Disorders in Alcohol Use from Kaplan

Question 1

Alcohol Use Disorder
Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Strongly suggest alcohol dependence and alcohol abuse:

Answer 1

• a need for daily use of large amounts of alcohol for adequate functioning,
• a regular pattern of heavy drinking limited to weekends,
and
• long periods of sobriety interspersed with binges of heavy alcohol intake lasting for weeks or months

Question 2

• inability to cut down or stop drinking
• repeated efforts to control or reduce excessive drinking by “going on the wagon” (periods of temporary abstinence) or by restricting drinking to certain times of the day
• binges (remaining intoxicated throughout the day for at least 2 days)
• occasional consumption of a fifth of spirits (or its equivalent in wine or beer)
• amnestic periods for events occurring while intoxicated
(blackouts)
• the continuation of drinking of drinking despite a serious physical disorder that the person knows is exacerbated by alcohol use
• drinking non-beverage alcohol, such as fuel and commercial products containing alcohol

Answer 2

Drinking patterns often associated with certain behaviors

Question 3

persons with alcohol dependence and alcohol abuse show impaired social or occupational functioning because of:

Answer 3

• alcohol use (e.g. violence while intoxicated, absence from work, job loss)
• legal difficulties (e.g. arrest for intoxicated behavior and traffic accidents while intoxicated)
• arguments or difficulties with family members or friends about excessive alcohol consumption

Question 4

late onset,
few childhood risk factors,
relatively mild dependence,
few alcohol-related problems,
and little psychopathology

Answer 4

Type A alcohol dependence

Question 5

respond to interactional psychotherapies

Answer 5

Type A alcohol dependence

Question 6

many childhood risk factors
severe dependence
early onset of alcohol-related problems
much psychopathology
strong family of alcohol abuse
frequent polysubstance abuse
long history of alcohol treatment
a lot of severe life stresses

Answer 6

Type B alcohol dependence

Question 7

respond to training in coping skills

Answer 7

Type B alcohol dependence

Question 8

who do not yet have complete alcohol

dependence syndromes

Answer 8

Early stage

Question 9

who tend to drink daily in moderate amounts in social settings

Answer 9

Affiliative

Question 10

who have severe dependence and tend to drink in binges and often alone

Answer 10

Schizoid-isolated

Question 11

concerns control problems in which persons are unable to stop drinking once they start when drinking is terminated as a result of ill health or lack of money, these persons can abstain for varying periods

Answer 11

Gamma alcohol dependence

Question 12

must drink a certain amount each day but are unaware of a lack of control may not be discovered until a person who must stop drinking for some reason exhibits withdrawal symptoms

Answer 12

Delta alcohol dependence

Question 13

late onset,

more evidence of psychological than of physical dependence

Answer 13

Type I, male limited

Question 14

onset at an early age,

spontaneous seeking of alcohol for consumption socially disruptive set of behaviors when intoxicated

Answer 14

Type II, male limited

Question 15

predominance in men, a poor prognosis, early onset of alcohol-related problems

Answer 15

Antisocial alcoholism

Question 16

primary tendency for alcohol abuse that is exacerbated with time as cultural expectations foster increased opportunities to drink

Answer 16

Developmentally cumulative alcoholism

Question 17

common in women, likely to use alcohol for mood regulation and to help ease social relationships

Answer 17

Negative-effect alcoholism

Question 18

Frequent bouts of consuming large amounts of alcohol; the bouts become less frequent as a person age and respond to the increased expectations of society about their jobs and families

Answer 18

Developmentally limited alcoholism

Question 19

• alcohol drunkenness
• based on evidence of recent ingestion of ethanol, maladaptive behavior, and at least one of several possible physiological correlates of intoxication
• legal definition of intoxication 80-100 mg/dL or 0.08 - 0.10 g/dL

Answer 19

Alcohol Intoxication

Question 20

signs of alcohol intoxication

Answer 20

o slurred speech
o dizziness
o incoordination
o unsteady gait
o nystagmus
o impairment in attention or memory
o stupor or coma
o double vision

Question 21

anyone who does not show significant levels of impairment in motor and mental performance at approximately 150 mg/dL probably has

Answer 21

significant pharmacodynamic tolerance

Question 22

slowed motor performance and decreased

thinking ability

Answer 22

20-30 mg/dL

Question 23

Increases in motor and cognitive problem

Answer 23

30-80 mg/dL

Question 24

Increases in incoordination and judgement
errors
Mood lability
Deterioration in cognition

