Alcohol Symposium - Mental Health

Question 1

There are 4 sort of “diagnoses” of alcoholism:

Answer 1

• Acute Intoxication
• Harmful Use
• Dependence
• Withdrawal State

Question 2

What is harmful use?

Answer 2

A pattern of use leading to physical or mental health damage over 1 month or repeatedly over 12 months

Question 3

What is required to diagnose Dependence on alcohol?

Answer 3

3+ of the following criteria over 1 month or repeatedly over 12 months:

• Craving/compulsion
• Difficulty controlling use
• Primacy
• Tolerance
• Withdrawal
• Persistance despite harmful consequences

Question 4

Define the Withdrawal State?

Answer 4

A cluster of symptoms that vary in presentation/severity, occurring when a substance is withdrawn after persistant use

Question 5

What are the symptoms of Withdrawal?

Answer 5

Tremor
Weakness
N&V
Anxiety
Seizures
Confusion
Agitation 
Death

Question 6

A more “severe” form of withdrawal can also occur, called?

Answer 6

DTs
Delirium Tremors

Typically occurs 2-3 days into the withdrawal symptoms

Question 7

What are Delirium Tremors?

Answer 7

Profound:

• Tremor
• Confusion
• Agitation
• Hallucination
• Delusion
• Sleepiness
• Autonomic Overactivity

Question 8

What are the big risks of DTs?

Answer 8

They can lead to death in several ways:

• CV collapse
• Infection
• Hyperthermia
• Seizure
• Self-injury

Question 9

List some of the major mental health problems that can be related to alcohol use?

Answer 9

Anxiety
Depression
Sleep disruption
Self-harm / suicide
Morbid Jealousy
Alcoholic Hallucinosis

Main treatment for all of them is Abstinence

Question 10

What is Wernicke’s encephalopathy?

Answer 10

A condition that can occur due to thiamine deficiency in alcoholics

Question 11

What causes Wernicke’s Encephalopathy?

Answer 11

Thiamine Deficiency from:

• Poor Nutrition
• Poor absorption (due to alcohol damage to gut)
• Poor hepatic function
• Use of thiamine for alcohol metabolism

Question 12

How does Wernicke’s Encephalopathy present?

Answer 12

Typically with a triad (or mix) of:
- Confusion
- Opthalmoplegia
- ataxia
& Nystagmus

Question 13

Wernicke’s Encephalopathy is bad enough on it’s own, but why is it so important we treat it as early as possible?

Answer 13

It can progress to Korsakoff’s Psychosis which can be very disabling and permanent

Question 14

What does Korsakoff’s psychosis do?

Answer 14

Impairs recent & remote memory, both anterograde & retrograde (although it leaves immediate recall)

+ Impaired learning & disorientation

sometimes nystagmus & ataxia

Question 15

What screening tools can we use looking for an alcohol problem?

Answer 15

• CAGE questions (2+ = likely)
• AUDIT (Alcohol Use Disorders Identification Test)
• FAST = smaller version of AUDIT for use in A&E
• PAT - Paddington Alcohol Test (also used in A&Es etc)

Question 16

How do we manage alcohol withdrawal?

Answer 16

Chlordiazepoxide

Its a benzo very similar to Diazepam

Question 17

Why do we use Chlordizepoxide?

Answer 17

It’s not well known meaning patient’s don’t try to get it or sell their prescription like they do with diazepam

Question 18

What meds can we use to prevent Wernicke’s?

Answer 18

Thiamine

Question 19

What drugs do we have to help with maintaining abstinence?

Answer 19

Aversion meds = Disulfiram

Anti-craving meds = Acamprosate + Naltrexone & Nalmefene

Question 20

How do Naltrexone & Nalmefene work?

Answer 20

They block endogenous opioid release, quite specifically to alcohol so doesn’t affect other processes

Question 21

Explain the effect of alcohol on your neurochemistry?

Answer 21

Enhances inhibitory GABA A, Glycine & Adenosine

Reduces Excitatory NMDA glutamate & Aspartate

Promotes Endogenous Opioid & Endocannabinoid release