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Year Three - Psychiatry > Alcohol Dependency > Flashcards

Alcohol Dependency Flashcards

1
Q

What is another term for alcohol dependence?

A

Alcoholism

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2
Q

What is alcohol dependence?

A

It is a condition in which individuals experience a strong, often uncontrollable, desire to drink

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3
Q

What is the recommended alcohol intake per week for both men and women?

A

14 units

In cases where individuals drink 14 units a week, this should be spread evenly over 3 or more days and not more than 5 units in a single day

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4
Q

What is the recommended maximum number of alcohol units consumed in one day?

A

5 units

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5
Q

What is the function of alcohol screening?

A

It is a systematic process of identifying individuals whose alcohol consumption places them at increased risk of physical, psychological or social problems, thus who would benefit from preventative intervention

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6
Q

What are the five alcohol screening questionnaires?

A

CAGE Questionnaire

AUDIT Questionnaire

FAST Questionnaire

PAT Questionnaire

Tweak Questionnaire

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7
Q

What is the CAGE questionnaire?

A

It is a series of four questions used to check for features of alcohol dependency

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8
Q

What are the four questions in the CAGE questionnaire?

A

Have You Ever Felt You Should Cut Down Your Drinking?

Have People Annoyed You By Criticising Your Drinking?

Have You Ever Felt Bad Or Guilty About Your Drinking?

Have You Ever Had A Drink First Thing In The Morning To Steady Your Nerves or Get Rid Of A Hangover? (Eye Opener)

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9
Q

When does the CAGE questionnaire indicate alcohol dependency?

A

When patients present with two positive answers

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10
Q

What is the AUDIT questionnaire?

A

It is a series of ten questions to check for features of alcohol dependency

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11
Q

What is the gold standard alcohol screening questionnaire?

A

AUDIT questionnaire

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12
Q

When does the AUDIT questionnaire indicate harmful alcohol intake?

A

When patients present with a score > 8

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13
Q

What is the FAST questionnaire?

A

It is a series of four questions to check for features of alcohol dependency

It is a subset of AUDIT questions

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14
Q

Where is the FAST questionnaire used?

A

Emergency departments,

However, it can be used in a variety of health and social care setting

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15
Q

When does the FAST questionnaire indicate alcohol dependency?

A

When patients present with a score > 3

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16
Q

How do we progress when individuals have a positive FAST questionnaire?

A

It is recommended that the remaining AUDIT questions are asked to identify dependency

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17
Q

Where is the PAT questionnaire used?

A

Emergency departments

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18
Q

What is the TWEAK questionnaire?

A

It is a series of five questions to check for features of alcohol dependency

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19
Q

When is the TWEAK questionnaire used?

A

In pregnant women

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20
Q

What two criteria are used to diagnose alcohol dependency?

A

ICD-10

DSM-5

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21
Q

What is the ICD-10 criteria for alcohol dependency?

A

It states that at least 3 of the following criteria should be present for more than 1 month…

  • Compulsions To Drink
  • Difficulties In Controlling Use
  • Neglect of Alternative Interests (Primacy)
  • Tolerance Increase
  • Physiological Withdrawal Upon Cessation
  • Persistence Despite Harmful Consequences
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22
Q

What are the nine clinical features of alcohol dependency on examination?

A

Jaundice

Hepatomegaly

Spider Naevi

Palmar Erythema

Gynaecomastia

Caput Medusae

Ascites

Asterixis

Anorexia

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23
Q

What is asterixis?

A

A flapping tremor

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24
Q

What are the five blood tests used to diagnose alcohol dependency?

A

Gamma-Glutamyl Transferase (GGT)

Mean Corpuscular Volume (MCV)

AST:ALT Ratio

Carbohydrate-Deficient Transferrin (CDT)

