alcohol dependence Flashcards
what is harmful use in ICD10
- alcohol use causing either physical or mental damage
- no dependence
- often criticised by others
- adverse social consequences
ICD 10 criteria for dependence syndrome?
- strong compulsion to take substance
- can’t control behaviour
- withdrawal state - classic withdrawal for the substance
- use of the substance or similar to relieve withdrawal symptoms
- evidence of tolerance
- neglect of alternative pleasures (primacy)
- persisting with use despite evidence of harmful consequences (eg liver, depression, cognitive probs)
what is dependence syndrome?
3+ dependency criteria present together at some time in past year
some additional signs of dependence syndrome?
narrowed repertoire and patterns - stereotyped behaviour
reinstatement after period of abstinence
units in pint of beer?
2-4 depends on strength
large glass of wine units?
3
bottle of wine?
9 units
bottle of alcopops units?
1.5
women units/day?
2-3
men units/day?
3-4
gender distribution of dependence?
7.5% male 2% female
lifetime prevalence of alcohol dependence?
14%
who are the heaviest drinkers?
young men
drinking and women- comorbidity?
more likely than men to have affective disorder
most drinkers live in ______
urban
occupations and drinking?
- easy access
- unsociable hours
- shift work
- away from home
relationship status drinkers?
single
lowest drinking class?
middle
comorbidities and drinking?
- other substance
- affective
- anxiety
at risk drinking men and women?
men - >14 drinks wk/>4 per session
women >7 /wk or >3 session
how much ethanol in one unit?
10-12g
weekly women alcohol?
14
weekly men alcohol?
21
biological link with alcohol dependence?
yes possibly - twin studies and adoption studies - mostly males
dopamine pathway in alcohol use?
- activation: NA, dopamine
- euphoria: dopamine, opioid, serotonin
- anxiolytic: increased GABA
what is CAGE?
- ever been told to cut down
- ever been annoyed by others giving out about your drinking
- Ever felt guilty?
- eye - opener
CAGE score _____ has a high sense and spec for problem drinkers
2+
normal AUDIT score is _______
5 female, 7 male
what is an alcohol dependent score in AUDIT?
20+
what are the psychiatric consequences of alcohol dependence?
- alcohol hallucinosis
- DTs
- generalised anxiety
- panic attacks
- low mood
- depression/anxiety dx
what is hallucinosis?
3rd person derogatory auditory, assoc w/ higher risk of schizophrenia and reduction in dose
_____ % of suicides have alcohol
20 prior to taking life
27% have hx of alcohol abuse
45% have attended GP for alcohol counselling
comorbidities with alcohol dependence?
x2 mental, x7 drug
- affective - 20% depressed
- suicide - lifetime risk 4%
- othello syndrome
- anxiety disorders
- eating disorders
what is othello syndrome?
- males
- delusional jealousy
- try to prove infidelity
- risk to spouse
withdrawal symptoms?
- NV
- tremor
- sweats
- anxiety
- tactile perception prob
- auditory hallucination
- visual hallucination
- confused
- DT
- convulsions (within 24hrs)
_____ scale rates withdrawal symptoms and informs mx
CIWA
signs of DT?
- confused
- agitated
- ANS probs
- fever
- visual hallucinations - lilliputian, affect of terror
- tactile - formication
mx of DT?
- chlordiazepoxide - long actcing benzo
- can give stat if tremulous
- 5-40mg QDS - increase if signs withdrawal - DTs protocol is 60mg QDS +/- haloperidol
- then taper down
- +/- anticonvulsants
- supportive
neurological complications of alcohol dependence?
- intoxication
- wernicke’s
- korsakoff’s
- cerebellar degeneration
- epilepsy
- dementia
- central pontine myelinosis
- optic atrophy
what is WE?
confusion ataxia ophthalmoplegia tetrad - nystagmus also: peripheral neuropathy, hypothermia, hypotension, coma
what is korsakoff’s
impaired recent memory and new learning
confabulation
poor time sense
what is damaged in korsakoff’s
mamillary bodies
who gets WE?
- heavy drinkers
- thiamine deficiency
- hyperemesis gravidarum
- anorexia
WE untreated leads to ______ in _____% of cases
korsakoff’s
84%
tx WE?
pabrinex 1 pair ampoules daily for 3-5 days
thiamine 2-300mg PO daily thereafter
s/e pabrinex?
allergy- rare
GIT consequences of alcohol
- oesophagitis
- mallory weiss
- varices
- oes ca
- pancreatitis
- portal HTN
liver consequences alcohol?
alcoholic hepatitis
fatty liver
cirrhosis
CVS consequences alcohol?
arrhythmia
DCM
HTN
metabolic side effects of alcohol
ketoacidosis
hypoglycaemia
MSK symptoms of alcohol?
dupuytrens gout proximal myopathy AVN OP
BAC ____ = double vision
0.3%
BAC _____ = unconscious
0.45%
BAC ______ = death
0.65%
alcohol related issues are ____ of all med admissions
15%
children of alcoholic more at risk of:
conduct disorder
deliquency
drinking is implicated in ______ of fatal RTAs
75%
mx of alcohol dependence
- abstinence
2. detox - OPD or IP
when to do IP detox?
- prior hx of DTs or seizures
- > 65yrs
- poor social support
- comorbid psych issues
- suicidal
- failed community detox
- cognitive impairment
Rfs for DTs in detox
- severe dependence
- past hx
- older age
- acute illness
- severe withdrawal symptoms
symptomatic tx of alcoholism
- dehydrated - fluids
- pain- paracetamol
- NV- prochlorpromazine or metoclopramide
- diarrhoea - loperamide
- lactulose - hepatic encepalopathy
how to maintain abstinence in ADependence? (meds)
- disulfram
- acamprosate
- naltrexone
what is disulfram?
causes facial flushing, throbbing headache, palpitations, tachycardia, nausea, vomiting when drink alcohol within 15 mins
CAN BE FATAL
acamprosate what does it do?
GABA agonist - reduces craving
what does naltrexone do?
opioid antagonist
antagonises endorphins released by alcohol
psychological tx for alcohol dependence?
- motivational interviewing - cycle of change, non confrontational, contact, advice, goals
- addiction counsellor
- relapse prevention - FRAMES
what is FRAMES?
feedback responsibility advice menu of options empathy self efficacy
social tx of alcohol dependence?
AA - 12 steps - there is a teen version
address social problems
poor px factors in alcohol dependence?
- male
- co morbid psych
- low IQ
- long hx
- personality disorder
