Substance missuse

Question 1

DSM criteria for dependence (WITHDraw IT)

Answer 1

At least 3/7 within 12 months.

Withdrawal symptoms

Interest/ important activities given up or reduced

Tolerance
- Increase of dose

Harmm
- To physical or psychosocial health, but still continues to use.

Desider
- To cut down or control

Time
- Spent too much

Question 2

Alcohol withdrawal symptoms

Answer 2

1. Seizures
   - Generalised, tonic clonic

Minor withdrawal symptoms
- Tremor
- Anxiety
- Nausea and vomiting
- sweating, palpitations, insomnia, anorexia

3. Delirium tremens
4. Wernicke’s encephalopathy-
   - confusion
   - Ophthalmoplegia
   - Ataxia

Question 3

Delirium tremens

Answer 3

Rapid onset of confusion due to alcohol withdrawal.
- commonly 2-3 days after abstinence

Symptoms
- Hallucinations
- Agitation
- Global confusion
- Disorientation
- Fever
- Autonomic hypersensitivity

Question 4

Immediate management of severe withdrawal symptoms
- Minor
- seizure
- delirium tremens

Answer 4

Minor
- Reducing regimen of benzos

Seizure
- Diazepam 10 mg PR

Delirium tremens
- Lorazepam PO. IM second line

Question 5

Korsakoff’s syndrome

Answer 5

Progression of Wernicke’s encephalopathy.

Features
- Confabulation
- Anterograde amnesia
- Intact working and procedural memory

Question 6

Benzos withdrawal symptoms

Answer 6

Syndrome
- Increased anxiety
- Tremor
- Irritability
- Restlessness

Seizures, delirium, confusion

Question 7

Substitute medication inn opiate dependence

Answer 7

Methadone
- Synthetic opioid

Buprenorphine
- Partial opiate receptor

Suboxone (bup + naloxone)

Question 8

1 unit of alcohol is equal to… [3]

Answer 8

• Half a pint of 3% cider/ beer/ larger
• 25mL of 40% spirit
• 50mL of fortified wine (20%)

Question 9

Alcohol use disorder
- Definition

Answer 9

Encompasses harmful drinking and alcohol dependency.

Harmful drinking
- Drinking leading of alcohol related health problems including depression and acute pancreatitis

Dependency
- Cravings, tolerance and preoccupation with drinking

Question 10

Wernicke’s encephalopathy

Answer 10

Neurological disease arising from thamine deficiency in alcoholism characterised by
- Ophtalmoplegia/ nystagmus
- Confusion
- Ataxia

Question 11

FRAMES method for structured brief advice

Answer 11

Method for sessions of structured brief advise on alcohol use disorders
F- Feedback
- Review risk of having alcohol problems

Responsibility
- Change in person’s responsibility

Advise
- Offer advise when requested

Menu
- Review options for change

Empathy

Self-efficiacy
- Optimism about person’s ability to change

Question 12

Methods for reducing alcohol consumptions

Answer 12

• Switching type of alcohol
• Recognising personal cues
• Removing self from high-risk situations
• Drinking soft drinks before alcohol
• Finding alternate activites to drinking
• Having a drinking diary.