ILA

Question 1

Investigations for information of Psychosis

Answer 1

Full MSE,
Physical health status (sleep, diet, any recent ill health or long-term conditions, medications, investigations, recent stressors - physical, psychological, social).
Residential detox team
Substance misuse services
GP
Friends and family - if consent given

Question 2

Ddx of psychosis

Answer 2

Drug-induced Psychosis, Paranoid Schizophrenia, Delusional Disorder, Anxiety Disorder, PTSD, Bi-polar Disorder, Schizoaffective Disorder, Emotionally Unstable Personality Disorder.

Note lack of insight, thought content and form

Question 3

Biopsychosocial psychosis ix

Answer 3

Bio:
Drug screen
Physical checks - rule out physical causes
Prescribe anti-psychotic
Psycho:
CBT/talking therapy post-crisis
Social:
Support worker/social care package to integrate back into social contacts

Question 4

Issues with psychosis treatment

Answer 4

Trust of others, engagement with care/

Question 5

Recognise the potential connection between alcohol/stimulant use and hallucinations/ delusions.

Answer 5

Stimulants (cocaine and amphetamines) can contribute to psychotic symptoms that can last days, months, and years after the drug use stops. Long-term use is attributed to loss of memory and problems with concentration.

Delusions attributed to alcohol can cause disorientation, disorganized speech and mental confusion.

Hallucinogens like phencyclidine (PCP) and lysergic acid diethylamide (LSD) affect the user in a way that mimics psychosis.

Question 6

Identify that her attendance at 12-step groups is a key source of both abstinence support and social support, and the potential impact her withdrawal from the groups may have on her mental state.

Answer 6

12-step therapy programmes encourage participants to accept responsibility for their role in their addiction. 12 Step models provide support, encouragement and accountability for people who genuinely want to overcome their addiction. The sponsorship model plus regular meeting times encourage social support to prevent relapse.

Question 7

Discuss a negative attitude to medication and how this might impact on future treatment.

Answer 7

She will be used to talking treatments and group work as part of her residential stay and will require considerable reassurance and support to consider and adhere to medication. Try to engage someone from her previous treatment – e.g., a key worker could be helpful if practicable.

Strategies for responding to non-adherence could include:
Motivational interviewing
Psychoeducation
CBT.
Ask pharmacy - they are happy and willing to discuss medication issues one to one with patients.

Question 8

Discuss the implications of teenage history of harassment on relationships with staff.

Answer 8

Think anniversary, other triggers – could be real – she may have been the victim, witness or perpetrator, or her experiences could have been early manifestations of mental illness. Therefore, need to ask – tactfully – around this issue.

Question 9

Discuss possible connections between her teenage harassment incident and her current concerns about accusations of paedophilia, including whether this might suggest a history of trauma.

Answer 9

Data from the National Comorbidity Survey 2007 were used to estimate the relationship between interpersonal trauma and the likelihood of a classification of psychosis.

Childhood physical abuse predicted psychosis, and there was a significant cumulative relationship between trauma and psychosis, with number of trauma types experienced increasing the probability of psychosis. Overall, physical abuse predicted psychosis. In addition, a significant gender-by-rape interaction was observed, with rape having higher predictive value for psychosis in male subjects.

Question 10

Discuss the psychological implications of pregnancy termination

Answer 10

Some research indicates that childhood and partner adversities, including reproductive coercion, were associated with negative mental health symptoms, as is perceived abortion stigma. Cultural and religious aspects can also impact an individual/family response.

Question 11

Reflect on attitudes to drug/alcohol misuse and personal responsibility, and how these might influence equitable treatment.

Answer 11

Recognise that people utilise drugs and alcohol often as maladaptive coping strategies. We should avoid value judgements or assumptions about how and why people use substances. In addition, we should not let features of drug dependency – historic or current cloud an objective assessment including possible physical causes of mental state.

Question 12

Consider the impact of sleeplessness on current mental state

Answer 12

Fatigue, hallucinations, query schizoaffective disorders (psychotic and mood symptoms)

Question 13

Understand the social and identity issues that may be raised by long-term unemployment

Answer 13

Self-image, identity, sense of worth and purpose internalised negative thoughts, practical financial burdens. Views of others, stigma, discrimination, and social exclusion. Think standard of living – funding and resources, insecurity of income, stigma and loss of self-esteem, loss of social contacts and independence

Question 14

Discuss risk factors that might be associated with current mental state

Answer 14

Risk – vulnerability, exploitation, emotional, physical, sexual, financial. Exhaustion, lack of self care

Question 15

“Define the terms “hallucination” & “delusion”.
“

Answer 15

Hallucination is a perception in the absence of external stimulus that has qualities of real perception.