Answer 24

80-200 mg/dL

Question 25

Nystagmus, marked slurring of speech,

and alcoholic blackouts

Answer 25

200-300 mg/dL

Question 26

Impaired vital signs and possible death

Answer 26

> 300 mg/dL

Question 27

• can be serious even without delirium
• seizures and autonomic hyperactivity
• conditions that may predispose to or aggravate
withdrawal symptoms:
o fatigue
o malnutrition
o physical illness
o depression

Answer 27

Alcohol Withdrawal

Question 28

DSM 5: require the cessation or reduction of alcohol use that was heavy and prolonged as well as the presence of specific physical or neuropsychiatric symptoms - also allows for the specification “with perceptual disturbances”

Answer 28

Alcohol Withdrawal

Question 29

study of blood flow during alcohol withdrawal in otherwise healthy persons with alcohol dependence reported a globally low rate of metabolic activity
- further inspection – activity was especially
low in the left parietal and right frontal areas

Answer 29

Positron emission tomography (PET)

Question 30

Alcohol Withdrawal classic signs:

Answer 30

o tremulousness – although the spectrum of
symptoms can expand to include psychotic
and perceptual symptoms, seizures and the
symptoms of delirium tremens
▪ commonly called “shakes” or the
“jitters”
▪ develop 6 to 8 hours after cessation of drinking
o psychotic and perceptual symptoms – 8-12 hours
o seizures in 12-24 hours
o DT anytime during the first 72 hours

Question 31

The syndrome of withdrawal sometimes skips the usual progression and, for example, goes directly to

Answer 31

Delirium and tremor

Question 32

– continuous tremor of

great amplitude and of >8Hz

Answer 32

physiological tremor

Question 33

– bursts of tremor activity

<8Hz

Answer 33

familial tremor

Question 34

• stereotyped, generalized, and tonic-clonic in character
• patients often have more than one seizure 3-6 hours after the first seizures
• status epilepticus – relatively rare and occurs in less than 3% of patients

Answer 34

Withdrawal Seizures

Question 35

long term alcohol abuse – can result in

Answer 35

hypoglycemia, hyponatremia and hypomagnesemia; all of which are associated with seizures

Question 36

primary meds to control alcohol withdrawal

o help control seizure activity, delirium, anxiety, tachycardia, hypertension, diaphoresis, and tremor

o orally or parenteral

Answer 36

Benzodiazepines

Question 37

should be given IM

o bec of their erratic absorption by this route

Answer 37

Diazepam or Chlordiazepoxide

Question 38

as effective as benzodiazepines and has the added benefit of minimum abuse liability

Answer 38

Carbamazepine 800 mg daily

Question 39

– used to block the symptoms of sympathetic hyperactivity

o but neither drug is an effective treatment for
seizures or delirium

Answer 39

β-adrenergic receptor antagonist and Clonidine

Question 40

o autonomic hyperactivity
▪ tachycardia
▪ diaphoresis
▪ fever
▪ anxiety
▪ insomnia
▪ hypertension
o perceptual distortions, most frequently visual or tactile hallucinations
o fluctuating levels of psychomotor activity,
ranging from hyperexcitability to lethargy

Answer 40

features of alcohol intoxication delirium

Question 41

episodes of DTs

Answer 41

30s or 40s after 5 to 15 years of heavy

drinking, typically of the binge type

Question 42

patients withdrawing from alcohol who exhibit

withdrawal phenomena should receive

Answer 42

benzodiazepine

o chlordiazepoxide 25-50 mg every 2-4 hours
until they seem to be out of danger

o once delirium appears – chlordiazepoxide 50-100 mg every 4 hours orally OR lorazepam
IM

Question 43

– avoided bec it may reduce seizure

threshold

Answer 43

antipsychotics

Question 44

What is not useful in preventing or treating alcohol withdrawal convulsions?

Answer 44

Nonbenzodiazepine anticonvulsant

Question 45

• global decreases in intellectual functioning, cognitive abilities, and memory are observed
• recent memory difficulties are consistent with global cognitive impairment – distinguishes this from alcohol induced persisting amnestic disorder
• brain functioning improves with abstinence
• half of affected patients – long term and even
permanent disabilities in memory and thinking

Answer 45

Alcohol-Induced Persisting Dementia

Question 46

50-70% Alcohol-Induced Persisting Dementia, what happens to their brain?

