Substance Abuse Disorders Flashcards
Name the triad of wernicke encephalopathy
Delirium
Ophthalmoplegia (nystagmus, cn vi palsy, conjugate gaze palsy )
Ataxia
Name 3 symptoms of korsakoff syndrome
- Extensive anterograde and retrograde amnesia - can’t make new memories!
- frontal lobe dys fx
- Psychotic symptoms in absence of delirium
What causes korsakof psychosis?
Chronic thiamine deficiency (b1), usually from alcoholism
Criterion A to diagnose substance use disorder has which 4 subgroups and criteria?
Need 2 or more criteria.
- Impaired control (1-4): taking more longer than intended, persistent desire to cut down or regulate use with no success, great time spent obtaining/using/recovering from substance, craving.
- Social impairment (5-7): not fulfilling obligations at school work home, continue despite social or interpersonal problems caused by it, important social/occupational/ recreational activities given up.
- Risky use (8-9): recurrent use where it’s physically hazardous, continue despite knowing a physical/physiological problem caused by substance
- Pharmacological criteria (10-11): tolerance, withdrawal
Pec with mcat
(Cont despite physical / psychological, external roles not fulfilled, cut down unsuccessful, withdrawal, cont despite interpersonal, tolerance, use in hazardous situations, more used than intended, craving, activities given up, excessive time spent on using/finding)
How is substance use disorder diagnosed according to criteria and graded?
At least 2 symptoms from criterion A
Mild: 2-3
Moderate -4-5
Severe: 6 or more
Define early remission from sud
At least 3 but less than 12 months without sud (except craving)
Define sustained remission for sud
12 months without criteria, except craving.
Define alcohol misuse
Drinking > 14 standard drinks per week for men, >7 for women
Define binge drinking
5 standard drinks in 2 hours for men, 4 for women. WHO = 60 g pure alcohol on one occasion
Name 8 symptoms of alcohol withdrawal syndrome 6-12 hours after cessation
Minor withdrawal symptoms: insomnia, git upset, headache, diaphoresis, tremulousness, mild anxiety, palpitations, anorexia
Name symptoms of alcohol withdrawal syndrome 12-24 hours after cessation
Alcoholic hallucinations
Name symptoms of alcohol withdrawal syndrome 24-48 hours after cessation
Withdrawal seizures: generalized tonic clonic
Name symptoms of alcohol withdrawal syndrome 48-72 hours after cessation
Alcohol withdrawal delirium- Emergency!
Hallucinations (visual), disorientation, tachycardia, ht, low grade fever, agitation, diaphonesis
What is the pharms treatment of alcohol withdrawal delirium? (5)
- Thiamine replacement iv 300 - 500 mg/day
- iv glucose to prevent wernicke encephalopathy
- diazepam (benzo) 5-20mg IM or lorazepam 1-4 mg iv/im until sedation achieved. Do not give oxazepam - contraindicated in liver disease! May not give any other type of anti epileptic!
- anti-psych only if agitation persists as adjunct to sedatives. Haloperidol 0,5 - 5 mg IM
- iv vit B Co high potency over 2 days.
Use CIwA - A (clinical instate withdrawal assessment for alcohol) scoring system to assess severity of withdrawa
Name 10 signs of a substance use disorder
- Face puffy/blushing/pale
- Poor overall health. Runny nose, hacking cough
- Poor hygiene
- Unusual smells body, breath, clothes
- Sweating
- Cold palms
- Tremor
- Red, watery eyes
- miosis / mydriasis
- Needle marks
Poor physical coordination, stumbling gait, altered activity and talkativeness
Name 10 risk factors for committing or attempting suicide
- Males > completes
- Females > attempters
- Extremes of socio-economic classes
- Fall in socio-economic class
- Atheism
- Depressive disorders
- Alcohol related conditions
- Schizophrenic
- Maladaptive personality traits eg OCD
- Previous attempts
loss social support, serious physical illness, sleep disturbances, previously married etc.
Which stage of change is described by not acknowledging or denying the issue?
Pre-contemplation
Which stage of change is described by acknowledge of problem but not yet ready to make change , making excuses?
Contemplation
Which stage of change is described by acknowledgement and intention to eventually act? Eg doing research
Preparation
Which stage of change is described by behavioural change?
Action
Which stage of change is described by effort to sustain change
Maintenance
Which stage of change is described by a reversion to a previous stage?
Relapse
How does opioid intoxication present? (3)
• cns depression!
• resp depression! (Overdose cause of death)
• miosis !
• bradycardia
Also euphoria, decreased gag reflex
How does cannabis intoxication present? (5)
- Conjunctival injection!
- Altered judgement
- increased appetite
- dry mouth
- tachycardia
- decreased reaction time
- calm