Delusion; A false belief held despite strong evidence against it.

Question 16

Describe the different types of hallucination) and delusion (that a psychiatric patient may present with

Answer 16

“Visual, auditory, olfactory, tactile, gustatory

Delusion; A false belief held despite strong evidence against it. Persecutory, grandeur, jealousy, erotomania, somatic, mixed.
“

Question 17

Able to differentiate psychotic disorder from other causes, e.g., organic brain disease.

Answer 17

Delirium, dementia, endocrine, metabolic, autoimmune, infection, narcolepsy, drug induced.

Question 18

“Describe the first rank symptoms of schizophrenia and understand their significance.
“

Answer 18

“Auditory hallucinations, hearing thoughts spoken aloud, hearing voices referring to self made in the third person – outsider ‘you’ ‘it’, auditory hallucinations – commentary, thought withdrawal, insertion and interruption, broadcasting, somatic hallucinations, delusional perception, feelings/actions experienced as made or influenced by external agents.

Positive symptoms (e.g., auditory hallucinations, thought disorder, delusions) and negative symptoms (e.g., de-motivation, self-neglect, and reduced emotion).

For a diagnosis, at least one of the following must be present: delusions, hallucinations, or disorganised speech for one month or more.”

Question 19

“Able to initiate and interpret appropriate investigations (neurological, biochemical,
radiological, electrophysiological, urine toxicology)

”

Answer 19

“Neurological, biochemical, radiological, electrophysiological, urine toxicology.

Medical history PSE and full physical examination, weight, waist
circumference, pulse, bp, Fasting blood glucose, glycosylated haemoglobin (HbA1c), blood lipid profile and prolactin levels.

ECG if indicated CT or MRI not recommended as a routine part of the initial investigations; only performed if indicated by clinical picture.

Follow-up overall physical health, Weight and waist circumference, Pulse and blood pressure, Fasting blood glucose, HbA1c and lipid profile.”

Question 20

“Able to assess risk and develop a management plan with others involved in care.
“

Answer 20

Vulnerability: physical, social and psychological. Risk of further deterioration of physical and mental health. Consider cultural and spiritual aspects of care. Identify any culturally appropriate support from voluntary and faith community. Welfare advocacy and housing are important.

Question 21

“Knowledge of common law and use of Mental Health Act and Mental Capacity Act; understanding of ethical implications of use of legislation; understanding of psychological and social impact of detention and/or involuntary treatment.

”

Answer 21

English common law allows all citizens to defend themselves against attack, providing they use a reasonable degree of force to do so. Equally, it is legitimate to prevent an unlawful attack on bystanders; again, providing reasonable force is used. This common law right is encompassed in the Criminal Justice and Immigration Act 2008.

Section 136 gives police the power to remove a person from a public place, when they appear to be suffering from a mental disorder to a place of safety. Most often the place of safety will be on a Mental Health Unit or at the Accident and Emergency Department – it can last up to 24 hours with a possible 12-hour extension in extenuating circumstances.

Many patients in an acute hospital suffer from a combination of both physical illness and a disturbance of their mind or their brain. In the most general terms, the MCA can give clinicians the authority to treat patients who lack capacity in their best interests.

Note: many patients treated under the MHA retain capacity to make decisions, despite possible non-compliance with treatment for their mental disorder.

Question 22

“Demonstrate knowledge of how cultural factors can impact access to services and
health inequalities”

Answer 22

“Inclusivity: Lack of accessible, culturally appropriate information relating to health and care are a barrier to health services.

Discrimination: Stigma/discrimination. Patients may avoid seeking care as a result of past negative experiences or worry of being judged or misunderstood.

Languages: If services mainly offered in just a few languages and this is different than patient’s main spoken language, this will affect ability to navigate the healthcare system, understanding of services/treatment and therefore access to services. Lack of easily accessible information acts as a barrier to access.
Socioeconomics: Underlying disparities that some cultural groups face in socioeconomic status. This affects ability to access healthcare eg costs of travel, ability to get medication

Healthcare professionals: lack of training/awareness of professionals in cultural needs affecting quality of care”

Question 23

Demonstrate knowledge of the association between ethnicity and incidence of severe mental illness.

