Psychiatric effects of drugs and alcohol

Question 1

Common factor model of substance abuse and mental illness

Answer 1

The idea that one common factor predisposes to both substance use and mental illness e.g. genetic factor or socioeconomic status

Question 2

Secondary use model of substance abuse and mental illness

Answer 2

The idea that patients use substances to alleviate symptoms of mental illness

Question 3

Supersensitivity model of substance abuse and mental illness

Answer 3

The idea that mentally unwell patients are unusually sensitive to the negative consequences of substance use which leads to a diagnosis of substance use disorder

Question 4

Secondary illness model of substance abuse and mental illness

Answer 4

The idea that substance use disorders lead to mental illness

Question 5

Most common hallucinations seen in alcoholic hallucinosis

Answer 5

Unstructured voices or sounds that are threatening

Question 6

Differences between alcoholic hallucinosis and schizophrenia

Answer 6

Later age of onset of symptoms in alcoholic hallucinosis
Onset of alcohol preceding symptoms in alcoholic hallucinosis
Remission of symptoms during abstinence in alcoholic hallucinosis
Lack of thought disorder in alcoholic hallucinosis
Thought congruence in alcoholic hallucinosis

Question 7

Classic triad of Wernicke’s encephalopathy

Answer 7

Confusion
Ataxia
Nystagmus

Question 8

Percentage of patients with Wernicke’s encephalopathy who present with the classic triad

Answer 8

10%

Question 9

Vitamin deficiency causing Wernicke’s encephalopathy

Answer 9

Thiamine deficiency (vitamin B1)

Question 10

Type of memory most affected by Korsakoff’s syndrome

Answer 10

Anterograde memory

Question 11

Are of the brain lesions are most often seen in Korsakoff’s syndrome

Answer 11

Dorsomedial thalamus

Question 12

Areas of the brain where lesions cause confabulation in Korsakoff’s syndrome

Answer 12

Frontal
Diencephalic

Question 13

Type of cells in the cerebellum where degeneration is seen in chronic alcohol use

Answer 13

Purkinje cells

Question 14

Clinical features of cerebellar degeneration associated with chronic alcohol abuse

Answer 14

Limb ataxia
Dysarthria

Question 15

Clinical features of hepatic encephalopathy due to liver failure

Answer 15

Altered conscious level
Flapping tremor
Hyperreflexia
Extensor plantar reflexes

Question 16

Syndrome seen in those who make a partial recovery from hepatic encephalopathy

Answer 16

Hepatocerebral degeneration

Question 17

Clinical features of hepatocerebral degeneration

Answer 17

Tremor
Choreoathetosis
Dysarthria
Gait ataxia
Dementia/cognitive impairment

Question 18

Type of alcohol associated with Marchiafava-Bignami syndrome

Answer 18

Red wine

Question 19

Pathological findings in Marchiafava-Bignami syndrome

Answer 19

Demyelination of the corpus callosum and adjacent subcortical white matter

Question 20

Clinical features of Marchiafava-Bignami syndrome

Answer 20

Dementia
Spasticity
Dysarthria
Gait changes
Coma

Question 21

Clinical features of central pontine myelinolysis

Answer 21

Pain in the limbs
Bulbar palsy
Quadriplegia
Disordered eye movements
Vomiting
Confusion
Coma/locked in syndrome

Question 22

Electrolyte abnormality seen in alcoholic pancreatitis

Answer 22

Hypocalcaemia

Question 23

Hallmark of amphetamine induced psychosis

Answer 23

Paranoia

Question 24

Specific features seen in amphetamine induced psychosis

Answer 24

Limited negative symptoms
Visual hallucinations
Congruent affect
Hyperactivity
Disinhibited sexual behaviour
Confusion and incoherence but no formal thought disorder

Question 25

Disorder seen after hallucinogen use where the patient experiences flashbacks to the hallucinogenic experience they had at the time of taking the substance

Answer 25

Hallucinogen persisting perception disorder

Question 26

Drug associated with amotivational syndrome in chronic use

Answer 26

Cannabis

Question 27

Percentage of patients with Wernicke's encephalopathy who present with confusion

Answer 27

80%

Question 28

Lifetime suicide risk in dependent drinkers

Answer 28

10-15%

Question 29

Percentage of alcoholics who develop cerebellar degeneration

Answer 29

33%

Question 30

Brain area where gliosis and small haemorrhages are seen in patients with Wernicke's encephalopathy

Answer 30

Mamillary bodies

Question 31

Brain area at which alcohol blocks the consolidation of new memories into old memories

Answer 31

Hippocampus

Question 32

Type of memory most affected in Korsakoff syndrome

Answer 32

Episodic memory

Question 33

Affect of Korsakoff's syndrome on intelligence on the WAIS

Answer 33

Intelligence is preserved

Question 34

Normal result in a digit span memory test for someone with Korsakoff's syndrome

Answer 34

Normal

Question 35

Features of Korsakoff's syndrome

Answer 35

Inability to form new memories Apathy Lack of initiative Lack of insight Preserved implicit memory

Question 36

Most common presenting symptom of Wernicke's encephalopathy

Answer 36

Confusion

Question 37

Mortality rate of untreated Wernicke's encephalopathy

Answer 37

10-20%

Question 38

Percentage of patients with Wernicke's encephalopathy who go on to develop Korsakoff's if untreated

Answer 38

80%

Question 39

Medication which should be avoided in a patient with Wernicke's encephalopathy

Answer 39

IV glucose

Question 40

Symptoms most likely to improve when Wernicke's is treated

Answer 40

Confusion Ophthalmoplegia

Question 41

Most common symptom of Korsakoff syndrome

Answer 41

Amnesia