Clinical Approach to Addiction Psychiatry

Question 1

A woman with an opioid use disorder becomes pregnant. She visits her ObGyn and advises she plans to stop using opioids. What should the physician advise?

Answer 1

The patient should NOT discontinue use of the opioids as withdrawal WILL cause termination of the pregnancy. The patient should carefully be transitioned to suboxone, buprenorphine, or methadone.

Question 2

What brain structures/systems are implicated in substance use disorders?

Answer 2

The limbic system & basal ganglia

Question 3

What are the stages of addiction?

Answer 3

Binge & intoxication, withdrawal & negative effects, preoccupation & craving

Question 4

This psychostimulant binds to norepinephrine, and serotonin transporters to block uptake AND induces additional release of neurotransmitters.

Answer 4

Amphetamines

Question 5

Substance withdrawal occurs in two stages. The acute phase generally lasts less than one week. What is the second phase and what happens then?

Answer 5

Post-Acute Withdrawal - emotional and psychological symptoms as the body returns to normal/equilibrium

Question 6

What drug has the lowest incidence of neonatal abstinence syndrome?

Answer 6

Suboxone > Buprenorphine > Methadone

Question 7

Withdrawal from this drug occurs in three phases presented by depressing symptoms (sleep, irritability, depression, anxiety).

Answer 7

Cocacine (initial crash, acute withdrawal, extinction)

Question 8

Buprenorphine may precipitate withdrawal in a patient with recent opioid use. How does this affect the use of the drug in treating substance use disorders?

Answer 8

Patients must already be in mild withdrawal before buprenorphine can be initiated.

Question 9

What is the MOA of cocaine?

Answer 9

Binds to dopamine, norepinephrine, and serotonin transporters to block uptake

Question 10

This drug is a partial agonist of mu receptors and serves as a maintenance therapy for substance use disorders.

Answer 10

Buprenorphine

Question 11

What is addiction?

Answer 11

The most severe, chronic stage of a substance use disorder

Question 12

This drug is a long-acting mu agonist.

Answer 12

Methadone

Question 13

On what receptors do opioids act?

Answer 13

Mu, kappa, delta

Question 14

This receptor is most associated with opioid abuse.

Answer 14

Mu receptors

Question 15

True/False. Fentanyl has a higher affinity for mu receptors than buprenorphine.

Answer 15

False. Buprenorphine has the highest affinity for mu receptors of any opioid/opiate.

Question 16

Withdrawal from these drugs produces stimulatory symptoms that may result in seizures or death.

Answer 16

Alcohol, Benzodiazepenes

Question 17

What is the neurobiological effect of alcohol?

Answer 17

Enhances GABA and glutamate functioning. Chronic alcohol use increases the density of glutamate NMDA receptors (this is why we develop tolerance)

Question 18

What are the risks associated with methadone?

Answer 18

Difficult to discontinue (mu agonist), potential for unintentional overdose, drug-drug interactions, respiratory depression, QT prolongation

Question 19

What is suboxone?

Answer 19

A combination drug of naloxone and buprenorphine to treat substance use disorders

Question 20

This drug is a full antagonist of mu receptors. When can it be administered to treat a substance use disorder?

Answer 20

Naltrexone - administered after 14 days of no opioid use

Question 21

What is a substance use disorder?

Answer 21

Recurrent use of alcohol or other drug that causes clinically and functionally significant impairment

Question 22

Withdrawal from this drug causes depressed symptoms and may present with psychosis in serious cases.

Answer 22

Methamphetamine

Question 23

What factors increase the risk of developing a substance use disorder?

Answer 23

Family history, early exposure, high-risk environmental, certain mental illnesses, traumatic brain injury

Question 24

True/False. It is not possible to overdose on an opioid while taking buprenorphine.

Answer 24

False. Buprenorphine has a high binding affinity for mu receptors. If a person increases the dose of the abusing opioid, buprenorphine may be displaced all at once and cause overdose and death.

Question 25

True/False. A patient who has a positive feeling upon first use of a drug has the same risk of developing a substance use disorder as a person who has a negative first feeling.

Answer 25

False - a positive feeling after first use is associated with a higher risk of developing a substance use disorder

Note, that a positive feeling is not the same as liking the substance (i.e. Hate taste of beer, but like feeling of intoxication)

Question 26

True/False. Nicotine use in adolescence harms brain development, but does not increase the risk of a future substance use disorder.

Answer 26

False - nicotine affects various parts of the brain AND increases the risk of developing a future substance use disorder

Question 27

Withdrawal from this drug mimics symptoms of severe flu.

Answer 27

Opioids

Question 28

This neurotransmitter is most implicated in substance use disorders.

Answer 28

Dopamine