Substance Disorders+Alcohol Flashcards
1
Q
What is substance related disorders broken up into?
A
- Substance use disorders
2. Substance induced disorders-intoxication, withdrawal, substance/medication induced disorders
2
Q
What are some aetiological factors that can lead to substance disorders?
A
- Genetic predisposition
- Environmental factors
- Individual determinants
3
Q
What is the most prevalent thing that is abused?
A
Alcohol
4
Q
Which group of people are more likely to develop problems of substance use?
A
Males
They start earlier and they are 2-3 times at a increased chance but women develop more severe symptoms
5
Q
What is white pipe?
A
The combination of cannabis and mandrax
6
Q
What is whoonga?
A
ARV, efavirenz and heroin
7
Q
What is nyaopi or pinch?
A
Cheap heroin and cannabis
8
Q
Which route has a faster onset of actions?
A
Injection and oral intake instead of oral intake
9
Q
Which anti-depressants are more likely to be abused?
A
Benzodiazepines
10
Q
What allows the crossing into the blood brain barrier faster?
A
- The more lipophilic the substance is
- The route
- Shorter half life
11
Q
What does intoxication mean?
A
A reversible substance specific syndrome that occurs due to the recent us of a substance
12
Q
What is tolerance?
A
The adaptability of the body to the heavy and repeated use of a substance where more of the substance is required to get the desired effect or the same amount has a reduced effect
13
Q
What is withdrawal?
A
It is a substance specific syndrome that is caused by the cessation or the reduced use of a substance after heavy and prolonged use
14
Q
What is reinstatement?
A
When a sober addict that has been abstinent for years then uses the substance again and quickly develops tolerance and withdrawal
15
Q
What is Maslows hierarchy?
A
- Experimenting
- Recreational use
- Substance use disorder(mild, moderate or severe)
16
Q
What is alcohol intoxication?
A
Upon recent drinking the person develops problematic behavior or psychological changes like impaired judgement and aggressiveness They also present with: -slurred speech -incoordination -nystagmus -impaired memory and attention -unsteady gait -coma
17
Q
What is alcohol withdrawal?
A
It is the cessation or reduction of the use of alcohol that’s leads to specific symptoms
- anxiety
- insomnia
- autonomic (sweating, tachycardia, hypertension)
- nausea and vomiting
- tonic clonic seizures
- hand tremor
- psychomotor agitataion
18
Q
How do we screen a patient for alcohol use?
A
- AUDIT from WHO
2. Clinical questioning such as the heavy drinking days and what they drink and how much
19
Q
How much alcohol is too much?
A
Males: 5 drinks per day or more than 15 per week
Females: 4 drinks per day and not more than 8 per week
20
Q
What is Wernicke’s encephalopathy?
A
Linked to chronic alcohol use and caused by thiamine deficiency
The triad is:
-ophthalmoplegia ( abnormal eye muscle movements)
-ataxia
-confusion or Delirium
Plus dietary deficiencies
21
Q
What percentage of patients that have Wernickes encephalopathy develop Karsokoffs?
A
80%
22
Q
How do we treat wernickes encephalopathy?
A
By starting prompt IV thiamine to reverse the symptoms
23
Q
Why do we need to give the patient thiamine with glucose?
A
We need thiamine to metabolize glucose
24
Q
What is Korsakoff’s syndrome?
A
The inability to learn or retain new memory with confabulation
25
What are the risk factors for developing Wernicke’s encephalopathy?
1. Nausea and vomiting
2. Malnutrition
3. Recent weight loss
4. Drinking more than 15 units per week of alcohol
5. Peripheral neuropathy
6. Chronic illness
26
What is delirium tremens?
It is alcohol withdrawal in 5% of people who stop alcohol abruptly
27
How does delirium tremens usually present?
It presents 2-5 days later usually at night
Presents with:
-delusions
-anxiety, signs of withdrawal and agitation
-disorientation
-visual and auditory delusions
28
What is the risk of death of delirium tremens?
Without treatment: 35%
| With treatment: 5-15%
29
What are withdrawal seizures?
They occur 8-24 hours after the last drink
| Usually generalised tonic clonic seizures
30
What disorders is alcohol associated with?
