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Substance abuse and eating disorders Flashcards

1
Q

What are the eating disorders

A

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

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2
Q

Diagnostic criteria for bulimia nervosa

A

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

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3
Q

Examples of compensatory methods in bulimia

A

Excessive exercising
Diet pill
Diuretics
Self induced vomiting
Laxatives

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4
Q

Physical signs of bulimia nervosa

A

Erosion of teeth
Russels sign- calluses on knucjles or back of hand
From induced vomiting

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5
Q

Management of bulimia nervosa

A

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

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6
Q

Classifying bulimia nervosa

A

Mild
- over 1 episode a week
Moderate
- over 2 episodes a week
- no other abnormalities
Severe
- electrolyte abnormalities
- daily purges

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7
Q

When would admit someone with eating disorder

A

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

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8
Q

How does alcohol withdrawal present

A

6-12 hours
- tremor
- restless
- sweating
- palpitations

36 hours
- seizures

48-72 hours (delirium tremens)
- coarse tremor
- confusion
- delusions
- auditory and visual hallucinations
- fever

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9
Q

What is mechanism behind alcohol withdrawal

A

Alcohol consumption enhances GABA inhibition and inhibits glutamate receptors
In withdrawal the opposite happens

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10
Q

What is treatment for alcohol withdrawal

A

1st line:
- chlordiazepoxide
- can use carbamezapine
2nd line clomethiazole
Offer advice on local services for addiction

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11
Q

Treatment of delirium tremens

A

1st line: oral lorazepam
If persist- IV lorazepam or haloperidol
Can use chlordiazeperoxide

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12
Q

Management of seizures in alcohol withdrawal

A

Lorazepam or chlordiazeperoxide

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13
Q

What class of drug is chlordiazepoxide

A

Benzo

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14
Q

Management of alcohol withdrawal

A

Fill out clinical institute withdrawal assessment (CIWA)
Used to determine need for seizure prophylaxis or benzos

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15
Q

Low BMI
Bradycardia
Hypotension
Enlarged salivary glands

A

A nervosa

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16
Q

Blood findings of a nervosa

A

Hypokalaemia
Low FSH, LH, oestrogen and testosterone, platelets
Raised Cs and Gs
Cortisol
Cholesterol
GH
Glucose- impaired glucose tolerance

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17
Q

What are lanugo hairs seen in

A

Anorexia- fine downy hair growth in response to loss of body fat

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18
Q

Presentation of opiate withdrawal

A

Everything runs
Neuro- agitation, mydriasis, parasthesia
Psych- depression, craving
Gastro- D&V
Derm- lacrimation, sweating, rhinorrhoea
Goosebumps

