Substance abuse and eating disorders Flashcards
What are the eating disorders
Anorexia nervosa- low body weight from restriction of food
Bulimia nervosa- episodes of uncontrolled eating followed by compensatory behaviours
Binge eating disorders- where eat excessively but no compensatory behaviours
Atypical eating disorders- closely resemble other disorders but do not meet criteria
Diagnostic criteria for bulimia nervosa
Binge eating episodes with compensatory behaviour to prevent weight gain at least once a week for 3 months
Feel as if have no control over episodes
Physical signs may be present
Examples of compensatory methods in bulimia
Excessive exercising
Diet pill
Diuretics
Self induced vomiting
Laxatives
Physical signs of bulimia nervosa
Erosion of teeth
Russels sign- calluses on knucjles or back of hand
From induced vomiting
Management of bulimia nervosa
Refer immediately to eating disorder specialist
First line is BN focused guided self help for 4 weeks
If ineffective then ED-CBT
Can cosider high dose fluoxetine
Classifying bulimia nervosa
Mild
- over 1 episode a week
Moderate
- over 2 episodes a week
- no other abnormalities
Severe
- electrolyte abnormalities
- daily purges
When would admit someone with eating disorder
CVD instability
Concurrent infection
Generally unwell
Hypothermia
Electrolyte abnormality
Reduced muscle power on sit-up squat stand test
BMI under 16
Hypoglycaemia
High risk of refeeding syndrome
How does alcohol withdrawal present
6-12 hours
- tremor
- restless
- sweating
- palpitations
36 hours
- seizures
48-72 hours (delirium tremens)
- coarse tremor
- confusion
- delusions
- auditory and visual hallucinations
- fever
What is mechanism behind alcohol withdrawal
Alcohol consumption enhances GABA inhibition and inhibits glutamate receptors
In withdrawal the opposite happens
What is treatment for alcohol withdrawal
1st line:
- chlordiazepoxide
- can use carbamezapine
2nd line clomethiazole
Offer advice on local services for addiction
Treatment of delirium tremens
1st line: oral lorazepam
If persist- IV lorazepam or haloperidol
Can use chlordiazeperoxide
Management of seizures in alcohol withdrawal
Lorazepam or chlordiazeperoxide
What class of drug is chlordiazepoxide
Benzo
Management of alcohol withdrawal
Fill out clinical institute withdrawal assessment (CIWA)
Used to determine need for seizure prophylaxis or benzos
Low BMI
Bradycardia
Hypotension
Enlarged salivary glands
A nervosa
Blood findings of a nervosa
Hypokalaemia
Low FSH, LH, oestrogen and testosterone, platelets
Raised Cs and Gs
Cortisol
Cholesterol
GH
Glucose- impaired glucose tolerance
What are lanugo hairs seen in
Anorexia- fine downy hair growth in response to loss of body fat
Presentation of opiate withdrawal
Everything runs
Neuro- agitation, mydriasis, parasthesia
Psych- depression, craving
Gastro- D&V
Derm- lacrimation, sweating, rhinorrhoea
Goosebumps
Features of opiate withdrawal
Occur within 12 hours typically
Not life threatening
How does cocaine withdrawal present
2 phases
First phase within hours of last use- like a crash
- depression
- exhaustion
- agitation
- irritbaility
Second phase
- increased cravings
- tired
- poor concentration
- insomnia
- slowed activity
What is excited delirium
A complication of cocaine and other illicit drug intoxication
How does excited delirium present
Profuse sweating
Delirium
Hallucinations
Super human strength
What happens to amylase in anorexia
High
Management of paracetamol overdose
If present within 2 hours of ingestion can use activated charcoal
Measure levels after 4 hours of ingestion
Determines if need for IV n-acetylcysteine infusion
What do if present within 2hours of paracetamol OD
Activated charcoal
What is used in the assisted withdrawal from alcohol
Reducing doses of benzos- chlordizepoxide or diazepam
What is used to prevent relapse of alcoholism
Acamprosate
Naltrexone
2nd line- disulfiram
MOA of disulfiram
Acetaldehyde inhibitor which promotes feelings of hangover
What presents with poor executive functioning, sexual disnhibition and impulsivity, lack of insight into personality change and forced utilisation
Frontal lobe syndrome
What can cause frontal lobe syndrome
Head injury
Stroke
Picks disease
Presentation of frontal lobe syndrome
Poor executive functioning
Change in social behaviour and personality
Forced utilisation (where use objects correctly but at wrong time)
Re-emergence of primitive reflexes
Difference in administration of methadone versus buprenorphine
Methadone a liquid
Buprenorphine a sublingual tablet
Difference between CIWA and AUDIT
CIWA used to manage alcohol withdrawal (when to give benzos)
AUDIT used to manage alcohol dependance
Management if come in wanting to sort out alcohol dependance
AUDIT- Alcohol use disorders identifcation test
If over 20 refer for specialist management
First line psychotherapy for alcoholism
Self help groups
Administration methods of opiods
IV
Inhalation
Diagnositc criteria for AN
BMI under 17.5
Deliberate weight loss
Body image disotortion
Amenorrhoea in women or low libido in men
How is atypical AN diagnosed
AN criteria but without 1 feature
Low weight differentials
IBD, addisons, hyperthyroid
Socioeconomic
Confusion
Personality disorders
Depression
OCD
When monitoring someone with eating disorder what physical things are worried about
Weight
Bone mineral density
Management of anorexia nervosa in children
1st line- family therapy
2nd ED CBT or adolescent psychotherapy for AN
Management of anorexia nervosa in adults
Choose from either CBT, MANTRA and selective supportive clinical management
If neither of these work then consider Focal psychodynamic therapy
What is refeeding syndrome
When refeed after period of starvation get intracellular shift of magnesium, potassium, phosphate
