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Psychiatry > Alcohol and substance misuse > Flashcards

Alcohol and substance misuse Flashcards

1
Q

What are the risk factors for substance misuse?

A
  • Peer pressure
  • Life stressors
  • Parental drugs use
  • Cultural acceptability
  • Positive reinforcement: from peers or effect of drus
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2
Q

Which sex uses drugs more?

A

Male

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3
Q

Which drugs are commonly misused?

A

Opiods

Cannabinoids

Stimulants

Sedative-hypnotics

Hallucinogens

Volatile solvents

Anabolic steroids

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4
Q

What are the physical, psychological and social complications of substance misuse?

A

Physical = death, infection (HIV, Hep A, B or C, S. Aureaus, TB), endocarditis, superficial thrombosis, PE

Psychological = craving, anxiety, cognitive disturbance, drug-induced psychosis

Social = Crime, imprisonment, homelessness, prostitution, relationship problems

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5
Q

What are the features of substance dependence?

A
  • Compulsion to consume substance
  • Preoccupation with substance use
  • Withdrawal
  • Tolerance
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6
Q

What to ask in substance misuse OSCE?

A

TRAP (type, route, amount and pattern)

Risk assessment (incl. needle sharing)

Possible triggers or stressful life events

Past substance use

Complications of drug abuse

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7
Q

What investigations for substance misuse?

A
  • Bloods (HIV screen, Hep B, C and TB, U&Es for renal function, LFTs and clotting for hepatic function and drug levels)

Urinalysis: drug metabolites e.g. cannabis and opiods can be detected in urine

ECG for arrhythmias, ECHO for endocarditis

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8
Q

What are the differentials for substance misuse?

A

Psychosis

Mood disorder

Anxiety disorder

Delerium

Organic: Hyperthyroidism, CVA, intracranial haemorrhage, neurological disorders (e.g. cerebellar pathology)

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9
Q

What is the management of patients with substance misuse?

A
  • Keyworker with training in substance misuse
  • Hep B immunization
  • Motivational interviewing and CBT (for co-morbid depression or anxiety)
  • Supportive help e.g. housing, finance and employment
  • Self-help groups e.g. NA or cocain anonymous
  • Issue of driving and DVLA
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10
Q

What drug can be used to wean patient off of opiods?

A

Methadone or Buprenorphine for detoxification and maintenance

Naltrexone can be used for those who have recovered from an opiod-dependency (also used as an antidote to opiod overdose)

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11
Q

What is alcohol abuse?

A

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

Binge drinking is drinking twice the recommended level of alcohol per day, in one session

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12
Q

What is the effect of alcohol?

A

Affects neurotransmitters (effect on GABA causes anxiolytic and sedative effects)

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13
Q

What is the long term effect of alcohol consumption?

A

Down-regulation of inhibitory neuronal GABA receptors and up-regulation of excitatory glutamate receptor (when withdrawn causes CNS hyper-excitability)

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14
Q

Define operate conditioning and alcohol misuse?

A

Positive or negative reinforcement from the effects of drinking will either perpetuate or deter drinking habits, respectively

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15
Q

What are the risk factors for alcohol abuse?

A
  • Male
  • Younger adults
  • Genetics
  • Pre-morbid antisocial behaviour
  • Life stressors (financial problems, marital issues, certain occupations)
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16
Q

What are the features of alcohol dependence?

A

CAGE

Cut back, annoyed at comments, guilty, eye-opener

17
Q

What are some complications of alcohol abuse?

A

Medical = fatty liver, hepatitis, cirrhosis, hepatocellular carcinoma, peptic ulcer, varices, pancreatitis, HTN, cardiomyopathy, anaemia, seizures, peripheral neuropathy, Wernicke’s encephalopathy, Korsakoff’s psychosis, head injury, fetal alcohol syndrome

Psychatric = morbid jealousy, delf-harm, mood disorders, anxiety, delerium tremens

Social = domestic violence, drink driving, employment difficulties, financial problems, homelessness

18
Q

What are some symptoms of alcohol withdrawal?

A

Malaise

Tremor

Nausea

Insomnia

Transient hallucinations

6-12 hours = automonic hyperactivity

36 hours = seizures

19
Q

When is the peak incidence of delerium tremens?

A

48-72 hours

20
Q

How does delerium tremens present?

A
  • Cognitive impairment
  • Vivid perceptual abnormalities
  • Paranoid delusions
  • Marked tremor
  • Automonal arousal (tachycardia, fever, pupillary dilatation, increased sweating)
21
Q

What is the medical treatment of delerium tremens?

A
  • Large dose of benzodiazepines (e.g. chlordiazepoxide)
  • Haloperidol for psychotic features
  • IV Pabrinex (replacement vitamins)
22
Q

Name some peripheral stigmata of chronic liver disease?

A
  • Palmar erythema
  • Dupuytren’s contracture
  • Spider naevi
  • Gynaecomastia
  • Clubbing, caput medusa, oesophageal varices
23
Q

What investigations for alcohol dependence?

A
  • Bloods: alcohol level, FBC (anaemia), U&Es (dehydration, decreased urea), LFTs including gamma GT, MCV, vit B12/folate/ TFTs, amylase, hepatitis serology, glucose (hypoglycaemia)
  • Alcohol questionnaires (FAST, SADQ)
  • CT head
  • ECGs
24
Q

What is Wernicke’s encephalopathy?

A

Acute encephalopathy due to thiamine deficiency - presents with delerium, nystagmus, opthalmoplegia, hypothermia and ataxia

May progress to Korsakoff’s

Treat with parenteral thiamine

25
Q

What is Korsakoff’s psychosis?

A

Irreversible short term memory loss with confabulation and disorientation to time

26
Q

How to calculate the amount of units?

A

Volume of alcohol x volume (L)

27
Q

What is the biopsychosocial management of alcohol abuse?

A

Bio = Chlorsiazepoxide detox + thiamine. Disulfiram / naltrexone. Treatment of medical complications.

Psycho = Motivational interviewing + CBT

Social = Alcoholics anonymous. Social support including family involvement. Advise patient to contact DVLA

28
Q

What is the long term treatment of alcohol dependence?

A

Disulfiram = causing a build-up of acetaldehyde on consumption of alcohol causing anxiety, flushing and headaches

Acamprosate = reduces craving by enhancing GABA transmission

Naltrexone = blocks opiod receptors (antagonist) in the body, thus reducing the pleasurable effects of alcohol

Alcoholics anonymous = 12 step approach using psychosocial techniques with social support networks, rewards with a sponsor assigned

Motivational interviewing / CBT

Prophylactic oral thiamine if malnourished

Psychiatry (13 decks)

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