Answer 23

Risk of psychosis is higher in ethnic minority groups but higher in black ethnic minorities.
Higher incidence of of psychosis in migrant groups.
Experiences of racism increase risk of ill mental health, both of common and severe mental disorders.

People in all ethnic groups but notably Black Caribbean, Black African and Black British people with a severe mental illness experience higher rates of admission to psychiatric hospitals, less voluntary in-patient care and less primary care intervention.

Question 24

Demonstrate awareness of the impact of cultural perspectives on the causation and expression of mental illness.

Answer 24

Culture can influence how people describe and feel about their symptoms. It can affect whether someone chooses to recognise and talk about symptoms. It affects the meaning people give to their illness eg whether they view their condition as real or intangible, a mental or physical issue, or warrants sympathy or scrutiny.

Culture impacts how people express their illness eg study in Asian Americans found higher focus on physical rather than emotional experiences and higher somatic complaints.

Culture can also affect what people believe about the cause of their illness, such as cultural causes or spiritual or religious causes eg supernatural causes

How a certain illness is expressed would vary between individuals but more so between cultures. Thoughts and behaviours are shaped by cultural beliefs and experiences. Expression of illness may incorporate elements of cultural beliefs.

Seeking help - threshold at which to express distress/seek help differs across cultures.

Culturally shaped beliefs can also be misunderstood as being a disorder but may not be. It is important to clarify whether they are outside of the patients cultural norms.

Question 25

Ask questions about
possible safeguarding
issues regarding his step
daughter in a non-
judgemental, empathic way.

Answer 25

Risk – previous suicidal ideation. Care of stepdaughter. Is
she at nursery – contact with birth mother/other
relatives/friends in caring role?

Question 26

Formulate a
biopsychosocial
management plan, including
prescribing a mood
stabiliser, especially Lithium

Answer 26

Paul may need referral to Citizens Advice
Bureau for welfare advocacy. Short term would advise Home
Treatment to manage reduction in Paroxetine and Mirtazapine
and consider mood stabiliser. Possibly Olanzapine initially and
then consider Lithium. If prescribing Lithium follow ups for
regular bloods etc need to be arranged with GP.
Psycho-education on mood and medication for Paul and his
husband – significant other. Also devise a relapse/recovery
plan as part of MDT to identify triggers and signs and reactive
plan if there is a future episode. An advanced statement could
be considered and a carer’s assessment for his husband
should be considered/offered.

Question 27

Consider potential
safeguarding issues
regarding either Paul’s step-
daughter or possibly Paul
himself. Is he now a
vulnerable person? Who is
Davis and what are his
motivations?

Answer 27

Safeguarding – child and adult, financial risks, ability to
care/cope, impact on relationship and resources – realisation
for Paul when this phase is over? Guilt and shame and risk of
slipping into a depressive state given his long history.
If your patient meets the 3 stage test you need to raise a
safeguarding concern. This can be done on Insight:
Contact children’s social care (0114) 2734855. Ensure that
you record clearly what has been communicated to you and
your actions.

Question 28

Four principles of sustainable healthcare:

Answer 28

Prevention - prevent mental illness, build social capital and promote
individual, social and community reliance and mental well-being.
● Empowerment of patients and staff - Empower patients, staff and carers to
manage their mental health.
● High value care - Eliminate wasteful activity.
● Reducing carbon (reducing waste) - Make use of low-carbon alternatives

Question 29

Examples of sustainable practice with this patient:

Answer 29

Social prescribing (social prescribing is a means of enabling health
professionals to refer people to a range of local, non-clinical services.
Schemes delivering social prescribing can involve a range of activities that
are typically provided by voluntary and community sector organisations.
Examples include volunteering, arts activities, group learning, gardening,
befriending, cookery, healthy eating advice and a range of sports). Social
prescribing can help address isolation, loneliness and inactivity. Also
empowers people to pursue their own non-pharmacological solutions to their
social, practical and emotional problems.
● Co-production - collaborative care planning with the patient.

