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CPI Flashcards

0
Q

Implications of alcohol misuse

A
  • economic (cost, decreased production, job loss)
  • criminal justice system
  • health care system
  • HIV
  • social
  • individual development
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1
Q

Areas of impact of substance misuse

A
  • social
  • medial
  • psychological
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2
Q

Spectrum of substance misuse

A
  • acute intoxication
  • at-risk use
  • harmful use
  • dependence
  • withdrawal
  • complicated withdrawal
  • substance-induced psychosis
  • cognitive impairment disorders
  • residual disorders
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3
Q

Progression to disease (alcohol)

A
  • experimental use
  • recreational use
  • harmful use
  • dependence
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4
Q

Things classified under substance use disorders

A
  • alcohol abuse

- alcohol dependence

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5
Q

Things classified under substance induced disorders

A
  • intoxication
  • withdrawal
  • substance induced mental disorders
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6
Q

Definition of alcohol abuse

A 
Within a 12 month period
Recurrent use:
- resulting in failure to fulfill obligations
- resulting in recurrent legal problems
- hazardous situation

Continued use despite recurrent or persistent social or interpersonal problems related to abuse

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7
Q

Definition of alcohol dependence

A
  • Tolerance
  • withdrawal or persistent use to prevent symptoms of withdrawal
  • compulsive use/loss of control/increase salience
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8
Q

Definition of addiction

A

A condition which causes a person to continue behaviors demonstrated as harmful to that person

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9
Q

Possible pathways to addiction

A
  • genes and family history of addiction
  • brain reward mechanism
  • psychosocial factors
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10
Q

Mood altering drugs (MAD)

A

Drugs that acutely increase dopamine levels in the mid brain

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11
Q

Pattern across all MADs

A

Use
Repetitive loss of control
Return

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12
Q

Drug classes

A
  • depressants (downers)
  • stimulants (uppers)
  • hallucinogens (psychedelics)
  • narcotics
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13
Q

What increases the risk of a drug being abused?

A
  • psychoactive
  • fast effect
  • wears off quickly
  • easy to administer
  • passes easily through blood-brain barrier
  • cheap
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14
Q

Effects of substances

A
  • intoxication
  • tolerance
  • withdrawal
  • craving
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15
Q

Possible substance induced disorders

A
  • delirium
  • dementia
  • amnestic disorder
  • psychotic disorder
  • mood disorder
  • anxiety disorder
  • sexual dysfunction
  • sleep disorder
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16
Q

Definition of a unit of alcohol

A

10ml alcohol, 8g of alcohol

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17
Q

How to calculate the number of units in drink

A

Alcohol % x volume of alcohol (ml)/1000

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18
Q

Symptoms of uncomplicated withdrawal

A

Few hours to 5 days after:

  • sweating
  • tremor
  • anxiety/restlessness
  • nausea and vomiting
  • tachy and HT
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19
Q

How to treat uncomplicated withdrawal

A

Diazepam for 3 days

- thiamine and B complex vitamin

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20
Q

Signs of delirium tremens (complicated withdrawal)

A
  • 48-72 hours after
  • May be preceded by withdrawal seizures
  • increased autonomic hyperactivity
  • delirium:
  • impaired attention
  • fluctuating consciousness
  • psychomotor activity
  • disorientated
  • hallucinations
  • risk to self and others
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21
Q

Types of alcohol induced psychiatric disorders

A
  • delirium
  • dementia
  • amnestic disorder (korsakoff psychosis)
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22
Q

How to manage alcohol induced mood and anxiety disorders

A
  • treat addiction as priority
  • review symptoms after 2-4 weeks of abstinence
  • use agents with low abuse and self harm potential
  • check regularly for compliance
  • preferred agents (SSRIs, mood stabilisers)
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23
Q