Ethanol Levels

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25
What is GGT?
A liver enzyme created when the liver is injured
26
What GGT result indicates alcohol dependency?
The GGT levels are elevated, usually > 40
27
What is the most reliable biochemical marker of alcohol dependency?
GGT
28
What is MCV?
A measure of the red blood cell size
29
What MCV result indicates alcohol dependency?
The MCV is increased, usually > 100 (macrocyte)
30
What will cause MCV values to return back to normal?
When there is alcohol abstinence for several weeks
31
What are AST & ALT?
They are liver enzymes created when the liver is injured
32
What AST:ALT ratio result indicates alcohol dependency?
It is elevated in alcohol dependency, usually > 2
33
What is CDT?
It is a molecule involved in iron transport in blood
34
What CDT result indicates alcohol dependency?
The CDT levels are elevated, usually > 60 It is not useful as a screening test for alcohol abuse, however, may be useful in detecting those who have relapsed
35
What do elevated ethanol levels indicate?
Isolated drinking episode Chronic abuse
36
What ethanol level indicates that an individual is a chronic heavy drinker?
A blood alcohol level > 80mg per 100ml
37
What arterial pH result indicates alcohol dependency?
Low (<7.3)
38
What bicarbonate level result indicates alcohol dependency?
Low (<22)
39
What PaCO2 result indicates alcohol dependency?
Low (<35)
40
What chlorine level result indicates alcohol dependency?
Low (<95)
41
What potassium level result indicates alcohol dependency?
Low (<3.5)
42
Why are chlorine and potassium level low in alcohol dependency?
Vomiting
43
What sodium level result indicates alcohol dependency?
Low (<133)
44
What urea level result indicates alcohol dependency?
High (>7.8)
45
What creatinine level result indicates alcohol dependency?
High (>104)
46
What serum osmolality result indicates alcohol dependency?
High
47
Why are the sodium levels low and urea, creatinine and serum osmolarity levels high in alcohol dependency?
Dehydration
48
What anion gap result indicates alcohol dependency?
High (>18)
49
What is the anion gap?
It is e difference between the total concentration of cations (Na+ + K+) and anions (Cl- + HCO3-) in the blood
50
Why is the anion gap high in alcohol dependency?
Due to the low level of bicarbonate ions
51
What does a blood gas result of low PCO2, low bicarbonate levels and normal PO2 indicate?
Metabolic acidosis with respiratory compensation
52
What does a blood gas result of low PCO2, low bicarbonate levels and normal PO2 indicate when it is directly related to alcohol intake?
Alcoholic ketoacidosis (AKA)
53
When does alcoholic ketoacidosis tend to occur?
The day after a massive binge
54
How do we manage alcoholic ketoacidosis?
IV thiamine AND 0.9% saline
55
How is alcohol dependency psychologically managed?
Psychoeducation Cognitive Behaviour Therapy (CBT) Community Support Groups
56
What is psychoeducation?
It involves providing patients with information about reducing alcohol intake
57
What website do we refer patients to for alcohol psychoeducation?
Drink aware
58
What is CBT?
It is a talking therapy used to manage the way in which patients think, feel and behave
59
What two community support groups are used to support alcohol dependent patients?
AA ADA
60
What is the function of community support groups?
They help individuals deal with the challenges of getting sober, provide support to family members and friends and avoid relapses
61
What are the three pharmacological management options used in alcohol dependency?
Nutritional Support Anti-Craving Medication Aversion Therapy
62
What nutritional support is given to alcohol dependent patients? Why?
They are administered vitamins, such as thiamine To prevent alcohol related complications
63
What is the first line pharmacological option used in alcohol dependency after successful withdrawal?
Anti-craving medication
64
What are the four types of anti-craving medications?
Acamprosate Naltrexone Nalmefene Baclofen
65
What is the first line anti-craving medication?
Acamprosate
66
What is the second line anti-craving medication?
Naltrexone
67
What drug class do naltrexone and nalmefene belong to?
Opioid receptor antagonists
68
What drug is used in aversion therapy?
Disulfiram
69
What is an Antabuse reaction?
It is a reaction in which disulfiram interacts with alcohol to cause an accumulation of acetaldehyde
70
What are the six clinical features associated with Antabuse reactions?
Headache Facial flushing Palpitations Dyspnoea Tachycardia Nausea
71
How long after alcohol consumption does disulfiram cause an Antabuse reaction?
Within 10 minutes
72
When is aversion therapy used?
It is the second line pharmacological management option used in cases where anti-craving medications are unsuitable It should only be used when individuals have stopped their consumption of alcohol
