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Block 33 Mental Health > CT 7 - The Patient Missuing Alcohol Or Other Substances > Flashcards

CT 7 - The Patient Missuing Alcohol Or Other Substances Flashcards

1
Q

when taking a drug and alcohol history what should be asked

A
    • types of drugs used
  • quantity and frequency
  • route of admin
  • symptoms of dependence
  • ## source of drug
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2
Q
A
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3
Q

What should be included in a focused drug and alcohol history?

A

Types of drugs used, quantity and frequency of use, route of administration, symptoms of dependence, source of the drug, tobacco use, prescribed medication

Important for assessing substance use and dependence.

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4
Q

What are common disorders that may suggest alcohol abuse?

A
  • Hepatitis
  • Cirrhosis
  • Seizures
  • Gastritis
  • Anaemia (megaloblastic, sideroblastic, macrocytic)
  • Unexplained raised MCV
  • Abnormal LFTs (raised GGT)
  • Raised carbohydrate-deficient transferrin (CDT)
  • Cardiomyopathy
  • Repeated accidents
  • Tuberculosis
  • Head injuries
  • Hypertension
  • Treatment-resistant psychiatric conditions
  • Erectile dysfunction

These conditions can indicate potential alcohol misuse.

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5
Q

What does breath testing measure?

A

Recent alcohol consumption in mg per 100ml of blood to calculate blood alcohol concentration (BAC)

A discrepancy between high BAC and lack of intoxication suggests tolerance.

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6
Q

What substance can urine testing detect related to alcohol?

A

Ethyl glucuronide

This metabolite remains elevated for several days after alcohol consumption.

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7
Q

What does the CAGE questionnaire screen for?

A

Risky drinking

CAGE stands for: C = Cut down, A = Annoyed, G = Guilty, E = Eye-opener.

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8
Q

What is substance misuse disorder?

A

Persistent use of drugs/alcohol despite substantial harm and adverse consequences

This includes both physical and psychological dependence.

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9
Q

What defines acute intoxication?

A

Initial, reversible physical and mental abnormalities caused by substance use

These effects are characteristic for each substance.

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10
Q

What are the symptoms of withdrawal?

A

Symptoms are often the opposite of the acute effects of the drug

Withdrawal occurs when there is physical dependence on the drug.

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11
Q

What characterizes substance-induced psychotic disorder?

A

Hallucinations and/or delusions due to substance-induced neurotoxicity

Diagnosis can be confused with primary psychiatric illnesses.

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12
Q

What are cognitive impairment syndromes?

A

Reversible cognitive deficits occurring during intoxication, potentially leading to dementia

This can happen with heavy chronic use of certain substances.

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13
Q

What is pathological intoxication?

A

A reaction to a small amount of alcohol causing severe agitation and violent behaviour, followed by amnesia

This condition involves profound deep sleep after the incident.

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14
Q

What is the impact of addiction on families?

A
  • Relationship difficulties
  • Occupational difficulties
  • Risk of passing addiction to younger generations
  • Risk to others in the family

Addiction can have wide-ranging effects on family dynamics.

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15
Q

What are the consequences of alcohol misuse for driving?

A

Loss of license for 6 months (G1) or 1 year (G2) with a requirement for abstinence

Alcohol dependence can lead to longer license suspensions.

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16
Q

What is the role of genetics in alcohol misuse risk?

A

First-degree relatives of alcoholics have double the risk

Southeast Asians have a lower risk due to a metabolically inactive form of aldehyde dehydrogenase.

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17
Q

What are common substances misused?

A
  • Opiates (e.g., heroin, morphine)
  • Depressants (e.g., alcohol, benzodiazepines)
  • Stimulants (e.g., cocaine, amphetamines)
  • Hallucinogens (e.g., LSD, magic mushrooms)
  • Cannabis

Each class has distinct effects and risks.

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18
Q

What is the primary effect of opiates?

A

Euphoria, intense relaxation, anxiolytic effects, and diminished pain sensation

They can also lead to respiratory distress and increased risk of infections.

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19
Q

What characterizes stimulant effects?

A

Increased alertness, energy, confidence, euphoria, and lowered need for sleep

Stimulants can lead to dangerous cardiovascular effects.

