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Psychiatry > Alcohol related illness > Flashcards

Alcohol related illness Flashcards

1
Q

Define substance dependence?

A

Physical and psychological effects produced by the habitual taking of a drug

Characterised by a compulsion to continue taking the drug

Withdrawal occurs if they stop taking it

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2
Q

Define substance abuse?

A

Using a substance in excess, causing significant harm (physical, emotional, financial, career, relationships)

Not necessarily dependent

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3
Q

What is meant by dual diagnosis?

A

When a person has a mental illness alongside a substance abuse problem.

Usually depression

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4
Q

People with dual diagnosis do better than people who only have mental health problems. True or false? Why?

A

False.

People with dual diagnosis are more likely to be admitted to hospital and to self-harm and commit suicide

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5
Q

How many units a week can we have? How many glasses of wine or pints is that?

A

14 units

6 small glasses of wine or 6 pints

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6
Q

How do you calculate units?

A

(Strength (%) x volume(ml) )/1000 = units

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7
Q

How many units are in a 75cl bottle of 13.5% wine?

A

(13.5x 750) / 1000

= 10.1 units

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8
Q

How many units are in a 750ml bottle of 45% vodka?

A

(45x 750) / 1000

= 33.8 units

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9
Q

List the 7 phenomena associated with alcohol dependence?

A
  1. Primacy: alcohol is the most important thing in their life
  2. Tolerance: need more alcohol each time to get to same level of satisfaction
  3. Withdrawal: physical or mental symptoms happen when they don’t drink
  4. Relief drinking: drinking to calm down when stressed
  5. Narrowing of repertoire: drinking same things everyday
  6. Set drinking pattern: drinking at same times, places, situations
  7. Restarting after abstinence
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10
Q

What is a common alcohol misuse screening tool?

A

CAGE

Cutting down
Angry when others criticise drinking
Guilty about drinking
Eye opener in the morning

Also AUDIT

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11
Q

What are the stages of damage alcohol does to the liver?

At what stage does damage become irreversible?

A
  1. Fatty liver
  2. Hepatitis
  3. Cirrhosis

Once gets to cirrhosis becomes irreversible

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12
Q

Symptoms of cirrhosis?

A 
Fatigue
Malaise
Weight loss
Itching
Palmar erythema
Ascites
Jaundice
Cognitive problems
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13
Q

Which LFT is the best for detecting alcoholic liver disease? Why?

A

Gamma GT

It is the main enzyme involved in alcohol metabolism

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14
Q

Function of the liver?

A 
Storing glycogen
Processing fats
Making proteins and clotting factors
Metabolising drugs
Removing poisons and toxins from blood
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15
Q

Describe the symptoms of uncomplicated alcohol withdrawal?

Do they need hospital admission?

A 
Coarse tremor
Sweating
Headache
Palpitations
Nausea, vomiting
Anxiety, agitation
Insomnia

No, only if complications occur or mental health issues causing risk

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16
Q

Do hallucinations occur in uncomplicated alcohol withdrawal?

A

Occasionally, but not very common!

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17
Q

In uncomplicated alcohol withdrawal:

  • How long after stopping drinking symptoms occur?
  • When do symptoms peak?
  • How long do they last?
A
  • 4-12 hours after last drink
  • peak at 48 hours
  • usually last 2-5 days
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18
Q

What is delirium tremens?

A

Acute confusional state secondary to alcohol withdrawal

It is a medical emergency as can cause death

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19
Q

In delirium tremens:

How long after stopping drinking before symptoms occur?

When do symptoms usually peak?

A

1-7 days after last drink

48 hours after last drink

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20
Q

Which patients are at an increased risk of delirium tremens?

A

If severe dependence
Infection
Liver damage

21
Q

Clinical features of delirium tremens?

A

Withdrawal symptoms PLUS altered mental state

Hallucinations (usually visual, Lilliputian)
Confusion
Delusions
Severe agitation
Seizures
Tachycardia, fever,  high BP
22
Q

Why do patients with delirium tremens get tachycardia and raised BP?

A

Their CNS has been supressed for a long time while they have been drinking. When they stop, CNS goes into overdrive.

23
Q

Why does delirium tremens cause death? How often does it cause death?

A

It is due to the CNS going into overdrive.

5-10% motality

24
Q

Management of delirium tremens?

A

Supportive care: calm environment, fluids

Benzodiazepines:

  • chlordiazepoxide
  • lorazepam (in severe liver damage)

Zopiclone to help with insomnia

Buccal midazolam: in case of seizure

25
Q

What is Wernicke encephalopathy? Describe basic pathophysiology.

