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Year 4 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

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3
Q

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

A 
Strong Complisooon
Preoccupation with Substance Misuse
Withdrawal State
Tolerance
Persistent use despite harm
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4
Q

Give three examples of Stimulant Drugs

A

Cocaine
Crack
Ecstasy

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5
Q

Describe the psychological effects of Stimulant Drugs

A

Euphoria
Increased Energy
Grandiose
Aggression

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6
Q

Describe the physical effects of Stimulant Drugs

A

Tachycardia
Hypertension
Arrhythmias

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7
Q

Describe the withdrawal effects of Stimulant Drugs

A 
Lethargy
Psychomotor Agitation
Craving
Increased Appetite
Insomnia
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8
Q

Name two Hallucinogens

A

LSD

Magic Mushrooms

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9
Q

Describe the psychological effects of Hallucinogenic Drugs

A

Anxiety
Illusions
Hallucinations
Derealisation/Depersonalisation

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10
Q

Describe the physical effects of Hallucinogenic Drugs

A

Tachycardia
Palpitations
Sweating
Tremor

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11
Q

Describe the psychological effects of Volatile Solvent Drugs

A

Aggression

Impaired attention and judgement

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12
Q

Describe the physical effects of Volatile Solvent Drugs

A

Unsteady Gait
Diplopia
Nystagmus

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13
Q

Describe the psychological effects of Anabolic Steroids

A

Euphoria
Depression
Aggression
Mood Swings

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14
Q

Describe the physical effects of Anabolic Steroids

A

Increased muscle mass
Reduced fat
Acne
Reduced sperm count

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15
Q

Give 5 potential consequences of Substance Misuse

A 
Endocarditis
Drug Induced Psychosis
DVT
Crime
Homelessness
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16
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

17
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

18
Q

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

A

Benzodiazepines

Up to 2y possession and 14y for supply

19
Q

Name four investigations for a known substance abuser

A

Bloods - BBV, LFTs, U&Es
Urinalysis - Drug Metabolites
ECG - Arrhythmias
Echo - Endocarditis

20
Q

Describe the management of Opioid Dependence

A

Detoxification and Maintenance- Methadone/Buprenorphine

Continued Abstinence (ie after detoxification) - Naltrexone

Overdose antidote = Naloxone

21
Q

Describe four psychosocial interventions for Substance Misuse

A

Motivational interviewing and CBT

Contingency Management (changing specific behaviours by offering incentives for positive behaviours)

Supportive help with finance/housing/employment

Narcotics Anonymous

22
Q

Define Alcohol Abuse

A

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

23
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

24
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

25
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

26
Q

Describe the psychological theories behind alcohol dependence

A

Social Learning Theory

Operant Conditioning Therapy

27
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

28
Q

Describe the clinical features of Alcohol Dependence (SAW DRINk)

A

Subjective awareness of compulsion
Avoidance of withdrawal symptoms by drinking
Withdrawal symptoms
Drink seeking behaviour predominates
Reinstatement if drinking after failed abstinence
Increase tolerance
Narrowing of drinking repertoire (fixed times)

29
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

30
Q

Give 5 long term manifestations of Alcoholism

A 
Cirrhosis
HCC
Peptic Ulcers
Pancreatitis
Wernickes and Korsakoff
31
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

32
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

33
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
34
Q

Name three questionnaires for Alcohol Abuse

A

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

35
Q

Describe the biological management of Alcohol withdrawal

A

High Dose Benzodiazepines used and tapered over 5-9 days

Thiamine Orally or IV as Pabrinex

36
Q

Describe the long term Biological management of Alcohol Dependence

A

Disulfiram
Acamprosate (reduces craving by enhancing GABA)
Naltrexone

37
Q

Describe the Psychological management of Alcohol Abuse

A

Motivational Interviewing
CBT
Environment based therapy

38
Q

Motivational interviewing uses the Stages Of Change Model, describe it

A

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

39
Q

Describe the social management of Alcohol abuse

A

Alcoholics Anonymous

Year 4 Psychiatry (12 decks)

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