compulsive substances use leading to addiction, tolerance and the potential for withdrawal syndromes

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4
Q

ICD-10 criteria for substance misuse for withdrawal state

A

Physical and/or psychological effects from complete cessation of a substance after prolonged, repeated or high level of use

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5
Q

ICD-10 criteria for substance misuse for psychotic disorder

A

Onset of psychotic symptoms within 2 weeks of substance use

- must persist for more than 48 hours

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6
Q

ICD-10 criteria for substance misuse for amnesic syndrome

A

Memory impairment in recent memory and ability to recall past experiences

  • impaired learning of new material
  • defect in recall
  • clouding of consciousness
  • global intellectual decline
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7
Q

ICD-10 criteria for substance misuse for residual disorder

A

Specific features subsequent to substance misuse

- flashbacks, personality disorder, affective disorder, dementia, persisting cognitive impairment

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8
Q

Chain of events leading to substance dependence

A

Biological
- genetic variations in enzymes that metabolise drugs, neurochemical - abnormalities in dopamine, GABA and opioid systems
Environmental
- peer pressure, life stressors, parental drug use, cultural acceptability, personal vulnerability - lack of resources to cope with stressors
Takes substance
- cost, availability, effect of drug itself, route
Positive reinforcement
- psychosocial - from peer or pleasurable effects of drugs
- biological - activates mesolimbic dopaminergic reward pathways
Dependence

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9
Q

Examples of opiates

A

Morphine - PO and IV
Diamorphine (heroin) - IN, IV, smoked
Codeine/methadone - PO

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10
Q

Effects of opiates

A

Psychological
- apathy, disinhibition, psychomotor retardation, impaired judgement and attention, drowsiness, slurred speech
Physical
- respiratory depression, hypoxia, low BP, hypothermia, coma, pupillary constriction

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11
Q

Withdrawal state of opiates

A 
Craving
Rhinorrhoea
Lacrimation
Myalgia
Abdo cramps
N+V
Diarrhoea
Pupillary dilation
Piloerection
Increased HR/BP
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12
Q

Effects of cannabinoids

A

Psychological
- euphoria, disinhibition, agitation, paranoid ideation, temporal slowing, impaired judgement/attention/reaction time, hallucinations
Physical
- increased appetite, dry mouth, conjunctival injection, increased HR

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13
Q

Features of withdrawal state of canabinoiods

A

Anxiety, irritability, tremor of outstretched hands, sweating, myalgia

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14
Q

Types of sedative-hypnotics

A

Benzodiazepines
Barbiturates
Taken PO or IV

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15
Q

Effects of benzodiazepines

A

Psychological
- euphoria, disinhibition, apathy, aggression, anterograde amnesia, labile mood
Physical
- unsteady gait, difficulty standing, slurred speech, nystagmus, erythematous skin lesions, reduced BP, hypothermia, depression of gag reflex, coma

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16
Q

Features of withdrawal state of benzodiazepines

A

Tremor of hands, tongue or eyelids, N+V, increased HR, postural hypotension, headache, agitation, malaise, transient illusions/hallucinations, paranoid ideation, grand mal convulsions

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17
Q

Complications of substance misuse

A

Physical
- death, infection (HIV, hep A, B or C, Staph aureus, group A strep, clostridium, TB), endocarditis, superficial thrombosis, DVT, PE
Psychological
- craving, anxiety, cognitive disturbances, drug-induced psychosis
Social
- crime, imprisonment, homelessness, prostitution, relationship problems

18
Q

Features of substance dependence

A

> 3 manifestations over 1 month

  • strong desire to consume substance
  • preoccupation with substance use
  • withdrawal state when substance ingestion is reduced or stopped
  • impaired ability to control substance-taking behaviour
  • tolerance to substance
  • persisting with use despite evidence of harmful effects
19
Q

Management of substance misuse

A

Key worker with therapeutic alliance - psychosocial support
Hep B immunisation
Motivational interviewing and CBT
Contingency management - changing specified behaviours by offering incentives for positive behaviours
Supportive help - housing, finance and employment
Self help groups

20
Q

Define detoxification

A

Process in which the effects of the drug are eliminated in a safe manner

  • withdrawal symptoms avoided
  • attempt to attain abstinence
21
Q

Define maintenance thearpy

A

Abstinence not priority

Aim is to minimise harm

22
Q

Management of opioid dependence

A

Biological
- methadone
- buprenorphine for detoxification or morphine
IV naloxone for antidote to opioid overdose

23
Q

Define alcohol abuse

A

Consumption of alcohol at a level sufficient to cause physical, psychiatric and/or social harm

