Alcohol Disorders Flashcards
Criteria for alcohol dependence
- withdrawal symptoms when not having alcohol
- cravings
- cannot control the use
- increased tolerance
- salients - neglecting everything around you to concentrate on the substance
- specific type of alcohol (narrowing of repertoire) - often cheapest and strongest
How to calculate units of alcohol
% x volume (L) = units of alcohol
Recommended units of alcohol per week
14 units over at least 3 days
Pharmacological treatment of alcohol misuse
- Detoxification using chlordiazepoxide or diazepam for 7 days. Use qds then slowly taper off
- Disulfiram as adjunct
Biopsychosocial management of alcohol
Biological:
- decide whether to admit or not depending on risk
- chlordiazepoxide or diazepam (benzodiazepine) for 7 days
Psychological:
- motivational interviewing
Social:
- social worker
- social prescribing
What does Chlordiazepoxide do?
- Benzodiazepine acts as a GABA agonist which allows a slow increase of GABA to return
- reduces the risk of agitation and seizures for a safe withdrawal
Wernicke’s - korsakoff symptoms
Wernicke’s encephalopathy triad:
- ataxia
- nystagmus
- opthalmoplegia
- confusion
- dizziness
Untreated Wernicke’s encephalopathy can cause Korsakoff psychosis
Cause of Wernicke’s - Korsakoff
Thiamine deficiency due to:
- malnutrition therefore less B vitamins as can only store for 30 days
- require intrinsic factor to absorb vit B12 but alcoholics often have gastritis and ulcerate stomachs
Korsakoff’s psychosis
Anterograde and retrograde amnesia
Requires 24 hour social care provisions
Caused by micro haemorrhages in the brain
When is delirium tremens seen
- Associated with heavy alcohol use and alcohol withdrawal
- seen 72 hours after withdrawal
Symptoms of delirium tremens
Aggression Shouting Delirium Hallucinations Agitated
Management of delirium tremens
Antipsychotics
Alcohol withdrawal peak incidence of seizures, symptoms and delirium tremens
Symptoms - 6 - 12 hours
Seizures - 36 hrs
Delirium tremens - 72 hours
Screening tools
CAGE questionnaire
TWEAK questionnaire
CAGE questionnaire
- Do you want to cut down?
- Have people been annoyed
- Have you felt guilty
- Have you ever had a drink in the morning as an eye opener
