Alcohol Disorders

Question 1

Criteria for alcohol dependence

Answer 1

• 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

Question 2

How to calculate units of alcohol

Answer 2

% x volume (L) = units of alcohol

Question 3

Recommended units of alcohol per week

Answer 3

14 units over at least 3 days

Question 4

Pharmacological treatment of alcohol misuse

Answer 4

• Detoxification using chlordiazepoxide or diazepam for 7 days. Use qds then slowly taper off
• Disulfiram as adjunct

Question 5

Biopsychosocial management of alcohol

Answer 5

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

Question 6

What does Chlordiazepoxide do?

Answer 6

• 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

Question 7

Wernicke’s - korsakoff symptoms

Answer 7

Wernicke’s encephalopathy triad:

• ataxia
• nystagmus
• opthalmoplegia
• confusion
• dizziness

Untreated Wernicke’s encephalopathy can cause Korsakoff psychosis

Question 8

Cause of Wernicke’s - Korsakoff

Answer 8

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

Question 9

Korsakoff’s psychosis

Answer 9

Anterograde and retrograde amnesia
Requires 24 hour social care provisions
Caused by micro haemorrhages in the brain

Question 10

When is delirium tremens seen

Answer 10

• Associated with heavy alcohol use and alcohol withdrawal

- seen 72 hours after withdrawal

Question 11

Symptoms of delirium tremens

Answer 11

Aggression 
Shouting 
Delirium 
Hallucinations 
Agitated

Question 12

Management of delirium tremens

Answer 12

Antipsychotics

Question 13

Alcohol withdrawal peak incidence of seizures, symptoms and delirium tremens

Answer 13

Symptoms - 6 - 12 hours
Seizures - 36 hrs
Delirium tremens - 72 hours

Question 14

Screening tools

Answer 14

CAGE questionnaire

TWEAK questionnaire

Question 15

CAGE questionnaire

Answer 15

1. Do you want to cut down?
2. Have people been annoyed
3. Have you felt guilty
4. Have you ever had a drink in the morning as an eye opener

Question 16

TWEAK questionnaire

Answer 16

1. Tolerance - how many drinks can you hold
2. Worried - friends and family
3. Eye opener - drink in the morning
4. Amnesia - black outs
5. Cut down - ever feel the need to cut down?

Question 17

Consequences of alcoholism

Answer 17

Liver:

• fatty liver
• cirrhosis and liver failure

CNS:

• poor memory
• cerebellar atrophy
• Wernicke’s encephalopathy
• Korsakoff’s

GI:

• Diarrhoea, nausea and vomiting
• peptic ulcers
• erosions
• pancreatitis

Cardiac:

• arrhythmias
• hypertension
• cardiomyopathy

Bones:
- osteoporosis

Fertility - decreased

Question 18

Which malignancies are increased by alcohol consumption

Answer 18

GI

Breast

Question 19

Signs of withdrawal

Answer 19

Increased pulse
Hypotension
Tremor/ fits
Hallucinations