24
Q

Define binge drinking

A

Drinking over twice the recommended level of alcohol per day in one session

25
Q

Define harmful alcohol use

A

Drinking above safe levels with evidence of alcohol related problems

26
Q

Pathophysiology of alcohol abuse

A

Affects several neurotransmitters
- GABA -> anxiolytic and sedative effects
- dopamine -> sensitisation leads to dependence
Long term use leads to down-regulation of inhibitory neuronal GABA and up-regulation of excitatory glutamate receptors

27
Q

Risk factors for alcohol abuse

A

Male - increased risk and increased metabolism
Younger adults
Genetics
Antisocial behaviour
Lack of facial flushing - metabolises acetaldehyde more slowly
Life stressors - financial problems, marital issues, certain occupations

28
Q

Clinical features of alcohol intoxication

A 
Slurred speech
Labile affect
Impaired judgement
Poo co-ordination
Severe cases - hypoglycaemia, stupor and coma
29
Q

Clinical features of alcohol dependence

A

Subjective awareness of compulsion to drink
Avoidance or relief of withdrawal symptoms by further drinking
Withdrawal symptoms
Drink-seeking behaviours
Reinstatement of drinking after attempted abstinence
Increased tolerance
Narrowing of drinking repertoire -

30
Q

Features of alcohol withdrawal

A 
Malaise
Tremor
Nausea
Insomnia
Transient hallucinations
Autonomic hyperactivity - 6-12 hrs
Seizures - 36 hours
31
Q

Negative effects of alcohol consumptoms

A 
Medical
- fatty liver, hepatitis, cirrhosis, hepatocellular carcinoma
- peptic ulcer disease, oesophageal varices, pancreatitis, oesophageal carcinoma
- hypertension, cardiomyopathy, arrhythmias
- anaemia, thrombocytopenia
- seizures, peripheral neuropathy, cerebellar degeneration, Wernicke's encephalopathy, Korsakoff's psychosis
- foetal alcohol syndrome
Psychiatric
- morbid jealousy
- self-harm and suicide
- mood disorders
- anxiety disorders
- alcohol-related dementia
- alcoholic hallucinations
- delirium tremens
Social
- domestic violence
- drink driving
- employment difficulties
- financial problems
- homelessness
- accidents
- relationship problems
32
Q

ICD-10 criteria for alcohol intoxication

A

General criteria for acute intoxication met
- clear evidence of psychoactive substance at high dose levels
- disturbance in consciousness, cognition, perception or behaviour
- not accounted for by medical or mental disorder
Evidence of dysfunctional behaviour
- disinhibition
- argumentativeness
- aggression
- labile mood
- impaired attention/concentration
- interference with personal functioning
One of the following
- unsteady gait, difficulty standing, slurred speech, nystagmus, flushing, reduced consciousness, conjunctival injection

33
Q

ICD-10 criteria for alcohol withdrawal

A

General criteria for a withdrawal state met
- clear evidence of recent cessation or reduction of substance after prolonged or high level usage
- not accounted for by medical or mental disorder
Any three of the following
- tremor, sweating, N+V, tachycardia, increased BP, headache, psychomotor agitation, insomnia, malaise, transient hallucinations, grand mal convulsions

34
Q

Features of delirium tremens

A 
Withdrawal delirium 
- develops between 24 hrs and one week after alcohol cessation
Characterised by 
- cognitive impairment
- vivid perceptual abnormalities
- paranoid delusions
- marked tremor
- autonomic arousal
35
Q

Treatment of delirium tremens

A

Large dose benzodiazepines
Haloperidol for psychotic features
IV pabrinex

36
Q

Define Wernicke’s encephalopathy

A

Acute encephalopathy due to thiamine deficiency

37
Q

Features of Wernicke’s encephalopathy

A 
Delirium
Nystagmus
Ophthalmoplegia
Hypothermia
Ataxia
38
Q

Management of Wernicke’s encephalopathy

A

Parenteral thiamine

39
Q

Define Korsakoff’s psychosis

A

Profound, irreversible short-term memory loss with confabulation (unconscious filling of gaps with imaginary events) and disorientation to time

40
Q

How to calculate alcohol units

A

Strength x volume / 1000

41
Q

Management of alcohol abuse

A

Biological
- chlordiazepoxide detox regime + thiamine
- disulfiram - build up of acetaldehyde on consumption of alcohol
- Acamprosate - reduces craving by enhancing GABA transmission
- naltrexone - blocks opioid receptors
- treatment of medical and psychiatric complications
Psychological
- motivational interviewing
- social network and environment based therapies
Social
- alcoholics anonymous
- social support including family involvement

Yr4 - Psych (13 decks)

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