Lecture 6: Addiction Flashcards
Addiction
repeated involvement with a substance or activity, despite current harm, because the substance or activity is pleasurable or valuable
Addictive personality (5)
*not a Dx, descriptive
- impulsivity
- sensation-seeking
- nonconformity to social standards
- social alienation and tolerance for deviance
- heightened stress with poor coping skills
Substance Abuse (4)
- impaired control
- social impairment
- risky use patterns
- pharmacological indicators
Impaired control (4)
- use in larger amounts or for loner than intended
- unsuccessful attempts to cut down or stop
- spending excessive time obtaining, using, or withdrawing from substance
- intense cravings occupy attention
* patient may feel out of control
Social Impairment (2)
- substance use despite interference with work, social, or family obligations
- missing work, isolation, loss of income - interpersonal impairment: fighting, withdrawal from social groups or hobbies
Risky Use Pattern (2)
- continued in risky circumstances
- driving, operating machinery, business transactions - continued use despite physical, medial, or financial impairments resulting from use
Pysiological Impairment (2)
- tolerance
2. withdrawal
Tolerance
requiring higher doses of substance to achieve desired effect or avoid withdrawal
Withdrawal
physiological symptoms associated with reduction or cessation of substance use
Disorders (3)
- substance intoxication
- substance use disorder
- substance withdrawal disorder
Alcohol
3 factors leading to abuse
- common substance abuse due to pleasurable effects, legal status, and wide availability
Stats of alcohol usage (2)
in a 12 month period
- 8.5% US adults suffer from alcohol use disorder
- 4.6% adolescents suffer from alcohol use disorder
Alcohol intoxication sx
- Slurred speech
- incoordination
- unsteady gait
- nystagmus
- impaired attention, memory
- stupor, coma
*sx occur shortly after alcohol use
Alcohol intoxication effects
cause clinically significant behavioral or psychological changes
- agression
- mood lability
- imparted judgement
Alcohol Use Disorder
- At least 2 of the following within a 12-month period
a. increased consumption alcohol
b. unsuccessful efforts to cut down or control use
c. excessive time spent using, recovering from alcohol use
d. craving for alcohol
e. recurrent use despite negative consequences
f. social, occupational, recreational activities reduces or given up
g. recurrent use in hazardous situations
h. continued use despite awareness of physical or psychological problems
I. tolerance-increased amounts of decreased effect of use
J. withdrawal-pyshioligal sx when use is cutrail
Alcohol Wihdrawal sx (8)
- follows reduction or cessation of alcohol use, 2 or more of these develop
1. autonomic hyperactivity (sweating, tachycardia)
2. temor, especially in hands
3. insomnia
4. nausea vomiting
5. transient visual, tactile, or auditory hallucinations
6. psychomotor agitation
7. anxiety
8. generalized tonic-clonic seizures
Delirium Tremens (4) (DTs)
- historical term for delirium assoc. with alcohol withdrawal
- disorientation, confusion, wandering, “picking”, vivid hallucinations (especially visual)
- may require intensive care management
- assoc. with prolonged use and poor prognosis
* not super common, but serious
Wernicke’s Encephalopathy
cause
sx (3)
tx
- results of thiamin (vitamin B1) deficiency and results effects on the central nervous system
A. ophthalmoplegia (eye movement disorder, usually lateral nystagmus)
B. Ataxia or other cerebellar signs
C. Confusion and/or memory impairment
- can be treated with thiamine supplementation
Karsakoff’s Syndrome
4 sx/signs
- results from untreated Wenicke’s Encephalopathy
A. Global amnesia -anterograde, retrograde, fixation B. Confabulation -blackouts and invented memories C. Apathy -lack of interest in conversation D. lack of insight E. Not reversible with thiamine
Medical Complications Alcohol Use Disorder (5)
- Hepatic cirrhosis
- cerebral atrophy
- cerebellar atrophy
- bone marrow impairment
- vascular disease
Tx Alcohol Withdrawal (3)
- Benzodiazepine’s (ativan, oxazepam, chlordiazepoxide)
- Anticonvulsants (phenobarbital, carbamazepine)
- Sx tx: nausea, vomiting, cramps, diarrhea, pain, insomnia
(treat the symptoms)
Caffeine Intoxication sx (12)
a. restlessness
b. nervousness
c. excitement
d. insomnia
e. facial flushing
f. diuresis
g. GI disturbance
h. muscle twiching
