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Systems: Psychiatry AB > 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

Intoxication.

A

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

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3
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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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 or more of the following for >1month or repeatedly over 12 months:
ravings/compulsions to take
-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 of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance

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7
Q

What neurochemical changes occur with alcohol use?

A
  • Increase in inhibitory GABA A
  • Increase in glycine
  • Decrease in excitatory NMDA glutamate
  • Promotes endocannabinoid release
  • Promotes endogenous opioid release
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8
Q

What are the signs and symptoms of alcohol withdrawal state?

A
  • Tremor
  • Weakness
  • Nausea
  • Vomiting
  • Anxiety
  • Seizures
  • Confusion
  • Agitation
  • Death
  • Delirium tremens
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9
Q

What is delirium tremens?

A

Rapid onset of confusion usually caused by withdrawal from alcohol

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10
Q

What are the signs and symptoms of DT?

A
  • Profound confusion
  • Tremor
  • Agitation
  • Hallucinations
  • Delusions
  • Sleeplessness
  • Autonomic over activity
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11
Q

When do DTs usually occur?

A

48-72 hours after alcohol is stopped

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12
Q

How can death occur due to DTs?

A
  • Cardiovascular collapse
  • Infection
  • Hyperthermia
  • Seizures
  • Self-injury
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13
Q

What are the categories of alcohol related problems?

A
  • Physical health
  • Mental health
  • Relationships
  • Employment/ finances
  • Legal
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14
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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15
Q

What neurological problems can occur as a result of alcohol?

A
  • Brain damage
  • Loss of memory
  • Hallucinations
  • Fits
  • Dementia
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16
Q

What respiratory problems can occur as a result of alcohol?

A

Risk of chest infections

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17
Q

What hepatic problems can occur as a result of alcohol?

A
  • Swollen liver
  • Hepatitis
  • Cirrhosis
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18
Q

What problems can occur in the extremities as a result of alcohol?

A
  • Tingling nerves
  • Numbness
  • Trembling hands
  • Loss of muscle
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19
Q

What cardiovascular problems can occur as a result of alcohol?

A
  • Poor control of diabetes
  • Enlarged heart
  • Hypertension
  • Irregular pulse
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20
Q

What GIT problems can occur as a result of alcohol?

A
  • Ulcers
  • Gastritis
  • Vomiting blood
  • Pancreatitis
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21
Q

What sexual problems can occur as a result of alcohol?

A
  • Impotence in me

- Infertility in women

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22
Q

What problems can occur due to thiamine deficiency?

A
  • Wernicke’s encephalopathy

- Korsakoff’s psychosis

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23
Q

How does Wernicke’s encephalopathy present?

A
  • Confusion
  • Ataxia
  • Opthalmoplegia
  • Nystagmus
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24
Q

How does Korsakoff’s psychosis present?

A

-Prominent 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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25
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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26
Q

What screening tools are there?

A
  • CAGE
  • AUDIT
  • FAST
  • PAT
27
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?
28
Q

How can alcoholism be managed?

A
  • Practical advice
  • Education
  • Harm reduction
  • Support for patient and family
  • Psychological help
  • Social work input
  • Skills training
  • Community support
  • Inpatient or residential treatment
  • Medication
29
Q

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

A

Thiamine

30
Q

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

A

Benzodiazepines (commonly chlordiazepoxide)

31
Q

What medication can be used for aversion/deterrent?

A

Disulfiram (Antabuse)

32
Q

What medications can be used to help fight cravings?

A
  • Acamprosate (Campral)
  • Naltrexone
  • Nalmefene
  • (Baclofen)
33
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
34
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
35
Q

What role does the liver play in carbohydrate metabolism?

A
  • Excess glucose: glycogenesis (storage)

- Low blood glucose: glycogenolysis to provide more

36
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

37
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
38
Q

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

A
  • Glucose
  • Iron
  • Copper
  • Vitamins
39
Q

What does the liver synthesise?

A
  • Fibrinogen (to Fibrin for clotting)

- Thrombopeitin (platelet production in bone marrow)

40
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
41
Q

What are the recommended alcohol consumption guidelines?

A
  • <14 units per week

- Spread over 3 days

42
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
43
Q

What causes of cirrhosis are there?

A
  • Alcohol related liver disease
  • Fatty liver disease
  • Hepatitis C virus
  • Autoimmune diseases
  • Other
44
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)

45
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
46
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
47
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

48
Q

What is alcoholic hepatitis?

A

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

49
Q

What does alcoholic hepatitis result in?

A
  • Hepatomegaly
  • Jaundice
  • Abdominal Pain
  • Fever
  • Hepatic decompensation
50
Q

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

A

Glasgow Alcoholic Hepatitis Score

51
Q

How is alcoholic hepatitis managed?

A
  • Steroids
  • Management of infection
  • Nutrition
  • Abstinence
52
Q

How do liver fibroids occur?

A
  • Chronic inflammation
  • Activation of stellate cells
  • Collagen production
  • Makes liver stiff
53
Q

What happens to the liver when fibrosis/cirrhosis occurs?

A
  • Localised fibrosis around vein
  • Collagen bridging between veins/tracts
  • Loss of lobule structure
54
Q

What are the complications of liver fibrosis/cirrhosis?

A
  • Variceal haemorrhage
  • Encephalopathy
  • Ascites
55
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
56
Q

What act provides regulation of the sale of alcohol?

A

Licensing (Scotland) Act 2005

57
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
58
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
59
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
60
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
61
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
62
Q

What social vulnerability factors are there in alcohol consumption?

A
  • Alcohol pricing, availability, regulation
  • Drinking context
  • Socio-economic status
  • Culture
63
Q

What individual vulnerability factors are there in alcohol consumption?

A
  • Mental health
  • Homelessness
  • Gender
  • Age

Systems: Psychiatry AB (18 decks)

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