1. Mood disorders
2. Anxiety disorders
3. Dementia
4. Sleep disorders
5. Sexual disorders
6. Personality disorders
7. Amnesia disorders
8. Pathological jealousy-othello syndrome
31
What is the difference between hallucinosis and delirium tremens?
In hallucinoisis the patient is not confused
32
What is hallucinosis?
The person hears accusatory or threatening voices
| And can occur in intoxication or during withdrawal and usually occurs after years of heavy drinking
33
What is pathological jealousy?
It is also known as Othello syndrome
This is where there is a strong delusional belief that the partner is being unfaithful without proof
Has a high risk of violence and homicide
34
Where is alcohol absorbed the most?
In the small intestine and so if we delay gastric emptying through eating food it reduces the effect of alcohol
35
10% is alcohol is not metabolized, how is it then excreted?
Through urine, sweat and breath
36
How is alcohol metabolized?
It is metabolized in the liver where hepatic alcohol dehydrogenase is converted into acetaldehyde
Then hepatic aldehyde dehydrogenase is converted into acetate
37
What receptor does alcohol work on?
GABA which causes inhibition and this is a downer
38
How does alcohol become addictive?
It causes an increase in activity of the inhibitory GABA receptors and with chronic alcohol use they become less sensitized and so you need more alcohol to have the same effects
It also releases opioids endogenously which leads to increased dopamine release
39
What is the best things we can just fro alcohol detoxification?
1. Benzodiazepines
Particularly diazepam because it is long acting
2. If patient has liver damage then use oxazepam
40
What is the general care that a patient should receive for alcohol detoxification?
Correcting fluids and electrolytes
| Correcting the thiamine deficiency
41
How do we treat delirium tremens?
1. Benzodiazepines and haloperidol
2. Treat somatic disorders
3. Nutrition and fluid
4. Rest and sleep
42
How do we treat withdrawal seizures?
1. Benzodiazepines
| 2. Exclude organic cause of the seizure
43
What are the medications that we can use to stop alcohol addiction?
1. Aversion-disulfram
2. Anti-craving-
acamprosate and naltrexone
44
What is Disulfram and how does it work?
It works by inhibiting acetaldehyde dehydrogenase and prevents the conversion to acetate
Which then causes throbbing, flushing, heart palpitations, fear, seizures , death etc.
-it must be used with psychosocial services
45
Why is it important to monitor the use of disulfram?
It causes hepatotoxicity and so we need to ensure we observe the AST/ALT
46
What is the dose of Disulfram that we give to patients?
200mg daily or 400mg on alternate days
47
How does Acamprosate work?
It causes a decrease in cravings and blocks the NMDA receptors and activates the GABA receptors
The best choice for patients with liver impairment
Do not use in kidney impairment
48
What is the dose of Acamporsate?
2 tablets 3 times a day >60 kg
| <60kg 2 tablets in the morning and 1 midday and evening
49
What does naltrexone do?
It blocks the opioid reward system
| Avoid in liver dysfunction
50
What is the dose of naltrexone?
50mg
51
What other drugs can we use in the treatment of alcohol?
1. SSRI
2. Topiramite
3. Ondansetron
4. Baclofen-can be used in patients with patients with liver cirrhosis
52
What are the diagnostic criteria fro substance use disorders?
1. Cravings
2. Tolerance
3. Withdrawal
4. Substance use in physically hazardous environments
5. Role failure in work, school or home because of the substance
6. Large amounts of time is spent in obtaining and recovering from the effects of the substance
7. Taking the substance in more quantities and longer than originally planned
8. Desire and effort to cut down is unsuccessful
9. Relationship difficulties or social problems due to/made worse by the substance use
53
The severity of substance use disorder depends on the number of symptoms namely:
1. Mild substance use disorder: 2-3 symptoms
2. Moderate substance use disorder: 4-5 symptoms
3. Severe substance use disorder: 6 or more symptoms
54
Why do people become addicted?
1. Can be psychological or socio-cultural factors
2. Dopaminergic pathway activation
3. Impaired frontal lobe functioning
4. Amygdala and hippocampus can precipitate a relapse
5. Genetics-children of alcoholics have 4-5 times risk of alcohol problems
Environmental factors like rural vs urban , diet, drug availability and how these turn gene expression on and off
6. Maladaptive learnt behavior-conditioning, reinforcement and punishment
55
What is the path of the dopaminergic pathway?