Four stage model for managing addcition

A
  • identify
  • motivate
  • treat/ rehabilitate
  • prevent relapse
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24
Problems with awareness of doctors
– failure to detect - few have treatment plan/management - much blaming and enabling
25
How to identify misuse
- quantity/ frequency questionnaire - cage - audit - physical, psychiatric, social problems
26
Stage of change model
- pre contemplation - contemplation - preparation - action - maintenance - relapse
27
Definition of a brief intervention
5-10 minute intervention aimed at providing patient information in a caring and empathic manner - in order to create ambivalence and motivate change
28
Frames
- feedback - responsibility - advice - menu - empathy - self-efficacy
29
Soape
- support - optimism - absolution - plan - explanatory model
30
Basic treatment strategies
- use doctor patient relationship - establish goals in concrete terms - retain family perspective - engage patient in self monitoring - balance emphasis - stopping alcohol should be worthwhile
31
Possible public health interventions
- restrict availability - drink-driving laws - price and taxation - advertising and sponsorship restrictions - alcohol free environments
32
Unmet challenges of depression
- incomplete neurobiological understanding - stigma - under recognition - under treatment - no evidence in decline of incidence
33
Conceptual issues with depression
- normal vs pathological - gender - culture - ethical and legal considerations - mood disorders and creativity
34
Types of depressive disorders
- major depressive disorder - persistent depressive disorder - pre-menstrual dysphoric disorder - disruptive mood dysregulation disorder
35
Definition of a depressive episode
- depressed mood and/or loss of interest - accompanied by 3-4 typical symptoms - somatic, psychomotor, cognitive, behavioral - persists for more than 2 weeks - functional shift - exclusion criteria
36
Typical symptoms of a depressive episode
- depressed mood - loss of interest - disturbed sleep - disturbed appetite/ weight - disturbed psychomotor behavior - disturbed energy - poor concentration - thoughts of worthlessness/guilt - thoughts of death/ suicide
37
Complications/ markers of severity for depression
- anxiety/ agitation - melancholia - catatonia - psychosis - suicide
38
Spectrum of depressive disorders
- adjustment disorder - lifespan - bipolar/ atypical depression - seasonal affective disorder - reproductive cycle - depression associated with medical conditions
39
Difficulties specific to primary care (depression)
- high patient volumes - co morbidity - atypical presentations - cumbersome standard diagnostic tools - screening questionnaires - unique opportunities
40
Principles of depression management
- secure diagnosis - assess severity - co-morbidities - risk assessment - therapeutic alliance/family involvement - best practice based on evidence
41
Issues with antidepressants
- most common first line treatment - delayed therapeutic effect - high rates of relapse especially with residual symptoms
42
How long do patients need to maintain use do antidepressants
- 6-9 months after first episode - 2 years after relapse - indefinitely with recurrent episodes
43
Describe the use of psychotherapy
- cognitive behavioral therapy - problem-solving - can be first line for mild non-psychotic - useful as adjunct therapy
44
What is the most powerful antidepressant
ECT
45
Other types of therapy
- phototherapy (SAD) - repeated trans cranial magnetic stimulation - vagus nerve stimulation - neurosurgery
46
Possible complementary treatments for depression
- St. John's wort - omega 3 fatty acids - tryptophan
47
Definition of inquest
- judicial inquiry into a death other than due to natural causes
48
What is determined by an inquest
- identity of the deceased - time and place of death - cause of death - whether any person may be liable for the death
49
Definition of clinical forensic medicine
- practiced by medical practitioners or forensic nurses - medial examination of living victims of violent crimes - medial examination of people accused of crimes
50
Definition of forensic pathology
- practiced by forensic pathologists and medical officers - media cal examination of suspicious scenes of death - postmortem examination of unnatural deaths
51
Doctors obligations (death)
- be aware of the process of dying - be able to diagnose death - distinguish between natural and unnatural death - complete and sign a death notification form - know when an autopsy may or must be performed
52
What happens when person dies of natural cause
- medical practitioner who attended to person before death May issue DNF - medical practitioner who did not attend patient may examine the corpse and issue DNF
53
What happens when person dies of unnatural cause
- if medical practitioner suspects death due to other than natural cause - inform police - autopsy must be done - medical practitioner performing autopsy will issue DNF
54
Death documentation
- declaration of death - notification of death form - death certificate
55
Definition of natural death
Result of disease processes which are not the result of: - another persons act - another persons omission - violence - acts of God
56
Definition of unnatural death
- application of force, physical, chemical or other factors - act of omission or commission - procedure-related death - unexpected or unexplained death
