Psych - Clinical Presentation of Addiction

Question 1

How do we calculate units of alcohol

Answer 1

(% strength x ml of alcohol) ÷ 1000

Question 2

What questionnaire can we use to screen alcohol harmful use

Answer 2

CAGE questionnaire (alongside AUDIT-C)

Question 3

What do we ask in a CAGE questionnaire

Answer 3

1. Have you ever felt the need to CUT down?
2. Have you ever felt ANNOYED at someone criticising your drinking?
3. Have you ever felt GUILTY about your drinking
4. Have you ever needed a drink in the morning (EYE opener) to steady your nerves or rid a hangover?

Question 4

What are the signs of opiate withdrawal

Answer 4

Restless
Tachy
Anxiety/irritable 
Runny nose
Dilated pupils 
Sweating 
Bone ache
GI upset
Gooseflesh 
Yawning 
Tremor

Question 5

What scale do we use for opiate withdrawal

Answer 5

COWS Clinical Opiate Withdrawal Scale (5-12 = mild, 25-36= moderately severe), 36+ = severe withdrawal

Question 6

What are the 6 criteria for dependence syndrome

Answer 6

1. Strong desire or sense of compulsion to take a substance
2. Trouble controlling substance use with onset, termination and level of use
3. Physical withdrawal in absence or reduction
4. Tolerance
5. Progressive neglect of alternative activities
6. Persisting substance use despite clear evidence of harm

Question 7

How many of the dependence syndrome criteria do we need to a diagnosis

Answer 7

3 of 6

Question 8

What is harmful use classed as

Answer 8

pattern of substance use that should have caused physical or mental health damage in the absence of a diagnosis of dependence syndrome

Question 9

What are the criteria for harmful use

Answer 9

Does not fulfil any other diagnosis within substance sue e.g. dependence

Question 10

What do we include in our psychiatric history for substance use

Answer 10

PC and HPC
Past psych history 
PMHx
DHx and allergies 
FHx
Personal Hx
Permorbid personality 
Risk assessment

Question 11

What are common co-morbidities of addiction

Answer 11

Depression
Anxiety
Suicidality 
Personality disorder
PTSD
bipolar disorder

Question 12

What is the onset of alcohol withdrawal

Answer 12

Starts 6 hours with minor withdrawal symptoms e.g. mild tremor

Question 13

What is a serious sign alcohol withdrawal

Answer 13

Alcoholic hallucinosis (12-24 hours)
Withdrawal seizures (12-48 hours)
Delirium tremens (48-72 hours)

Question 14

What is delirium tremens

Answer 14

Auditory and visual hallucinations, confusion and disorientation, hypertension, agitation, tachycardia, fever (± infection), severe tremor in hands and body. Medical emergency

Question 15

What do opioids do

Answer 15

Relieve pain (analgesia)
Sense of euphoria

Question 16

What do endogenous endorphins do

Answer 16

Also regulate pain and mood

Question 17

What opioid receptors do we have

Answer 17

Mu, delta, kappa

Question 18

What is the difference between opiates and opioids

Answer 18

Opiates refer to natural opioids such as morphine, codeine, opium, heroin to some extent

Opioids refer to natural, semisynthetic and synthetic opioids

Question 19

what are the signs of opiate overdose

Answer 19

Not moving and can't be woken 
Slow or no breathing
Choking, gurgling, sounds
Tiny pupils
Clammy or cold skin
Blue lips and nails

Question 20

What can we give during opiate overdose

Answer 20

Naloxone

Question 21

What are g drugs

Answer 21

GHB (Gamma hydroxybutyrate)

GBL (Gamma butyrolactone)

Question 22

What do you not mix with g

Answer 22

Alcohol - can cause death

Question 23

What does G do

Answer 23

Depressant drugs which produce a high with small doses and sedation as you increase the dose - causes euphoria, loss of inhibition and higher confidence and sex drive

Question 24

What are the risks of G

Answer 24

Easily overdosed on - small window between effective dose and toxic dose
Highly addictive and causes dependence