Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatric Principles > Final: Addictive Disorders > Flashcards

Final: Addictive Disorders Flashcards

1
Q

Clinical steps re addition tx

A
  1. assess, dx
  2. Referral (inpt v outpt)
  3. Detox protocols
  4. Rehab involvement (inpatient)
  5. Intensive Outpt (ie 3x/wk for 3 hr for 3m)
  6. Long term f/u (outpt)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

describe the bio-psycho social model

A

Bio: genetic predisposition, cellular changes

Psycho: Cognitive Behavior

Social: environment, inner circle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe the systems of the brain

A

*Prefrontal cortex: judgment and willpower, EXECUTIVE CONTROL

Limbic system: basic emotions and learning

Amygdala: alerts brain to temptation

Substantia nigra: DA, (mvmt)

Locus Ceruleus

*Ventral tegmental area: REINFORCEMENT

– as a neutral disorder, the balance bw drive and control systems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the interactions bw the systems

A

Locus ceruleus to VTA (reinforcement) to nucleus accumbens to activate (+) prefrontal cortex (executive control)

Prefrontal cortex inhibits (-) Nucleus accumbens and VTA (reinforcement)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What underlies genetic predispositions for addiction

A

inherited abnormalities in DA system

DA transporter.. any compulsive disorder, there is some dysregulation of this receptor

cocaine blocks reuptake of DA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

As a kid, exposure to chronic stress around age 4-6….

A

results in cortisol secretion that can prime brain pleasure pathway for addiction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Compulsive disorder cycle

A

anxiety/stress causes repetitive behaviors which serve as relief of anxiety/stress -> obsessions –> back to anxiety and stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Levels of drug use include? where is America?

A
  1. Abstinence
  2. experimentation
  3. Social/recreational use**
  4. Habituation
  5. Abuse
  6. Addiction

most of Americans are social/rec use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

3 step clinical process for recovery…

A
  1. Screen our job in Primary care: CAGE or AUDIT screen questions
  2. Dx: Psychiatry/addiction med via MAST, DSM etc
  3. Treat: inpt detox/rehab and/or outpatient rehab/follow up
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how can we screen for addiction?

A

best to do so in context of other lifestyle questions in primary care setting

  1. CAGE
    a) 2+ as cut off, quick and easy
  2. AUDIT - 10 questions
    a) best for ETOH abuse, problem drinking
  3. MAST
    a) best for alcohol dependence

– if positive screen, assess for referral & dx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the breakdown for DSMIV organization of addiction dx

know** for exam

A

CLASS: substance related disorders

GROUP: Substance USE disorders v Substance INDUCED disorders

DISORDER:

a) *under substance use: ABUSE vs DEPENDENCE
b) under substance induced: intoxication, withdrawal, delirium, dementia, amnesia, psychosis etc

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

DSM-IV criteria: use disorders - substance abuse

A

1 or more within 1 yr:

a) failure to fulfill work, school, or home obligations
b) physically hazardous situations
c) Legal problems
d) Recurrent social or interpersonal problems

[[failed obligations, physical health risk, legal trouble, relationships]]

obligations, health, law, relationship (one OHLR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

DSMIV criteria: use disorders: SUBSTANCE DEPENDENCE

*3D

A

THREE of more within 1 yr

  1. Tolerance
  2. Withdrawal
  3. Use over longer than intended
  4. Unsuccessful efforts to cut down
  5. Sig time to obtain/recover from substance
  6. Giving up social, work, recreation activities
  7. Use despite harm (physical/psych)

Mnemonic for dependence dx:
“totally will take U through absolute hell” - DEPEND on it

totally: tolerance
Will: withdrawal
take: time - use longer
U: unsuccessful at cutting down
through: time - sig to obtain/recover from
absolute: activities sacrificed for drug
Hell: harm to health (psych, physical)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Mnemonic for substance dependence dx (use disorders) - **remember, need 3 w/in a year

A

totally will take U through absolute hell - you can DEPEND on it

totally: tolerance
Will: withdrawal
take: time - use longer
U: unsuccessful at cutting down
through: time - sig to obtain/recover from
absolute: activities sacrificed for drug
Hell: harm to health (psych, physical)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Process for tx of substance abuse

A

how much is too much? tolerance + dependence + compulsion = NEED HELP

assessment: Primary care clinician in crisis center or ER

Tx: inpatient detox (hospital), inpatient rehab (14-28d+), outpatient rehab (IOP) or 1/2 way house, therapy (individual and group counseling-12step), inner circle support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

principles of 12 step group therapy program

A

Admittance,
amends,
personal inventory,
service

17
Q

Overall medical mgmt. of substance dependence/ abuse

A

COMBO of therapy and meds

  • individual and group therapy
    • 1:1 counseling ie motivational interviewing, CBT, behavioral modification
  • -Groups: 12 step, specific support groups
  • MEDS
  • -detox (manage withdrawal sx)
  • -anti craving (weak or partial agonist)
  • -Long term maintenance (SSRIs, anxiolytics, naloxone, antabuse etc)

*be aware of Dual dx.. aka mentally ill, chemically addicted (that is, substance use disorder and co-morbid psych condition)

18
Q

alcohol detox tx

A

INPT

Delirium tremens:

  • Diazepam (valium)
  • Lorazepam (Ativan)
  • Phenobarbitol

Thiamine supplement

Long term: disulfiram (antabuse), Acamprosate (Campral), Naltrexone (revia), AA, individual counseling

19
Q

Tx Opiate addiction

A

DETOX: inpt if mod/severe

  • OD: naloxone (narcan)
  • Clonidine for SNS overstimulation
  • Substitution of longer acting opioid (methadone) - taper

Extended tx:

  • Methadone or Buprenorphine (suboxone) maintenance program - taper off
  • individual and group counseling (narcotics anonymous)
20
Q

What is Buprenorphine (suboxone)? and how does it work?

A

First med developed to treat opiate addiction in physicians office

  • binds same Mu receptors as Morphine w/o same effects
    • weak agonist: reduces cravings (mild withdrawal sx)
  • -Partial antagonist: prevents euphoria (low abuse potential)
    • Long acting and decreased respiratory depression (high safety profile)
  • requires DEA X license: addictionists
  • careful monitoring provides best success
21
Q

Conclusions/summaries re tx of substance abuse/dependence

A 
be vigilant
appreciate the pathophysiology
know DSM
Use favorite screening tools
Have a plan (know where to refer)
Be VERY familiar of meds you rx
Be empathetic and supportive

Psychiatric Principles (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions