Alcohol dependance

Question 1

definition of harmful alcohol use?

Answer 1

causing damage to physical or mental health (including impaired judgement/behaviour) for at least 1 month or occurred repeatedly

Question 2

definition of dependence syndrome?

Answer 2

3 or more of:

• strong desire/compulsion to take alcohol
• difficulty controlling use
• persistent use despite evidence of harm
• preoccupation with substance use
• increased tolerance
• psychological withdrawal state

Question 3

what are the general principles of treating alcohol dependence?

Answer 3

must address other issues first, i.e - family, money, mental health, coping mechanisms etc before tackling alcohol

Question 4

describe the Prochaska and DiClemente 5 stages of change

Answer 4

pre-contemplation > contemplation > preparation > action > relapse > precontemplation etc
often requires 3-4 cycles

Question 5

what must be done during the admission process of an alcoholic?

Answer 5

psychiatric history
rating scales
physical exam (liver function etc)
monitor withdrawal
medical treatment
psychological work
relapse prevention
social rehabilitation

Question 6

what is FAST and how is it used?

Answer 6

Fast Alcohol Screening Test

score of 3 or more = possible hazardous drinking

Question 7

what is audit scoring?

Answer 7

scoring system used to diagnose dependence drinking and determines management
first 4 Qs are fast and rest are audit

Question 8

what are the parameters for audit scoring?

Answer 8

0-7 = low risk
8-15 = hazardous
16-19 = harmful
20+ = possible dependance

Question 9

what supportive treatments are available for alcohol dependence?

Answer 9

vitamins (thiamine for low risk, pabrinex for high risk)
nutrition
hydration
anti-emetics
anti-diarrhoeals

Question 10

AUDIT 0-7 management?

Answer 10

no change needed

Question 11

audit 8-14 management?

Answer 11

brief intervention

Question 12

audit 15-19 management?

Answer 12

brief intervention > motivational enhancement therapy and possible medication

Question 13

audit 20+ management?

Answer 13

refer to TSMS

Question 14

what is SADQ?

Answer 14

questionnaire on dependence severity

used if audit >20

Question 15

what are the parameters for SADQ score?

Answer 15

<15 = mild
15-29 = moderate
30+ = severe

Question 16

when does withdrawal kick in?

Answer 16

4-12 hrs after last drink

Question 17

when do seizures become a risk and what can increase the likelihood?

Answer 17

6-48 hrs

if severe withdrawal (severe alcoholic) or predisposed to seizures e.g - epilepsy

Question 18

is withdrawal with delirium a medical emergency?

Answer 18

yes

Question 19

what is delirium tremens?

Answer 19

severe confusion, hallucinations and autonomic hyperactivity (tachycardia, sweating etc) associated with alcohol withdrawal

Question 20

when does delirium tremens occur and how long can it last?

Answer 20

72-96 hours after drink and can last from 1 week to 1 month

Question 21

how is delirium tremens treated and why is it treated as an emergency?

Answer 21

start with ABCDE
diazepam for seizure risk > parbinex > glucose if needed for rehydration
other supportive measures if needed
seizures common and 5% mortality

Question 22

what is the triad of wernickes encephalopathy?

Answer 22

ataxic gait
confabulation
opthalmoplegia

Question 23

what else can cause similar symptoms to wernickes encephalopathy?

Answer 23

combination of alcohol and diazepam

Question 24

what is Korsakoff syndrome sometimes confused with?

Answer 24

dementia

Question 25

how are alcoholic hallucinations differentiated from psychotic?

Answer 25

history
during/after drinking
arise in clear consciousness
resolve <6 months

Question 26

first line treatment for relapse prevention?

Answer 26

Acamprosate and naltrexone

Question 27

second line for relapse prevention?

Answer 27

disulfiram

Question 28

what other ways can relapse be prevented other than drugs?

Answer 28

intervention, therapy, 12 steps, employment, social help etc