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Psychiatry > Alcohol use disorders > Flashcards

Alcohol use disorders Flashcards

1
Q

What are some of the effects of alcohol in low doses?

A
  • Euphoria
  • Reduced anxiety
  • Relaxation
  • Sociability
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2
Q

What is intoxication?

A

Intoxication is the pathological state produced by a drug, serum, alcohol or any toxic substance

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3
Q

What are some symptoms of alcohol intoxication?

A
  • Impaired attention
  • Impaired judgement
  • Unsteadiness
  • Flushing
  • Nystagmus
  • Mood instability
  • Disinhibition
  • Slurring
  • Stupor
  • Unconsciousness
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4
Q

What are the levels of substance use

A
  1. Non-user
  2. Low risk user
  3. Hazarous substance use
  4. Episode of harmful use
  5. Harmful substance use
  6. Substance dependance
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5
Q

What is harmful use?

A

Pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months

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6
Q

What is dependance?

A

2 or more of the following for >3 months or repeatedly over 12 months:

  • Impaired control over alcohol use
  • Alcohol becomes an increasing priority in life
  • Physiological features
    • Tolerance
    • Withdrawal
    • Repeated use to prevent or alleviate withdrawal
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7
Q

What is withdrawal?

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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8
Q

What is the only withdrawal state that can cause death

A

Alcohol withdrawal

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9
Q

What is the major complication of alcohol withdrawal?

A

Delirium tremens

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10
Q

When does Delirium Tremens occur in alcohol withdrawal

A

48-72 hours after cessation

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11
Q

What are some symptoms of delirium tremens?

A
  • Profound confusion
  • Tremor
  • Agitation
  • Hallucinations
  • Delusions
  • Sleeplessness
  • Autonomic over-activity
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12
Q

What is the mortality rate of delirium tremens?

A

5%

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13
Q

How does delirium tremens cause death?

A
  • Cardiovascular collapse
  • Infection
  • Hyperthermia
  • Seizures
  • Self-injury
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14
Q

What are Roizen’s 4 categories of harm in alcohol misuse?

A

Lover - Relationship damage
Liver - Liver damage
Lifestyle - Lifestyle breakdown
Law - Criminality

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15
Q

What are some co-morbid psychiatric conditions that may occur in alcohol misuse?

A
  • Anxiety
  • Depression
  • Sleep disturbance
  • Morbid jealousy
  • Alcohol hallucinosis
  • Deliberate self-injury
  • Suicidal thoughts or acts
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16
Q

What are some facial features of alcohol misuse?

A
  • Puffy face
  • Bloodshot eyes
  • Dark circles under eyes
  • Dry skin
  • Rosacea
  • Rhinophyma
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17
Q

What are some physical symptoms of alcohol misuse?

A
  • Wernicke-Korsakoff’s syndrome
  • Chest infections
  • Hepatitis
  • Cirrhosis
  • Muscle loss
  • Cardiomegaly
  • Hypertension
  • Ulcers, gastritis and haematemesis
  • Pancreatitis
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18
Q

What are the 7 types of cancer in which alcohol is indicated?

A
  • Mouth and upper throat
  • Larynx
  • Oesophagus
  • Breast
  • Liver
  • Bowel
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19
Q

How can alcohol increase risk of cancer?

A

This is because alcohol can damage cells, increase damage from tobacco, affect hormones linked to breast cancer and break down into cancer-causing chemicals

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20
Q

What are the 2 disease processes involved in Wernicke-Korsakoff syndrome?

A
  • Wernicke’s encephalopathy
  • Korsakoff’s psychosis
21
Q

What are some symptoms of Wernicke’s encephalopathy?

A
  • Confusion
  • Ataxia
  • Ophthalmoplegia
  • Nystagmus
22
Q

What are some symptoms of Korsakoff psychosis?

A
  • Significant impairment of recent and remote memory
  • Preservation of immediate recall
  • Impaired learning and disorientation
  • Nystagmus and ataxia
23
Q

What causes Wernicke-Korsakoff’s syndrome?

