Substance abuse

Question 1

What is EtOH’s mechanism of action?

Answer 1

Altering functioning of neuronal balance affecting GABA and Glu balance

Question 2

What is neurotoxicity of essential alcoholism?

Answer 2

Alcohol-specific damage (not due to other conditions associated with alcoholism)

Question 3

What are characteristics of neuronal damage from alcoholism?

Answer 3

Brain atrophy due to loss of white matter in the cerebral hemispheres, PFC, hypothalamus, and cerebellum

Question 4

What are features of Korsakoff syndrome?

Answer 4

Brain atrophy, microhemorrhages, lesions of DM nucleus of thalamus, mam bodies, mamillothalamic tract and gliosis due to thamine deficiency

Question 5

What percent of patients with alcoholism meet criteria for alcohol-induces amnestic disorder/dementia?

Answer 5

10%

Question 6

What is the trajectory of mild to moderate cognitive deficits?

Answer 6

Resolve in 70-90% over 6 mo

Persist in 10-30%

Question 7

WHat are cognitive effects of social drinking?

Answer 7

Mixed results
Framingham Heart Study:
modest positive effect of social drinking for women on all test performances except the WAIS Sims

Men - WMS Delayed Memory

Question 8

What are effects of chronic heavy drinking

Answer 8

Reductions in word-list generation, VS skills, memory, and processing speed

Question 9

What are features of non-Korsakoff alcoholism?

Answer 9

NP impairment on measures of abstraction, problem solving, and perceptual motor skills

Question 10

What are models of non-Korsakoff impairment?

Answer 10

RH dysfunction
EF dysfunction

Two systems model:
cerebellar-pontine-prefrontal (motor)
prefrontal-parietal corticocortical (cognitive)

Question 11

What are features of alcohol withdrawal syndrome?

Answer 11

Anxiety, depression, difficulty thinking clearly, fatigue, headache, insomnia, irritability, nausea, pale skin, sweating, vomiting

Treated with benzos

Question 12

What is delirium tremens?

Answer 12

Worsening of alcohol withdrawal syndrome in 5% of patients:

rapid muscle tremors, irregular heartbeat, heavy sweating, hallucinations

Question 13

What is Wernicke’s encephalopathy?

Answer 13

Progressively worsening and potentially permanent neuropsychiatric syndrome in the context of DT

Death in 20%

Required immediate thiamine treatment

Confusion, optix ataxia, ataxia of gait, abulia, apathy, global amnesia

Question 14

What is a common manifestation of cirrhosis from alcoholism?

Answer 14

Minimal hepatic encephalopathy

Problems with complex attention/EF, slowed processing speed

Question 15

What is another name for Wernicke-Korsakoff syndrome?

Answer 15

Alcohol-induced persisting amnestic disorder

Global amnesia, confabulation
Also EF deficits

Question 16

What are neurotransmitter involved and congitive effects of THC?

Answer 16

Cannobinoid receptor

Acute effects on learning and memory, typically resolve within a month

IS THIS TRUE??

Question 17

What are neurotransmitter involved and congitive side effects of cocaine?

Answer 17

Increases DA in limbic system

Deficits in attention, WM, visual memory, and EF

Question 18

What are neurotransmitter involved and congitive side effects of amphetamines?

Answer 18

Nigrostriatal DA projections

Decreased verbal memory, procesign speed, WM, and EF

Question 19

What are neurotransmitter involved and congitive side effects of benzodiazepines?

Answer 19

GABA

Immediate - Mental slowing and anterograde amnesia

Long-term therapeutic dose - significant widespread impairment

Question 20

What are neurotransmitter involved and cognitive side effects of opiates?

Answer 20

Endogenous opioid receptors

Deficits in EF

Question 21

What are neurotransmitter involved and cognitive side effects of ectasy?

Answer 21

Serotonin

Decreased ST and LTM and attention

Question 22

What are main treatment types for addition?

Answer 22

Treatment during detox (benzos for EtOH)
Substituiton therapy (methadone for opiates)
Relapse prevention (bupropion for nicotine)

Question 23

What is the best predictor of cognitive impairment in alcoholism?

Answer 23

Max quantity over past 6 months

Question 24

What brain structure is primarily affected by thiamine deficiency?

Answer 24

Cerebellum

Question 25

What is the rate of substance abuse relapse?

Answer 25

50%