Dependence Flashcards

1
Q

What is hazardous drinking?

A
  • pattern of alcohol consumption that increases someones risk of harm
  • physical, mental health and social consequences (as in harmful use)
  • hazardous drinking applies to anyone drinking over recommended limits (14 units a week) but without alcohol related problems
  • moves into harmful drinking when regularly consuming over 35 units per week
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2
Q

What is the equation for units calculation?

A

strength (ABV) x volume (ml) divided by 1000

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3
Q

What is the recommendation for alcohol consumption levels in the UK?

A

No more than 14 units a week on a regular basis

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4
Q

What are the 7 types of cancer that alcohol is associated with?

A
  • mouth and upper throat
  • larynx
  • oesophagus
  • breast (in women)
  • liver
  • bowel
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5
Q

What are the 4 ways in which alcohol can cause cancer?

A
  • damages cells
  • increases damage from tobacco
  • affects hormones linked to breast cancer
  • breaks down into cancer causing chemicals
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6
Q

Name the different tools that can be used for screening alcohol use

A
  • FAST; useful in A and E settings, quick
  • AUDIT; alcohol use disorders identification test
  • CAGE; screening for dependence
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7
Q

The FRAME acronym is used to capture the elements of a brief intervention - what does it stand for?

A
  • feedback; review problems experienced because of alcohol
  • responsibility; patient is responsible for change
  • advice; advise reduction or abstinence
  • menu; provide options for changing behaviour
  • empathy; use empathic approach
  • self-efficacy; encourage optimism about changing behaviour
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8
Q

Describe the pathophysiology of alcohol withdrawal

A
  • unopposed upregulated excitation
  • excess glutamate activity and reduced GABA activity leads to alcohol withdrawal symptoms
  • excessive glutamate activity is toxic to the nerve cell
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9
Q

Describe the features of alcohol dependence syndrome

A
  • only if three or more of the following have been present together at one time during the previous year
  • strong desire or sense of compulsion to take drug
  • difficulty in controlling use of substance in terms of onset, termination or level of use
  • physiological withdrawal state
  • evidence of tolerance
  • progressive neglect or other pleasures / interests because of their use / effects of substance
  • persistence with use despite clear evidence of harmful consequences
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10
Q

Describe the features of alcohol withdrawal syndrome

A
  • first symptoms occur within hours and peak at 24-48 hours
  • restlessness, tremor, sweating, anxiety, nausea and vomiting, loss of appetite and insomnia
  • tachycardia and systolic hypertension evident
  • generalised seizures usually in first 24 hours
  • can progress to the medical emergency delirium tremens
  • in most, symptoms resolve in 5-7 days
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11
Q

Describe the features of delirium tremens

A
  • 5% of cases
  • peak onset within 2 days of abstinence
  • often presents insidiously with night time confusion
  • confusion, disorientation, agitation, hypertension, fever, visual and auditory hallucinations, paranoid ideation
  • mortality 2-5% (assoc, with cardiovascular collapse and infection)
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12
Q

Describe the management of alcohol withdrawal

A
  • general support; reassurance, advice etc
  • benzodiazepines; cross tolerant with alcohol, use long acting agents, titrate against severity of withdrawal symptoms, reduce gradually over 7 days or more
  • vitamin supplementation
  • thiamine (pabrinex) as prophylaxis against wernickes encephalopathy; must be parenteral, increase dose if wernickes suspected
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13
Q

When would detoxing be conducted in an inpatient setting?

A
  • severe dependence
  • history of delirium tremens or alcohol withdrawal seizures
  • failed community detox
  • poor social support
  • cognitive impairment
  • psychiatric co-morbidity
  • poor physical health
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14
Q

Describe the pharmacological interventions in relapse prevention

A
  • disulfiram; inhibits acetaldehyde dehydrogenase leading to accumulation if alcohol ingested, leads to flushed skin, tachycardia, n+v, arrhythmias and hypotension
  • acamprosate; acts centrally on glutamate and GABA systems, reduces cravings, start as soon as detox complete, continue through relapses, prescribe along with psychosocial interventions, side effects include headache, diarrhoea, nausea
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15
Q

Describe the psychosocial interventions in relapse prevention

A
  • CBT (coping skills therapy)
  • motivational enhancement therapy
  • 12 step facilitation therapy (e.g. AA)
  • behavioural self control training
  • family and couple therapy
  • project MATCH
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16
Q

What are the features of gaming disorder

A
  • a pattern of gaming behaviour characterised by;
  • impaired control over gaming
  • increasing priority given to gaming over other activities
  • continuation or escalation of gaming despite the occurrence of negative consequence
  • pattern must be of sufficient severely to result in significant impairment in personal, family, social, educational, occupational or other important areas for at least 12 months
17
Q

What is the CAGE criteria?

