Psy 4 - Alcohol Abuse

Question 1

What are the stages of behavioral change associated with substance use disorder?

Answer 1

Precontemplation. Contemplation. Preparation/determination. Action/willpower. Maintenance. Relapse.

Question 2

What are the symptoms of alcohol intoxication?

Answer 2

Mood elevation. Disinhibition. Decreased anxiety. Sedation. Severe mental impairment. Somnolence. Respiratory depression.

Question 3

What are the symptoms of alcohol withdrawal?

Answer 3

Agitation. Anxiety. Insomnia. Tremor.

Question 4

Where does alcohol act on the brain?

Answer 4

Effect on GABA receptors.

Question 5

What is the treatment for alcohol intoxication?

Answer 5

No reversal agent for alcohol intoxication.

Question 6

What is Delirium Tremens?

Answer 6

Nightmares. Agitation. Disorientation. Hallucinations. Fever. Hypertension or hypotension. Diaphoresis. Symptoms being 2-3 days after cessation of alcohol. Can have seizures and extreme autonomic hyperactivity.

Question 7

What are the treatment for alcohol withdrawal?

Answer 7

Benzodiazepines (longer acting). Alcohol.

Question 8

What are the long term damages caused by alcoholism?

Answer 8

Liver damage (fatty change; increased GGT, AST twice higher than ALT (A Scotch and Tonic). Alcoholic cirrhosis. Hepatitis. Pancreatitis. Peripheral neuropathy. Testicular atrophy. Saturday night palsy (compression of radial artery/nerve in spiral groove). Aspiration pneumonia.

Question 9

What is CAGE questionnaire?

Answer 9

[CAGE] Cut back. Annoyance. Guilt. Eye-opener. Used to screen alcoholics.

Question 10

What is Wernicke-Korsakoff syndrome?

Answer 10

Caused by thiamine deficiency (Vitamin B1). Wernicke encephalopathy is the acute presentation of thiamine deficiency and Korsakoff syndrome is the long-term consequence. Causes damage in medial thalamus and mammillary bodies of posterior hypothalamus.

Question 11

What are the symptoms of Wernicke encephalopathy?

Answer 11

Confusion. Nystagmus. Ophthalmoplegia. Ataxia. Sluggis pupillary reflexes. Coma and death if untreated.

Question 12

What are the symptoms of Korsakoff syndrome?

Answer 12

Anterograde amnesia (inability to form new memories). Retrograde amnesia (loss of existing memories). Confabulation (false perceptions or memories). Hallucinations.

Question 13

Why should we not give a solution of glucose With thiamine to someone with Weknicke-Korsakoff syndrome?

Answer 13

Alcohol impairs the liver to undergo gluconeogenesis, and the active form of thiamine is a major cofactor in the metabolism of glucose, therefore anything that will increase glucose metabolism (like putting glucose) in the body will worsen symptoms.

Question 14

What is Mallory-Weiss syndrome?

Answer 14

Longitudinal laceration of the gastroesophageal junction caused by excessive vomiting.

Question 15

What are esophageal varices?

Answer 15

Extremely dilated submucosal veins in lower esophagus. Caused by portal HTN. Present with coffee ground emesis.

Question 16

What are the long term treatments for alcoholism?

Answer 16

Alcoholics Anonymous is the tried and true best relapse prevention. Naltrexone. Disulfiram. Topiramate. Acamprosate.

Question 17

What is the mechanism of action of the drug Disulfiram?

Answer 17

It inhibits acetaldehyde dehydrogenase. When taken with alcohol, the accumulation of acetaldehyde leads to symptoms.

Question 18

When does delirum tremens occur?

Answer 18

2-3 days after cessation of alcohol.

Question 19

RFF: Medical treatment for alcohol withdrawal.

Answer 19

Benzodiazepines.

Question 20

RFF: Most effective treatment for alcohol abuse.

Answer 20

Alcoholics anonymous.

Question 21

RFF: Atrophy of the mammillary bodies.

Answer 21

Wernicke encephalopathy.

Question 22

What is substance use disorder and what are the criteria to diagnose it?

Answer 22

Problematic pattern of substance use that leads to significant impairment or distress. Needs 2 of the following for at least a year: tolerance, withdrawal symptoms, persistent desire or unsuccessful attempts to cut down, significant energy spent obtaining, using or recovering, social, occupational or recreational activities reduced, continued use in spite of knowledge of problems, craving, recurrent use in physically dangerous situations, failure to fulfill obligations at work, school, or home, social or interpersonal conflicts.