● Self monitoring - using smartphone / other device to track symptoms has
been shown to benefit a variety of disorders.
● Peer support - e.g. involving peer support worker in mental health team (Peer
support workers are people who have lived experience of mental health
challenges themselves. They use these experiences and empathy to support
other people and their families receiving mental health services).
● Access to green space and nature has been shown to promote mental health -
e.g. green walking groups. This is something the peer support worker could help
the patient to attend.
● Liaise with the GP to review medication concordance and optimise medications.
We need to establish why the patient has stopped medications and whether
these medications are still necessary. This would reduce pharmaceutical waste,
polypharmacy and overprescribing. This also forms further opportunities for
shared decision-making over treatment.
● Offer video appointments to this patient as this has lower carbon emissions

Question 30

Have a knowledge of the
difference between learning disability and
learning difficulty.

Answer 30

Learning disability
A significantly reduced ability to understand new or complex
information or to learn new skills; a reduced ability to cope
independently; an impairment that started before adulthood, with
a lasting effect on development.
NICE states that: 'A learning disability is generally defined by
three core criteria:
● Lower intellectual ability (usually an IQ of less than 70).
● Significant impairment of social or adaptive functioning.
● Onset in childhood. '

A learning difficulty includes children and young people who have
‘specific learning difficulties’, for example dyslexia, but who do not
have a significant general impairment of intelligence.

Question 31

Be aware of appropriate
services for people with
a learning disability.

Answer 31

How much do you think it would cost for a carer per hour – how
many hours do you think he would need? Could he manage at
night?
Adult social care
Disability Sheffield Centre for Independent Living
Sheffield Mencap
AllAbout You
Autism Centre for supported employment
Bridge Poll Ltd – offer short breaks

Question 32

Discuss adaptation to
major life changes, such
as bereavement, as they
pertain to individuals
with learning disability.

Answer 32

Bereavement booklet for people with LD will be sent out after
session. Key issues are:
People with learning disabilities experience grief like anyone else.
Each person with a learning disability will grieve in their own way.

Some people may feel that withholding information about death
from a person with a learning disability can minimise anxiety,
however, generally, this is not helpful.

Question 33

Explain the psychosocial
factors that can
contribute to illness in
patients with learning
disability.

Answer 33

stress, hostility, depression, hopelessness, self-esteem
- family factors
- educational opportunities
- public attitudes - stigma - job control

Question 34

Demonstrate
knowledge of
range of
psychological
interventions for
anxiety
conditions

Answer 34

Offer an individual trauma-focused CBT intervention to adults with a diagnosis of
PTSD or clinically important symptoms of PTSD who have presented more than
1 month after a traumatic event. These interventions include:
● Cognitive processing therapy – patients who have experienced a
traumatic event can develop associations among objectively safe
reminders of the event (e.g., news stories, situations, people), meaning
(e.g., the world is dangerous) and responses (e.g., fear, numbing of
feelings). Changing these associations that lead to unhealthy functioning
is the core of emotional processing.
● Cognitive therapy for PTSD - making changes to how you think and act,
anxiety and stress management, developing coping strategies –
grounding.
● Narrative exposure therapy: reconstruction of the client’s life history.
The client and the therapist create a written autobiography containing the
major emotional memories from birth to the present. In the lifeline
exercise, the client identifies the chronological sequence of positive,
negative and traumatic events across their lifespan.
● Prolonged exposure therapy: consists of imaginal exposures, which
involve recounting the traumatic memory and processing the revisiting
experience, as well as in vivo exposures in which the client repeatedly
confronts trauma-related stimuli that were safe but previously avoided.
● Eye movement desensitisation and reprocessing (EMDR) - It is
based on a theoretical model which posits that the dysfunctional
intrusions, emotions and physical sensations experienced by trauma
victims are due to the improper storage of the traumatic event in implicit
memory. The EMDR procedures are based on stimulating the patient’s
own information processing in order to help integrate the targeted event
as an adaptive contextualized memory.

Question 35

Understand the
legal, moral and
ethical
responsibilities
involved in
protecting and
promoting the
health of
individual
patients
including
vulnerable
groups such as
those with
mental illness.

Answer 35

Detention under MHA? This could/should be managed in the community
– initially may require Home Treatment.
● Safeguarding issues, legal aspects of military engagement, welfare of
children. Risk of harm due to alcohol intake. Vulnerability due to
aggression and being perpetrator or victim of violence.
● Credibility – lack of understanding and appreciation of military lifestyle
and impact of losing structure and adapting to civilian life. Major
stressors: loss of functioning, role, status, survivor guilt.

