Clinical management and presentation of addictions Flashcards
What are the signs of opiate withdrawal?
Tachycardia
Anxiety/ irritability
Restlessness
Tremor
Pupil dilation
Sweating
Gooseflesh skin
Bone pain
GI upset
Runny nose
Yawning
What additional questions would you ask a person presenting with addiction in relation to family history?
Include mental illnesses and addiction disorders
What questions would you ask about a person’s substance misuse history?
Length of current use and when last used
Current amount and how long have they been using at that level
Total length of use, max use, and any periods of abstinence
Mode/method of use
Evidence of withdrawals and severity (seizures, admissions)
Any previous overdoses (accidental/ intentional)
Any previous treatment (medication, psychotherapy, detox, rehab)
Assess triggers for substance/ alcohol use
Assess individual’s motivation to change/ engage with treatment
What red flags could you see in the psychiatric history of an individual presenting with addiction?
often history of trauma including neglect and abuse- ask about family history of substance use/ violence
screen for developmental disorders especially ADHD and get general developmental and education history
What common comorbid conditions are there for substance abuse/ addiction?
Depression
Anxiety
Suicidality
Bipolar
Personality disorder
PTSD
What are major causes of morbidity and mortality associated with substance abuse?
Trauma (e.g. fractures
Road traffic accidents
Suicide
Homicide
Overdose
Cirrhosis (alcohol)
Endocarditis (IV)
Abscesses (IV)
Blood borne viruses: hepatitis B/C, HIV (IV)
Describe drug induced psychosis
A cluster of psychotic phenomena occurring during/ after drug use, especially stimulants such as crack, methamphetamines etc. Includes,
Vivid hallucinations, often auditory
Paranoid delusions (can be severe)
Symptoms usually resolve in 1-6 months
Need to take care in not misdiagnosing as something serious like a schizophrenic episode
What aspects of patient history are specific to alcohol?
Alcohol psychosis
Alcohol seizures
Delirium tremens
Melaena
Haematemesis
What aspects of examination are specific to alcohol?
Jaundice
Anaemia
Clubbing
Cyanosis
Oedema
Ascites
Lymphadenopathy
DVT
What investigations would be carried out in a person presenting with alcohol addiction?
Bloods (LFT, GGT, U & E, lipids, amylase)
Breathalyser
Urine drug screen
Fibro scan/US
What aspects of examination of patient would be specific to opioid use?
Collapsed veins/ track marks
Endocarditis
Skin abscesses
Hepatitis B/C, HIV
Pneumonia
What investigations would you carry out on a patient presenting with opioid addiction?
Bloods (LFT, GGT, U & E, lipids, amylase)
Breathalyser
Urine drug test
Sexual health screening/BBV
Describe epidemiology of alcohol consumption
- 30% UK population drink above safe limit
- 25% of men have drinking problem at some point
- In last 12 months. 7% men & 2% women are dependent
- 14-24 y/o have heaviest use
- Unemployed > employed
- Divorced/separated > single > married
What is CAGE screening and what questions would you ask an individual during this screening process?
Alcohol assessment tool
Have you felt the need to CUT down on drinking?
Do you feel ANNOYED when people tell you to decrease drinking?
Do you feel GUILTY about your alcohol consumption?
Do you feel the need to have a drink first thing in the morning? (EYE-OPENER)
What are the immediate physical effects of acute alcohol consumption?
CNS: impaired reaction time and motor co-ordination, impaired judgement, sedation
Senses: less acute vision, smell, hearing, taste
Stomach: nausea, inflammation, bleeding
Skin: flushing, sweating, broken capillaries, heat loss and hypothermia
Sexual function: reduced erection in men, reduced vaginal lubrication
Describe the onset of alcohol withdrawal
