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psychiatry > Alcohol Symposium > Flashcards

Alcohol Symposium Flashcards

1
Q

What effects does alcohol have at low doses?

A
  • euphoria
  • reduced anxiety
  • relaxation
  • sociability
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2
Q

What effects does alcohol have at higher doses?

A
  • impaired attention and judgement
  • unsteadineness
  • flushing
  • nystagmus
  • mood instability
  • disinhibition
  • slurring
  • stupor
  • unconsciousness
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3
Q

what is intoxication

A

the pathological state produced by a drug, serum, alcohol or any toxic substance; poisoning

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4
Q

What is harmful use?

A

pattern of drinking causing damage to physical or mental health
-Use >1 month or repeatedly over 12 months

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5
Q

What are the signs of dependence?

A

3 for > 1month or repeatedly over 12 months:

  • cravings
  • difficulty controlling use
  • primacy
  • increased tolerance
  • physiological withdrawal on reduction/cessation
  • persistence despite harmful consequences
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6
Q

What is withdrawal state?

A

group of symptoms (variable clustering and severity) on complete/relative withdrawal of a psychoactive substance

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7
Q

What are the signs and symptoms of alcohol withdrawal state?

A
  • tremor, weakness, seizures
  • nausea, vomiting, anxiety
  • confusion, agitation
  • death
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8
Q

What is delirium tremens?

A

rapid onset of confusion usually caused by withdrawal from alcohol

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9
Q

What are the signs and symptoms of delirium tremens (DT)

A
  • profound confusion, tremor, agitation
  • hallucinations, delusions, sleeplessness
  • autonomic over-activity
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10
Q

When do DTs usually occur?

A

48-72 hours after alcohol is stopped

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11
Q

How can death occur due to DTs?

A
  • cardiovascular collapse
  • infection
  • hyperthermia
  • seizures
  • self-injury
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12
Q

What are the categories of alcohol related problems?

A
  • physical health
  • mental health
  • relationships
  • employment/ finances
  • legal
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13
Q

How can alcohol affect your mental health?

A
  • anxiety
  • depression
  • sleep disruption
  • morbid Jealousy
  • alcoholic hallucinosis
  • deliberate self-injury
  • suicidal thoughts/acts
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14
Q

how can alcohol affect your physical health

A
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15
Q

What problems can occur due to thiamine deficiency?

A
  • Wernicke’s encephalopathy

- Korsakoff’s psychosis

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16
Q

How does Wernicke’s encephalopathy present?

A
  • confusion
  • ataxia
  • ophthalmoplegia
  • nystagmus
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17
Q

How does Korsakoff’s psychosis present?

A
  • impairment of recent and remote memory
  • preservation of immediate recall
  • no general cognitive impairment
  • retrograde and anterograde memory
  • impaired learning and disorientation
  • may exhibit nystagmus and ataxia
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18
Q

Why does thiamine deficiency occur with excessive alcohol consumption?

A
  • poor intake and absorption
  • poor hepatic function
  • increased requirement for alcohol metabolism
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19
Q

What screening tools are there?

A
  • CAGE
  • AUDIT
  • FAST
  • PAT
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20
Q

What are the 4 components of the CAGE questionnaire?

A
  • 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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21
Q

How can alcoholism be managed?

A
  • practical advice: education, harm reduction

- holistic/bio-psycho-social support: skills training, medication, social work

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22
Q

What medication can be used in the prevention of Wernicke-Korsakoff syndrome?

A

Thiamine

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23
Q

What medication can be used in the management of alcohol withdrawal?

A

Benzodiazepines (commonly chlordiazepoxide)

24
Q

What medication can be used for aversion/deterrent?

A

Disulfiram (Antabuse)

25
Q

What medications can be used to help fight cravings?

A
  • acamprosate (Campral)
  • naltrexone
  • nalmefene
  • (baclofen)
26
Q

What are the top 5 causes of admission due to alcohol?

A
  • unintentional injuries
  • mental ill health and behavioural disorders
  • heart conditions and strokes
  • liver disease and pancreatitis
  • cancer
27
Q

What are the functions of the liver?

A
  • Carbohydrate metabolism
  • Fat metabolism
  • Protein metabolism
  • Storage
  • Synthesis
  • Kupffer cells collect rubbish (bacteria, old cells etc)
  • Production of bile
  • Metabolism of drugs and alcohol
28
Q

What role does the liver play in carbohydrate metabolism?

A
  • Excess glucose: glycogenesis (storage)

- Low blood glucose: glycogenolysis to provide more

29
Q

What role does the liver play in fat metabolism?

A
  • Lipid metabolism predominantly within the liver

- Breaks down fats to produce phospholipids and cholesterol

30
Q

What role does the liver play in protein metabolism?

A
  • Deamination (break down) and Transamination (make up) of amino acids
  • Byproduct is Ammonia – liver synthesises urea to remove
  • Albumin synthesis (main protein of blood plasma) almost exclusive to the liver
31
Q

What substances does the liver store for when you need them?

A
  • Glucose
  • Iron
  • Copper
  • Vitamins
32
Q

What does the liver synthesise?

A
  • Fibrinogen (to Fibrin for clotting)

- Thrombopeitin (platelet production in bone marrow)

33
Q

How is alcohol metabolised?