Question 36

Demonstrate an
awareness of some
of the possible
impacts of climate
change (both
direct and indirect)
on mental health.

Answer 36

Climate change may affect mental health directly by exposing people to trauma.
It may also affect mental health indirectly, by affecting (1) physical health (for
example, extreme heat exposure causes heat exhaustion in vulnerable people,
and associated mental health consequences) and (2) community wellbeing.
Within community, wellbeing is a sub-process in which climate change erodes
physical environments which, in turn, damage social environments. Vulnerable
people and places, especially in low-income countries, will be particularly badly
affected.
Direct effects
● trauma due to physical danger from acute weather events - leading to
increased anxiety disorders including PTSD as well as increased
prevalence of depression and substance use disorders
● Heatwaves have been linked to increased rates of suicide, increased
psychiatric admissions.
● psychological distress due to environmental degradation, eco-anxiety
(relates to fears about environmental doom and uncertainty)

Indirect effects
● damage to land, infrastructure and community functioning leading to
climate related displacement/migration, armed conflict, other violence -
and the mental health consequences of these.
● physical health consequences of climate change (e.g. increased
infectious diseases) and psychological burden from these.
Health inequalities - the risks to mental health posed by climate change are
higher for certain subpopulations - risk factors include young age, female
gender, low socioeconomic status, loss or injury of a loved one, being a member
of immigrant groups or indigenous people, pre-existing mental illness and
inadequate social support.

Question 37

Understand the physiological and
neurochemical effects of acute
and repeated trauma.

Answer 37

Brain areas implicated in the stress response include the
amygdala, hippocampus, and prefrontal cortex. Traumatic
stress can be associated with lasting changes in these brain
areas. Traumatic stress is associated with increased cortisol
and norepinephrine responses to subsequent stressors.

Question 38

Have an awareness of biosocial
theory in relation to personality
development.

Answer 38

Dr Marsha Linehan’s biosocial theory of BPD (1993) – went on
to develop DBT
The dysfunction proposed by Linehan is one of broad
dysregulation across all aspects of emotional responding. As a
consequence, individuals with BPD have
(a) heightened emotional sensitivity,
(b) inability to regulate intense emotional responses, and
(c) slow return to emotional baseline.

From Linehan’s perspective, the construct of emotion (and thus
of emotion dysregulation) is very broad and includes emotion-
linked cognitive process, biochemistry and physiology, facial
and muscle reactions, action urges, and emotion-linked actions.
Emotion dysregulation subsequently leads to dysfunctional
response patterns during emotionally challenging events.
Linehan suggested a number of possible biological substrates of
emotional dysregulation (e.g., limbic dysfunction).
Early impulsivity is a predisposing vulnerability for both current
and future difficulties with emotion regulation?

Question 39

Understand attachment theory
and its relevance in personality
development.

Answer 39

Infants are born with a biological drive to seek proximity to a
protective adult for survival. They are dependent on the physical
and emotional availability of the key adults who take care of
them. Their relationships with adults are crucial to their trust of
other people, their understanding of relationships generally and
their feelings about themselves .The drive for closeness
promotes attachment behaviours, which helps children feel safe.
Attachment theory draws on the work of John Bowlby and Mary
Ainsworth.
Attachment refers to the special bond and the lasting
relationships that young children form with one or more adults. It
refers specifically to the child’s sense of security and safety
when in the company of a particular adult.

Question 40

Understand the impact of trauma
on psychological and personality
development.

Answer 40

Trauma is a strong and negative experience, which has an
effect on human mental and physical health.
Our brain is designed to sense, process, and store, perceive
and act on information from the external and internal world to
keep us alive. In order to do this, our brain has hundreds of
neural systems working in a continuous, dynamic process of
modulating, regulating, compensating - increasing or decreasing
activity to control the body’s physiology.
Each of our many complex physiological systems has a rhythm
of activity that regulates key functions. For each of these
systems there are ‘basal’ or
homeostatic patterns of activity within which the majority of
environmental challenges can be sustained. When an internal
condition (such as dehydration) or an external challenge (an
unpredictable and unstable employment situation) persists, this
is a stress on the system.
Stress occurs when homeostasis is disrupted. If this stress is
severe, unpredictable, prolonged or chronic, the compensatory

mechanisms can become over activated, or fatigued and
incapable of restoring the previous state of equilibrium or
homeostasis.

