Alcoholism Flashcards
Name some biological causes of alcoholism
Genetics
Family links
Name some psychiatric causes of alcoholism
Having a psychiatric illness such as depression, anxiety, personality disorders, physical illnesses
Psycho active theories – positive reinforcement – negative reinforcement Conditioned response to circumstances Modelling behaviour
Name some social reasons for alcoholism
– Availability of substance – occupation (stress) – advertising and pay pressure – homelessness – life events (bereavement, separation, loss of employment) -dysfunctional family/truancy
Name some symptoms of alcohol intoxication
Argumentative Aggression Labile mood Impaired attention Impaired judgement Interference with personal functioning
Name some physical symptoms of alcohol intoxication
Unsteady gait Difficulty standing Slurred speech Nystagmus Decrease consciousness Flushed face Conjunctival injection
Name some withdrawal symptoms that you would experience if you were a dependent alcoholic coming off alcohol
Tremoring Sweating Nausea, retching, vomiting Tachycardia or hypertension Agitation Headaches Insomnia Weakness Hallucinations are lesions Grande Mal convulsions Delirium tremens
Name the seven symptoms of alcohol dependency
– Compulsion to drink – repeated withdrawal - Reinstatement after abstinence - Primacy of drinking over other activities (saliency) - Narrowing of drinking repertoire - Increased tolerance - Relief drinking
How would you investigate a patient he believed could have an alcohol related problem?
– Triage the patient (audit/SADQ)
- History including cage questionnaire and collateral history
- determine their consumption, dependence and related problems
-mental state examination
-Bloods: GGT ALP, AST and MCV
-Blood alcohol concentration over 300 mg per 100 mls= equals extreme intoxication
– 400 mg per 100 mls= fatal intoxication
How would you manage /Treat patients who are high risk drink is/has mild dependency (they don’t need assisted alcohol withdrawal
– Office psychotherapy: CBT, behavioural therapy, social/environmental therapy (AA) or couples therapy: these usually last for around 12 weeks
– if this does not work alone, or if the patient requests pharmacological help:
– acamprosate or oral naltrexone can be given alongside the psychotherapies mentioned above
For assisted alcohol withdrawal how many times should a patient with mild- moderate alcoholism dependency be seen by community based programs?
What if they had a severe addiction?
What if they drank >30 units per day?
2 to 4 times per weekly in community
4-7 days weekly in community
Inpatient/residential help
What medication would you prescribe to help with assisted alcohol withdrawal?
Chlordiazepoxide or diazepam at a therapeutic dose and titrate downwards for 7 to 10 days.
– Lorazepam should be used at a reduced dose If the patient has a liver impairment, however if the liver impairment is severe don’t use anything at all
After a patient has successfully been withdrawn from alcohol how would you prevent them from going back to substance abuse
– Acamprosate or oral naltrexone can be used alongside psycho therapy (CBT, AA, behavioural therapy, couples therapy)
– – disulphiram can be given second line
– do not give disulfiram with alcohol as side-effects include flashing, nausea, palpitations it can also cause hepatotoxicity
– – before prescribing acamprosate, oral now track soon or disulfiram check the patient’s
- U+ E
- LFT
- GGT (gamma-glutamic transpeptidase) raises in lover damage
How would you treat alcohol related problems in children
– Think about offering CBT/various family therapies
– if needed can prescribe acamprosate or oral naltrexone
How would you describe delirium tremens?
It is a medical emergency!!! – Symptoms are like delirium – 5% of alcohol dependent people Will develop delirium tremens within 1 to 3 days of abstinence – Symptoms include Clouding of consciousness Disorientation Impairment of recent memory Hallucinations Insomnia Autonomic distances: heart rate blood pressure temperature et cetera Cause trauma Nausea and vomiting Seizures Fear agitation and restlessness
How would you treat a patient who has presented with delirium tremens
Using benzodiazepines
Also correct electrolyte and fluid imbalances, treat infections and give multivitamin injections
How would you describe wernicke – Korsakoff syndrome?
Wernickes encephalopathy- confusion, ataxia and opthamoplegia (ocular palsy) classic triad
20% recover, 10% die, 70 develop Korsakoff’s syndrome
Korsakoffs- irreversible amnesia, impairment of retaining new information mainly, also forget old.
Confabulation (falsification of memory in clear consciousness)
How would you prevent werncikes encephalopathy from developing into Korsakoff’s syndrome?
- parental thiamine (IV)
What is fetal alcohol syndrome?
Alcohol in pregnancy Can lead to fetal alcohol syndrome,
Presentation: growth retardation, dysmorphology, CNS involvement (learning difficulties, impulsivity)
Name some medical problems which can arise from consuming too much alcohol
– Cirrhosis – liver disease – cancer – cardiomyopathy – seizures – neurological disease
Name some psychiatric problems which can arise from excessive alcohol intake
Depression, anxiety, suicidal thoughts, drug misuse
Name some social problems which can arise from increased alcohol intake
Impaired work performance
Relationship problems
Violent crimes
What are the four questions part of the CAGE Questionnaire
Have you ever felt that you should cut down on your drinking?
Do people annoy you by commenting on your drinking?
Do you ever felt guilty about your drinking?
Do you need a drink in the morning to study your nerves up to get rid of a hangover? (Eye-opener)
How would you define binge drinking?
Having twice the recommended daily limit in one session
How would you define both hazardous and harmful drinking?
Hazardous= risk of harming health : 14 to 35 units per week Harmful= damaging health: >35 units per week
Is alcohol a GABA agonist?
Yes
Is alcohol a depressant?
Yes
