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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
LSD - intake method
Paper tab Powder Tablet
26
LSD - mechanism of action
Indolealkylamine – v similar to serotonin Agonist on most of serotonin receptor subtypes in brain Indirect effects on DA pathways
27
LSD - acute negative effects
dilated pupils, tachyC, HTN. Acute intoxication – perceptual distortions + high-risk behaviour
28
Benzos - intake method
PO | IM/IV
29
Benzos - mode of action
Potentiate effects of GABA at GABAa receptors
30
Acute negative effects of benzos
``` intoxication, drowsiness, dizziness + blurred vision. Impaired conc, impaired coordination, HoTN + resp depression ```
31
Chronic negative effects benzos
impaired memory + concentration, depression, tolerance/dependence, withdrawal: seizures, delirium, psychosis
32
What % 16-25 y/o drink daily
1%
33
What % 25-44 y/o drink daily
4%
34
What % >65 s drink daily
13%
35
What % of men in the UK are dependent on alcohol?
9%
36
What % of women in the UK are dependent on alcohol?
4%
37
What is the most common cause of alcohol related death?
Alcoholic liver disease
38
biological aetiology - alcohol misuse
1st degree relatives 7x more likely
39
Psychological aetiology - alcohol misuse (3)
MH illness Stress, high soc anxiety, low self-esteem Psychological theories negative + positive reinforcement
40
Social aetiology - alcohol misuse (5)
``` Low SE class Price of alcohol Social isolation Loss of spouse Certain professions ```
41
What is ICDs 2 step approach to diagnosis psychoactive substance abuse?
``` 1 - Specify the substance or class of subustance 2 - Specify the type of disorder ```
42
Different types of substance abuse disorders (6)
``` Acute intoxication Harmful use Dependence syndrome Withdrawal state w/ delirium Amnestic disorder MH/Behavioural disorder ```
43
Def acute intoxication
Transient physical and mental abnormalities occuring shortly after administration and cause by the direct effects of he psychoactive substacnes
44
Def dependence syndrome
Cluster of physiological, behavioural and cognitive phenomena relevant to a persons relationship w/ partic substance
45
When is dependence syndrome diagnosed
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
Def alcohol withdrawal syndrome
Any pt who is alcohol dependent and abruptly stops drinkings
47
RF for more severe alcohol syndrome (3)
Intercurrent medical illness Advanced liver disease Prev withdrawal eps
48
Mild/uncomplicated alcohol withdrawal syndrome: ONSET
4-12hrs post last alcoholic drink
49
Mild/uncomplicated alcohol withdrawal syndrome: duration
2-5 days
50
Mild/uncomplicated alcohol withdrawal syndrome: features (9)
``` Coarse tremor Sweating Insomnia TachyC N+V Psychomotor agitation Anxiety Intense cravings +/- transient hallucinations ```
51
What % of alcohol withdrawal cases are complicated by grand mal seizures?
15%
52
RF seizures post alcohol withdrawal (4)
Heavy prolonged drinking Prev seizures Idiopathic epilepsy Hx head injury
53
Mx alcohol withdrawal syndrome
1 - chlordiazepoxide 2 - vits - thiamine/multivit 3 - close monitoring 4 - consider if need inpt or output
54
Def Dual Diagnosis
Severe MH problem and problematic substance misuse
55
CAGE questions
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 to ask - lifetime pattern of alcohol consumption
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
O/E - alcoholism (8)
``` 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
Ix Alcoholism (8)
``` Urine + saliva Dx screen Breath alcohol level FBC U+E LFT - GGT, ALT/AST Clotting screen ECG IVDU - hepatitis serology/HIV test ```
59
Alcohol misuse - neurological complications (7)
``` 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
CV effects of Alcohol misuse (3)
Alcoholic cardiomyopathy Arrhythmias HTN
61
Hepatic complications of alcohol misuse (5)
``` ALD Fatty liver changes Alcoholic hepatitis Cirrhosis Hepatocellular carcinoma ```
62
Bowel complications of alcohol misuse (3)
Malabsorption Diarrhoea Lower GI carcinoma
63
Oesophageal and gastric complications of alcohol misuse (6)
``` Mallory-Weiss tears Oesoph varices +/- haemorrhage Barretts/carcinoma Gastritis + erosions Peptic ulcer disease Gastric carcinoma ```
64
Female sexual/reproductive complications alcohol misuse (3)
FOS Fertility problems Sexual dysfunction
65
Male sexual/reproductive complications alcohol misuse (2)