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20
Q

What is the primary action of cocaine?

A

Blocks dopamine, serotonin, and adrenergic reuptake, increasing their availability in the synapse

This leads to its addictive properties and acute harmful effects.

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21
Q

What are the acute harmful effects of MDMA?

A
  • Increased sweating
  • Nausea and vomiting
  • Erectile dysfunction
  • Teeth grinding
  • Deaths due to dehydration and hyperthermia

MDMA is associated with club culture and can have serious health risks.

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22
Q

What are common antidotes to overdose?

A
  • Naloxone (opioid overdose)
  • Sodium bicarbonate (tricyclic overdose)
  • Flumazenil (benzodiazepine overdose)
  • Fomepizole (methanol and ethylene glycol overdose)

These antidotes can reverse the effects of specific drug overdoses.

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23
Q

What is the mesolimbic pathway’s role in addiction?

A

Involved in reward processing and dopamine release, central to the sensation of pleasure

Drugs of abuse affect this pathway, leading to dependency.

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24
Q

What happens to the brain with chronic drug exposure?

A

Leads to permanent neuroadaptive changes and gene transcription of brain-derived neurotrophic factor (BDNF)

These changes make repeated drug use essential for normal dopaminergic activity.

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25
What defines alcohol dependence syndrome?
The drug and the need to obtain it become the most important aspects of life, overshadowing other activities ## Footnote This prioritization can lead to moral decline and criminal behavior.
26
What is the mechanism by which alcohol affects GABA channels?
Alcohol works on GABA channels similarly to benzodiazepines, allowing chlorine to enter neurons and cause hyperpolarisation, leading to reduced action potentials.
27
What characterizes alcohol dependence syndrome?
The drug and the need to obtain it take priority over all other activities and interests, diminishing the person's moral sense and increasing likelihood of committing crimes.
28
What happens to a person's tolerance in substance dependence?
Tolerance increases, requiring more of the same drug for the same effect. The person may also change the route of administration to combat this.
29
Describe the withdrawal symptoms experienced during alcohol dependence.
Symptoms include coarse tremor, sweating, insomnia, tachycardia, nausea, vomiting, psychomotor agitation, and generalized anxiety.
30
What is the timeframe for uncomplicated alcohol withdrawal syndrome symptoms to occur?
Symptoms occur 6-12 hours after the last alcoholic drink.
31
What is delirium tremens, and when does it typically occur?
Delirium tremens is an acute confusional state secondary to alcohol withdrawal, usually occurring 3 days after the last drink.
32
What are the key features of delirium tremens?
* Clouding of consciousness * Disorientation * Amnesia for recent events * Lilliputian hallucinations * Fluctuations in severity
33
What should be considered for prophylaxis against alcohol withdrawal syndromes?
Consider prophylaxis in patients with a history of dependence, previous withdrawal syndrome, or who have consumed more than 10 units of alcohol daily for the past 10 days.
34
What is the role of harm reduction in managing drug users?
Harm reduction aims to reduce mortality and morbidity without requiring abstinence, including safer drug practices and treatment for co-morbid illnesses.
35
What psychological treatments are available for substance misuse?
* CBT * Individual counselling * Group support (e.g., AA) * Advice to prevent future relapse
36
What are the pharmacological treatment options for opioid addiction?
* Methadone * Buprenorphine
37
What is the function of disulfiram in alcohol addiction treatment?
Disulfiram irreversibly inhibits acetaldehyde dehydrogenase, causing toxic acetaldehyde buildup when alcohol is consumed.
38
What is Wernicke-Korsakoff syndrome?
It consists of Wernicke’s encephalopathy and Korsakoff psychosis, caused by thiamine/B1 deficiency, mainly seen in heavy drinkers.
39
What are the symptoms of Wernicke’s encephalopathy?
* Acute confusional state * Ophthalmoplegia * Nystagmus * Ataxic gait
40
What is the treatment for Wernicke-Korsakoff syndrome?
High potency parenteral B1 replacement and avoiding carbohydrate load until thiamine replacement is complete.
