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alcohol dependence Flashcards

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1
Q

what is harmful use in ICD10

A
  1. alcohol use causing either physical or mental damage
  2. no dependence
  3. often criticised by others
  4. adverse social consequences
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2
Q

ICD 10 criteria for dependence syndrome?

A
  1. strong compulsion to take substance
  2. can’t control behaviour
  3. withdrawal state - classic withdrawal for the substance
  4. use of the substance or similar to relieve withdrawal symptoms
  5. evidence of tolerance
  6. neglect of alternative pleasures (primacy)
  7. persisting with use despite evidence of harmful consequences (eg liver, depression, cognitive probs)
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3
Q

what is dependence syndrome?

A

3+ dependency criteria present together at some time in past year

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4
Q

some additional signs of dependence syndrome?

A

narrowed repertoire and patterns - stereotyped behaviour

reinstatement after period of abstinence

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5
Q

units in pint of beer?

A

2-4 depends on strength

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6
Q

large glass of wine units?

A

3

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7
Q

bottle of wine?

A

9 units

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8
Q

bottle of alcopops units?

A

1.5

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9
Q

women units/day?

A

2-3

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10
Q

men units/day?

A

3-4

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11
Q

gender distribution of dependence?

A

7.5% male 2% female

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12
Q

lifetime prevalence of alcohol dependence?

A

14%

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13
Q

who are the heaviest drinkers?

A

young men

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14
Q

drinking and women- comorbidity?

A

more likely than men to have affective disorder

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15
Q

most drinkers live in ______

A

urban

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16
Q

occupations and drinking?

A
  1. easy access
  2. unsociable hours
  3. shift work
  4. away from home
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17
Q

relationship status drinkers?

A

single

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18
Q

lowest drinking class?

A

middle

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19
Q

comorbidities and drinking?

A
  1. other substance
  2. affective
  3. anxiety
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20
Q

at risk drinking men and women?

A

men - >14 drinks wk/>4 per session

women >7 /wk or >3 session

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21
Q

how much ethanol in one unit?

A

10-12g

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22
Q

weekly women alcohol?

A

14

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23
Q

weekly men alcohol?

A

21

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24
Q

biological link with alcohol dependence?

A

yes possibly - twin studies and adoption studies - mostly males

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25
Q

dopamine pathway in alcohol use?

A
  1. activation: NA, dopamine
  2. euphoria: dopamine, opioid, serotonin
  3. anxiolytic: increased GABA
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26
Q

what is CAGE?

A
  1. ever been told to cut down
  2. ever been annoyed by others giving out about your drinking
  3. Ever felt guilty?
  4. eye - opener
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27
Q

CAGE score _____ has a high sense and spec for problem drinkers

A

2+

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28
Q

normal AUDIT score is _______

A

5 female, 7 male

29
Q

what is an alcohol dependent score in AUDIT?

A

20+

30
Q

what are the psychiatric consequences of alcohol dependence?

A
  1. alcohol hallucinosis
  2. DTs
  3. generalised anxiety
  4. panic attacks
  5. low mood
  6. depression/anxiety dx
31
Q

what is hallucinosis?

A

3rd person derogatory auditory, assoc w/ higher risk of schizophrenia and reduction in dose

32
Q

_____ % of suicides have alcohol

A

20 prior to taking life

27% have hx of alcohol abuse

45% have attended GP for alcohol counselling

33
Q

comorbidities with alcohol dependence?

A

x2 mental, x7 drug

  1. affective - 20% depressed
  2. suicide - lifetime risk 4%
  3. othello syndrome
  4. anxiety disorders
  5. eating disorders
34
Q

what is othello syndrome?

A
  1. males
  2. delusional jealousy
  3. try to prove infidelity
  4. risk to spouse
35
Q

withdrawal symptoms?

A
  1. NV
  2. tremor
  3. sweats
  4. anxiety
  5. tactile perception prob
  6. auditory hallucination
  7. visual hallucination
  8. confused
  9. DT
  10. convulsions (within 24hrs)
36
Q

_____ scale rates withdrawal symptoms and informs mx

A

CIWA

37
Q

signs of DT?

A
  1. confused
  2. agitated
  3. ANS probs
  4. fever
  5. visual hallucinations - lilliputian, affect of terror
  6. tactile - formication
38
Q

mx of DT?

