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Y3R3 - Psychiatry 🧠 > L10: Addiction & Substance Abuse Disorder > Flashcards

L10: Addiction & Substance Abuse Disorder Flashcards

1
Q

General Definition of Addiction

A
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2
Q

Specific Definition of Addiction

A
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3
Q

Epidemeology of substance use disorder

A
  • One-year prevalence of any substance use disorder in the USA is approximately 8%.
  • Men > women.
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4
Q

what are the most commonly used substances in addiction?

A
  • Alcohol and nicotine (are the most commonly used substances)
  • Most common substance In Egypt: Nicotin, cannabis all; opiate.
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5
Q

Def of Acute intoxication

A
  • Transient disturbances of consciousness, cognition, perceptions, affect or behaviors following the large amount use of a psychoactive substance.
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6
Q

Def of Harmful use

A
  • Use in a manner that damage to the individual’s health and with adverse effects on family and society.
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7
Q

Def of Co-dependence

A
  • Term used to refer to family members affected by or influencing the behavior of the substance abuser. Related to the term enabler, which is a person who facilitates the abuser’s addictive behavior (e.g., providing drugs directly or money to buy drugs).
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7
Q

Def of Dependence

A
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8
Q

Def of Withdrawal state

A
  • physical and psychological symptoms occurring on absolute or relative (decrease dose) withdrawal of a substance after repeated, usually prolonged and/or high-dose use.
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9
Q

def of Tolerance

A

The need for increased amount of the substance to achieve the same effect.

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10
Q

Def of Cross-Tolerance

A

When tolerance develops to one drug as the result of use of another drug.

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11
Q

Def of Addiction

A

Is a slang languages used in non scientific fields.

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12
Q

DSM5 Classification of Substance Related Disorders

A
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13
Q

DSM 5 Criteria of Substance Use Disorder

A
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14
Q

what are other addictive disorders in DSM5?

A
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15
Q

Signs of Drug Intoxication

A
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16
Q

Why Do Some People become addicted while others Don’t?

A
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17
Q

Continuum of Drug Use

A
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18
Q

Drugs Wheel

A
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19
Q

Stimulants Vs Depressants

A
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20
Q

…

A
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21
Q

Epidemeology of Alcohol Dependence

A
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22
Q

Standard Drinking of alcohol

A
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23
Q

How much alcohol can you drink at a safe level ?

A
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24
Q

Clinical Presentation of alcohol intoxication

A
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25
Q

Types of alcoholism

A
  • Alpha
  • Beta
  • Gamma
  • Delta
  • Epsilon
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26
Q

Alpha alcoholism

A

Earliest stage, to relieve pain, can control drinking

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27
Q

Beta alcoholism

A

Heavy drinkers, drink daily, physical symptoms, no addiction, can quit, no withdrawal symptoms

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28
Q

**

Gamma alcoholism

A

Loss of control in drinking, physical dependence, can quit, withdrawal seen

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29
Q

Delta alcoholism

A

Physical dependence, withdrawal seen, cant quit

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30
Q

**

Epsilon alcoholism

A

Final stage of drinking, continual and insatiable urge to drink (craving), compulsive drinking.

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31
Q

what are drinking patterns?

A
  • Moderate Alcohol Consumption
  • Low-Risk Drinking and Alcohol Use Disorder (AUD)
  • Binge Drinking
  • Extreme Binge Drinking
  • Heavy Drinking
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32
Q

Moderate Alcohol Consumption

A

Defined as up to 1 drink/day for women and up to 2 drinks/day for men

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33
Q

Low-Risk Drinking and Alcohol Use Disorder (AUD)

A
  • For women, no more than 3 drinks/day and < 7 drinks/week.
  • For men, <4 drinks /day and <14 drinks /week.
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34
Q

Binge Drinking

A
  • A pattern of drinking that brings blood alcohol concentration to 0.08 grams per deciliter (0.08%) or higher.
  • Woman consumes 4 drinks or a man consumes 5 drinks in a 2-hour time frame
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35
Q

Extreme Binge Drinking

A
  • Drinking at levels far beyond the binge threshold, resulting in high peak blood alcohol concentrations. (i.e., 10 or more standard drinks for men, and 8 or more for women)
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36
Q

Heavy Drinking

A
  • Heavy drinking as binge drinking on each of 5 or more days in the past 30 days
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37
Q

