L55 Addiction Flashcards by Grace Lepis

what is the criteria for diagnosing addition (dependence syndrome) according to the International Classification of Diseases (ICD) #10?

Three or more of the following together at some time during the previous year:
• A strong desire … to take the substance
• Difficulties in controlling substance-taking behavior in terms
of its onset, termination, or levels of use
• A physiological withdrawal state when substance use has ceased …;; or use of the same … with the intention of relieving or avoiding withdrawal symptoms
• Evidence of tolerance, such that increased doses of the psychoactive substance are required …
• Progressive neglect of alternative pleasures or interests …
• Persisting with substance use despite clear evidence of overtly harmful consequences …

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what is the cause of dependence syndrome?

bio-psycho-social disease!

twins studies raised separately
children of alcoholics were more likely to develop alcoholism than children of non-alcoholics

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what NT seems to be lacking (most likely genetic) in individuals with an addiction disease?

serotonin

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what is the criteria of a Type I Addition according to Cloninger’s tridimensional personality theory

novelty seeking
harm avoidance
reward dependence

low
high
high

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what is the criteria of a Type 2 Addition according to Cloninger’s tridimensional personality theory

novelty seeking
harm avoidance
reward dependence

high
low
low

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what can activate the brain reward mechanism (ventral segmental dopamine system)?

addictive substances

- electrical brain stimulation

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what feelings does the NT dopamine induce?

euphoria or orgasm

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all addictive substances are able to increase the activity of dopaminergic neurons in the ______ resulting in a release of ____

nucleus accumbens

dopamine

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what does the ventral segmental area (VTA) communicate with that are all involved in motivation?

nucleus accumbens
striatum
frontal cortex

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what is the name of a dopamine receptor blocker and what is its action

haloperidol - reduces the rewarding effect

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what does the brain reward system play an important role in?

generating normal behavior like food and water intake or reproductive behavior

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the mood-altering experience is _____

inerasable

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what are the main effects of drugs?

sedative
hallucinogenic
stimulative

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what are examples of sedatives?

tetra-hydro-cannabinol
alcohol
benzodiazepine
barbiturate
opiate/opiod

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what are examples of hallucinogens?

magic mushrooms (psilocybin)
ketamine
LSD
phencyclidine (angle dust)
solvents

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what are examples of stimulants?

amphetamine
cocaine
ecstasy

what drugs have a psychic dependence?

all drugs

what drugs have a physical dependence?

sedatives

what happens with withdrawal from sedatives?

excitation
high BP
tachycardia
epileptic seizures
psychosis

*medical tx necessary

what happens with withdrawal from stimulants?

sedation
low BP
bradycardia

*do not require medial tx

what does the socio-cultural factor performance have on addicts?

Deadlines must be met, quantity of output predisposes for stimulants to work and sedatives to sleep

what does the socio-cultural factor consumption have on addicts?

Hunger satisfaction leads to excessive eating of different things and addiction of consumption (junk food)

what does the socio-cultural factor urbanization have on addicts?

Adaptation and dependence on technical environment

what does the socio-cultural factor mass society have on addicts?

De-individualization leads to isolation and loneliness causing additive behaviors (depression=drugs)

what are the symptoms of alcohol detoxification?

``` tachycardia htn hallucinations nausea, vomiting trembling craving alcohol extreme cases -seizures delerium tremors (5% of pts) begin 2-3 days after stopping and in extreme cases may be fatal ``` *LIFE THREATENING, sometimes ICU - treatment is NECESSARY

how long do the symptoms of alcohol detoxification last?

about 7 days

with respect to opiate and alcohol withdrawal symptoms, what effects does the NT noradrenaline do to: - drug effect - withdrawal effect - withdrawal symptoms

decrease increase ``` hyperhidrosis tachycardia htn tremor nausea ```

with respect to opiate and alcohol withdrawal symptoms, what effects does the NT dopamine do to: - drug effect - withdrawal effect - withdrawal symptoms

decrease increase psychotic symptoms

with respect to opiate and alcohol withdrawal symptoms, what effects does the NT glutamate do to: - drug effect - withdrawal effect - withdrawal symptoms

decrease increase epileptic seizures

what does dependence refer to?

psychic dependence and physical dependence

explain psychic dependence

experience of impaired control

explain physical dependence

tolerance and withdrawal symptoms

what type of drug is diazepam

benzodiazepine (valium) anti-convulsive and a little bit of anti-adrenergic large therapeutic window

what type of drug is haloperidol?

anti-psychotic large therapeutic window

what type of drug is clonidin?

anti-adrenergic

describe "cold" opiate detoxification

``` • Symptoms like gastrointestinal influenza • Not life-threatening • Symptomatic medication against – Nausea – Diarrhea – Tachycardia / Hypertension • 2nd and 3rd days are the worst • Not longer than 5 – 7 days • Hyposomnia can continue for weeks ```

describe "warm" optiate detoxification

``` • Substitution of opiates with methadone • Reduction of methadone-dose over app. 3 weeks • Symptomatic medication against – Nausea – Diarrhea – Tachycardia / Hypertension • Problem: long stay on a closed ward • High chance of breaking-off ```

why is vitamin B1 (thiamine) given to alcoholics?

because they do not eat properly and can lack vitamins a lack of vitamin B1 can cause Wernicke-Korsakoff syndrome Thiamine is a co-enzyme needed to metabolize carbohydrates and without it can alter PPP and cerebral energy metabolism Acute deficiency causes oculogyric crisis, ataxia and delirium similar to a diabetic coma Thus, giving glucose (D50) without thiamine can be very bad or fatal

what is Wernick Korsakoff syndrome?

Wernicke encephalopathy and Korsakoff syndrome are different conditions. Both are due to brain damage caused by a lack of vitamin B1 (thiamine). Lack of vitamin B1 is common in people with alcoholism. It is also common in persons whose bodies do not absorb food properly (malabsorption), such as sometimes occurs after obesity (bariatric) surgery. Korsakoff syndrome, or Korsakoff psychosis, tends to develop as Wernicke symptoms go away. Wernicke encephalopathy causes brain damage in lower parts of the brain called the thalamus and hypothalamus. Korsakoff psychosis results from permanent damage to areas of the brain involved with memory.