Psychiatry Flashcards
What are screening tools used for alcoholism?
CAGE - cut down, annoyed, guilty and eye-opener
AUDIT - Alcohol Use Disorders Identification Test
SADQ - Severity of Alcohol Dependence Questionnaire
Briefly outline the 6 key features of dependence syndrome
- Strong desire to take the substance
- Difficulties controlling substance-taking behaviour (onset, termination or amount of use)
- Tolerance
- Withdrawal symptoms
- Neglect of other pleasures
- Persistence despite evidence of harmful consequences
What are the main effects of opioids?
Euphoria and Analgesia
SE of opioids
Respiratory depression
Constipation
Reduced appetite
Low libido
What is a beneficial effect of buprenorphine?
Creates a ceiling effect - no additional effect above a certain drug dose (reduced overdose likelihood)
Psychological therapies for opioid misuse
CBT
Motivational counselling
Support Groups
What can occur in withdrawal of Benzodiazepines?
Withdrawal symptoms including rebound symptoms
Commonest drugs in anxiolytics and hypnotics class?
Benzodiazepines
barbiturates
Commonest drugs in the Stimulants class?
Amphetamines and cocaine
Which substances more commonly cause paranoia?
Stimulants and Alcohol
Clinical effects of stimulants?
Sympathetic: pupils dilate, tachycardia, increased alertness, dry mucus membranes
Overactivity and Insomnia
Mood swings
What neurotransmitters are affected by cocaine?
Dopamine - reward pathways leading to euphoria, pleasure and emotional ‘high’
Noradrenaline - sympathetic symptoms
Serotonin - increased confidence
What is Ecstasy/MDMA?
Hallucinogen with stimulant properties
What is negative and positive reinforcement in relation to addiction?
Negative - negative (withdrawal) symptoms encourages further substance use
Positive - positive and euphoric symptoms associated with the substance encourage further use
Clinical and Physical effects of ecstasy.
Clinical:
Positive mood
Euphoria, sociability and intimacy
Sensations of newly discovered insights and heightened perceptions
Physical:
Sympathetic
Bruxism (gurning)
Example of a hallucinogen and clinical effects.
LSD
Sympathetic followed up psychological:
Distortions and intensifications of sensory perception
Out-of-body experiences
Altered mood
How does the dose affect symptoms of ketamine use?
Low - mood elevation
High - hallucinogenic similar to LSD
What is Korsakoff’s Psychosis?
Amnestic-confabulation Syndrome:
Amnesia (anterograde and retrograde)
Confabulation
Lack of insight
Apathy
What is Wernicke’s Encephalopathy?
Classical triad:
Ophthalmoplegia
Ataxia
Confusion
At what point may delirium tremens occur?
48-72hrs after alcohol withdrawal
When do symptoms typically peak and subside in acute alcohol withdrawal?
Peak after 2/7 and subside after 4-5/7
How does delirium tremens differ to classical withdrawal symptoms?
Evidence of altered mental state in DT
e.g. hallucination, delusions, confusion, agitation
When are alcohol withdrawal seizures likely to occur?
What type of seizure?
24-48hrs post withdrawal
Generalised tonic-clonic
RF to consider admission for acute alcohol withdrawal.
- Age <18 years
- Lives alone (no support)
- Previous withdrawal seizures/DT
- Previous failed withdrawal
- Complications e.g. Wernicke’s