Question 41

Identify appropriate psychological
strategies for managing patients
with self-harm.

Answer 41

Mentalization based therapy "thinking about thinking". It is
being able to understand our own mental state and that of other
people, and how this affects our behaviour.
Schema therapy Where CBT aims to teach clients to suppress
their negative emotions, ST uses experiential techniques to
evoke affect as the therapist tries to bring about change in an
emotionally connected way.
Dialectical behaviour therapy The basic premise behind it is
that you have to accept who you are, but at the same time be
willing to change. It skills up people in therapy to develop
Distress Tolerance, Mindfulness, Emotional Regulation,
Interpersonal Effectiveness There are 4 elements:
Individual therapy
Group skills training
Intersession contact
Peer consultation

Question 43

Delirium tremens treatment

Answer 43

Chlordiazepoxide 7-10 days or a little bit of alcohol
More often than not admission too as lack of psychological support

Question 44

If both Benzo withdrawal and alcohol withdrawal treatment

Answer 44

Lorazepam / diazepam - due to alcohol being more severe and less easily treatable

Question 45

Alcohol detox

Answer 45

Encourage students to not just think of medication

● Importance of assessing motivation to change

● Preparation for detox courses, exploring the psychosocial
aspects, drivers for change, challenges, dealing with
cravings, how to fill the void stopping drinking leaves

● Engaging with services

● Need to assess if community detox or inpatient detox
required, based on risks (if previous seizures or
physically unwell etc then inpatients)

● Pharmacological treatment – chlordiazepoxide. Be aware
of risk of build up in patients with severe liver disease
(metabolised by liver), they may present as drowsy or
become unconscious several days into detox. Consider
lorazepam/oxazepam in severe liver disease as these
bypass liver metabolism.

● Thiamine - Vitamin B1 (pabrinex) supplement

● Midazolam in case of seizures, zopiclone

● Rehabilitation and support on discharge

Question 46

Complications alcohol dependence

Answer 46

Wernickes and Korsakoff’s encephalitis/psychosis
describes the acute and chronic phases of a single
disease process caused by thiamine deficiency,
commonly seen in heavy drinkers

• Wernickes: Approx 2% of alcohol abusers develop the
  syndrome. Mortality 15%. Triad of:
  1. Acute confusion
  2. Ataxia – unsteady, uncoordinated walking
  3. Opthalmoplegia – nystagmus, double vision
• Korsakoff’s: If Wernicke’s remains untreated around 84%
  develop features of Korsakoff’s. Anterograde amnesia -
  significant impairment in laying down new memories and
  variable memory of past events. “Confabulation”
  falsification of memory in clear consciousness.

Question 47

Treatment wernickes

Answer 47

• Treat with high dose thiamine replacement
  PABRINEX for 3-5 days

Question 48

Treatment korsakoffs

Answer 48

Treatment
– oral thiamine for 2 yrs, 25% may show mild
improvement, most remain unchanged.

Question 49

Immediate management plan of drug withdrawal in LOC

Answer 49

Airway, Breathing, Circulation, BM
● Naloxone – be aware of short half life, may wear off and
she could go unconscious again
● Possibly toxicology

Question 50

Short and Long term SE of IV drug use

Answer 50

Short term: overdose, infections, respiratory depression,
clouded mental functioning, nausea and vomiting,
suppression of pain

Long term: poor general health, DVT/PE, blood borne
viruses (HIV/Hepatitis B), collapsed veins, abscesses,
cellulitis, liver disease, infective endocarditis, pneumonia

Question 51

RA of IV drug use and pregnancy

Answer 51

Risk to self – physical, mental health, vulnerability, no
income, homeless, risks dangerous or potentially illegal
behaviours in order to fund habit

● Potential risks to foetus – maternal malnutrition, poor
foetal growth, baby may experience withdrawals at birth
and possible respiratory depression, developmental
delay, behavioural difficulties

● Risk of disengagement with drug services

If willing to engage with services, how would she cope if
partner continues to use drugs

Specialist midwife, consultant led obstetric care

Question 52

Amphetamines

Answer 52

Is a psychostimulant drug which produces increased wakefulness and
focus in association with decreased fatigue and appetite.
● The street name for amphetamine is speed.
● Amphetamine can either be ingested or injected.
● The effects of amphetamine can last for up to 6 hours and are generally
followed by a long, slow comedown.
● Amphetamine is a class B drug and is highly addictive. Note Khat.