Types of drinkers

A
  • Social Drinker
  • Alcohol Abuser
  • Alcoholic
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38
Q

Alcohol Abuser

A
  • An alcohol abuser’s drinking habit may become physically harmful to themselves and others around them.
  • They may begin to drive under the influence and could be arrested for DUI at least once.
  • Along with legal problems, an alcohol abuser may begin to put work and family obligations to the side.
  • Alcohol may begin to occupy their thoughts; the abuser may begin to feel like they need to have a drink more often.
  • Till now they not developed tolerance and withdrawal.
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38
Q

Social Drinker

A
  • A social drinker is a person who drinks on an occasional basis.
  • Whenever they do drink, a social drinker will not have any problems or negative consequences.
  • Friends or family do not complain about a social drinker’s consumption.
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39
Q

Alcoholic drinker

A
  • An alcoholic means that a person has an addiction to alcohol. When a person becomes an alcoholic, they are unable to control or set limits for their consumption.
  • An alcoholic will have developed a tolerance and full-fill all criteria of dependance.
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40
Q

Dx of Alcohol Dependence

A
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41
Q

MOA of Alcohol

A
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42
Q

Alcohol Metabolism

A
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43
Q

Enzyems Related To Metabolism of Alcohol in Heavy Drinkers & Asians

A
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44
Q

Timeline of Alcohol Withdrawal Symptoms

A

usually begin in 6-24 hours and last 2-7 days.

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45
Q

Symptoms of Alcohol withdrawl

A
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46
Q

Characters of Delirium tremens (DTs)

A
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47
Q

Complications of Alcoholism

A
  • Wernicke’s encephalopathy
  • Korsakoff syndrome
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48
Q

What causes Wernicke’s encephalopathy?

A

Caused by thiamine (vitamin B1) deficiency resulting from poor nutrition.

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49
Q

Prognosis of Wernicke’s encephalopathy

A
  • Acute and can be reversed with thiamine therapy.
  • If left untreated, Wernicke’s encephalopathy may progress to Korsakoff syndrome.
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50
Q

Symptoms of Wernicke’s encephalopathy

A

Ataxia (broad-based), confusion, ocular abnormalities (nystagmus, gaze palsies).

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51
Q

Def of Korsakoff syndrome

A

Chronic amnestic syndrome.

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52
Q

prognosis of Korsakoff syndrome

A

Reversible in only about 20% of patients.

53
Q

Symptoms of Korsakoff syndrome

A

Impaired recent memory, anterograde amnesia, compensatory confabulation (unconsciously making up answers when memory has failed).

54
Q

TTT of Alcohol Withdrawal

A
55
Q

Medications used in Alcohol Use Disorder

A

First-line treatments:
- Naltrexone (Revia, IM-Vivitrol)
- Acamprosate (Campral)

Second-line treatments:
- Disulfiram (Antabuse)
- Topiramate (Topamax)

56
Q

MOA of Naltrexone (Revia, IM Vivitrol)

A
  • Opioid receptor blocker works by decreasing desire/craving associated with alcohol.
57
Q

Uses of Naltrexone (Revia, IM-Vivitrol)

A

Maybe greater benefit is seen in men with a family history of alcoholism.

58
Q

SE of Naltrexone (Revia, IM-Vivitrol)

A

In patients with concurrent opioid dependence, it will precipitate withdrawal.

59
Q

MOA of Acamprosate (Campral)

A

Thought to modulate glutamate transmission.

60
Q

Use of Acamprosate (Campral)

A
  • Should be started post-detoxification for relapse prevention in patients who have stopped drinking.
  • Major advantage is that it can be used in patients with liver disease.
61
Q

SE of Acamprosate (Campral)

A
  • Contraindicated in severe renal disease.
62
Q

MOA of Disulfiram (Antabuse)

A

Blocks the enzyme aldehyde dehydrogenase in the liver and causes aversive reaction to alcohol (flushing, headache, nausea/vomiting, palpitations, shortness of breath).

63
Q

SE of Disulfiram (Antabuse)

A
  • Contraindicated in severe cardiac disease, pregnancy, psychosis.
  • Liver function should be monitored.
64
Q

when is Disulfiram (Antabuse) best used?

