Alcohol dependence and substance misuse Flashcards
symptoms of acute intoxication due to use of alcohol
Elevated mood Disinhibition Impaired judgement Slurred speech Ataxia & nystagmus Aggression Labile mood Coma
define harmful alcohol use
Persistent use of alcohol above safe drinking limits
how many units in 1 shot
1
how many units in 125ml wine
1.5
how many units in 175ml wine
2.1
how many units in 1 pint of beer
2
weekly unit allowance
14 units
how do you calculate units
strength (ABV) x volume (ml) / 1000
give some medical consequences of chronic alcohol use
Cardiovascular disease, Hypertension & Stroke Alcoholic Liver Disease & Liver Failure, Ascites, Oesophageal Varices Cancer, eg Hepatocellular Wernicke-Korsakoff Syndrome Alcoholic Dementia Hepatic Encephalopathy TB and Pneumonia Erectile dysfunction
give some psychological consequences of alcohol use
Depressive illness
Anxiety
Suicidal behaviour and DSH
Alcoholic hallucinosis
what are the Dependency syndrome: ICD-10 criteria (6)
- Strong desire/sense of compulsion to use alcohol
- Impaired capacity to control alcohol use: onset/termination/levels of use/reduction of use
- Physiological withdrawal state on reduction/ceasing use or use to relieve/avoid withdrawal symptoms
- Tolerance
- Preoccupation with alcohol use
- Persistent use despite awareness of harmful effects
Three or more occurring together for at least 1 month, or if less than 1 month, occurring together repeatedly within a 12 month period
what do you cover in the assessment of someone with alcoholism
Full history Mental State Examination Mood & Anxiety, Suicidal ideation Hallucinations, delusions, cognition Physical examination Focussed to relevant problems Appropriate investigations MCV, Gamma GT Imaging may be useful
common presentation of someone with alcoholism
Dishevelled Frequent absentee from work Frequent falls Fits Confusional state, smell of alcohol Frequent attendance to A & E Homelessness Relationship problems/ Child care issues Requests for benzodiazepines Missed appointments
what is included in a full history for psychiatry
History of Presenting Complaint Past Medical and Psychiatric History Medication and allergies Alcohol, Smoking and Substance Misuse Social History Family History Personal History Forensic History
what to include in an alcohol history
Amount and type of alcohol consumed
Frequency or pattern of use, and whether drinks alone
How long have they been drinking in this fashion
Symptoms of dependence (LEARN) : Any withdrawal symptoms? What time first drink is taken? Any feelings of craving? Tolerance: do you need to use more than you used to? Attempts at reduction, and outcome
Awareness of negative consequences (social, psychological, physical)
Current treatment or contact with services
When had first drink
Pattern of use since then
Progression of use
Consequences
When became a problem
Associated life events
Treatment received
