L55 Addiction Flashcards

1
Q

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

A

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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2
Q

what is the cause of dependence syndrome?

A

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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3
Q

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

A

serotonin

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4
Q

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

  • novelty seeking
  • harm avoidance
  • reward dependence
A

low
high
high

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5
Q

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

  • novelty seeking
  • harm avoidance
  • reward dependence
A

high
low
low

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6
Q

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

A
  • addictive substances

- electrical brain stimulation

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7
Q

what feelings does the NT dopamine induce?

A

euphoria or orgasm

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8
Q

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

A

nucleus accumbens

dopamine

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9
Q

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

A

nucleus accumbens
striatum
frontal cortex

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10
Q

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

A

haloperidol - reduces the rewarding effect

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11
Q

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

A

generating normal behavior like food and water intake or reproductive behavior

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12
Q

the mood-altering experience is _____

A

inerasable

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13
Q

what are the main effects of drugs?

A

sedative
hallucinogenic
stimulative

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14
Q

what are examples of sedatives?

A
  • tetra-hydro-cannabinol
  • alcohol
  • benzodiazepine
  • barbiturate
  • opiate/opiod
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15
Q

what are examples of hallucinogens?

A
  • magic mushrooms (psilocybin)
  • ketamine
  • LSD
  • phencyclidine (angle dust)
  • solvents
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16
Q

what are examples of stimulants?

A
  • amphetamine
  • cocaine
  • ecstasy
17
Q

what drugs have a psychic dependence?

A

all drugs

18
Q

what drugs have a physical dependence?

A

sedatives

19
Q

what happens with withdrawal from sedatives?

A
  • excitation
  • high BP
  • tachycardia
  • epileptic seizures
  • psychosis

*medical tx necessary

20
Q

what happens with withdrawal from stimulants?

A
  • sedation
  • low BP
  • bradycardia

*do not require medial tx

21
Q

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

A

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

22
Q

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

A

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

23
Q

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

A

Adaptation and dependence on technical environment

24
Q

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

A

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

25
Q

what are the symptoms of alcohol detoxification?

A
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

26
Q

how long do the symptoms of alcohol detoxification last?

A

about 7 days

27
Q

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

  • drug effect
  • withdrawal effect
  • withdrawal symptoms
A

decrease
increase

hyperhidrosis
tachycardia
htn
tremor 
nausea
28
Q

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

  • drug effect
  • withdrawal effect
  • withdrawal symptoms
A

decrease
increase

psychotic symptoms

29
Q

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

  • drug effect
  • withdrawal effect
  • withdrawal symptoms
A

decrease
increase

epileptic seizures

30
Q

what does dependence refer to?

A

psychic dependence and physical dependence

31
Q

explain psychic dependence

A

experience of impaired control

32
Q

explain physical dependence

A

tolerance and withdrawal symptoms

33
Q

what type of drug is diazepam

A

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

large therapeutic window

34
Q

what type of drug is haloperidol?

A

anti-psychotic

large therapeutic window

35
Q

what type of drug is clonidin?

A

anti-adrenergic

36
Q

describe “cold” opiate detoxification

A
• 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
37
Q

describe “warm” optiate detoxification

A
• 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
38
Q

why is vitamin B1 (thiamine) given to alcoholics?

A

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

39
Q

what is Wernick Korsakoff syndrome?

A

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.