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brs (phase 1b) > (psych) clinical management and presentation of addiction > Flashcards

(psych) clinical management and presentation of addiction Flashcards

1
Q

what is the unit equation for alcohol?

A

% strength x (ml/1000) = units

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2
Q

what is the recommended weekly limit for alcohol?

A

for both men and women, a maximum of 14 units a week

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3
Q

what is the excretion rate of alcohol?

A

approx 1 unit per hour

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4
Q

what are signs of harmful drug use or drug dependency?

A

craving

loss of control

restricted interest (preoccupied w getting high)

distress if cannot procure drug

regular injecting

WITHDRAWAL effects

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5
Q

what are the symptoms of opiate withdrawal?

A 
tachycardia
sweating
restlessness
dilated pupils
bone/joint aches
runny nose
upset GI tract
tremor
yawning
anxiety and irritability
gooseflesh skin
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6
Q

what is COWS?

A

clinical opiate withdrawal scale

an 11-item scale designed to be administered by a clinician that rate and monitor the progression of common signs and symptoms
of opiate withdrawal

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7
Q

what can IV drug use cause?

A

infective endocarditis

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8
Q

how can IV drug use cause infective endocarditis?

A

increased risk of infection due to unsterilised needles = infective endocarditis

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9
Q

how is dependence syndrome classified?

A

three or more of the following in past year:

  • sense of compulsion to take a substance
  • difficulties in controlling substance-taking behaviour
  • a physical withdrawal state when substance use has ceased or been reduced (mainly alcohol, opiates, benzodiazepines, G-drugs)
  • tolerance (ie. need to take more of the substance to get the same effect)
  • progressive neglect of alternative pleasures or interests because of substance use (increased amount of time necessary to obtain or take alcohol or to recover from its effects)
  • persisting with substance use despite clear evidence of overtly harmful consequences
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10
Q

summarise how dependence syndrome is classified

A

three OR more of the following in the last year:

  • compulsion to take a substance
  • difficulty controlling
  • withdrawal symptoms
  • tolerance
  • neglect (of other aspects in life)
  • persistence with the habit
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11
Q

what is harmful use?

A

a pattern of substance use that causes damage to health

damage = physical OR mental AND has adverse social consequences

= bingeing on substances also counts as harmful use but a hangover alone does not (!!!)

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12
Q

what are the classifications of harmful use?

A

1) physical
2) mental

= has adverse social consequences

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13
Q

can harmful use and dependence both be present in a patient?

A

a patient CANNOT have a diagnosis of BOTH harmful use AND dependence

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14
Q

what is used instead of the term ‘alcohol/opioid abuse’ and ‘dependence’ according to DSM-5?

A

opioid use disorder

alcohol use disorder

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15
Q

how is the severity of substance use disorders classified?

A

mild, moderate and severe

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16
Q

how is a history taken in addiction patients?

A 
presenting complaint 
HPC
past psychiatric history
past medical history
medication & allergies
drug history
family history
social history
personal history
premorbid personality
risk assessment

and MSE

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17
Q

how is a substance misuse history taken?

A

length of current use and when last used

current amount (units/grammes per day) and for how long at this level

total length of use, max use, and any periods of abstinenc

mode/method of use

evidence of withdrawals and severity (e.g. seizures, admissions)

any previous treatments - medication, psychotherapy, detox, rehab.

any previous substance overdoses (accidental vs deliberate)

assess triggers to use substances/alcohol

assess motivation to change/engage in treatment

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18
Q

what are common co-morbid conditions in addiction?

A 
depression
anxiety
suicidality
personality disorder
PTSD
bipolar disorder
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19
Q

what must you screen for when taking a past psychiatric history?

A

screen for developmental disorders especially ADHD, and ascertain general developmental and educational history

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20
Q

in addiction, what is the most common template of past psychiatric history?

A

history of trauma most commonly = always think traumatic life experiences (especially in childhood)

e.g. neglect and abuse; family history of substance misuse/violence

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21
Q

how is a social history taken for addiction?

