Alcohol and substance use disorders

Question 1

What are some common withdrawal clinical features?

Answer 1

Question 2

What are some severe withdrawal symptoms/ complications?

Answer 2

Question 3

What is Delerium Tremens ?

Answer 3

Toxic confusional state due to severe alcohol withdrawal. Characterised by cognitive impairment, disorientation, agitation, fluctuating levels of confusion and sometimes psychotic symptoms.

Question 4

What is Wernicke-Korsakoff syndrome?

Answer 4

spectrum of disease resulting from thiamine deficiency, consisting of:
Wernicke’s encephalopathy; neurological symptoms (classic triad of confusion, ataxia and ophthalmoplegia rarely present)
Korsakoff’s syndrome; late manifestation where WE has progressed
Marked deficits in anterograde memory, apathy, confabulation, relative preservation of other intellectual abilities

Question 5

What are some questionnaires to determine alcohol use?

Answer 5

CAGE – Cutting down, annoyed when challenged, guilty about drinking, eye opener.

SADQ – Severity of alcohol Dependence questionnaire

AUDIT

Question 6

What are some pharmacological intervention to prevent alcohol cravings ?

Answer 6

Question 7

What vitamin must you consider in high alcohol use and why ?

Answer 7

Thiamine

Vitamin supplementation - Up to 80% of individuals with alcohol dependence develop a thiamine deficiency.

WHY DO WE NEED TO PRESCRIBE THIAMINE? – Body doesn’t naturally produce thiamine - Heavy alcohol use causes inflammation of the stomach lining and digestive tract, which reduces the body’s ability to absorb vitamins. Thiamine is poorly absorbed orally in alcohol dependant patients so consider Pabrinex for all those admitted needing detox.

Question 8

What is the treatment for heroin use ?

Answer 8

Methadone

Question 9

What assessment tool is used to assess the severity of alcohol withdrawal?

What medication can be given for alcohol withdrawl?

Answer 9

CIWA

Chlordiazepoxide