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CP2 Psychiatry > Alcohol + Substance Misuse > Flashcards

Alcohol + Substance Misuse Flashcards

1
Q

How long does 1 unit of alcohol take to be metabolised

A

1 hour

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2
Q

How to calculate units of alcohol

A

ABV x vol (in L)

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3
Q

E.g.s of opiates (6)

A 
Heroin 
Morphine 
Opium
Methadone 
Dipianone 
Pethidine
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4
Q

Effect of opiates

A

Euphoria + sedation

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5
Q

E.g.s of ‘depressants’ (4)

A

Cannabis
Barbiturates
Benzos
Alcohol

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6
Q

Effect of depressants

A

Suppress CNS activity –> relief from anxiety

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7
Q

E.g.s of stimulants (4)

A

Cocaine
Crack
Amphetamines
MDMA

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8
Q

Effect of stimulants

A

Feelings of extreme well-being, increased mental + motor activity

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9
Q

Egs of Hallucinogens (5)

A 
Cannabis 
LSD
PCP
Ketamine 
Psilocybin
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10
Q

Effect of hallucinogens

A

Altered sensory + perceptual experiences

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11
Q

Heroin: Intake route

A

Mostly smoked

Also IV

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12
Q

Heroin: mechanism

A

Mu opioid receptors agonist

Inhibits GABA release –> incr dopamine

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13
Q

Effects of Heroin (negative)

A 
N+V
Constipation 
Resp depression 
Loss consciousness 
If IV --> abscess, cellulitis, bBE, septicaemia 
Transmission HIV/Hep B,C
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14
Q

Cocaine: Intake route

A

Snorting
Dissolved/injected
If Crack = smoked

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15
Q

Cocaine: mechanism of action

A

Inhibs MOA uptake

–> >DA, NA, 5HT

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16
Q

Acute negative effects cocain

A 
CV
CVA
MI
Arrhythmias 
Acute anxiety/panic attacks 
Impaired junction/impulsitivity
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17
Q

Chronic negative effects cocaine

A

Necrosis septum

CKD

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18
Q

Psychiatric complications of taking cocaine

A

GAD
Psychosis
Panic disorder

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19
Q

Cannabis: Intake route

A

Smoked

Edibles

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20
Q

Cannabis: mechanism of action

A

THC binds to +activates CB1 receptors

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21
Q

Negative effects cannabis

A 
Increased HR
Dizzy
Incr appetitie 
Anxiety
Dysthymia/reduced motivation 
Increased risk of developing schizophrenia
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22
Q

MDMA - intake route

A

PO

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23
Q

MDMA - mechanism of action

A

Serotongeric, NA + D in CNS

Causes serotonin release + blocks reuptake from synaptic cleft

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24
Q

Acute negative effects - MDMA

A 
Jaw clenching 
Nausea
Blurred vision 
Increased body temp 
Comedown 12-48hrs
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25
Q

LSD - intake method

A

Paper tab
Powder
Tablet

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26
Q

LSD - mechanism of action

A

Indolealkylamine – v similar to serotonin
Agonist on most of serotonin receptor subtypes in brain
Indirect effects on DA pathways

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27
Q

LSD - acute negative effects

A

dilated pupils,
tachyC,
HTN.
Acute intoxication – perceptual distortions + high-risk behaviour

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28
Q

Benzos - intake method

A

PO

IM/IV

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29
Q

Benzos - mode of action

A

Potentiate effects of GABA at GABAa receptors

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30
Q

Acute negative effects of benzos

A 
intoxication, 
drowsiness, 
dizziness +
 blurred vision.
 Impaired conc, 
impaired coordination,
 HoTN +
 resp depression
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31
Q

Chronic negative effects benzos

A

impaired memory + concentration,
depression, tolerance/dependence, withdrawal:
seizures, delirium, psychosis

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32
Q

What % 16-25 y/o drink daily

A

1%

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33
Q

What % 25-44 y/o drink daily

A

4%

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34
Q

What % >65 s drink daily

A

13%

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35
Q

What % of men in the UK are dependent on alcohol?

A

9%

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36
Q

What % of women in the UK are dependent on alcohol?

A

4%

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37
Q

What is the most common cause of alcohol related death?

A

Alcoholic liver disease

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38
Q

biological aetiology - alcohol misuse

A

1st degree relatives 7x more likely

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39
Q

Psychological aetiology - alcohol misuse (3)

A

MH illness
Stress, high soc anxiety, low self-esteem
Psychological theories negative + positive reinforcement

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40
Q

Social aetiology - alcohol misuse (5)

A 
Low SE class 
Price of alcohol 
Social isolation 
Loss of spouse 
Certain professions
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41
Q

What is ICDs 2 step approach to diagnosis psychoactive substance abuse?