A
  • cut down
  • annoyed
  • guilty
  • eye opener
18
Q

Which neural pathway is implicated in ‘wanting’?

A

The mesolimbic pathway (connections between VTA in midbrain and nucleus accumbens)

19
Q

What are the effects of dopaminergic activity in the mesolimbic pathway?

A
  • is a motivating signal
  • incentivises behaviour
  • is involved in normal pleasurable experiences
20
Q

What neuronal receptors are decreased in addiciton?

A

Dopamine D2 receptors

21
Q

Describe the ‘tolerance to reward’ principle in relation to dependence

A
  • due to repeated dopamine release, dopamine receptors down regulate
  • thresholds for rewards during abstinence is thus increased
  • normal experiences don’t evoke adequate reward response
  • these changes persist despite prolonged abstinence from substance abuse
22
Q

The pre-frontal cortex has what roles normally?

A
  • helps intention guide behaviour
  • modulates the powerful effects of the reward pathway
  • sets goals, focuses attention
  • makes sound decisions
  • keeps emotions and impulses under control to achieve long term goals
23
Q

What is the direction of cortical maturation?

A
  • back to front direct
  • beginning in the primary motor cortex and spreading anteriorly over the superior and inferior frontal gyri, with the prefrontal cortex developing last
  • frontal lobe areas that mediate executive functioning mature late than limbic (emotional) systems
24
Q

Describe the effects on the pre-frontal cortex and addictive drugs

A
  • dopamine release effects;
  • ability to update new information within the PFC
  • ability to select new goals
  • the ability to avoid compulsive repetition of a behaviour
  • addictive drugs provide a potent signal that disrupts normal dopamine related learning in the PFC
25
Q

Describe the role of the hippocampus and amygdala in dependence

A
  • the hippocampal and amygdala are critical in acquisition, consolidation and expression of the drug stimulus learning
  • learned drug associated can then cue internal states of craving
26
Q

Describe the role of the orbito-frontal cortex in dependence

A
  • provides internal representations of the saliency of events and assigns values to them
  • key creator of motivation to act
  • addicts show increased activation of OFC when presented with drug cues
  • hyperactivity correlates with self reported drug cravings following exposure to cues
  • overall changes in OFC persist into abstinence
27
Q

Name the areas of the brain that are associated with dependence

A
  • prefrontal cortex
  • anterior cingulate gyrus
  • orbitofrontal cortex
  • subcallosal cortex
  • nucleus accumbens
  • ventral pallidum
  • hippocampus
  • amygdala
28
Q

Name some of the core features of addictive behaviour

A
  • salience (importance, dominance)
  • mood modification (rush and escape)
  • tolerance (escalation for effect)
  • withdrawal
  • conflict (interpersonal, intrapsychic, loss of control)
  • relapse
29
Q

What are the different types of opiates?

A
  • natural from plants like opium poppy e.g. morphine, codeine
  • semi-synthetic; hydrocodone, hydromorphone
  • fully synthetic; methadone, tramadol
30
Q

What are the 4 phases of treatment of opioid dependence?

A
  • induction
  • optimisation
  • maintenance
  • reduction
31
Q

Describe the features of methadone

A
  • Mu (opioid) receptor agonist
  • long half life
  • peak plasma con. 4 hours
  • steady state 5 days
  • hepatic metabolism CY3P4
  • evidence shows higher doses (60-100ml) more effective
32
Q

Describe the features of buprenorphine

A
  • Mu receptor partial agonist with low intrinsic activity and high affinity
  • peak plasma levels 1.5-2.5 hours
  • duration of effect dose related
  • effective doses in range of 12-24 mg
  • sublingual tablets