Alcohol dependance Flashcards
definition of harmful alcohol use?
causing damage to physical or mental health (including impaired judgement/behaviour) for at least 1 month or occurred repeatedly
definition of dependence syndrome?
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
what are the general principles of treating alcohol dependence?
must address other issues first, i.e - family, money, mental health, coping mechanisms etc before tackling alcohol
describe the Prochaska and DiClemente 5 stages of change
pre-contemplation > contemplation > preparation > action > relapse > precontemplation etc
often requires 3-4 cycles
what must be done during the admission process of an alcoholic?
psychiatric history rating scales physical exam (liver function etc) monitor withdrawal medical treatment psychological work relapse prevention social rehabilitation
what is FAST and how is it used?
Fast Alcohol Screening Test
score of 3 or more = possible hazardous drinking
what is audit scoring?
scoring system used to diagnose dependence drinking and determines management
first 4 Qs are fast and rest are audit
what are the parameters for audit scoring?
0-7 = low risk 8-15 = hazardous 16-19 = harmful 20+ = possible dependance
what supportive treatments are available for alcohol dependence?
vitamins (thiamine for low risk, pabrinex for high risk) nutrition hydration anti-emetics anti-diarrhoeals
AUDIT 0-7 management?
no change needed
audit 8-14 management?
brief intervention
audit 15-19 management?
brief intervention > motivational enhancement therapy and possible medication
audit 20+ management?
refer to TSMS
what is SADQ?
questionnaire on dependence severity
used if audit >20
what are the parameters for SADQ score?
<15 = mild 15-29 = moderate 30+ = severe
when does withdrawal kick in?
4-12 hrs after last drink
when do seizures become a risk and what can increase the likelihood?
6-48 hrs
if severe withdrawal (severe alcoholic) or predisposed to seizures e.g - epilepsy
is withdrawal with delirium a medical emergency?
yes
what is delirium tremens?
severe confusion, hallucinations and autonomic hyperactivity (tachycardia, sweating etc) associated with alcohol withdrawal
when does delirium tremens occur and how long can it last?
72-96 hours after drink and can last from 1 week to 1 month
how is delirium tremens treated and why is it treated as an emergency?
start with ABCDE
diazepam for seizure risk > parbinex > glucose if needed for rehydration
other supportive measures if needed
seizures common and 5% mortality
what is the triad of wernickes encephalopathy?
ataxic gait
confabulation
opthalmoplegia
what else can cause similar symptoms to wernickes encephalopathy?
combination of alcohol and diazepam
what is Korsakoff syndrome sometimes confused with?
dementia
how are alcoholic hallucinations differentiated from psychotic?
history
during/after drinking
arise in clear consciousness
resolve <6 months
first line treatment for relapse prevention?
Acamprosate and naltrexone
second line for relapse prevention?
disulfiram
what other ways can relapse be prevented other than drugs?
intervention, therapy, 12 steps, employment, social help etc
