L55 Addiction Flashcards
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 …
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
what NT seems to be lacking (most likely genetic) in individuals with an addiction disease?
serotonin
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
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
what can activate the brain reward mechanism (ventral segmental dopamine system)?
- addictive substances
- electrical brain stimulation
what feelings does the NT dopamine induce?
euphoria or orgasm
all addictive substances are able to increase the activity of dopaminergic neurons in the ______ resulting in a release of ____
nucleus accumbens
dopamine
what does the ventral segmental area (VTA) communicate with that are all involved in motivation?
nucleus accumbens
striatum
frontal cortex
what is the name of a dopamine receptor blocker and what is its action
haloperidol - reduces the rewarding effect
what does the brain reward system play an important role in?
generating normal behavior like food and water intake or reproductive behavior
the mood-altering experience is _____
inerasable
what are the main effects of drugs?
sedative
hallucinogenic
stimulative
what are examples of sedatives?
- tetra-hydro-cannabinol
- alcohol
- benzodiazepine
- barbiturate
- opiate/opiod
what are examples of hallucinogens?
- magic mushrooms (psilocybin)
- ketamine
- LSD
- phencyclidine (angle dust)
- solvents
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.