A
  • Alcohol consumed and absorbed into blood from mouth, oesophagus, stomach and intestines
  • Blood arrives at the liver and is broken down to acetaldehyde and acetate by ADH and ALDH
  • Acetate is converted to fatty acids, C2O and H2O
  • Healthy liver can process 1 unit of alcohol per hour.
  • Acetaldehyde is a carcinogen and so overload can predispose to pathology
34
Q

What are the recommended alcohol consumption guidelines?

A
  • <14 units per week

- Spread over 3 days

35
Q

Why does alcohol affect some people more than others?

A
  • Poor dietary status – nutritional deficiencies
  • Simultaneous exposure to other drugs (affects metabolism)
  • Genetic variations/polymorphisms of enzymes (Fast acting ADH or slow acting ALDH (build-up of acetaldehyde))
  • Dependence and progression
  • Female gender more vulnerable
  • Coexisting viruses eg hepatitis C
36
Q

What causes of cirrhosis are there?

A
  • Alcohol related liver disease
  • Fatty liver disease
  • Hepatitis C virus
  • Autoimmune diseases
  • Other
37
Q

How does alcohol related liver disease progress?

A
  • Normal liver
  • Fatty liver (steatosis)
  • Steatohepatitis
  • Fibrosis
  • Liver cirrhosis

(Step 1- 2 is reversible)
(Step 3 may be missed out)

38
Q

Why does steatosis (fatty liver) occur?

A
  • Alcohol is calorie rich
  • Broken down to fatty acids which are deposited around the central veins then parenchyma
  • Reversible as liver can return to normal through abstinence
39
Q

What are the indicators of chronic alcohol use?

A
  • Elevated gamma GT (liver enzyme)
  • Macrocytosis (large red blood cells)
  • Low platelets
  • Elevated ferritin
  • Enlarged smooth edged liver on AUSS
  • POSITIVE HISTORY
40
Q

Describe the structure of the liver.

A

Central vein is a branch of the hepatic vein whereas the interlobular vein is a branch of the portal vein next to branch of the hepatic artery and portal tract

41
Q

What is alcoholic hepatitis?

A

Fatty change within the liver with infiltration of leucocytes and hepatic necrosis

42
Q

What does alcoholic hepatitis result in?

A
  • Hepatomegaly
  • Jaundice
  • Abdominal Pain
  • Fever
  • Hepatic decompensation
43
Q

What system is used to predict 28 day survival for alcoholic hepatitis?

A

Glasgow Alcoholic Hepatitis Score

44
Q

How is alcoholic hepatitis managed?

A
  • Steroids
  • Management of infection
  • Nutrition
  • Abstinence
45
Q

How do liver fibroids occur?

A
  • Chronic inflammation
  • Activation of stellate cells
  • Collagen production
  • Makes liver stiff
46
Q

What happens to the liver when fibrosis/cirrhosis occurs?

A
  • Localised fibrosis around vein
  • Collagen bridging between veins/tracts
  • Loss of lobule structure
47
Q

What are the complications of liver fibrosis/cirrhosis?

A
  • Variceal haemorrhage
  • Encephalopathy
  • Ascites
48
Q

What are the roles of the North East Division Licensing Team?

A
  • Respond to the Licensing Board in respect of alcohol licensing applications
  • Respond to the Licensing Committee in respect of civic licensing applications
  • Represent the Chief Constable at sittings
  • Monitor incidents at licensed premises
  • Engage with premises licence holders through intervention – address issues
  • Work in partnership – local authorities, health, the trade, security industry and many initiatives
49
Q

What act provides regulation of the sale of alcohol?

A

Licensing (Scotland) Act 2005

50
Q

Give examples of licensing offences.

A
  • Sale to, on behalf of, allow consumption by (on premises) , under 18 and under 18 to buy, attempt to buy consume (on premises), give to under 18 (public place) ,deliver to, send for…
  • Attempt to enter whilst drunk, or be drunk and incapable of taking care of self (on)
  • Sell to drunk person, obtain or attempt to obtain for a drunk person (on)
  • Whilst drunk, behave in disorderly manner or use obscene/indecent language to annoyance of others
  • Allow drunkenness or disorderly conduct (on)
  • Refuse to leave
51
Q

What vulnerability is there through intoxication?

A
  • Increased risk of committing a crime, becoming the victim of a crime or misadventure
  • Actions and decisions are affected by alcohol
  • Adverse incidents – reactive measure
52
Q

What risk factors are important to consider in a bid to reduce intoxication?

A
  • Private space consumption
  • Longer and later hours
  • Physiological factors
  • How alcohol is consumed
  • Are customers drinking rapidly
  • Other substances involved
  • Mix of types of alcohol
  • Bottle sales - consider a policy
  • ‘Shots’ drinks – consider a policy
53
Q

How do I know if my patient is drinking above the low risk guidelines?

A
  • Screening tools
  • FAST, Paddington alcohol test etc
  • Self -disclosure
54
Q

What should I do if my patient is drinking more than the low risk guidance?

A
  • Opportunity to reduce their risk of health harm
  • If alcohol dependence is likely – refer to treatment services
  • Offer feedback, assess how willing they are to change and offer support strategies
55
Q

What social vulnerability factors are there in alcohol consumption?

A
  • Alcohol pricing, availability, regulation
  • Drinking context
  • Socio-economic status
  • Culture
56
Q

What individual vulnerability factors are there in alcohol consumption?

A
  • Mental health
  • Homelessness
  • Gender
  • Age

psychiatry (23 decks)

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