57
Two acts of autopsy legislation
- inquest act (investigation of unnatural death) | - national health act (medical investigation of natural deaths - contagious disease)
58
Difference between medico-legal autopsy and hospital autopsy
Need consent for hospital autopsy | Hospital needs to be authorized by medical practitioner in charge
59
5 periods of psychosocial support for family with sick child
- at diagnosis - in remission - at relapse - end of life care - after death
60
Emotions possible at diagnosis of child
- rejection/rationalization - guilt - disbelief - depression and helplessness
61
What to do when telling parents of diagnosis
- be explicit - emphasize what can be done - never deny hope - reassure them that good therapy is avail - be honest about therapy limitations - reassure that you will always be honest
62
Definition of reasonable hope
- relational - practice - recognizes that future is uncertain - seeks goals and pathways - accommodates doubt, contradiction and despair
63
Things that may influence understanding of diagnosis
- language - cultural issues - religious considerations - socio-economic issues
64
What to tell patients younger than6
- simple explanation - warn before procedures - reassure that parent will be there
65
What to tell patient 6-11
- name illness - point out that there is treatment - emphasize hope
66
Issues that sick children may have at school
- difficulty adjusting - problems with concentration - make contact with teacher - beware changes in body image - prepare for more absent days
67
Pitfalls of remission
- problems with siblings or marriege may arise | - SES issues
68
What to tell patients when time for palliative care
- no further treatment will help - team will care for child and keep them free of pain - not possible to say when child will die - they will know when end is near and will be supported
69
Stages of grief
- denial - anger - bargaining - depression - acceptance
70
Advantages of dying at home
- familiar surroundings and possessions - no routine - easier on family
71
Disadvantages of dying at home
- increased responsibility - May be lonely - often very tiring - May have difficulty getting to hospital in an emergency
72
Recurring themes (child death)
- privacy - protected time and space - preparation - simplicity - authenticity - honesty - openness - patience - planning - practicality - team worm
73
Definition of domestic violence
The use of physical, sexual, economic and/or emotional abuse by one person in an intimate relationship in order to establish and maintain power and control over the other person
74
What types of psychological abuse found
- threats - intimidation - emotional abuse - isolation
75
Characteristics of batterers
- sense of entitlement - controlling - manipulative - frequently charming - show contempt for others
76
What is DV is not caused by
- illness - genetics or gender - alcohol or other drugs - anger - stress - victims behavior - relationship problems
77
What makes batterers powerful
- isolation of the victim - societal denial - use of religious issues - use of cultural issues - threats of retaliation
78
How are children traumatized in DV
- physical injuries - psychological injuries Witnessing violence Increased risk of battering or being battered
79
Effects of DV
- severe injury and death - chronic pain syndromes - suicide - IBS - alcohol abuse - anxiety - depression - PTSD
80
Why leaving DV is a process
- safety issues - threats of retaliation - fears of talking about abuse to others - breaking isolation - access to resources - survival strategies - batterer accountability
81
Why we don't ask about domestic violence
- not enough time - fear of offending patient - powerless to intervene - no control over patient behavior - too close for comfort
82
What increases incidence of DV
- under 35 - single, divorced, separated - alcohol and drug abuse - smoke - pregnant - poor - recent restraining order - childhood abuse
83
Characteristics of abuser
- alcohol use - abused as a child - seen mother abused - low self esteem - unmet dependency needs - jealous - different personas - deeply held beliefs about masculinity
84
Why don't abusive men ask for help?
- acceptance of violence - notions of masculinity - ignorance - fear and shame
85
Why do women stay in abusive relationships?
- rear of leaving greater than fear of staying - economic factors - perceived needs of the children - expectations of others - self blame - hope abuse will stop - concern for welfare of spouse - learned helplessness - beliefs
86
Approach to helping women in abusive relationships
- identify the abuse - listen and believe her - assure that she is not alone and not to blame - defend her right to live without fear of violence
87
Legal options for DV
- restraining order - lay a charge - sue the abuser - legal aid
88
Risk factors for injury and death (DV)
- increased severity and frequency of abuse - available weapon - threats to kill her, children or himself - previous attempts to kill her children or himself - suicidical attempts by patient - stalking
89
Steps in applying for protection order
- applying - finalizing - using
90
Duties of police in acute situation
- get immediate protection order - take for medical attention - protect while collect personal belongings - inform of rights - arrest abuser if evidence - remove weapons

March Exams (14 decks)

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