Psych - Clinical Presentation of Addiction Flashcards
How do we calculate units of alcohol
(% strength x ml of alcohol) ÷ 1000
What questionnaire can we use to screen alcohol harmful use
CAGE questionnaire (alongside AUDIT-C)
What do we ask in a CAGE questionnaire
- Have you ever felt the need to CUT down?
- Have you ever felt ANNOYED at someone criticising your drinking?
- Have you ever felt GUILTY about your drinking
- Have you ever needed a drink in the morning (EYE opener) to steady your nerves or rid a hangover?
What are the signs of opiate withdrawal
Restless Tachy Anxiety/irritable Runny nose Dilated pupils Sweating Bone ache GI upset Gooseflesh Yawning Tremor
What scale do we use for opiate withdrawal
COWS Clinical Opiate Withdrawal Scale (5-12 = mild, 25-36= moderately severe), 36+ = severe withdrawal
What are the 6 criteria for dependence syndrome
- Strong desire or sense of compulsion to take a substance
- Trouble controlling substance use with onset, termination and level of use
- Physical withdrawal in absence or reduction
- Tolerance
- Progressive neglect of alternative activities
- Persisting substance use despite clear evidence of harm
How many of the dependence syndrome criteria do we need to a diagnosis
3 of 6
What is harmful use classed as
pattern of substance use that should have caused physical or mental health damage in the absence of a diagnosis of dependence syndrome
What are the criteria for harmful use
Does not fulfil any other diagnosis within substance sue e.g. dependence
What do we include in our psychiatric history for substance use
PC and HPC Past psych history PMHx DHx and allergies FHx Personal Hx Permorbid personality Risk assessment
What are common co-morbidities of addiction
Depression Anxiety Suicidality Personality disorder PTSD bipolar disorder
What is the onset of alcohol withdrawal
Starts 6 hours with minor withdrawal symptoms e.g. mild tremor
What is a serious sign alcohol withdrawal
Alcoholic hallucinosis (12-24 hours) Withdrawal seizures (12-48 hours) Delirium tremens (48-72 hours)
What is delirium tremens
Auditory and visual hallucinations, confusion and disorientation, hypertension, agitation, tachycardia, fever (± infection), severe tremor in hands and body. Medical emergency
What do opioids do
Relieve pain (analgesia) Sense of euphoria
What do endogenous endorphins do
Also regulate pain and mood
What opioid receptors do we have
Mu, delta, kappa
What is the difference between opiates and opioids
Opiates refer to natural opioids such as morphine, codeine, opium, heroin to some extent
Opioids refer to natural, semisynthetic and synthetic opioids
what are the signs of opiate overdose
Not moving and can't be woken Slow or no breathing Choking, gurgling, sounds Tiny pupils Clammy or cold skin Blue lips and nails
What can we give during opiate overdose
Naloxone
What are g drugs
GHB (Gamma hydroxybutyrate)
GBL (Gamma butyrolactone)
What do you not mix with g
Alcohol - can cause death
What does G do
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
What are the risks of G
Easily overdosed on - small window between effective dose and toxic dose
Highly addictive and causes dependence