A 
1 - Specify the substance or class of subustance 
2 - Specify the type of disorder
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42
Q

Different types of substance abuse disorders (6)

A 
Acute intoxication 
Harmful use 
Dependence syndrome 
Withdrawal state w/ delirium 
Amnestic disorder 
MH/Behavioural disorder
43
Q

Def acute intoxication

A

Transient physical and mental abnormalities occuring shortly after administration and cause by the direct effects of he psychoactive substacnes

44
Q

Def dependence syndrome

A

Cluster of physiological, behavioural and cognitive phenomena relevant to a persons relationship w/ partic substance

45
Q

When is dependence syndrome diagnosed

A

3 or > of following presented @ same time in 1y:
Primacy
Continued used despoite negative conseq
Loss of control of consumption
Narrowing of repertoire
Rapid reinstatement of dependent use after abstinence
Tolerance + withdrawal

46
Q

Def alcohol withdrawal syndrome

A

Any pt who is alcohol dependent and abruptly stops drinkings

47
Q

RF for more severe alcohol syndrome (3)

A

Intercurrent medical illness
Advanced liver disease
Prev withdrawal eps

48
Q

Mild/uncomplicated alcohol withdrawal syndrome: ONSET

A

4-12hrs post last alcoholic drink

49
Q

Mild/uncomplicated alcohol withdrawal syndrome: duration

A

2-5 days

50
Q

Mild/uncomplicated alcohol withdrawal syndrome: features (9)

A 
Coarse tremor 
Sweating 
Insomnia 
TachyC
N+V
Psychomotor agitation 
Anxiety 
Intense cravings 
\+/- transient hallucinations
51
Q

What % of alcohol withdrawal cases are complicated by grand mal seizures?

A

15%

52
Q

RF seizures post alcohol withdrawal (4)

A

Heavy prolonged drinking
Prev seizures
Idiopathic epilepsy
Hx head injury

53
Q

Mx alcohol withdrawal syndrome

A

1 - chlordiazepoxide
2 - vits - thiamine/multivit
3 - close monitoring
4 - consider if need inpt or output

54
Q

Def Dual Diagnosis

A

Severe MH problem and problematic substance misuse

55
Q

CAGE questions

A

Have you ever felt you ought to CUT down on your drinking
Have people ever ANNOYED you by criticizing your driking
Have you ever felt GUILTY about your drinking
Labe you ever needed an EYE-opener

56
Q

q to ask - lifetime pattern of alcohol consumption

A

Age of 1st drink
Age when began to drink regularly
When did they begin to feel it was a problem?
Period of abstinence/heavier drinking + reasons for this

57
Q

O/E - alcoholism (8)

A 
Evidence acute use/intoxication 
Signs of withdrawal 
LT medical complications (ALD/Hep B/C, HIV) 
General condition 
Facial capillarization 
Stigmata of liver disease 
Cerebellar signs 
Peripheral neuropathy
58
Q

Ix Alcoholism (8)

A 
Urine + saliva Dx screen 
Breath alcohol level 
FBC
U+E
LFT - GGT, ALT/AST
Clotting screen
ECG
IVDU - hepatitis serology/HIV test
59
Q

Alcohol misuse - neurological complications (7)

A 
Cognitive + memory impairment 
Reduction in brain W/vol
Wernicke-Korsakoff syndrome 
Central pontine myelinolysis
Cerebellar degeneration 
ALcoholic peripheal neuropathy/myopathy 
Optic atrophy/visual changes
60
Q

CV effects of Alcohol misuse (3)

A

Alcoholic cardiomyopathy
Arrhythmias
HTN

61
Q

Hepatic complications of alcohol misuse (5)

A 
ALD
Fatty liver changes 
Alcoholic hepatitis 
Cirrhosis 
Hepatocellular carcinoma
62
Q

Bowel complications of alcohol misuse (3)

A

Malabsorption
Diarrhoea
Lower GI carcinoma

63
Q

Oesophageal and gastric complications of alcohol misuse (6)

A 
Mallory-Weiss tears 
Oesoph varices +/- haemorrhage 
Barretts/carcinoma 
Gastritis + erosions 
Peptic ulcer disease 
Gastric carcinoma
64
Q

Female sexual/reproductive complications alcohol misuse (3)

A

FOS
Fertility problems
Sexual dysfunction

65
Q

Male sexual/reproductive complications alcohol misuse (2)

A

Erectile dysfunction

Hypogonadism

66
Q

Psychiatric complications of alcohol misuse

A 
Auditory hallucinations 
Wernicke-Korsakoff syndrome 
Patholgical jealousy e.g. monosymptomatic delusional disorder 
Anxiety + depression disorders 
Suicide 
Schizophrenia relapse
67
Q

What is monosymptomatic delusional disorder

A

INdividual presents with the 1’ delusion that his partner is being unfaithful
May go to great lengths to obtain evidence of infedility

68
Q

Lifetime risk of suicide for dependent alcohol drinkers

A

10-15%

69
Q

Social consequences alcohol misuse (7)