A
  1. chlordiazepoxide - long actcing benzo
  2. can give stat if tremulous
  3. 5-40mg QDS - increase if signs withdrawal - DTs protocol is 60mg QDS +/- haloperidol
  4. then taper down
  5. +/- anticonvulsants
  6. supportive
39
Q

neurological complications of alcohol dependence?

A
  1. intoxication
  2. wernicke’s
  3. korsakoff’s
  4. cerebellar degeneration
  5. epilepsy
  6. dementia
  7. central pontine myelinosis
  8. optic atrophy
40
Q

what is WE?

A 
confusion
ataxia
ophthalmoplegia
tetrad - nystagmus
also: peripheral neuropathy, hypothermia, hypotension, coma
41
Q

what is korsakoff’s

A

impaired recent memory and new learning

confabulation

poor time sense

42
Q

what is damaged in korsakoff’s

A

mamillary bodies

43
Q

who gets WE?

A
  1. heavy drinkers
  2. thiamine deficiency
  3. hyperemesis gravidarum
  4. anorexia
44
Q

WE untreated leads to ______ in _____% of cases

A

korsakoff’s

84%

45
Q

tx WE?

A

pabrinex 1 pair ampoules daily for 3-5 days

thiamine 2-300mg PO daily thereafter

46
Q

s/e pabrinex?

A

allergy- rare

47
Q

GIT consequences of alcohol

A
  1. oesophagitis
  2. mallory weiss
  3. varices
  4. oes ca
  5. pancreatitis
  6. portal HTN
48
Q

liver consequences alcohol?

A

alcoholic hepatitis
fatty liver
cirrhosis

49
Q

CVS consequences alcohol?

A

arrhythmia
DCM
HTN

50
Q

metabolic side effects of alcohol

A

ketoacidosis

hypoglycaemia

51
Q

MSK symptoms of alcohol?

A 
dupuytrens
gout
proximal myopathy
AVN
OP
52
Q

BAC ____ = double vision

A

0.3%

53
Q

BAC _____ = unconscious

A

0.45%

54
Q

BAC ______ = death

A

0.65%

55
Q

alcohol related issues are ____ of all med admissions

A

15%

56
Q

children of alcoholic more at risk of:

A

conduct disorder

deliquency

57
Q

drinking is implicated in ______ of fatal RTAs

A

75%

58
Q

mx of alcohol dependence

A
  1. abstinence

2. detox - OPD or IP

59
Q

when to do IP detox?

A
  1. prior hx of DTs or seizures
  2. > 65yrs
  3. poor social support
  4. comorbid psych issues
  5. suicidal
  6. failed community detox
  7. cognitive impairment
60
Q

Rfs for DTs in detox

A
  1. severe dependence
  2. past hx
  3. older age
  4. acute illness
  5. severe withdrawal symptoms
61
Q

symptomatic tx of alcoholism

A
  1. dehydrated - fluids
  2. pain- paracetamol
  3. NV- prochlorpromazine or metoclopramide
  4. diarrhoea - loperamide
  5. lactulose - hepatic encepalopathy
62
Q

how to maintain abstinence in ADependence? (meds)

A
  1. disulfram
  2. acamprosate
  3. naltrexone
63
Q

what is disulfram?

A

causes facial flushing, throbbing headache, palpitations, tachycardia, nausea, vomiting when drink alcohol within 15 mins

CAN BE FATAL

64
Q

acamprosate what does it do?

A

GABA agonist - reduces craving

65
Q

what does naltrexone do?

A

opioid antagonist

antagonises endorphins released by alcohol

66
Q

psychological tx for alcohol dependence?

A
  1. motivational interviewing - cycle of change, non confrontational, contact, advice, goals
  2. addiction counsellor
  3. relapse prevention - FRAMES
67
Q

what is FRAMES?

A 
feedback
responsibility
advice
menu of options
empathy
self efficacy
68
Q

social tx of alcohol dependence?

A

AA - 12 steps - there is a teen version

address social problems

69
Q

poor px factors in alcohol dependence?

A
  1. male
  2. co morbid psych
  3. low IQ
  4. long hx
  5. personality disorder

Psych (23 decks)

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