When do you get seizures in alcohol withdrawal
36 hours
Management of binge eating disorder
First line- self help guides with supportive sessions
Second line- group-CBT
Third line- individual CBT
What is difference in MOA of acamprosate vs naltrexone
Acamprosate- reduces cravings for alcohol
Naltrexone- reduces pleasure of drinking alcohol
How is alcoholism diagnosed according to ICD-10
3 of the following/6
Drinking not problematic without three criteria
Desire- craving
Neglect- do you miss things because of drinking
Pervasive- have there been problems in your life
Withdrawal- what happens when dont drink
Tolerance- has your tolerance increased
Control- have they lost control
How assess patient with anorexia nervosa after history
Obs
ECG
Squat test
BMI
Bloods- electrolytes, glucose
How does cannabis use present
Red eyes
Dry mouth
Increased HR
Increased appetite
Which /recreational drug is of main concern to psychiatrists nowadays
Spice/black mamba- synthetic cannabinoids
How can spice used present
Psychosis
Confusion
Aggression
Vomiting
How to investigate benzo withdrawal
Urine drug screen
How is benzo withdrawal managed
Contact addiction services
Convert to diazepam equivalent dose
Slowly reduce by 10% every 2 weeks
Talking therapies
What is difference between harmful use and substance abuse
Both involve using a psychoactive substance
Harmful use- pattern of use which has effect on health
Substance abuse- continued use which has effect on physical and mental health plus social responsibilities
What questionnaire can be used to quickly screen for alcohol abuse
FAST- fast alcohol screening test
How do you calculate units
(Volume x alcohol by volume)/1000
MOA of acamprosate
Modulates NMDA to reduce glutamergic transmission
MOA of naltrexone
Mixed opiod antagonist with high affinity for u-opiod receptor
What cant give before thiamine in alcohol withdrawal
Glucose
Triad for wernickes
Opthalmoplegia
Confusion
Opthalmoplegia
Management of alcohol withdrawal
CIWA- Chlordiazepoxide regime
Add pabrinex
How does korsakoffs syndrome
Anterograde amnesia
Confabulation
Psychosis
Frontal lobe symptoms- childlike personality
What is given to those on opiate susbstitution therapy
IM naloxone in case of resp depression
How manage OST in acute hospital care
Check with GP/drug service the drug and date of last collection
How do methadone and buprenorphine compare to heroin
Longer half life
Less euphoria and resp depression etc
Rating scale for opiate withdrawal
Clinical opiate withdrawal scale
Difference between withdrawal syndrome and complex withdrawal
Complicated involves delirium, seizures or psychosis
Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible
Central pontine myelinolysis as hyponatraemia common in alcoholism
Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible
Central pontine myelinolysis as hyponatraemia common in alcoholism
Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible
Central pontine myelinolysis as hyponatraemia common in alcoholism
What questionnaire for severity of dependance
SADQ- severity of alcohol dependance questionnaire
Management based on AUDIT and SADQ outcome
Over 20 on AUDIT- refer to alcohol services
Over 30 on SADQ- refer for inpatient withdrawal
How much of chlordiazepoxide do you give someone withdrawing from alcohol
No more than 2 days medication at a tome
Principles of managing opiate withdrawal
Test for blood borne viruses and offer vaccinations
Detoxification regime- methadone or buprenorphine (will lessen symptoms of withdrawal)
Treat symptomatically
Refer to drugs and alcohol services
- key worker
- talking therapies
Which SSRI for BN
Fluoxetine
What do you assume are units in a pint, glass of wine and a shot
Pint- 2
Glass of wine- 1.5
Shot- 1
What drugs can cause erectile dysfunction
Antihistamines
Parkinsonism
Benzos
TCA
Statins
B blockers
What is voyeurism
When enjoy watching other people have sex
What happens to carotemia in AN
Hyper- remember C and Gs go up
How manage a staggered paracetamol overdose vs all in one
If all pills consumed within 1 hour of eachother then measure levels after 4 hours
If a staggered OD (where over an hour between first and last pill) then give straight away
Eating disorder when purges but considerable focus on food and weight loss
Anorexia
How does body dysmorphic syndrome present
When person is consumed with negative and perceived flaws about their body- normally 1 part of body like nose breast size etc
How are cocaine induced myocardial infarctions managed
Benzodiazepines
What murmur can be heard in anorexia
Mid systolic murmur with a click due to mitral valve prolapse from loss of cardiac muscle
Under what act should you be admitted for anorexia forecful feeding
Section 2
What happens to WCC in anorexia
Down due to malnutrition
What is choice of replacement for opiods
1st line is methadone
Either can be chose first but methadone first choice, unless has history of OD on methadone
What is used for detoxification if people need pharmacological help with opiate withdrawal but want to avoid methadone or buprenorphine
Lofexidine
If want to quickly withdraw from opiates what do
Lofexidine
First clinical signs of refeeding
Tachycardia
Oedema
Confusion
Initial treatment of refeeding
Phosphate replacement
What are U waves seen in
Hypokalaemia
How does LSD use present
HTN
Tachycardia
Fever
Psychosis
What determines whether full dose or titrated boluses naloxone given
If apnoeic then give full dose
What do excoriation marks after an overdose suggest
Opiods as relesaes histamine
What drug can be given to help with anorexia nervosa treatment
Olanzapine as can reduce obsessions with food as well as increase appetite
