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Psychiatry > Alcohol Misuse > Flashcards

Alcohol Misuse Flashcards

1
Q

What are the 6 criteria for alcohol dependence

A
  1. Cravings/compulsions to take
  2. Difficulty controlling use/loss of control
  3. Primacy/takes priority
  4. Increased tolerance
  5. Physiological withdrawal on reduction/cessation
  6. Persistence despite harmful consequences
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2
Q

For how many and how long do the 6 criteria need to persist to diagnose dependence of alcohol

A

3 or more of the criteria
For >1month
Or
Repeatedly over 12 months

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3
Q

Describe clinical features of withdrawal

A 
Tremor
Weakness
Nausea
Vomiting
Anxiety
Seizures
Confusion, Agitation 
Death
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4
Q

Screening tools for Alcohol addiction

A

CAGE
FAST
AUDIT
PAT

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5
Q

Describe the CAGE screening tool

A

CAGE (2 or more = likely alcohol problem)
Have you tried to Cut down?
Have you felt Annoyed by people criticising your drinking?
Have you felt Guilty about drinking?
Have you felt the need to have an Eye-opener?

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6
Q

Which screening tool is often used by GPs

A

FAST

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7
Q

Triad of Wernicke’s Encephalopathy

A

Confusion
Ataxia
Opthalmoplegia (e.g nystagmus)

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8
Q

What is the cause of Wernicke’s Encephalopathy

A

Thiamine deficiency

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9
Q

Alcohol Hx questions to ask

A 
Type 
Units 
Has this increased
How long 
Pattern of drinking (typical day)
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10
Q

Prevention of Encephalopathy Rx

A

Thiamine

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11
Q

Rx for Wernicke’s Encephalopathy

A

IV Thiamine

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12
Q

Rx for withdrawal

A

Benzodiazepines (Chlordiazepoxide)

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13
Q

Which aversion/deterrent medication can be given as Rx

A

Disulfiram (Antabuse)

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14
Q

What is the action of aversion/deterrent medication

A

Means if the patient drinks alcohol having taken this medication they will feel awful

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15
Q

Which anti-craving medication can be given as Rx

A

Acamprosate (Campral)
Naltrexone
Nalmefene (Baclofen)

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16
Q

Psycho-social approach for alcohol addiction recovery

A

Support for patient and family
Psychological help (e.g. CBT, group therapy)
Social work input (benefits, housing, child protection)
Skills training
Community Support (eg AA, ADA)
Inpatient or residential treatment

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17
Q

What is delirium tremens

A

Profound acute confusion
48-72hrs after alcohol is withdrawn
Admit

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18
Q

Symptoms of delirium tremens

A 
Tremors
Agitation 
Hallucinations 
Delusions
Sleeplessness
Autonomic over activity
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19
Q

Effects of higher disease of alcohol

A 
Intoxication 
Impaired attention and judgement 
Unsteadiness
Flushing 
Nystagmus 
Mood instability 
Disinhibition 
Slurring 
Stupor 
Unconsciousness
20
Q

Effects of low doses of alcohol

A

Euphoria
anxiety
Relaxation
Sociability

21
Q

Effects of alcohol on mental health

A 
Anxiety 
Depression 
Sleep disturbance
 Morbid jealousy 
Alcoholic hallucinosis 
Deliberate self-injuryy 
Suicidal thoughts/acts
22
Q

Effects of alcohol on the brain

A 
Brain damage 
Loss of memory 
Hallucinations 
Fits 
Dementia
23
Q

Effects of alcohol on the chest

A

Risk of chest infection

24
Q

Effects of alcohol on the liver

A

Swollen liver
Hepatitis
Cirrhosis

25
Q

Effects of alcohol on the nervous system

A

Paraesthesia
Numbness
Trembling hands

26
Q

Effects of alcohol on the risks of STI

A

HIV and AIDS

27
Q

Effects of alcohol on the endocrine system

A

Poro control DM

28
Q

Effects of alcohol on the GI system

A

Ulcers
Gastritis
Haematemsis
Pancreatitis

29
Q

Effects of alcohol on sexual system

A

Impotence in men

Infertility in women

30
Q

How many units of alcohol does a healthy liver process in 1hr

A

1 unit per 1hr

31
Q

What is the recommended drinking units for M and F

A

both M and F

14 units

32
Q

What is alcoholic fatty liver

A

When fat is deposited in and around the liver

33
Q

What are the potential outcomes of alcoholic fatty liver

A

Reversible
Can become inflamed steatohepatitis
Can develop cirrhosis

34
Q

Which score is used to measure alcoholic hepatitis

A

Glasgow Alcoholic Hepaittis Scroe

35
Q

What does a GAHs score > 9 indicate with 30 day mortality

A

30 day mortality

Without steroids = 48%

With steroids = 22%

36
Q

What does a GAHs score >9 indicate with 84 day mortality

A

Without steroids - 62%

Within steroids - 41%

37
Q

What is the toxic product of alcohol breakdown

A

Acetaldehyde

38
Q

What happens to acetaldehyde in alcohol problems

A

There is an overload/increased amount causing harm

39
Q

Signs of chronic liver disease

A 
Spider naevi 
Palmar erythema
Gynaecomastia
Loss of axillary and pubic hair 
Ascites 
Encephalopathy 
Jaundice
40
Q

What does a raised GTT often relate to

A

Alcohol

41
Q

What causes hepatic encephalopathy

A

High levels of ammonia built up in the system

Crosses the BBB

42
Q

How is hepatic encephalopathy graded

A

1-4
1 = mild confusion
4 = coma

43
Q

Rx for alcoholic hepatitis

A

Steroids
Management of infection
Nutrition
ABSTINENCE

44
Q

What is the first stage of alcohol related liver disease

A

Fatty liver

Steatosis

45
Q

Is fatty liver disease reversible

A

yes with abstinence

46
Q

Rx for hepatocellular cancer

A

Surgical resection
Liver Tx
Radiofrequency/microwave ablation
Chemotherapy

47
Q

What is the most common reason for liver Tx in Scotland

A

Alcohol related liver disease

Psychiatry (15 decks)

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