Pyschiatry Flashcards
Alcohol absorption
Absorbed from the mouth, stomach and small bowel.
Maximum blood concentration is reached within 60 minutes of ingestion.
Absorption slowed by food and sped up by effervescent drinks. It is hydrophilic and therefore widely distributed in all bodily tissues
Alcohol pharmacodynamics
Enhances neurotransmission at GABA-A receptors (anxiolysis).
Stimulates dopamine release in the mesolimbic system (reward)
Inhibits NMDA mediated glutamate release (amnesic effects)
Alcohol metabolism
Ethanol is oxidised by alcohol dehydrogenase to acetaldehyde. This is oxidised by acetaldehyde dehydrogenase to carbon dioxide and water. 98% of alcohol metabolism occurs in the liver and 1 unit of alcohol (8g) can be metabolized per hour. Illicit brew may contain methanol which is broken down to formaldehyde and causes marked toxicity on the retina.
Alcohol assessment - neurological signs
Wernicke’s encephalopathy (ataxia, confusion, ophthalmoplegia) and Korsakoff’s syndrome (memory impairment)
Alcohol assessment - examination
Jaundice, bruising, clubbing, oedema, ascites, spider naevi
Alcohol assessment - investigations
Liver Fibro scan / Ultrasound
Bloods (LFT, GGT, Lipids, U&E, amylase)
Breathalyser
Urine Drug Screen
CAGE screening for alcohol
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)
Features of mild dementia
May live independently but some supervision/support often needed
Can still take part in community activities and can appear unimpaired to those who do not know them
Judgement and problem solving typically impaired
Social judgement may be preserved
Difficulty making complex plans/decisions and handling finances
Features of moderate dementia
Require supports to function outside the home and only simple household tasks are maintained
Difficulties with basic activities of daily living (ADL’s), such as dressing and personal hygiene
Significant memory loss
Judgment and problem solving are typically significantly impaired, and social judgment is often compromised
May have difficulty communicating with individuals outside the home without caregiver assistance
Socializing is increasingly difficult as the individual may behave inappropriately (e.g., in disinhibited or aggressive ways), with associated behaviour changes (e.g., calling out, clinging, wandering, disturbed sleep, or hallucinations).
Difficulties are often obvious to most individuals who have contact with the individual.
Severe dementia features
Severe memory impairment
Often total disorientation for time and place.
Often completely unable to make judgments or solve problems.
May have difficulty understanding what is happening around them.
Fully dependent on others for basic personal care in activities such as for bathing, toileting and feeding.
Urinary and faecal incontinence may emerge at this stage