A 
Divorce 
Domestic violence 
Homelessness 
Financial/legal problems 
Poor performance at work 
Risky sexual activity 
Psychological harm to family members
70
Q

Def delirium tremens

A

Rapid onest of confusion usually caused by the withdrawal of alcohol

71
Q

How long into withdrawal of alcohol does delirium tremens occur

A

3 days (72hrs)

72
Q

How long does delirium tremens last

A

2-3days

73
Q

Sx delirium tremens

A

Clouding consciousness + disorientation place/time/person
Amnesia recent events
Hallucinations + delusions

74
Q

2 phases of Wernicke Korsakoff syndrome

A

Wernicke’s encelphalopathy = acute phase

Korsakoff psychosis = chronic phase

75
Q

Cause of Wernicke Korsakoff syndrome

A

Neuronol degen due to B1/thiamine deficiency

76
Q

Who gets Wernicke Korsakoff syndrome

A

Heavy drinkers

B deficiency

77
Q

Why does chronic alcohol drinking cause Wernickes?

A

Reduces B1 absorption from GIT

+ Liver disease means reduced capacity for hepatic thiamine storage

78
Q

Triad of Sx seen in 10% Wernicke Korsakoff syndrome pt

A

Acute confusional state
Oculo-motor signs (ophthalmoplegia, nystagmus)
Ataxic gait

79
Q

Other Sx Wernicke Korsakoff syndrome

A

Peripheral neuropathy

Resting tachyC

80
Q

Which parts of brain are affected in Wernicke Korsakoff syndrome (3)

A

Mamillary bodies
Hypothalamus
Tegmentum of midbrain

81
Q

Tx Wernicke Korsakoff syndrome (3)

A

IV Pabrinex 2 ampoules 30mins bd 3-7days
Do NOT rehydrate w/ glucose
Tx co-existing alcohol withdrawal syndrome

82
Q

Mortality Wernicke-Korsakoff syndrome

A

15%

83
Q

Causes of Korsakoff syndrome (4)

A

Head injury
Encephalitic processes
CO poisoning
Alcoholism

84
Q

Does Korsakoff syndrome have to be preceded by Wernickes encephalopathy?

A

No

85
Q

CF Korsakoff syndrome (4)

A

Anterograde amneisa
Some degree retrograde amnesia
Confabulation (false memories)
Apathy

86
Q

Tx Korsakoff syndrome (2)

A

PO thiamine + multivits up to 2y

Psych interventions for cognitive impairment

87
Q

What % pt w/ Korsakoff’s syndrome make a complete recovery?

A

20%

88
Q

AIMS of Mx substance use disorders (5)

A 
Reduce harmful behaviours assoc w/ substance misuse 
Stop/reduce substance misuse safely 
Maintain change in L term 
Address psychical/mental health 
Address soc/occu/financial issues
89
Q

What method is used for harm reduction in substance misuse

A

Pyramid harm reduction hierarchy
Going from TOP = Don’t use
to BOTTOM - re-use or share uncleaned equipment

90
Q

Possible strategies for harm reduction (5)

A 
Needle distribtuion 
Take home naloxone to reverse opiate OD 
Substitute prescribing 
Assess + Tx co-morbid physical + mental illness 
Education RE safe sex practice
91
Q

Biological approach - alcohol Mx

A

Detoxification
Disulfiram
Acamprostate

92
Q

What does Disulfiram do

A

Deters

Due to if consume alcohol –> flushing, headache, tachyC, N+V

93
Q

What does Acamprosate do

A

Reduce alcohol graving

94
Q

Lofexidine

A

Amelioraites Sx of alcohol withdrawal

95
Q

Methadone

A

Long acting synthetic opioid

96
Q

Buprenorphine

A

Partial opiate agonist

97
Q

Prochaska + DiClemente model

A

Explains the processes for change

98
Q

What are the stages of change according to the Prochaska/Di Clemente model

A 
Precontemplation 
Contemplation
Preparation 
Action 
Maintenance 
Relapse 
Upward spiral
99
Q

Good prognostic factors - quitting alcohol/Dx (5)

A 
Motivated to change 
Supportive family/relationship 
In employment 
Tx co-morbid mental illness 
Alcoholics anon or Dx/alcohol services involved
100
Q

Poor prognostic factors - quitting alcohol/Dx (7)

A 
Ambivalent about change 
Unstable accomm/homelessness 
Absence of pro-social relationships 
Unemployment
Primacy 
Repeated Tx failure 
Cognitive impairment
101
Q

MI - Develop Discrepancy

A

Help a person recognise the discrepancy between their behaviour and their personal goals

102
Q

MI - Express empathy

A

Skillful reflective listening to understand a person’s feelings and perspectives without judging, criticising or blaming

103
Q

MI - Support self-efficacy

A

Self-efficacy a persons belief or confidence in their ability to carry out a target behaviour successfully

CP2 Psychiatry (15 decks)

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