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Psychiatry > Substance Abuse Disorders > Flashcards

Substance Abuse Disorders Flashcards

1
Q

Name the triad of wernicke encephalopathy

A

Delirium
Ophthalmoplegia (nystagmus, cn vi palsy, conjugate gaze palsy )
Ataxia

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2
Q

Name 3 symptoms of korsakoff syndrome

A
  • Extensive anterograde and retrograde amnesia - can’t make new memories!
  • frontal lobe dys fx
  • Psychotic symptoms in absence of delirium
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3
Q

What causes korsakof psychosis?

A

Chronic thiamine deficiency (b1), usually from alcoholism

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4
Q

Criterion A to diagnose substance use disorder has which 4 subgroups and criteria?

A

Need 2 or more criteria.

  1. 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.
  2. 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.
  3. Risky use (8-9): recurrent use where it’s physically hazardous, continue despite knowing a physical/physiological problem caused by substance
  4. 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)

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5
Q

How is substance use disorder diagnosed according to criteria and graded?

A

At least 2 symptoms from criterion A
Mild: 2-3
Moderate -4-5
Severe: 6 or more

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6
Q

Define early remission from sud

A

At least 3 but less than 12 months without sud (except craving)

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7
Q

Define sustained remission for sud

A

12 months without criteria, except craving.

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8
Q

Define alcohol misuse

A

Drinking > 14 standard drinks per week for men, >7 for women

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9
Q

Define binge drinking

A

5 standard drinks in 2 hours for men, 4 for women. WHO = 60 g pure alcohol on one occasion

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10
Q

Name 8 symptoms of alcohol withdrawal syndrome 6-12 hours after cessation

A

Minor withdrawal symptoms: insomnia, git upset, headache, diaphoresis, tremulousness, mild anxiety, palpitations, anorexia

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11
Q

Name symptoms of alcohol withdrawal syndrome 12-24 hours after cessation

A

Alcoholic hallucinations

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12
Q

Name symptoms of alcohol withdrawal syndrome 24-48 hours after cessation

A

Withdrawal seizures: generalized tonic clonic

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13
Q

Name symptoms of alcohol withdrawal syndrome 48-72 hours after cessation

A

Alcohol withdrawal delirium- Emergency!

Hallucinations (visual), disorientation, tachycardia, ht, low grade fever, agitation, diaphonesis

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14
Q

What is the pharms treatment of alcohol withdrawal delirium? (5)

A
  • 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

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15
Q

Name 10 signs of a substance use disorder

A
  1. Face puffy/blushing/pale
  2. Poor overall health. Runny nose, hacking cough
  3. Poor hygiene
  4. Unusual smells body, breath, clothes
  5. Sweating
  6. Cold palms
  7. Tremor
  8. Red, watery eyes
  9. miosis / mydriasis
  10. Needle marks
    Poor physical coordination, stumbling gait, altered activity and talkativeness
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16
Q

Name 10 risk factors for committing or attempting suicide

A
  1. Males > completes
  2. Females > attempters
  3. Extremes of socio-economic classes
  4. Fall in socio-economic class
  5. Atheism
  6. Depressive disorders
  7. Alcohol related conditions
  8. Schizophrenic
  9. Maladaptive personality traits eg OCD
  10. Previous attempts
    loss social support, serious physical illness, sleep disturbances, previously married etc.
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17
Q

Which stage of change is described by not acknowledging or denying the issue?

A

Pre-contemplation

18
Q

Which stage of change is described by acknowledge of problem but not yet ready to make change , making excuses?

A

Contemplation

19
Q

Which stage of change is described by acknowledgement and intention to eventually act? Eg doing research

A

Preparation

20
Q

Which stage of change is described by behavioural change?

A

Action

21
Q

Which stage of change is described by effort to sustain change

A

Maintenance

22
Q

Which stage of change is described by a reversion to a previous stage?