73
What other drug can produce an Antabuse reaction, however is not routinely prescribed for this purpose?
Metronidazole
74
What are the three main complications of alcohol dependency?
Alcohol Liver Disease (ARLD) Wernicke’s Encephalopathy Korsakoff’s Syndrome
75
What is alcohol liver disease?
It is a condition resulting from the effects of long term excessive consumption of alcohol on the liver
76
What is the stepwise progression of alcohol liver disease?
Alcohol related fatty liver Alcoholic hepatitis Liver cirrhosis
77
What is alcohol related fatty liver?
It is a condition in which alcohol leads to a build-up of fat in the liver
78
Is alcohol related fatty liver a reversible condition?
Yes It can be reversed after two weeks of alcohol abstinence
79
What is alcoholic hepatitis?
It is a condition in which excessive periods of alcohol consumption cause liver inflammation
80
Is alcoholic hepatitis a reversible condition?
Yes However only in mild cases when alcohol abstinence is permanent
81
What is liver cirrhosis?
It is a condition in which chronic inflammation of the liver results in the replacement of hepatic tissue with scar tissue
82
What is a complication of liver cirrhosis? How does this occur?
Portal hypertension The fibrosis affects the structure and blood flow through the liver, which causes increased resistance in the vessels supplying the liver
83
Is liver cirrhosis a reversible condition?
No However, alcohol abstinence can prevent further damage
84
What is Wernicke's encephalopathy?
It is a neurological emergency resulting from thiamine deficiency
85
What is thiamine?
Vitamin B1
86
What are the triad of clinical features associated with Wernicke's encephalopathy?
Confusion Ataxia Nystagmus
87
How do we treat Wernicke's encephalopathy?
We administer intravenous high-dose Pabrinex, which is a thiamine replacement therapy This should be followed by regular lower doses of oral thiamine
88
What is Korsakoff's syndrome?
It is a neurological emergency resulting from thiamine deficiency It is a complication of Wernicke’s encephalopathy
89
What is the pathophysiological cause of Korsakoff's syndrome?
It is due haemorrhage to the mammillary bodies of the hypothalamus and the medial thalamus
90
What are the three clinical features associated with Korsakoff’s syndrome?
Anterograde amnesia Retrograde amnesia Confabulation
91
What is anterograde memory impairment?
This is a loss in the ability to create new memories after the event that caused amnesia, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact.
92
What is retrograde amnesia?
This is when individuals can't recall memories that were formed before the event that caused the amnesia
93
What is confabulation?
This is when patients create, often fantastical, answers to fill the gaps in their memory
94
How do we treat Korsakoff's syndrome?
It is an irreversible condition and results in patients requiring full time institutional care The treatment involves administration of intravenous high-dose Pabrinex, which is a thiamine replacement therapy This should be followed by regular lower doses of oral thiamine
95
How does alcohol cause thiamine deficiency?
Poor thiamine absorption Lack of thiamine diet intake
96
What is alcohol withdrawal syndrome (AWS)?
It occur when severely dependent individuals, who have been drinking excessively for a prolonged period of time, undergo an abrupt reduction in alcohol intake
97
When does AWS present?
Within 6-72 hours of abrupt alcohol withdrawal
98
What are the eight clinical features associated with AWS?
Tremors Anxiety Nausea Headaches Sweating Confusion Irritability Insomnia
99
What are the eight clinical features associated with delirium tremens?
Confusion Irritability Fever Seizures Hallucinations Tachycardia Hypertension Insomnia
100
What are the two pharmacological management options used to treat AWS?
Benzodiazepines Anticonvulsants
101
What is the first line pharmacological option for treating AWS?
Benzodiazepines
102
What are the three benzodiazepines used to treat AWS?
Chlordiazepoxide Lorazepam Diazepam
103
What contraindicates the use of chlordiazepoxide? Why?
Hepatic failure To avoid the risk of increased sedation
104
What is the second line pharmacological option for treating AWS?
Anticonvulsants
105
What anticonvulsant is used to treat AWS?
Carbamazepine
106
What drug regimen is used in AWS?
Fixed-dose regimen
107
What is a fixed dose regimen?
This involves titrating the initial dose of medication to the severity of alcohol dependence and/or regular daily level of alcohol consumption This dose is then gradually reduced over 7-10 days to avoid alcohol withdrawal recurring

Year Three - Psychiatry (23 decks)

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