i. rambling flow of speech/thought
j. tachycardia or arrhythmia
k. periods in inexhaustibility
l. psychomotor agitation
Caffeine Withdrawal (4)
- after cessation or prolonged daily use of caffeine, three or more the following
a. headache
b. marked fatigue or drowsiness
c. dysphoric, irritable, or depressed mood
d. nausea, vomiting, or muscle pain/weakness
Cannabis Intoxication
4 sx
- 2 or more within 2 hours of cannabis use
a. conjunctival injection
b. increased appetite
c. dry mouth
d. tachycardia
- physiological (coordination problems) or psychological (euphoria, anxiety, sensation of slowed time, impaired judgement, social withdrawal) following use
Cannabis Use disorder
- problematic pattern of cannabis use over 12 month period, with two or more signs (same as alcohol use) including either tolerance or withdrawal
- clinically significant impiarment
Cannabis Withdrawal (7)
3 or more sx develop after prolonged use
- irritable, angry, or aggressive episodes
- nervousness or anxiety
- insomnia or disturbing dreams
- decreased appetite or weight loss
- restlessness
- decreased mood
- one physical sx: abdominal pain, shakiness/tremors, sweating, fever, chills, HA
Hallucinogens Examples (5)
- Phenylcylidine (agel dust, PCP)
- Ketamine (special K)
- MDMA (ecstacy)
- Psilocybin (mushrooms)
- LSD
PCP intoxication (8)
- vertical or horizontal nystagmus
- hypertension or tachycardia
- numbness or diminished pain response
- ataxia-loss of control of muscle movement
- dysarthria-slurred speech
- muscle rigidity
- seizures or coma
- hyperacuity
Hallucination Intoxication (8)
- vivid hallucinations in all sensory nodes
- pupillary dilation
- tachycardia
- sweating
- palpitations
- blurring of vision
- tremors
- incoordination
Inhalant abuse (3)
- inhaled volatile hydrocarbons- glue, paint thinner, computer cleaner, etc.
- short term effects of intoxication
- can lead to sustained neurological changes
Inhalant Abuse sx, at least 2 to dx (13)
- dizziness
- nystagmus
- incoordination
- slurred speech
- unsteady gait
- lethargy
- depressed reflexes
- psychomotor retardation
- tremor
- generalized weakness
- blurred or double vision
- stupor or coma
- euphoria
Opioid Use Disorder (2)
- increasing prevalence, going national public health crisis
- related to both prescription and illegal opiates
Hx of Dope
- derivative of the poppy plant, known for euphoric and analgesic properties since antiquity
- morphine, heroin, opium-early derivatives
- late 18th century, east india trading company began smuggling opium into china as a way to force opening of trade “opium wars”
Futher hx of dope
- heroin sold for many years as pain killer, then banned due to high abuse potential
- prescriptions for opiated soared in 1990s causing overconsumption and dependence
- oxycontin-extended release formulation of oxycodone became popular drug of abuce
- reformulation to reduce inhalation abuse prompted attention from drug cartels, initiated return of heroin trade
oxycontin
extend release formulation of oxycodone
Opiod Use disorder (2)
- problematic use of opiates not solely under medical supervision
- demonstrates common sx of substance use disorder
Opiate Intoxication (3)
- euphoria, apathy, dysphoria, motor changes, impaired jusdgement
- pupillary constriction, plus one of these
a. drowsiness, coma
b. slurred speech
c. impaired attention or memory - may have perceptual disturbances
Opiate withdrawal (9)
3 or more sx
- dysphoric mood
- nausea or vomiting
- muscle aches
- lacrimation or rhinorrhea
- pupillary dilation, piloerection, sweating
- diarrhea
- yawning
- fever
- insomnia
tx opiate withdrawal (3)
- alpha-2 blockers (clonidine)
- gabapentin
- symptomatic medicaitions for nausea, vomiting, abdominal cramping, insomnia, diarrhea
Maintenance treatment opiate use disorder
3 rx
- replaces opiates of abuse with long acting substitutes the produce less euphoria, gradually tapered in conjunction with psychological treatments
a. methadone
b. buprenorphine (suboxone, subutex)
c. naloxone (revia, vivitrol)
Sedative Abuse
- may include sedatives, hypnotics, or anxiolytics
2. typically benzodiazepines
Sedative intoxication
- mood liability, impaired judgement, aggression
one or more:
- slurred speech
- incoordination
- unsteady gate
- nystagmus
- cognitive impairment (attention, memory)
- stupor or coma
Sedative Withdrawal
2 or more sx
- autonomic hyperactivity : sweating, tachycardia, etc.