A

Relapse

23
Q

How does opioid intoxication present? (3)

A

• cns depression!
• resp depression! (Overdose cause of death)
• miosis !
• bradycardia
Also euphoria, decreased gag reflex

24
Q

How does cannabis intoxication present? (5)

A
  • Conjunctival injection!
  • Altered judgement
  • increased appetite
  • dry mouth
  • tachycardia
  • decreased reaction time
  • calm
25
Q

How classify severity of substance use disorders

A

Mild: 2-3 (out of 11) criteria
Moderate: 4-5
Severe: 6 or more

26
Q

Name 2 specifiers of substance use disorder

A
  • In controlled environment
  • On maintenance therapy
27
Q

Name 3 types dependence in substance use disorders

A
  • Behavioural dependence: substance - seeking activities + pathological use patterns
  • physical: withdrawal
  • cognitive: cravings to avoid dysphoria or attain drug state
28
Q

Treatment life-threatening cns/respiratory depression in opioid overdose?

A

Naloxone iv (opioid antagonist)

29
Q

Pharmacological maintenance treatment of opioid dependence and withdrawal? (4)

A
  • Methadone 20 - 60 mg daily (opioid agonist)
  • buprenorphine 0,8 - 4 mg daily (opioid agonist + antagonist) (better for mild addiction)
  • suboxane (buprenorphine + naloxone)
  • clonidine (alpha 2 agonist) for symptoms of withdrawal
30
Q

Opioid relapse prevention?

A

Long acting naltrexone depot (opioid antagonists )
(Can also be used for alcohol dependence )

31
Q

What is wernicke korsakoff syndrome?

A

Alcohol induced amnestic syndrome due to thiamine (B1) deficiency → necrotic lesions in mamillary bodies, thalamus, brainstem. 2 stages:

  • Wernicke’s encephalopathy: acute and reversible. Oculomotor dysfunction, ataxia, confusion.
  • Korsakoff’s syndrome: chronic, only 20% reversible. Anterograde amnesia, confabulation.
32
Q

Treatment Wernicke’s encephalopathy ?

A

Thiamine 500 mg iv bd or TDS for 72 hours then reassess

33
Q

Treatment korsakoff syndrome ?

A
  • Thiamine 500 mg bd or TDS iv for 72 hours then
  • 100 mg po TDS for 3-12 months
34
Q

Name 4 specifiers for substance use disorder

A
  • In early remission (3 - 12 months)
  • in sustained remission (12 months or more)
  • on maintenance therapy
  • in a controlled environment (restricted accessed jail )
35
Q

Name 7 signs/symptoms cannabis withdrawal

A

Need 3 or more

  • Irritable/conger/aggression
  • nervous / anxiety
  • sleep difficulty eg insomnia, disturbing dreams
  • decrease appetite/weight loss
  • restless
  • depressed
  • physical symptoms causing significant discomfort: abdominal pain, shakes / tremor, sweating, fever, chills or headache
36
Q

Name hallucinogen

A

Phencyclidine

37
Q

Name 8 symptoms or signs phencyclidine intoxication

A

2 or more

  • nystagmus
  • ht / tachycardia
  • numbness/ diminished responsiveness to pain
  • ataxia
  • dysarthria
  • muscle rigidity
  • hyperacusis
  • Seizure/coma
    Pupillary dilatation!
38
Q

Name 9 signs/symptoms stimulant (amphetamine, cocaine) intoxication

A

At least 2

  • Tachy/bradycardia
  • pupil dilation!
  • high/low bp
  • nausea, vomiting
  • perspiration/chills
  • evidence weight loss
  • psychomotor agitation/retard
  • muscular weak, resp depression, chest pain, arrhythmia
  • confusion, seizures, dyskinesias, dystonias, coma
39
Q

Prevention/treatment alcohol withdrawal?

A

Long acting benzodiazepines: diazepam 20mg 4x daily tailed off over 5-7 days as symptoms subside

40
Q

What treatment helps alcoholics recover (2)

A
  • Acamprosate for craving
  • disulfiram causes unpleasant reaction when alcohol is consumed
41
Q

Treatment opiate withdrawal?

A

Clonidine (alpha 2 agonist)

Psychiatry (31 decks)

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