Clinical approach to substance abuse disorders Flashcards
What is addictophrenia spectrum?
a conceptual model used for risk assessment & treatment planning
Addictophrenia spectrum
GENETIC history of:
- -addictive disorders
- -intractable mood disorders
- -personality disorder or habitual criminal behavior
PERSONAL history of:
- -polysubstance use
- -trauma (earlier=greater risk)
- -chronic psychosocial stressors starting at young age
Criteria for substance use disorder
- -using larger amounts or for longer time than intended
- -persistent desire or unsuccessful attempts to stop
- -great deal of time spent obtaining, using, or recovering
- -craving
- -fail to fulfill major roles
- -social or interpersonal problems causes by use
- -tolerance
- -withdrawal
- -use despite physical or psychological problems caused by use
neuroadaptation
CNS changes that occur following repeated use such that a person develops tolerance &/or withdrawal
- -adaptation of metabolizing system
- -ability of CNS to function despite high blood levels
symptoms of early alcohol withdrawal
anxiety, irritability, tremor, HA, insomnia, nausea, tachycardia, HTN
When do seizures generally occur during alcohol withdrawal?`
24-48 hrs
When does delirium tremens occur & what are the manifestations?
generally between 48-72 hrs (can be 3-10days)
–global confusion, hallucinations, fever, HTN, autonomic hyperactivity, tachycardia, sweating
Alcohol withdrawal tx
- -benzos: reduce risk of seizures, provide comfort/sedation
- -anticonvulsants: reduce risk of seizures
- -thiamine supplement
- -alcoholics anonymous
- -naltrexone & acamprosate
signs of benzo/barbiturate intoxication
similar to alcohol but less cognitive/motor impairment
benzo withdrawal symptoms
anxiety, irritability, insomnia, fatigue, HA, tremor, sweating
symptoms of opioid intoxication
constricted pupils, sedation, constipation, bradycardia, hypotension
symptoms of opioid withdrawal
not life threatening
dilated pupils, lacrimation, goosebumps, n/v, diarrhea
opiate disorder treatment
support, education
methadone
naltrexone
buprenorphine
Which drug should you never mix with methadone
benzos
causes QTc prolongation
also avoid another CYP3A4 substrate
symptoms of stimulant intoxication
euphoria, enhanced vigor, hyperactivity, restlessness, anxiety, anger, paranoia
also tachy, pupil dilation, HTN, diaphoresis
symptoms of chronic stimulant intoxication
affective blunting, fatigue, sadness, social withdrawal, hypotension, psychosis
symptoms of stimulant withdrawal
severe & even suicidal depression
neuroadaptation with cocaine
prevents reuptake of DA
stimulant use disorder tx
narcotics anonymous
support, education
no drugs are FDA approved
neuroadaptation with amphetamines
inhibit reuptake of DA, NE, SE–greatest effect on DA
symptoms of tobacco withdrawal
dysphoria, irritability, anxiety, decreased concentration
neuroadaptation with tobacco
nicotine acetylcholine receptors on DA neurons in ventral tegemental area release DA in nucleus accumbens
tx for tobacco use
CBT
nicotine gum, patch, etc
buproprion
varenicline
symptoms of MDMA intoxication
illusions, hyperacusis, sensitivity to touch, euphoria, panic, paranoia
–also be cautious of very high fever!! tachycardia, sweating
neuroadaptation with MDMA
affects serotonin, DA, NE (mostly serotonin)
symptoms of withdrawal from MDMA
unclear syndrome–sleepiness & depression
symptoms of withdrawal from cannabis
insomnia, irritability, anxiety, poor appetite, depression
symptoms of PCP intoxication
severe dissociative reactions, paranoid delusions, hallucinations, can become very agitated/ violent
NYSTAGMUS
has no tolerance or withdrawal
PCP abuse tx
antipsychotics or BZD
low stimulation environment
neuroadaptation with PCP
opiate receptor effects
allosteric modulator of glutamate NMDA receptor
