Drug and Alcohol Misuse Disorders Flashcards
Alcohol Withdrawal:
Symptoms occur _______
Seizures occur ______
Delirium Tremens occurs ______
6-12 hours
36 hours
72 hours
What pathway is the reward pathway? What is the motivating signal that incentivises behaviour and is involved in normal pleasurable experiences?
mesolimbic pathway
dopaminergic activity
All drugs of abuse have effects on ______ and end result is ________
dopamine level
dopaminergic activity within the mesolimbic pathway
Repeated exposure to the drug leads to down regulation of _________ meaning ________ the concept of ________
down regulation of dopamine receptors meaning more is needed to get the same response (concept of tolerance)
What puts the “brakes” on the reward pathway? When is it fully mature?
prefrontal cortex
not fully mature until 20s
What is dysfunctional in addicted people?
prefrontal cortex
Criteria for dependence syndrome?
1) Sense of compulsion
2) Craving
3) Physiological withdrawal
4) Evidence of tolerance
5) Preoccupation with substance use
6) Persistent use despite harmful consequences
Define hazardous drinking?
- A pattern of alcohol consumption that increases the harmful consequences for the user (not currently a diagnostic term)
- In women it is defined as > 14 units but < 35 units a week
- In men it is defined as > 14 units but < 50 units a week
Define harmful drinking?
- A pattern of alcohol consumption that is causing mental or physical damage
- In women it is defined as > 35 units a week
- In men it is defined as > 50 units a week
List some symptoms of alcohol withdrawal?
- Tremor of outstretched hands, tongue or eyelids
- Sweating
- Nausea, wretching or vomiting
- Tachycardia or hypertension
- Anxiety
- Psychomotor agitation
- Headache
- Insomnia
- Malaise or weakness
- Transient visual, tactile or auditory hallucinations or illusions
- Generalized tonic clonic seizures
What is the most serious withdrawal state? How do symptoms differ from normal withdrawal?
- Most serious withdrawal state – medical emergency
- The symptoms differ from normal withdrawal because there are signs of altered mental status
Presentation of delirium tremens?
- Patients are disorientated, agitated and have a marked tremor as well as tactile visual hallucinations (insects or small animals crawling on them)
- Signs include sweating, tachycardia, tachypnoea and pyrexia
Management of delirium tremens?
Can be treated with general measures such as correcting dehydration, electrolyte abnormalities and thiamine replacement as well as giving oral lorazepam
Wernicke Korsakoff syndrome is due to _____ which is due to ______
both are due to thiamine deficiency
Thiamine deficiency occurs in alcoholism for several reasons:
1. Ethanol interferes with conversion of thiamine to active form
2. Ethanol prevents absorption of thiamine
3. Cirrhosis of the liver interferes with liver storage of thiamine
4. Likely to have poor nutritional intake if an alcoholic
Wernicke / Korsakoff - acute or chronic?
Wernicke is acute
Korsakoff is chronic
What is happening in the brain in Wernicke’s encephalopathy?
cytotoxic oedema in mamillary bodies
What is happening in the brain in Korsakoff’s syndrome?
cerebral atrophy
Symptoms in Wernickes encephalopathy?
triad:
ocular dysfunction/ ophthalmoplegia
ataxia
acute confusion
Presentation of Korsakoff’s syndrome?
profound anterograde (cant remember anything new) and retrograde (cant remember anything from the past) amnesia
key feature is confabulation - patients basically make things up to fill in the gaps in their memory
there is generally a lack of insight
Management of Wernicke Korsakoff syndrome?
wernickes needs urgent recognition and thiamine replacement to prevent progression to korsakoff - generally normalise thiamine then also give glucose
korsakoff has low change of recovery but abstinence and nutrition are still important
What are two diagnostic markers of alcohol misuse in recent weeks?
elevated GGT and elevated mean corpuscular volume
Management of alcohol withdrawal?
- Reassurance
- If you speak to someone and they are coming back – do not tell them to stop drinking suddenly before next appointment – they need gradual withdrawal or at risk of DTs
- Long-acting benzodiazepines are used to help alleviate symptoms (they are cross tolerant with alcohol due to action on GABAA) usually chlorodiazepoxide is used and titrated against the severity of withdrawal symptoms
- The dose of chlorodizepoxide is reduced gradually over 7 days or more
- Vitamin supplementation should be given
- Thiamine should be given as prophylaxis for Wernicke’s encephalopathy and dose should be increased if the patient develops symptoms
- Most patients can be detoxified in the community but if they have severe dependence they may want to be detoxified as inpatients
- Development of delirium tremens requires immediate transfer to a medical ward
Should you tell people to stop drinking on their own?
no - suddenly stopping drinking is risky in those with alcohol dependence - tell them to keep drinking !
What drug is used to manage alcohol withdrawal?
chlorodiazepoxide - long acting benzodiazepine