A
  • Best used in highly motivated patients, as medication adherence is issue.
65
Q

MOA of Topiramate (Topamax)

A
  • Anticonvulsant that potentiates GABA and inhibits glutamate receptors.
66
Q

Use of Topiramate (Topamax)

A

Reduces cravings for alcohol and decreases alcohol use.

67
Q

Characters of Benzodiazepines

A
68
Q

Symptoms of acute intoxication of Benzodiazepines

A
69
Q

Symptoms of Sedative & Hypnotics Withdrawal

A
70
Q

TTT of Sedative Abuse

A
71
Q

THC content of different preparations of cannabis

A
72
Q

Hashish Vs Marijuana

  • Introduction
  • legality
  • Derived From
  • Ingestion
  • Active Ingredient
  • Form
A
73
Q

Cannabis intoxication diagnostic criteria

A
74
Q

Cannabis Withdrawal diagnostic criteria

A
75
Q

Marijuana legalization

A
76
Q

Neurochemistry of Opiods

A
  • Opioid works via interactions with the mu and delta receptors which result in:

A. Increased activity in the mesolimbic system

B. Increased dopamine released (by inhibits the release of GABA which have inhibitory effect on the dopaminergic neurons)

77
Q

Route of adminstration of Opiods

A
  • Opium would be commonly smoked.
  • Heroin is usually injected
78
Q

Signs of intoxicaion & tolerance of Opiods

A
79
Q

DSM 5 Criteria of Opiods use disorder

A
80
Q

Physical complications associated with opioid misuse

A
81
Q

Epidemiology of opiates dependence

A
  • 10% of opiate misusers become dependent (10% of them ever seek help)
  • 2-3% die annually.
  • 25% are abstinent at five years and 40% at 10 years.
82
Q

Early withdrawal symptoms of opiods

A
  • Tolerance and withdrawal develop quickly.
  • Early withdrawal symptoms (24-48 hours) include craving, flu-like symptoms, sweating and yawning. Mydriasis (dilation of the pupil), abdominal cramps, diarrhoea, agitation, restlessness, piloerection (‘gooseflesh’) and tachycardia occur later (7-10 days).
83
Q

reatment of opiates dependence

A
  • Methadone
  • Buprenorphine
  • Naltrexone
84
Q

Pros of Methadone

A
  • Administered once dally.
  • Significantly reduces morbidity and mortality in opiold-dependent persons.
85
Q

Cons of Methadone

A
  • Restricted to federally licensed substance abuse treatment programs.
  • Can cause QTc Interval prolongation: screening electrocardiogram is indicated, particularly in patients with high risk of cardiac disease.
86
Q

MOA of Methadone

A

Long-acting opiold receptor agonist

87
Q

MOA of Buprenorphine

A
  • Partial opioid receptor agonist—can precipitate withdrawal if used too soon after full opioid agonists
88
Q

Pros of Buprenorphine

A
  • Sublingual preparation that is safer than methadone, as its effects reach a plateau and make overdose unlikely.

Comes as Suboxone, which contains buprenorphine and naloxone; this preparation prevents intoxication from intravenous injection.

89
Q

Cons of Buprenorphine

A
  • Only available by prescription from specially licensed office-based physicians.
90
Q

MOA of Naltrexone

A
  • Competitive opioid antagonist, precipitates withdrawal if used within 7 days of heroin use
91
Q

Pros of Naltrexone

A
  • Either daily oral medication or monthly depot injection.
  • It is a good choice for highly motivated patients such as health care professionals.
92
Q

Cons of Naltrexone

A
  • Compliance is an issue for oral formulation.
93
Q

what are examples of stimulants?

A

Examples:
- Cocaine
- Caffiene
- Cannabis
- Amphetamine
- Tobacco

Effects:
* Racing speech and thoughts
* Physically strong
* Loss of apetite
* Alert, confident and energetic
* Paranoia and a low or crash

94
Q

Method of adminstration of Cocaine

A

sniffed, chewed or injected intravenously.

95
Q

Method of adminstration of Crack

A

Crack (a purified, very addictive form of cocaine) is smoked.

96
Q

Characters of Crack

A

The crack (high) is extremely short and, on withdrawal, persecutory delusions are common.