- hand tremor
- insomnia
- nausea or vomiting
- transient hallucinations or illusions
- agitation
- anxiety
- grand mal seizures
Stimulant abuse (2)
- prescription medication
- ritalin
- adderall
- dextrostat - methamphetamines
Stimulant intoxication
- euphoria, blunt affect (difficulty expressing emotion), hyper vigilance, anger or tension, stereotyped behaviors, impaired judgement
- 2 or more pysical sx
a. tachy or brady cardia
b. pupillary dilation
c. abnormal blood pressure
d. sweating or chills
e. nausea or vomiting
f. weight loss
g. agitation
h. muscle weakness, respiratory depression, cardiac arrhythmias
i. confusion, seizures, dyskinesias, dystonia, or coma
Stimulant Withdrawal
- dysphoric mood
- 2 of the following
a. fatigue
b. vivid, unpleasant dreams
c. insomnia or hypersomnia
d. increases appetite
e. psychomotor retardation or agitation
Tobacco use stats
- 21% adults active smokers
- 22% adults former smokers
- more than 80% able to quit for a period
- 60% (of the 80% that quit) relapse
Tobacco use effects (3)
- mild stimulation
- recudes nausea
- calms anxiety in chronic smokers
Tobacco withdrawal
- cessation is followed within 24 hours by 4 or more
a. irritability, frustration, anger
b. anxiety
c. difficulty concentrating
d. restlessness
e. depressed mood
f. insomnia
Behavioral Addictions
- persistent and problematic behavior leading to clinically significant impairment with 4 or more of the following
a. need to engage in behavior with increasing intensity
b. restless or irritable when trying to cut down
c. has made repeated unsuccessful attempts to reduce or eliminate behavior
d. preoccupied with the behavior
e. engages in behavior as a way to deal with stress
f. in competitive behaviors, chases losses
g. lies to conceal the extent of their involvement with the behavior
h. has jeopardized a significant relationships, job, or opportunity due the behavior
i. relies on others to rescue them from the consequences of the behavior
Eating and Feeding disorders (2)
- persistent disturbances of feeding or eating that altered consumption of absorption of food, leading to physical and psychological impairments
- seen in children and adults
Pica (3)
- persistent eating of nonnutritive, nonfood substances for at least one month
- inappropriate to developmental age (at least two years old)
- not a culturally normative practice
ex) ice, clay, soil, paper
Rumination Disorder (3)
- persistent regurgitation of food for at least one month.
- regurgitated food may be spit out, re-chewed, or re-swallowed - not resulting from a gastrointestinal problem or another eating disorder
Anorexia Nervosa (3)
- restriction of energy intake relative to requirements resulting in
significantly low body weight for age and developmental expectations - intense fear of gaining weight or becoming fat, resulting in persist behaviors that prevent weight gain despite low body weight
- disturbance in the experience of body weight or shape, and undue influence of body weight or shape on self-evaluation or persistent lack of recognition of the seriousness of current low body weight
Anorexia Subtypes (2)
- restricting type
2. binge-purge type
Restricting Type Anorexia
- during last 3 months
2. individual has not engaged in binge eating or purging episodes
Binge-Purge Types
- during last 3 months, individual engaged in recurrent episodes of binge eating or purging behavior
- forced vomiting
- missuse of laxatives
- dieuretics or enemas
Medical Complications Anorexia
- leukopenia
- elevated liver and kidney lab functions
- loss of serum magnesium, zinc, phosphorus
- prolonged vomiting can cause hypokalemia and alkalosis
- reduced thyroid hormone levels
- bradycardia, arrhythmias, prolonged QTc interval
- low bone mineral density with increased fracture rx
- amenorrhea (absence of menstrual cycle)
- suicide rx
Bulimia Nervosa (5)
- recurrent episodes of binge eating
- compensatory behaviors such as forced vomiting, fasting, laxative or diuretic abuse, excessive exercising
- at least once a week for 3 months
- self-evaluation is unduly influenced by body shape and weight
- not exclusively occurs as part of anorexia nervosa
Binge-Eating Disorder (4)
- recurrent episodes of binge eating, at least once a week for 3 months
- 3 or more
a. eating more rapidly than normal
b. eating until uncomfortably full
c. eating more than hunger requires
d. eating alone to avoid embarrassment at amount of food consumed
e. feeling disgusted, depressed, or guilty afterwards
- marked distress about binge eating behaviors
- not accompanied by compensatory behaviors as in bulimia nervosa
Treatment eating disorder (4)
- primarily focused on psychotherapy and education
- may include empiric pharmacology-apetite stimulants, antidepressants
- prolonged therapy usually requried
- significant medical complications mat require inpatient services
