Alcohol and substance related disorders Flashcards
In 2007, what proportion of men were found to engage in hazardous drinking?
33%
In 2007, what proportion of women were found to engage in hazardous drinking?
16%
In 2007, what proportion of men (16-75) were found to have a dependence to alcohol?
9%
In 2007, what proportion of women (16-75) were found to have a dependence to alcohol?
4%
What is the safe daily alcohol limit for men?
3-4 units a day with at least 2 alcohol free days a week
What is the safe daily alcohol limit for women?
2-3 units a day with at least 2 alcohol free days a week
What are the causes of and risk factors for alcohol dependence?
They are multifactorial:
Genetic element
Positive reinforcement - eg loss of inhibition
Negative reinforcement - eg withdrawal symptoms
Relatives and peers
Presence of other mental health problems
Culture
Social class
Profession - stress
Significant life event - eg. rape, bereavement
What are the 4 L’s which represent the areas affected by harmful use of alcohol?
Love
Livelihood
Liver
Law (crime)
What are the different psychoactive substance-related disorders?
Hazardous use of substance Harmful use of substance Substance dependence Substance intoxication Substance withdrawal Substance withdrawal delirium Substance-related cognitive disorders Substance-related psychotic disorder Substance-related mood disorder Substance-related anxiety disorder
What is the difference between harmful use and hazardous use of a substance?
Hazardous use - quantity or pattern of substance use that places the user AT RISK of adverse consequences, without dependence. eg drink driving
Harmful use - quantity or pattern of substance use that ACTUALLY CAUSES adverse consequences, without dependence. eg binge drinking
How does the ICD-10 define the diagnosis of dependence syndrome of any substance?
3 or more of the following have been present together at some time during the previous year:
- A strong desire or compulsion to take the substance
- Difficulties in controlling substance-taking behaviour (onset, termination, levels of use)
- Physiological withdrawal state when substance use has reduced or ceased; or continued use of substance to avoid withdrawal symptoms
- Signs of tolerance: increased quantities of substance are required to produce same effect originally produced by lower doses.
- Neglect of other interests activities due to time spent acquiring and taking substance, or recovering from its effects.
- Persistence with substance use despite clear awareness of harmful consequences (physical or mental)
Are patients who do not display or report signs of tolerance or withdrawal considered not dependent on a substance?
No. They may be dependent despite not exhibiting either tolerance or withdrawal. However, if they do exhibit either tolerance or withdrawal they are likely to be dependent.
What are the ‘uncomplicated’ features of alcohol withdrawal syndrome?
Tremulousness Sweating Nausea and vomiting Mood disturbance Sensitivity to sound Tachycardia Hypertension Mydriasis Pyrexia Sleep disturbance Psychomotor agitation
These features tend to develop 4-12 hours after drinking cessation
What are the more ‘complicated’ features of alcohol withdrawal syndrome?
Perceptual disturbances - illusions, hallucinations
Withdrawal seizures
Delirium tremens
How long after cessation of drinking do withdrawal seizures tend to develop?
6-48 hours
In what proportions of alcohol-dependant drinkers do withdrawal seizures occur?
5-15%
What type of seizures are associated with alcohol withdrawal syndrome?
Generalized and tonic-clonic
What electrolyte disturbances in an alcoholic patient might precipitate withdrawal seizures?
Low potassium
Low magnesium
What are the features of delirium tremens?
Altered consciousness Marked cognitive impairment - delirium Vivid hallucinations and illusions Marked tremor Autonomic arousal - sweating, raised BP and HR, pyrexia Paranoid delusions
How long after cessation of drinking does delirium tremens tend to develop?
1-7 days
What is the deficiency associated with Wernicke’s encephalopathy and Korsakoff psychosis?
Vitamin B1 - thiamine
What is the difference between Wernicke’s encephalopathy and Korsakoff psychosis?
Wernicke’s encephalopathy occurs in the acute brain damage phase due to thiamine deficiency whereas Korsakoff psychosis is the chronic state that emerges after Wernicke’s encephalopathy. They represent a continuum.
What is the classical triad that characterises Wernicke’s encephalopathy?
Delirium
Opthalmoplegia - nystagmus, sixth nerve palsy or conjugate gaze palsy
Ataxia