A

Neurological symptoms caused by biochemical lesions of nerves after exhaustion of thiamine in the body.

26
Q

Features of Wernicke’s encephalopathy?

A

Triad:

  1. Confusion
  2. Ataxia
  3. Opthalmoplegia (double vision, abnormal eye movements)
27
Q

Another name for thiamine? What is its main role in the body?
What foods is it found in?

A

Vitamin B1

Converting carbohydrate from our food into glucose to be used for energy

Milk, meat, eggs

28
Q

How does alcohol abuse lead to thiamine deficiency?

A

Poor diet, so reduced nutritional thiamine intake

Reduced absorption from GI tract

Impaired thiamine storage in liver due to damage

29
Q

Aside from alcohol abuse, what causes thiamine deficiency?

A

Anorexia and starvation

30
Q

Management of Wernicke’s encephalopathy.

A

Immediately give high does thiamine (called pabrinex) for 3-5 days

Assist with stopping alcohol misuse

31
Q

A patient comes into A+E. He is known to be an alcoholic and he presents appearing drunk. He’s confused and says he has double vision.

Is there anything you should consider before simply treating him for alcohol overdose?

A

He could have Wernicke’s encephalopathy.
He is at high risk, so best to treat just in case.
Thiamine treatment won’t do any harm.

32
Q

What is Korsakoff syndrome?

A

What happens if Wernicke’s encephalopathy is untreated.

33
Q

Why is it so important to treat Wernicke’s?

A

Mortality of 15%

If untreated 84% of patients will go on to develop Korsakoff syndrome

34
Q

Features of Korsakoff syndrome?

A

Anterograde amnesia: unable to lay down new memories

Retrograde amnesia: memory loss of past events

Confabulation

Minimal content in conversation

Lack of insight

Apathy

35
Q

What is confabulation?

A

Invented memories to fill the gaps in memory. Patient believes what they’re saying is true.

Think of House episode

36
Q

Treatment of Korsakoff syndrome?

A

Oral thiamine for 2 years

Only 25% of patients show mild improvement

37
Q

Management of alcohol dependence?

A

Advice on dangers and help on cutting down

Social support of family and friends

Figure out the factors that are making them drink

Help them set goals to cut down

Drugs

38
Q

Pharmacological treatments of alcohol dependence?

A

Naltrexone: reduces pleasurable effects of alcohol

Acamprosate: reduces cravings, used after detox to maintain abstention

Disulfiram: makes you acutely sensitive to alcohol

Antabuse: if they drink they get high levels of acetaldehyde, so if they drink = hypotension

39
Q

Aetiology of alcohol dependence?

A

Genetic factors

Environmental:

  • alcoholism in parent
  • abuse or neglect

Childhood behavioural problem

Peer influence

Mental health problem

Stress, financial problems

40
Q

List some consequences of alcohol excess:

  • physical
  • psychological
  • social
A

Physical:

  • malnutrition
  • liver disease
  • CVS disease
  • risk of injury

Psychological:

  • depression, anxiety
  • impaired cognition (concentration, memory)

Social:

  • breakdown of relationships
  • failing to live up to expectations (job, family)
  • financial
  • criminality
  • starting to use other drugs
41
Q

Investigations of alcohol abuse?

A

Bloods:

  • Renal function
  • LFTS (GGT)
  • Mean cell volume
  • Clotting
42
Q

A man has recently given up alcohol, he’s worried he will relapse over Christmas and New Year. What could you do to help him?

A

Prescribe disulfiram

Which will make him acutely sensitive to alcohol and have terrible symptoms if he drinks

43
Q

What happens to red blood cells in alcohol abuse? Why?

A

Macrocytosis (raised MCV)

Because of folate and B12 deficiency

44
Q

Causes of hematemesis in alcoholics?

A

Mallory Weiss tear
Gastritis
Varices
Peptic ulcer disease

45
Q

Immediate management of seizures in delirium tremens?

A

IV diazepam

46
Q

Bloods in Paracetamol OD?

A 
U+E, creatinine
Serum Paracetamol
ALT
INR
pH, plasma bicarb
47
Q

Management for Paracetamol OD?

A

N-acetyl cysteine

48
Q

How does Antabuse work?

A

Blocks alcohol dehydrogenase, if you drink alcohol it causes high levels of acetaldehyde in blood
Causing hypotension

Psychiatry (17 decks)

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