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19
Q

Features of opiate withdrawal

A

Occur within 12 hours typically
Not life threatening

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20
Q

How does cocaine withdrawal present

A

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

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21
Q

What is excited delirium

A

A complication of cocaine and other illicit drug intoxication

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22
Q

How does excited delirium present

A

Profuse sweating
Delirium
Hallucinations
Super human strength

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23
Q

What happens to amylase in anorexia

A

High

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24
Q

Management of paracetamol overdose

A

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

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25
What do if present within 2hours of paracetamol OD
Activated charcoal
26
What is used in the assisted withdrawal from alcohol
Reducing doses of benzos- chlordizepoxide or diazepam
27
What is used to prevent relapse of alcoholism
Acamprosate Naltrexone 2nd line- disulfiram
28
MOA of disulfiram
Acetaldehyde inhibitor which promotes feelings of hangover
29
What presents with poor executive functioning, sexual disnhibition and impulsivity, lack of insight into personality change and forced utilisation
Frontal lobe syndrome
30
What can cause frontal lobe syndrome
Head injury Stroke Picks disease
31
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
32
Difference in administration of methadone versus buprenorphine
Methadone a liquid Buprenorphine a sublingual tablet
33
Difference between CIWA and AUDIT
CIWA used to manage alcohol withdrawal (when to give benzos) AUDIT used to manage alcohol dependance
34
Management if come in wanting to sort out alcohol dependance
AUDIT- Alcohol use disorders identifcation test If over 20 refer for specialist management
35
First line psychotherapy for alcoholism
Self help groups
36
Administration methods of opiods
IV Inhalation
37
Diagnositc criteria for AN
BMI under 17.5 Deliberate weight loss Body image disotortion Amenorrhoea in women or low libido in men
38
How is atypical AN diagnosed
AN criteria but without 1 feature
39
Low weight differentials
IBD, addisons, hyperthyroid Socioeconomic Confusion Personality disorders Depression OCD
40
When monitoring someone with eating disorder what physical things are worried about
Weight Bone mineral density
41
Management of anorexia nervosa in children
1st line- family therapy 2nd ED CBT or adolescent psychotherapy for AN
42
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
43
What is refeeding syndrome
When refeed after period of starvation get intracellular shift of magnesium, potassium, phosphate
44
When do you get seizures in alcohol withdrawal
36 hours
45
Management of binge eating disorder
First line- self help guides with supportive sessions Second line- group-CBT Third line- individual CBT
46
What is difference in MOA of acamprosate vs naltrexone
Acamprosate- reduces cravings for alcohol Naltrexone- reduces pleasure of drinking alcohol
47
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
48
How assess patient with anorexia nervosa after history
Obs ECG Squat test BMI Bloods- electrolytes, glucose
49
How does cannabis use present
Red eyes Dry mouth Increased HR Increased appetite
50
Which /recreational drug is of main concern to psychiatrists nowadays
Spice/black mamba- synthetic cannabinoids
51
How can spice used present
Psychosis Confusion Aggression Vomiting
52
How to investigate benzo withdrawal
Urine drug screen
53
How is benzo withdrawal managed
Contact addiction services Convert to diazepam equivalent dose Slowly reduce by 10% every 2 weeks Talking therapies
54
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
55
What questionnaire can be used to quickly screen for alcohol abuse
FAST- fast alcohol screening test
56
How do you calculate units
(Volume x alcohol by volume)/1000
57
MOA of acamprosate
Modulates NMDA to reduce glutamergic transmission
58
MOA of naltrexone
Mixed opiod antagonist with high affinity for u-opiod receptor
59
What cant give before thiamine in alcohol withdrawal
Glucose
60
Triad for wernickes
Opthalmoplegia Confusion Opthalmoplegia
61
Management of alcohol withdrawal
CIWA- Chlordiazepoxide regime Add pabrinex
62
How does korsakoffs syndrome
Anterograde amnesia Confabulation Psychosis Frontal lobe symptoms- childlike personality
63
What is given to those on opiate susbstitution therapy
IM naloxone in case of resp depression
64
How manage OST in acute hospital care
Check with GP/drug service the drug and date of last collection
65
How do methadone and buprenorphine compare to heroin
Longer half life Less euphoria and resp depression etc
66
Rating scale for opiate withdrawal
Clinical opiate withdrawal scale
67
Difference between withdrawal syndrome and complex withdrawal
Complicated involves delirium, seizures or psychosis
68
Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible
Central pontine myelinolysis as hyponatraemia common in alcoholism
69
Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible
Central pontine myelinolysis as hyponatraemia common in alcoholism
70
What questionnaire for severity of dependance
SADQ- severity of alcohol dependance questionnaire
71
Management based on AUDIT and SADQ outcome
Over 20 on AUDIT- refer to alcohol services Over 30 on SADQ- refer for inpatient withdrawal
72
How much of chlordiazepoxide do you give someone withdrawing from alcohol
No more than 2 days medication at a tome
73
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
74
Which SSRI for BN
Fluoxetine
75
What do you assume are units in a pint, glass of wine and a shot
Pint- 2 Glass of wine- 1.5 Shot- 1
76
What drugs can cause erectile dysfunction
Antihistamines Parkinsonism Benzos TCA Statins B blockers
77
What is voyeurism
When enjoy watching other people have sex
78
What happens to carotemia in AN
Hyper- remember C and Gs go up
79
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
80
Eating disorder when purges but considerable focus on food and weight loss
Anorexia
81
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
82
How are cocaine induced myocardial infarctions managed
Benzodiazepines
83
What murmur can be heard in anorexia
Mid systolic murmur with a click due to mitral valve prolapse from loss of cardiac muscle
84
Under what act should you be admitted for anorexia forecful feeding
Section 2
85
What happens to WCC in anorexia
Down due to malnutrition
86
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
87
What is used for detoxification if people need pharmacological help with opiate withdrawal but want to avoid methadone or buprenorphine
Lofexidine
88
If want to quickly withdraw from opiates what do
Lofexidine
89
First clinical signs of refeeding
Tachycardia Oedema Confusion
90
Initial treatment of refeeding
Phosphate replacement
91
What are U waves seen in
Hypokalaemia
92
How does LSD use present
HTN Tachycardia Fever Psychosis
93
What determines whether full dose or titrated boluses naloxone given
If apnoeic then give full dose
94
What do excoriation marks after an overdose suggest
Opiods as relesaes histamine
95
What drug can be given to help with anorexia nervosa treatment
Olanzapine as can reduce obsessions with food as well as increase appetite
96
Person with alcoholism admitted to hospital and becomes quadriplegic with eye movements only possible
Central pontine myelinolysis as hyponatraemia common in alcoholism

Psych (Owen) (9 decks)

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