Erectile dysfunction | Hypogonadism
66
Psychiatric complications of alcohol misuse
``` Auditory hallucinations Wernicke-Korsakoff syndrome Patholgical jealousy e.g. monosymptomatic delusional disorder Anxiety + depression disorders Suicide Schizophrenia relapse ```
67
What is monosymptomatic delusional disorder
INdividual presents with the 1' delusion that his partner is being unfaithful May go to great lengths to obtain evidence of infedility
68
Lifetime risk of suicide for dependent alcohol drinkers
10-15%
69
Social consequences alcohol misuse (7)
``` Divorce Domestic violence Homelessness Financial/legal problems Poor performance at work Risky sexual activity Psychological harm to family members ```
70
Def delirium tremens
Rapid onest of confusion usually caused by the withdrawal of alcohol
71
How long into withdrawal of alcohol does delirium tremens occur
3 days (72hrs)
72
How long does delirium tremens last
2-3days
73
Sx delirium tremens
Clouding consciousness + disorientation place/time/person Amnesia recent events Hallucinations + delusions
74
2 phases of Wernicke Korsakoff syndrome
Wernicke's encelphalopathy = acute phase | Korsakoff psychosis = chronic phase
75
Cause of Wernicke Korsakoff syndrome
Neuronol degen due to B1/thiamine deficiency
76
Who gets Wernicke Korsakoff syndrome
Heavy drinkers | B deficiency
77
Why does chronic alcohol drinking cause Wernickes?
Reduces B1 absorption from GIT | + Liver disease means reduced capacity for hepatic thiamine storage
78
Triad of Sx seen in 10% Wernicke Korsakoff syndrome pt
Acute confusional state Oculo-motor signs (ophthalmoplegia, nystagmus) Ataxic gait
79
Other Sx Wernicke Korsakoff syndrome
Peripheral neuropathy | Resting tachyC
80
Which parts of brain are affected in Wernicke Korsakoff syndrome (3)
Mamillary bodies Hypothalamus Tegmentum of midbrain
81
Tx Wernicke Korsakoff syndrome (3)
IV Pabrinex 2 ampoules 30mins bd 3-7days Do NOT rehydrate w/ glucose Tx co-existing alcohol withdrawal syndrome
82
Mortality Wernicke-Korsakoff syndrome
15%
83
Causes of Korsakoff syndrome (4)
Head injury Encephalitic processes CO poisoning Alcoholism
84
Does Korsakoff syndrome have to be preceded by Wernickes encephalopathy?
No
85
CF Korsakoff syndrome (4)
Anterograde amneisa Some degree retrograde amnesia Confabulation (false memories) Apathy
86
Tx Korsakoff syndrome (2)
PO thiamine + multivits up to 2y | Psych interventions for cognitive impairment
87
What % pt w/ Korsakoff's syndrome make a complete recovery?
20%
88
AIMS of Mx substance use disorders (5)
``` 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
What method is used for harm reduction in substance misuse
Pyramid harm reduction hierarchy Going from TOP = Don't use to BOTTOM - re-use or share uncleaned equipment
90
Possible strategies for harm reduction (5)
``` Needle distribtuion Take home naloxone to reverse opiate OD Substitute prescribing Assess + Tx co-morbid physical + mental illness Education RE safe sex practice ```
91
Biological approach - alcohol Mx
Detoxification Disulfiram Acamprostate
92
What does Disulfiram do
Deters | Due to if consume alcohol --> flushing, headache, tachyC, N+V
93
What does Acamprosate do
Reduce alcohol graving
94
Lofexidine
Amelioraites Sx of alcohol withdrawal
95
Methadone
Long acting synthetic opioid
96
Buprenorphine
Partial opiate agonist
97
Prochaska + DiClemente model
Explains the processes for change
98
What are the stages of change according to the Prochaska/Di Clemente model
``` Precontemplation Contemplation Preparation Action Maintenance Relapse Upward spiral ```
99
Good prognostic factors - quitting alcohol/Dx (5)
``` Motivated to change Supportive family/relationship In employment Tx co-morbid mental illness Alcoholics anon or Dx/alcohol services involved ```
100
Poor prognostic factors - quitting alcohol/Dx (7)
``` Ambivalent about change Unstable accomm/homelessness Absence of pro-social relationships Unemployment Primacy Repeated Tx failure Cognitive impairment ```
101
MI - Develop Discrepancy
Help a person recognise the discrepancy between their behaviour and their personal goals
102
MI - Express empathy
Skillful reflective listening to understand a person's feelings and perspectives without judging, criticising or blaming
103
MI - Support self-efficacy
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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