A
  • relationships – partner, family, children (violence?)
  • safeguarding concerns?
  • accommodation problems?
  • money and debt?
  • employed/benefits?
  • forensic history? (cautions, convictions, time served, funding of habit, ongoing court cases)
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22
Q

what is drug-induced psychosis?

A

a cluster of psychotic phenomena that could occur during or immediately after substance use, especially stimulants

= vivid hallucinations, paranoid delusions (usually resolve in 1-6 months)

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23
Q

which stimulants cause drug-induced psychosis?

A

crack, methamphetamine

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24
Q

how does drug-induced psychosis present?

A

vivid hallucinations, often auditory

paranoid delusions (can be severe)

= usually resolves within 1-6 months

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25
Q

what is drug-induced psychosis similar to?

A

schizophrenic episode (that can be triggered by substance use too)

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26
Q

what are the major causes of morbidity and mortality associated with substance abuse?

A

trauma (e.g. fracture)

road traffic accidents

homicide and suicide

overdose (deliberate, but frequently accidental)

cirrhosis (alcohol)

endocarditis (IV)

abscesses (IV)

blood-borne viruses: Hep B/C, HIV (IV)

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27
Q

what does the examination for alcohol addiction consist of?

A

comment on the presence of jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT

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28
Q

which investigations are done for alcohol addiction?

A

fibro scan/ultrasound

bloods (LFT, GGT, lipids, U&E, amylase)

breathalyser

urine drug screen

29
Q

what does the examination for opioid addiction consist of?

A

collapsed veins/track marks

endocarditis

skin abscesses

hepatitis/HIV

pneumonia

30
Q

which investigations are done for opioid addiction?

A

bloods (LFT, U&E, GGT, glucose)

breathalyser

urine drug screen

sexual health screening

blood-borne viruses

31
Q

what is the epidemiology of alcohol?

A
  • 15-24 year-olds have heaviest use
  • unemployed > employed
  • divorced/separated > single > married
  • approx 30% of the UK population drink above safe limits
32
Q

what is the CAGE test for alcohol use?

A

a series of four questions that doctors can use to check for signs of possible alcohol dependency

33
Q

why is a CAGE test used?

A

less obtrusive question than asking someone directly if they have an alcohol problem

34
Q

what four questions are asked in a CAGE test?

A

have you ever felt you needed to Cut down on your drinking?

have people Annoyed you by criticizing your drinking?

have you ever felt Guilty about drinking?

have you ever felt you needed a drink first thing in the morning? (Eye-opener)

35
Q

what is the alcohol AUDIT tool?

A

simple screening tool to pick up the early signs of hazardous and harmful drinking and identify mild dependence

answer a series of questions and the resultant score indicates risk

36
Q

how are the results of an alcohol AUDIT assessment interpreted?

A

0-7 = low risk (consider VBA)

8-15 = increasing risk

16-19 = higher risk

20+ = possibility of dependence (refer to alcohol harm assessment team)

37
Q

what are the immediate physical effects of alcohol use?

A

CNS = impaired reaction time and motor coordination, impaired judgement

senses = poor visual acuity, smell, taste, hearing

stomach = nausea, inflammation

skin = sweating, heat loss, hypothermia

sexual = reduced erection response, reduced vaginal lubrication

38
Q

what are the systemic effects of chronic alcohol use?

A

CNS = brain atrophy, reduced brain size, damaged brain cells

CVS = weakened cardiac muscle, hypertension, arrhythmias

immune system = lower resistance to disease

digestive system = increased risk of cancers, cirrhosis

obesity

bone = increased osteoporosis, fractures

39
Q

what is alcohol withdrawal?

A

worsening pattern of symptoms after cessation of alcohol use

consists of tremors, fever, anxiety, hallucinosis, seizures, delirium tremors (rare but emergency)

40
Q

what is the onset of alcohol withdrawal?

A

usually after 6 hours

41
Q

what are delirium tremors?

