Alcohol and Substance Misuse Flashcards
State the seven ICD10 categories of Substance Misuse
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)
Describe the Biological Aetiology behind Substance Misuse
Genetics (variations in enzymes that metabolise drugs)
Neurochemical Abnormalities
Mesolimbic Dopaminergic Reward Pathway
Substance Dependence requires more than three of the following symptoms over a period of 1 month
Strong Complisooon Preoccupation with Substance Misuse Withdrawal State Tolerance Persistent use despite harm
Give three examples of Stimulant Drugs
Cocaine
Crack
Ecstasy
Describe the psychological effects of Stimulant Drugs
Euphoria
Increased Energy
Grandiose
Aggression
Describe the physical effects of Stimulant Drugs
Tachycardia
Hypertension
Arrhythmias
Describe the withdrawal effects of Stimulant Drugs
Lethargy Psychomotor Agitation Craving Increased Appetite Insomnia
Name two Hallucinogens
LSD
Magic Mushrooms
Describe the psychological effects of Hallucinogenic Drugs
Anxiety
Illusions
Hallucinations
Derealisation/Depersonalisation
Describe the physical effects of Hallucinogenic Drugs
Tachycardia
Palpitations
Sweating
Tremor
Describe the psychological effects of Volatile Solvent Drugs
Aggression
Impaired attention and judgement
Describe the physical effects of Volatile Solvent Drugs
Unsteady Gait
Diplopia
Nystagmus
Describe the psychological effects of Anabolic Steroids
Euphoria
Depression
Aggression
Mood Swings
Describe the physical effects of Anabolic Steroids
Increased muscle mass
Reduced fat
Acne
Reduced sperm count
Give 5 potential consequences of Substance Misuse
Endocarditis Drug Induced Psychosis DVT Crime Homelessness
Give an example of a Class A drug and the subsequent UK law
Cocaine
7 years prison for possession, up to life for supply
Give an example of a Class B drug and the subsequent UK law
Ketamine
5 years for possession, up to 14 years for supply
Give an example of a Class C drug and the subsequent UK law
Benzodiazepines
Up to 2y possession and 14y for supply
Name four investigations for a known substance abuser
Bloods - BBV, LFTs, U&Es
Urinalysis - Drug Metabolites
ECG - Arrhythmias
Echo - Endocarditis
Describe the management of Opioid Dependence
Detoxification and Maintenance- Methadone/Buprenorphine
Continued Abstinence (ie after detoxification) - Naltrexone
Overdose antidote = Naloxone
Describe four psychosocial interventions for Substance Misuse
Motivational interviewing and CBT
Contingency Management (changing specific behaviours by offering incentives for positive behaviours)
Supportive help with finance/housing/employment
Narcotics Anonymous
Define Alcohol Abuse
Consumption of alcohol at a level enough to cause physical psychiatric and social harm
Define Binge Drinking
Drinking twice over recommended level of alcohol per day in one session
>8 units for males
>6 units for females
Define Harmful Alcohol Use
Drinking above safe levels with evidence of alcohol related problems
>50 units per week for males and >35 units per week for females
Describe the biological effects of alcohol
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
Describe the psychological theories behind alcohol dependence
Social Learning Theory
Operant Conditioning Therapy
Describe the ICD10 criteria for Alcohol Intoxication
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
Describe the clinical features of Alcohol Dependence (SAW DRINk)
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)
Describe the ICD10 criteria for Alcohol Withdrawal
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
Give 5 long term manifestations of Alcoholism
Cirrhosis HCC Peptic Ulcers Pancreatitis Wernickes and Korsakoff
What is the CAGE questionnaire for Alcohol Abuse?
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
Describe the expected MSE for an Alcohol Intoxicated patient
Appearance - Poor coordination, alcohol smell
Speech - Slurred
Mood - Elevated or depressed
Thought - Variable
Perception- Normal
Cognition - Impaired judgement, reduced concentration
Insight - Poor
Describe the expected MSE for an Alcohol Withdrawn patient
Appearance - Agitated, Sweaty Speech - Confused Mood - Anxious Thoughts - Paranoid Delusions Perception - Visual Hallucinations, Illusions Cognition - Delirium, Inattention Insight - Poor
Name three questionnaires for Alcohol Abuse
AUDIT (Alcohol Use Disorders Identification Test)
SADQ (Severity of Alcohol Dependence Questionnaire)
FAST screening tool
Describe the biological management of Alcohol withdrawal
High Dose Benzodiazepines used and tapered over 5-9 days
Thiamine Orally or IV as Pabrinex
Describe the long term Biological management of Alcohol Dependence
Disulfiram
Acamprosate (reduces craving by enhancing GABA)
Naltrexone
Describe the Psychological management of Alcohol Abuse
Motivational Interviewing
CBT
Environment based therapy
Motivational interviewing uses the Stages Of Change Model, describe it
1) Precontemplation
2) Contemplation
3) Determination
4) Action
5) Maintenance
6) Relapse
Describe the social management of Alcohol abuse
Alcoholics Anonymous