A

This is caused by thiamine (B1) deficiency as alcohol leads to poor intake and absorption of thiamine, poor hepatic function and increased requirement for alcohol metabolism

24
Q

How can alcohol misuse cause relationship harm?

A

Alcohol can lead to intimate partner violence, both perpetration and victimisation

It can also cause poor parenting and neglect, possibly leading to loss of parenting rights

There may also be loss of friendships and social supports

25
Q

What is the CAGE screening tool for alcohol misuse?

A
  • C - have you ever tried to Cut down?
  • A - have you ever felt Annoyed by people criticising your drinking?
  • G - have you ever felt Guilty about drinking?
  • E - have you ever felt the need to have an Eye-opener?
26
Q

What are some forms of alcohol misuse screening tools?

A
  • FAST - Fast Alcohol Screening Test
  • AUDIT - Alcohol Use Disorder Identification Test
  • SADQ - Severity of Alcohol Dependance Questionnaire
  • CAGE
27
Q

What is the UK safe alcohol level?

A

<14 units per week spread across ≥3 days for both men and women

28
Q

Calculation for alcohol units

A

Unit = (ABV x ml) ÷ 1000
ABV (Alcohol By Volume) is the percentage of ethanol in an alcohol

29
Q

Units in:

A

1

30
Q

Units in:

A

1.5

31
Q

Units in:

A

2

32
Q

Units in:

A

3

33
Q

Units in:

A

9

34
Q

Units in:

A

30

35
Q

What are some holistic management options in alcohol misuse?

A
  • Support for patient or family
  • Motivational interviewing
  • Psychological suport
  • Social work input
  • Community support
  • Skills training
  • Inpatient or residential treatment
  • Medication
36
Q

What are some specialist treatments of alcohol misuse?

A

Medically assisted alcohol withdrawal (MAAW)
Vitamins

37
Q

What is involved in MAAW?

A

LA benzodiazepine regimen

38
Q

What vitamins may be given in alcohol misuse?

A
  • Oral thiamine
  • IV/IM Pabrinex
39
Q

What is an example of a deterrent medication used in alcohol misuse treatment

A

Disulfiram (Antabuse)

40
Q

What are some examples of anti-craving medications used in alcohol misuse management?

A
  • Acomprosate
  • Naltrexone
  • Nalmefene
  • Baclofen
41
Q

What are the 6 stages of change in alcohol misuse?

A
  1. Pre-contemplation
  2. Contemplation
  3. Preparation
  4. Action
  5. Maintenance
  6. Relapse*
42
Q

How does alcohol cause addiction?

A

Alcohol increases dopamine release in the Nucleus accumbens, playing a part in the reward system

This leads to positive reinforcement

Withdrawal leads to a decrease in dopamine, leading to dysphoria

It also increases GABA effects and decreases glutamate action, therefore decreasing levels of anxiety and causing relaxation

It also has an effect of the endogenous opioid system, which influences the mesolimbic dopamine system, further producing the positive reward effects of alcohol

43
Q

MOA of acomprosate

A

Inhibits glutamate NMDA receptor function

44
Q

MOA of naltrexone?

A
  • Opioid antagonist
  • Blocks pleasurable effects of alcohol and reduces the chances of a full-blown relapse after 1 drink
45
Q

Naltrexone contra-indications

A

Opiate use
Drinking persists for 4-6 weeks

46
Q

MOA of disulfiram

A

Blocks the breakdown of alcohol by inhibiting hepatic aldehyde dehydrogenase (ALDH)
Accumulation of acetaldehyde causes an unpleasant reaction

47
Q

What are some of the unpleasant affects of disulfiram with alcohol?

A
  • Flushing
  • Headache
  • Palpitations
  • Tachycardia
  • Nausea
  • Vomiting
  • Hypotension
  • Arrhythmias
48
Q

What are some contraindications of disulfiram?

A
  • Pregnancy
  • Severe mental illness
  • Stroke
  • Heart disease
  • Hypertension
49
Q
A

Psychiatry (29 decks)

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