diagnosis and treatment of alcohol problems

Question 1

effects of alcohol

Answer 1

low doses - euphoria, reduced anxiety, relaxation, sociability

higher doses - intoxication - impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability, disinhibition, slurring, stupor, unconsciosness

Question 2

diagnosis of harmful alcohol use

Answer 2

pattern of use causing damage to physical or mental health

use >1mth or repeatedly over 12mths

Question 3

diagnosis of alcohol dependence

Answer 3

3 or more of the following for >1mth or repeatedly over 12mths:

cravings/compulsions to take
difficulty controlling use
drinking the same type in the same ways
primacy - neglect of other interest and focus on alcohol
increased tolerance
physiological withdrawal on reduction/cessation
persistence despite harmful consequences

Question 4

diagnosis of alcohol withdrawal state

Answer 4

group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance

Question 5

features of alcohol withdrawal state

Answer 5

tremor
weakness
N+V
anxiety
seizured
confusion
agitation
death 

delirium tremens

Question 6

features of delirium tremens

Answer 6

profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness, autonomic over-activity

mortality 5%

death - CV collapse, infection, hyperthermia, seizures, self-injury

usually 48-72hrs after alcohol stopped

Question 7

problems w/ alcohol use

Answer 7

physical and mental health 
relationships
employment
finances
legal

Question 8

alcohol use and mental heatlh

Answer 8

anxiety
depression
sleep disruption
morbid jealousy
alcoholic hallucinosis 
deliberate self-injury
suicidal thoughts/acts

Question 9

alcohol and physical health

Answer 9

brain damage, memory loss, hallucinations, fits, dementia

chest infection

swollen liver, hepatitis, cirrhosis

tingling nerves, numbness, tremor

risk of STI and HIV/AIDS

poor diabetic control

loss of muscle

enlarged heart, HT, irregular pulse

ulcers, gastritis, haematemesis

pancreatitis

impotence in women, infertility in women

Question 10

features of Wernicke’s encephalopathy

Answer 10

triad: confusion, ataxia, opthalmoplegia

nystagmus

more reversible

Question 11

what causes Wernicke’s encephalopathy and Korsakoff’s psychosis

Answer 11

thiamine deficiency

poor intake and absorption, poor hepatic function

increased requirement for alcohol metabolism

Question 12

features of Korsakoff’s psychosis

Answer 12

prominent impairment of recent and remote memory

preservation of immediate recall

no general cognitive impairment

retrograde and antegrade memory

impaired learning and disorientation

may exhibit nystagmus and ataxia

Question 13

alcohol abuse and relationship issues

Answer 13

aggression - verbal and physical

marital difficulties - morbid jealousy

poor parenting, neglect, loss of parenting rights

loss of friendships and social support

Question 14

screening tools for harmful alcohol use

Answer 14

CAGE (2 or more = likely alcohol problem)
have you tried to Cut down
have you felt Annoyed by people criticising your drinking?
Have you felt Guilty about drinking?
Have you felt the need to have an Eye-opener?

AUDIT - alcohol use disorders identification tes
FAST - 4 Qs
PAT - paddington alcohol test, used in A+E

Question 15

management of alcohol abuse

Answer 15

Prevention of Wernicke-Korsakoff Syndrome
- Thiamine
Management of alcohol withdrawal
- Benzodiazepines , commonly Chlordiazepoxide
Aversion/deterrent medication
- Disulfiram (Antabuse) - avoid ALL alcohol (mouthwash, hairspray, perfume etc - very unpleasant reaction)
Anti-craving medication
- Acamprosate (Campral)
- Naltrexone
- Nalmefene
- (Baclofen)