A

confusion, auditory and visual hallucinations, agitation, fever, tachycardia = medical emergency as mortality is 15-20%

consider admitting and treating symptoms

42
Q

what are the risk factors for delirium tremors?

A

heavy daily alcohol use (60+ units)

history of DTs

older age

abnormal LFTs

43
Q

what is the function of opioids?

A

1) relieve pain = analgesic effect

2) creates a sense of euphoria, increasing pleasure and well-being

44
Q

what are endorphins?

A

type of endogenous opioid (along with enkephalins)

endorphins are peptides that act on the opiate receptors in the brain

= to relieve pain AND produce feelings of pleasure

45
Q

where are endorphins produced?

A

endogenous endorphins produced in the pituitary gland

can also be exogenous (i.e. opioid drug use)

46
Q

what are the opioid receptors?

A

mu, delta, kappa opioid receptors in the CNS (activate pain inhibitory pathways)

47
Q

which substances activate opioid receptors?

A

opioid agonists (heroin, methodone, fentanyl, codeine)

partial agonists (buprenorphine)

antagonists (naltrexone)

48
Q

name opioid receptor agonists

A

heroin, methodone, fentanyl, codeine

49
Q

name opioid receptor partial agonists

A

buprenorphine

50
Q

name opioid receptor anagonists

A

naltrexone

51
Q

define opioids

A

refer to all natural, semisynthetic,andsyntheticopioids

52
Q

define opiates

A

refer specifically to ONLY naturalopioidssuch as morphineandcodeine, and heroin to some extent

53
Q

differentiate between opiates and opioids

A

opioids = natural, semisynthetic and synthetic opioids

opiates = only NATURAL opioids

54
Q

name natural opioids

A

opium (mixture of morphine, codeine, thebaine, papaverine)

morphine

codeine

thebaine

55
Q

name synthetic opioids

A

fentanyl (x100 > than morphine)

methodone

tramadol

pethidine

56
Q

name semisynthetic opioids

A

heroin (x2 more potent than morphine)

hydrocodone

oxycodone

hydromorphone

57
Q

what are the signs of an opiate overdose?

A

not moving, cannot be woken up

slow/no breathing

choking

tiny pupils

clammy/cold skin

blue lips/nails

58
Q

how is an opiate overdose treated?

A

inject NALOXONE into upper arm or thigh, or nasal
spray (50% each nostril)

if no response after 3 mins = repeat

provide airway support, recovery position

59
Q

which medications are given to alcohol dependents during abstinence?

A

acamprosate

disulfiram

naltrexone (opioid antagonist)

nalmefene (opioid antagonist)

60
Q

which medications are given to opioid dependents during abstinence?

A

methadone (synthetic opioid)

buprenorphine (partial agonist)

61
Q

which medications are given to benzodiazepine dependents during abstinence?

A

maintenance on diazepam with a reducing regime (but many people struggle)

62
Q

what is the detox regime for alcohol dependents?

A

benzodiazepines

63
Q

what is the detox regime for opiate dependents?

A

maintenance treatment for at least 12 months before dose reduction

64
Q

what is the detox regime for benzodiazepine dependents?

A

medical supervision but must have access to an inpatient setting

baclofen (GABA agonist)

65
Q

what are G drugs?

A

the name given to the drugs GHB (gamma hydroxybutyrate) and GBL (gamma butyrolactone)

66
Q

how do G drugs interact with alcohol?

A

can lead to death

67
Q

what impact do G drugs have on the body?

A

effects usually occur in 15-20 mins and last up to 3-4 hours

precursor GBL is converted into GHB inside the body

68
Q

how do G drugs work?

A

depressant drugs produce a high with small doses and cause sedation with only slightly higher doses

= euphoria, loss of inhibition, increased confidence

69
Q

what are the risks of G drugs?

A

easy to overdose as not much difference between the dose required for high and that required for overdose

highly addictive

leads rapidly to dependence

brs (phase 1b) (71 decks)

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