97
Q

Effects of Cocaine

A
  • Restlessness, increased energy, abolition of fatigue and hunger resemble hypomania and last about 20 minutes.
  • Visual/tactile hallucinations of insects (formication) and paranoid psychoses occur.
  • Post-cocaine dysphoria, with sleeplessness and intense depression, precedes withdrawal (depression, insomnia and craving).
98
Q

Effects of Crack

A
99
Q

effects of Amphetamine

A
  • Uneven heartbeat, rise in blood pressure, physical collapse, stroke, heart attack, and death
  • cause euphoria, increased concentration and energy, mydriasis, tachycardia and hyper-reflexia, followed by depression, fatigue and headache. Acute use may cause psychosis.
100
Q

effects of methamphetamine

A
  • Memory loss, damage to heart and nervous system, seizures, and death
101
Q

Effects of Cocaine

A
  • Damage to nose lining and liver, heart attack, seizures, stroke, and death
102
Q

Effects of Crack

A

Damage to lungs if smoked, seizures, heart attack, and death

103
Q

MOA of amphetamines Speed

A

Taken orally or intravenously

104
Q

Charactesr of Methamphetamines

A

Chemically related but more potent, long lasting and harmful; it can be ingested, snorted or smoked (as crystal meth).

105
Q

Characters of Naphyrone and mephedrone

A

Closely related to amphetamines. They were originally manufactured as legal highs’ but are now class B drugs.

106
Q

Characters of Khat

A
  • Used particularly by men from Somalia and Yemen;
  • Contains cathinone, an amphetamine-like stimulant causing excitement and euphoria
107
Q

Stimulant withdrawal diagnostic criteria

A
108
Q

Lobacco Withdrawal diagnostic criteria

A
109
Q

Done

A

✅

110
Q

Stimulant intoxication diagnostic criteria

A
111
Q

What are substances with variable effect?

A
  • HALLUCINOGENS/ PSYCHEDELICS & DISSOCIATIVE DRUGS
  • EMPATHOGENS
112
Q

Examples of HALLUCINOGENS/ PSYCHEDELICS & DISSOCIATIVE DRUGS

A

Phencyclidine (PCP - Angel Dust)

113
Q

MOAd of Phencyclidine

A

Phencyclidine (PCP - Angel Dust) is usually smoked.

114
Q

Effects of Phencyclidine

A
115
Q

Empathogens

A
116
Q

Inhailants & Volatile Drugs & Solvents

A
117
Q

MOAd of Solvents

A

sniffed,

118
Q

Age of using Solvents

A

principally by boys (aged 8-19 years)

119
Q

Sign of abuse of Solvents

A

red rash around the mouth
and nose may be a sign of abuse).

120
Q

Effects of Solvents

A

Initial euphoria is followed by drowsiness.

121
Q

Dependence in Solvents

A

Psychological dependence is common but physical dependence is rare.

122
Q

Examples of Solvents

A

Amyl nitrite and butyl nitrite and isobutyl nitrite (called ‘poppers’)

123
Q

Characters of Solvents

A
  • Sniffed from small bottles.
  • They deliver a short, sharp high.
  • Side effects include severe headache and feeling faint.
  • They are toxic and can be fatal if swallowed
124
Q

Chronic abuse of Solvents

A

weight loss, nausea, vomiting, polyneuropathy and cognitive impairment.

125
Q

Toxic effects of Solvents

A

bronchospasm, arrythmias, aplastic anemia, hepatorenal and cerebral damage

126
Q

How do people misuse Anabolic Steroids?

A

to increase muscle growth and body bulk.

127
Q

MOAd of Anabolic Steroids

A

swallowed or injected.

128
Q

AE of Anabolic Steroids

A
  • gynecomastia in men and clitoral enlargement in women
  • bone hypertension
  • cardiac disorders
  • liver (e.g. drug induced hepatitis)
  • renal impairment
  • shrinking of testicles and priapism
    Infertility
  • aggression and irritability.
129
Q

Course of addiction and substance use disorder

A
  1. Addiction (with or without treatment)
  2. Remission
  3. relapse
130
Q

Outcome of addiction and substance use disorders

A
  • Chronicity
  • Natural recovery
  • Morbidity
  • Death
131
Q

Steps of TTT of addiction

A
132
Q

Infection (HIV and hepatitis C) is the greatest risk associated with injecting drug use; harm reduction strategies aim to minimize infection (e.g. needle exchange and improve safety.

A

..

Y3R3 - Psychiatry 🧠 (19 decks)

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