Alcohol Diagnosis and Treatment Flashcards
What are the low dose effects of alcohol?
Euphoria, decreased anxiety, relaxation, sociability
What are the high dose effects of alcohol?
Intoxication, impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability,
disinhibition, slurring, stupor, unconsciousness
What are the main aspects of diagnosis?
Acute intoxication
Harmful use
Dependence
Withdrawal
What constitutes harmful use of alcohol?
- Pattern of use causing damage to physical/mental health
- Use >1 month or repeatedly over 12 months
What constitutes dependence on alcohol?
- Difficulty controlling use
- Increased tolerance
- Primacy (drinking in the morning)
- Cravings/compulsions
- Physiological withdrawal on reduction/cessation
- Persistence despite harmful consequences
How many and how long must you have these symptoms to be considered dependent?
3 or more of the following for >1 month or repeatedly over 12 months
What are withdrawal symptoms?
Tremor Anxiety, Agitation Nausea, Vomiting Weakness Confusion Seizures Death Delirium tremens
What is delirium tremens?
- Profound confusion
- Autonomic overactivity (e.g. sweating, palpitations, etc)
- CV collapse
What are the mental health complications of alcohol abuse?
Anxiety, depression, sleep disruption, morbid jealousy, alcoholic hallucinosis, deliberate self injury, suicidal thoughts/acts
What are the physical health complications of alcohol abuse?
Brain damage, poor control of DM, loss of muscle, ventricular hypertrophy, GI problems, liver problems, pancreatitis, impotence/infertility, RTI, paraesthesia.
What is the triad for Wernicke’s encephalopathy?
- Confusion
- Ataxia
- Opthalmoplegia/Nystagmus
What is Korsakoff’s psychosis?
- Significant impairment of recent and remote memory in an otherwise alert person
- Can’t remember past information, can’t make new memories
- Impaired learning and disorientation
- May exhibit nystagmus and ataxia
What is Wernicke-Korsakoff syndrome?
not for exam, just to understand:
Wernicke’s encephalopathy and Korsakoff’s psychosis are both caused by thiamine deficiency, whcih you get in alcohol dependence cos they don’t eat anything. So you get both at the same time.
Why do you get thiamine deficiency in alcohol dependence?
Poor intake and absorption
Poor hepatic function Increased requirement for alcohol metabolism
Impact of alcohol dependence on relationships?
Aggression
Marital difficulties
Poor parenting/neglect +/- loss of parenting rights
Loss of friendships and social support
What are the screening questions for alcohol dependence?
CAGE AUDIT FAST PAT TWEAK
What does CAGE stand for?
Cut down?
Annoyed by people criticising?
Guilty about drinking?
Eye-opener?
What does AUDIT stand for?
Alcohol use disorders identification test
Which screening test can you use for pregnant women?
TWEAK
What is the treatment for alcohol dependence?
- Lifestyle: Practical advice, education, harm reduction
- Social support: Holistic/biopsychosocial approach
- Medication
What can be done in the holistic/biopsychosocial approach?
- Patient and family
- Psych help
- Social work input
- Skills training
- Community support eg AA
- Inpatient or residential treatment
What medications can be given for alcohol dependence?
Thiamine
BZDs (withdrawal)
Disulfiram (aversion, nausea on ingesting alcohol)
Anti-craving medication
What are anti-craving medications for alcohol?
Acamprostrate
Naltrexone
Nalmefene
Baclofen
What types of liver disease can be reversed by abstinence?
Hepatic steatosis
Alcoholic hepatitis
