Alcohol misuse disorders Flashcards
Roughly round about what is the age people first start to drink ?
12-14
What percentage of the drinking population (everyone who drinks) drinks half of the overall alcohol intake ?
10% of the people who drink, drinks half of the alcohol (due to alcoholism etc)
What age groups have the highest rates of drinking ?
Adolescence and early twenties (us lol)
Give some examples of high risk jobs for having higher rates of alcohol intake ?
bartenders, itinerant (travels from place to place) workers, professional autonomy eg doctors
How do you calculate the units of alcohol in a drink
no. units = (% of alcohol x volume (in ml)) divided by 1000
What are the normal recommened guidelines for alcohol intake in men and women ?
Men and women should not regularly drink more than 14 units of alcohol a week. Ideally, this should be spread evenly over three days or more
What is considered increased risk alcohol intake ?
Regularly consuming between 15 and 35 units per week.
What is considered high risk alcohol intake ?
Regularly consuming over 35 units per week.
Define harmful use of substances
A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (e.g. hepatitis following injection of drugs) or mental (e.g. depressive episodes secondary to heavy alcohol intake).
Describe what is meant by alcohol depedance syndrome
- Strong desire or sense of compulsion to take drug
- Difficulty in controlling use of substance in terms of onset, termination or level of use
- Physiological withdrawal state - when alcohol intake is reduced or suddenly stopped
- Evidence of tolerance - both the pleasurable and attentuating (e.g. poor co-ordination and sedation) are reduced in effect
- Progressive neglect of other pleasures /interests because of use /effects of substance (substance e.g. alcohol takes priority)
- Persistence with use despite clear evidence of harmful consequences
Which are the different screening tests available for detecting alcohol-use disorders ?
What laboratory tests can be carried out in alcohol use disorders and what is there main use ?
- GGT – indicator of liver injury. (isolated rise in this is indicative for alcholism - common one)
- Carbohydrate Deficient Transferin - identifies men drinking 5 or more units per day for 2 weeks or more.
- Macrocytic anaemia – alcoholism most common cause of raised MCV (thats not due to B12 or folate often due to alcohol)
These are not useful in the screening for alcohol related problems but they May have a role in monitoring response to treatment
What is the initial intervention for someone identified via screening as drinking a hazardous or harmful amount of alcohol?
Attending NHS or NHS-commissioned services or services offered by other public institutes.
This intervention lasts about 5-15mins during which FRAMES is assessed:
- Feedback - review problems experienced because of alcohol.
- Responsibility – patient is responsible for change.
- Advice – advise reduction or abstinence.
- Menu – provide options for changing behaviour.
- Empathy – use empathic approach.
- Self-efficacy –encourage optimism about changing behaviour.
When should you consider referral for specialist treatment in someone with alcohol related problems ?
If they:
- Show signs of moderate or severe alcohol dependence
- Have failed to benefit from structured brief advice and an extended intervention and wish to receive further help for an alcohol problem
- Show signs of severe alcohol-related impairment or have a related co-morbid condition.
When someone has be referred for specialist treatment what treatment options are provided ?
Detoxification
- The process by which patients become alcohol free.
And Relapse prevention
- A combination of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem free drinking following detoxification.
What is the main physiological mechanism behind alcohol withdrawal
- Alcohol inhibits the action of excitatory NMDA-glutamate controlled ion channels
- Alcohol potentiates the actions of inhibitory GABA type A controlled ion channels
- Alcohol withdrawal leads to excess glutamate activity and reduced GABA activity
What are the symptoms of alcohol withdrawal and when do symptoms usually occur ?
Ssymptoms usually occur within hours and peak at 24-48hrs following reduced or abstience from alcohol
Symptoms include:
- Restlessness,
- tremor,
- sweating,
- anxiety,
- Nausea and vomiting
- loss of appetite
- insomnia.
- Tachycardia
- systolic hypertension
What 2 complications other than symptoms of alcohol withdrawal can occur during withdral and when do they usually occur?
Generalised seizures and Delirium Tremens can occur – usually in first 24 hours.
How long do symptoms of alcohol withdrawal take to usually resolve ?
5-7 days
What is delirium tremens symptoms and what is the important thing to note it can result in ?
It is the most severe form of alcohol withdrawal
Symptoms include:
- Confusion
- disorientation
- agitation
- hypertension
- fever
- visual and auditory hallucinations
- paranoid ideation
Can result in death due to cardiovascular collapse (BP would be decreased here think more sock like) or infection
When does onset of delirium tremens usually occur in someone experiencing alcohol withdrawal ?
- Peak onset within 2 days of abstinence
- Often presents insidiously with night time confusion
What is the management of alcohol withdrawal ?
Give benzodiazepines: (titrate dose against severity of symptoms and then reduce dose over 7 days)
- 1st line = chlordiazepoxide
- 2nd line = diazepam etc
Give thiamine for prophylaxis against wernickes encephalopathy
Additional measures include:
- Adequate hydration
- Analgesia
- Antiemetics
- Treat intercurrent infections and other physical conditions.
- Environmental factors.
In what environment should someone be detoxified from alcohol ?
Can usually be done in the community
But done as an inpatient if:
- Severe dependence
- A history of Delirium Tremens or alcohol withdrawal seizures
- A history of failed community detoxifications
- Poor social support
- Cognitive impairment
- Psychiatric co-morbidity
- Poor physical health
Delirium Tremens requires prompt transfer to general medical ward.
After detoxification what is the replase prevention management for someone with alcohol addiction?
Psychosocial Interventions: (all different options which could be done)
- CBT (coping skills therapy)
- Motivational Enhancement Therapy
- 12 Step Facilitation Therapy (eg AA)
- Behavioural self control training.
- Family and Couple Therapy
Pharmacology:
- 1st line = Naltrexone
- 2nd line = Acamprosate
- 3rd line = Disulfiram
What is the mechanism of action of naltrexone and who shouldn’t you use it in and why ?
- Opioid antagonist and reduces reward from alcohol
- Shouldnt be used in people with current or recent opiod until they are opiod free for severeal days
What is the mechanism of action of acamprosate?
- Acts centrally on glutamate and GABA systems
- Reduces cravings with a modest treatment effect
What is the mechanism of action of Disulfiram (antabuse) and what happens when alcohol is consumed whens someone is on this drug?
- Inhibits acetaldehyde dehydrogenase leading to accumulation of acetaldehyde if alcohol is ingested.
- Leads to flushed skin, tachycardia, nausea and vomiting, arrhythmias and hypotension depending on volume consumed
What is wernickes encephalopathy ?
Wernicke’s encephalopathy is a neurological emergency resulting from thiamine deficiency (vitmain B1) with varied neurocognitive manifestations, typically involving mental status changes and gait and oculomotor dysfunction
What are the symptoms of wernickes encephalopathy ?
- Visual impairment
- Hearing impairment
- Reduced conscious level - confusion
- Hypothermia
- Lactic acidosis
- Circulatory changes
- Ataxia - lack of voluntary coordination of muscle movements that includes gait abnormality
- Opthalmoplegia (paralysis of muscles within or surrounding the eye) - These include gaze palsies, sixth nerve palsies, and impaired vestibulo-ocular reflexes
How is wernickes encephalopathy treated ?
Same as prophylaxis giving thiamine
What is Korsakoff syndrome?
- a chronic memory disorder caused by severe deficiency of thiamine
- most commonly caused by alcohol misuse
What are the symptoms of korsakoffs syndrome ?
Causes problems learning new information, inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected.