It starts in the ventral tegmental area of the brain stem then goes to the nucleus accumbens in the ventral striatum
When the dopamine is released into the nucleus accumbens then pleasurable events are sensations
56
What normally activates the release of dopamine?
Tasty meal
Praise
Exercise
Winning at sport
57
What happens when the person starts to take substances?
The dopamine is released to a greater magnitude and then neuro-adaptation occurs which leads to the down regulation of D2 dopamine receptors
58
What does epigenetics mean?
It is the regulation of genes by the environment
59
What is conditioning?
The process of behavior modification by which a person associates a desired beahaviour (feeling elated) with a previously unrelated stimulus(the substance)
60
What is Reinforcement?
The strengthening of a specific behavior due to its association with a stimulus
61
What is punishment?
Is used to reduce certain behaviours
62
What does the frontal lobe do?
-regulation, rationalising and analyzing of situations and so helps makes decisions and judgements when it comes to drugs and alcohol
63
How does the amygdala and hippocampus cause a relapse?
They are associated with substance related memories and any trigger can lead to a relapse
64
What are the causes of comorbidities medical problems associated with substance use disorders?
1. Direct toxicity of the substances
2. Substance related behaviors- injecting, sex for money/drugs
3. Socio-economic disadvantage and poverty due to poor nutrition and increased illnesses like TB
4. Reduced access to care and poor use of treatment
65
What are the common psychiatric conditions associated with substance use?
1. Mood disorders
2. Anxiety disorders
3. Psychotic disorders
4. Delusional disorder
5. Sleep disorders
6. Sexual disorders
7. Cognitive diorders
8. Personality disorder
66
What psychiatric condition do men typically present with?
Antisocial personality disorder
67
What psychiatric condition do females usually present with?
Depression
Anxiety
Post-traumatic disorder
68
What are the causes of psychiatric conditions and substance use being associated?
1. Common underlying aetiological factor predisposing someone to both-environmental triggers like trauma,stress or genetic vulnerability
2. A person may have two unrelated disorders that exacerbate one another
3. Direct toxicity or the stress of the substance use lifestyle can cause a psychiatric condition
4. Patients with psychiatric problems may try to self medicate with substances or because of their illness have decreased judgement and inhibitory control
69
What are the characteristics of good screening?
1. Reliable( repeat measuring should give consistent scores)
2. Valid( measure what it is supposed to mea sure)
3. Sensitive( correctly test positive if diagnosis is present)
4. Specific ( correctly test negative if diagnosis is absent)
70
What should we do if a patient presents with comorbidities psychiatric illness?
We must treat the psychiatric problem first before we enroll the patient to substance use disorder programme
71
How can we prevent the use of substances?
1. Primary prevention: Prevent the use of substances or delay the age at which they are used
2. Secondary prevention: early detection of potentially problematic substance use in order to prevent harm
3. Tertiary prevention: limiting harm from substance use disorder by providing effective substance treatment or harm reduction interventions
72
What is universal intervention?
This is intervention that target whole population groups
| Like a media campaign explaining the dangers os smoking
73
What is selective intervention?
This is intervention that targets a subgroup of individuals at risk of developing substance use disorder like adolescents at school
74
What does primary intervention entail?
It entails intervening before the onset of symptoms and include clear, scientifically accurate, culturally valid timely messages to a population group or a subgroup
75
What is secondary prevention?
Used in the early stages of substance use
Screening and identifying potential substance use before the onset of problems and early so unsealing interventions
This is indicated intervention
76
What is tertiary prevention?
The aim is to end or minimize the harmful sequalae resulting from substance use disorder
These patients with moderate to severe substance use disorder require specialized substance treatment
If they are not ready to completely stop using substances we can attempt harm reduction
77
Harem reduction
When a patient is not yet ready to stop using a substance, mitigate the potential dangers and health risks associated with the substance use
If a patient stops injecting and starts smoking instead we see it as a positive change
78
What is carbohydrate deficient transferase?
It is a full blood count marker that increases after recent alcohol use