41
What are the long-term consequences of alcohol misuse?
* Alcoholic liver disease * Neurological effects * Gastrointestinal effects * Cardiovascular effects * Social and economic consequences
42
What are the stages of change in substance misuse recovery?
* Precontemplation * Contemplation * Determination * Action * Maintenance * Relapse
43
What is motivational interviewing?
A patient-centered counseling style that helps patients explore and resolve mixed feelings about behavioral changes.
44
What is the initial management of acute alcohol withdrawal?
Benzodiazepines are used to relax the body and stop seizures, insomnia, and anxiety.
45
What are some controlled drinking techniques?
* Setting a weekly and daily alcohol limit * Not drinking alone * Alternating soft and alcoholic drinks * Pacing drinking
46
What is the evidence for the effectiveness of psychological treatment in substance misuse?
Pharmacological treatment combined with psychological treatment works best; SMART therapy shows 61% of participants stopped using drugs/alcohol within 6 months.
47
What are the gastrointestinal effects of alcohol?
* Gastritis * Gastric erosions * Peptic ulcers * Chronic pancreatitis
48
What are the cardiovascular effects of alcohol?
* Hypertension * Dilated cardiomyopathy * Arrhythmias * Strokes
49
What is the role of Alcoholics Anonymous (AA)?
AA views alcoholism as a lifelong, incurable disease, offering emotional and practical support through regular support groups.
50
What is the main goal of harm reduction strategies?
To manage drug users and reduce mortality and morbidity without requiring them to abstain from drugs.
51
What are the psychological and social management strategies for substance misuse?
* Individual counselling * Group support * Engagement with social services
52
What is the connection between substance misuse and crime?
Substance misuse can lead to increased criminal behavior as individuals prioritize drug-seeking over moral considerations.
53
What are the neurological effects of alcohol?
* Peripheral neuropathy * Central pontine myelinolysis * Corpus callosum degeneration * Optic neuropathy
54
What is the recommended maximum alcohol consumption per week?
14 units of alcohol ## Footnote There should be at least 2 non-drinking days a week, and the 14 units should be spread over several days.
55
Who should not drink alcohol at all?
People who were previously alcohol dependent, have chronic medical conditions, or are pregnant ## Footnote These groups are advised against consuming any alcohol.
56
Name a technique for controlled drinking.
Setting a weekly and daily alcohol limit ## Footnote Other techniques include not drinking alone and pacing drinking.
57
What are the symptoms of paracetamol overdose?
RUQ hepatic pain, tenderness, hypoglycaemia, encephalopathy, liver failure, coma ## Footnote RUQ stands for right upper quadrant.
58
What symptoms are associated with tricyclic overdose?
Anticholinergic symptoms, hyperthermia, hypertension, arrhythmias, respiratory failure ## Footnote Anticholinergic symptoms include dry eyes, dry mouth, and urinary retention.
59
What are the signs of aspirin/salicylate overdose?
Hyperventilation, tinnitus, deafness, vasodilation, sweating ## Footnote Tinnitus refers to ringing in the ears.
60
Which symptoms indicate a beta blocker overdose?
Bradycardia, hypotension, syncope, conduction abnormalities, heart failure ## Footnote There can be both respiratory alkalosis and metabolic acidosis.
61
What symptoms are associated with calcium channel blocker overdose?
Profound vasodilation, hypotension, arrhythmias ## Footnote Arrhythmias may include complete heart block and asystole.
62
What symptoms present in lithium overdose?
Ataxia, tremors, weakness, dysarthria, muscle twitching, electrolyte imbalance, convulsions, renal failure, hypotension, coma ## Footnote Ataxia refers to lack of voluntary coordination of muscle movements.
63
What are the signs of benzodiazepine overdose?
Drowsiness, dysarthria, ataxia, nystagmus ## Footnote Respiratory depression and coma are also possible.
64
Fill in the blank: Techniques for controlled drinking include not drinking alone, pacing drinking, and _______.
not buying rounds ## Footnote This helps in managing alcohol intake in social settings.
65
True or False: It is safe for pregnant women to consume alcohol in moderation.
False ## Footnote Pregnant women should not drink alcohol at all.

Block 33 Mental Health (12 decks)

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