Question 53

Methamphetamiens

Answer 53

Commonly referred to as crystal meth
● Is a stimulant drug that acts on the brain and nervous system.
● The commonest methamphetamine in the UK is MDMA or Ecstasy.
Ecstasy increases alertness and energy and in high doses can induce
euphoria and increase libido.
● Methamphetamine also causes hallucination, obsessive behaviours,
paranoia, insomnia, palpitations and tremors.

Question 54

Buprenorphine

Answer 54

A semi-synthetic opioid that is used to control pain and in the treatment of
opioid addiction.
● Buprenorphine is used recreationally, typically by opioid users, as it is
reported to provide a euphoric rush similar to other opioids.
● Common reactions associated with buprenorphine use are similar to
those of other opioids and include nausea, vomiting, drowsiness,
dizziness, headaches, perspiration, itchiness and dry mouth.
● Buprenorphine is a class C drug in the UK.

Question 55

Tolerance vs Withdrawal

Answer 55

Tolerancerefers to a physiological state where the effectiveness of a drug has
decreased due to chronic administration. This means that more of the drug
will be required to achieve the same effect in the future.

Withdrawal occurs when an individual suddenly stops the behaviour or
substance that they are addicted to, it is common for them to experience
withdrawal symptoms. Signs and symptoms of withdrawal will vary according to
each individual addiction, but usually include irritability, agitation, obsession with
the substance or behaviour, and depression.

Question 56

Benzo

Answer 56

A psychotropic drug which is commonly used as a sedative.
● Temazepam, Xanax and Diazepam are commonly prescribed forms of
benzodiazepines and are used as sleeping tablets.
● Some benzodiazepines cause memory-loss while withdrawal can cause
headaches, nausea, anxiety and confusion.
● Benzodiazepines are class C drugs and illegal to possess without
prescription.

Question 57

Barbituates

Answer 57

Barbiturates are derived from barbituric acid and act as central nervous
system depressants.
● Barbiturates are intoxicating and produce similar effects to ethanol
intoxication, including lower blood pressure, fatigue, fever, irritability and
confusion.

● Recreational users report that a barbiturate high gives them feelings of
relaxed contentment and euphoria.
● The main risks of barbiturate abuse are respiratory depression and
respiratory arrest, which may lead to death.

Question 58

Methadone

Answer 58

Is a synthetic opioid that is manufactured primarily for use as an opiate
substitute in the treatment of heroin addiction but it may also be used in
managing severe chronic pain.
● The effects of methadone mirror the effects of heroin and other opiates
as it depresses the nervous system, slows bodily functioning and reduces
physical and psychological pain.
● Methadone is a class A drug, making it illegal to have, give away or sell.

Question 59

Opiates

Answer 59

Opiates are alkaloids found naturally in the opium poppy plant. These
alkaloids include codeine and morphine, which is used to create heroin.
● Opiates are used medicinally to dull pain but are highly addictive causing
nausea, vomiting and drowsiness amongst other things.
● Heroin is even more dangerous when mixed with alcohol or other drugs
as this increases the risk of overdose.
● Heroin is a class A drug.

Question 60

Management of alcohol dependence system

Answer 60

A psychological intervention (such as cognitive behavioural therapy) should be
offered in mild dependence.

In those who have not responded to psychological
interventions alone or who have specifically requested a pharmacological
treatment, acamprosate calcium or oral naltrexone hydrochloride can be
used in combination with a psychological intervention.

Acamprosate calcium or oral naltrexone hydrochloride in combination with a
psychological intervention are recommended for relapse prevention in patients
with moderate and severe alcohol dependence, to start after successful assisted
withdrawal.

Disulfiram is an alternative for patients in whom acamprosate
calcium and oral naltrexone hydrochloride are not suitable, or if the patient
prefers disulfiram and understands the risks of taking the drug.

Nalmefene is recommended for the reduction of alcohol consumption in patients
with alcohol dependence who have a high drinking risk level, without physical
withdrawal symptoms, and who do not require immediate detoxification (see
National funding/access decisions for nalmefene).