Answer 46

inc size of brain ventricles and shrinkage of

the cerebral sulci

Question 47

• essential feature – disturbance in short term memory caused by prolonged heavy use of alcohol
• persons who have been drinking heavily for many years
• rare in <35 years old

Answer 47

Alcohol-Induced Persisting Amnestic Disorder

Question 48

o acute

o completely reversible

Answer 48

Wernicke encephalopathy

Question 49

o chronic

o only about 20% recover

Answer 49

Korsakoff’s syndrome

Question 50

o poor nutritional habits

o malabsorption problems

Answer 50

thiamine deficiency

Question 51

cofactor for several enzymes and may also

be involved in the conduction of the axon potential along the axon and in synaptic transmission

Answer 51

thiamine

Question 52

What are symmetrical and
paraventricular involving
o mamillary bodies
o thalamus
o midbrain
o pons
o medulla
o fornix
o cerebellum

Answer 52

neuropathological lesions

Question 53

• acute neurological disorder
• characterized by:
o ataxia (affecting gait)
o vestibular dysfunction
o confusion
o variety of ocular motility abn
▪ horizontal nystagmus
▪ lateral orbital palsy
▪ gaze palsy
o eye signs
▪ usually bilateral but not necessarily symmetrical
▪ sluggish reaction to light
▪ anisocoria
• may clear spontaneously in a few days or weeks or may progress to Korsakoff’s syndrome

Answer 53

Wernicke’s encephalopathy (alcoholic encephalopathy)

Question 54

responds to large doses of parenteral thiamine (effective in preventing the progression into Korsakoff’s syndrome)

Answer 54

early staged of WE

Question 55

• chronic amnestic syndrome that can follow WE
• cardinal features:
o impaired mental syndrome (esp. recent
memory)
o anterograde amnesia in an alert and
responsive patient
• may or may not have the symptom of confabulation

Answer 55

Korsakoff’s syndrome

Question 56

• 3% - experience auditory hallucinations or paranoid delusions
• most common auditory hallucinations are voices but they are often unstructured
o characteristically maligning, reproachful or
threatening
o some – pleasant and nondisruptive voices
• hallucinations – last <1week; impaired reality testing common
• hallucinations after withdrawal – rare and is distinct from withdrawal delirium
• can occur at any age but usually appear in long time alcohol abuse

Answer 56

Alcohol-Induced Psychotic Disorder

Question 57

Alcohol-Induced Psychotic Disorder differentiated from hallucinations of schizophrenia by

Answer 57

o the temporal association with alcohol
withdrawal
o absence of a classic hx of schizophrenia
o usually short-lived duration

Question 58

Alcohol-Induced Psychotic Disorder differentiated from the DTs

Answer 58

presence of clear sensorium

Question 59

• heavy intake of alcohol – results in many symptoms in major depressive disorder
• intense sadness markedly improves within several days to 1 month of abstinence
• 80% of alcoholics - have intense depression
o including 30-40% who were depressed for 2 or more weeks at a time

Answer 59

Alcohol-Induced Mood Disorder

Question 60

• common in the context of acute and protracted alcohol withdrawal
• 80% - report panic attacks during at least one acute withdrawal episode
o complaints can be sufficiently intense for the clinician to consider diagnosing panic disorder
• 1st 4 weeks or so of abstinence, people with severe alcohol problems are like to avoid some social situations for fear of being overwhelmed by anxiety; at times can be severe to resemble agoraphobia

Answer 60

Alcohol-Induced Anxiety Disorder

Question 61

• variously called pathologic, complicated, atypical, and paranoid alcohol intoxication
• severe behavioral syndrome develops rapidly after a person consumes small amount of alcohol that would have minimal behavioral effects on most persons

Answer 61

Idiosyncratic Alcohol Intoxication

Question 62

• often described to as confused and disoriented and is experiencing illusions, transitory delusions, and visual hallucinations
• may display greatly increased psychomotor activity and impulsive, aggressive behavior
• can be dangerous to others and may exhibit suicidal ideation and make suicide attempts
• lasting for a few hours terminates in prolonged sleep and those affected cannot recall the episodes on awakening
• most common in persons with high anxiety

Answer 62

Idiosyncratic Alcohol Intoxication

Question 63

patients who appear to have WK but does not respond to thiamine

• Niacin deficiency (nicotinic acid)
• Treatment:
o Niacin 50 mg 4x daily oral or
o Niacin 25 mg 2-3x daily parenteral

Answer 63

Alcoholic Pellagra Encephalopathy

Question 64

symptoms:
o confusion
o clouding of consciousness
o myoclonus
o oppositional hypertonias
o fatigue
o apathy
o irritability
o anorexia
o insomnia
o sometimes delirium

Answer 64

Alcoholic Pellagra Encephalopathy