Substance Misuse

Question 1

Korsakoff’s syndrome

Answer 1

1. Amnesic disorder; memory impairment in clear consciousness, however no other cognitive features of dementia

Features:

1. Chronic impairment of recent (anterograde)
   and remote (retrograde) memory, however
   immediate recall is preserved.
   Unable to learn new information; interference
   in daily functioning
2. No clouding of consciousness or disturbance
   of attention. No global cognitive decline.

Confabulation may be present (frontal and diencephalic defecit)

Lesion to dorsomedial thalamus, mamillary bodies

Question 2

Korsakoff’s syndrome

Answer 2

1. 80% of people recovering from Wernicke’s encephalopathy will develop Korsakoff’s syndrome
2. It can occur without WE, repeated sub-clinical WE can result in Korsakoff’s

Question 3

Wernicke’s encephalopathy

Answer 3

Triad: confusion, opthalmopegia (lateral rectus palsy/nystagmus) and ataxia

Only present in 10-20% all 3 in triad

Vitamin B1 defeciency = thiamine

Reversible; thiamine needs to be given before glucose

Opthalmoplegia responds in hours; memory longer

Untreated 20% mortality

Question 4

Neuropathology in wernicke’s encephalopathy

Answer 4

Small haemorrhages in periventricular and periaqueductal structures incl mamillary bodies, hypothalamus, mediodorsal thalamus nucleus, colliculi, mid-brain tegmentum.

Gliosis

Question 5

Alcoholic hallucinosis

Answer 5

Hallucinations in clear consciousness
During withdrawal or even still drinking
Usually auditory; fragmentery, then can have complex hallucinations
Can lead to persecutory delusions
Normally resolved in 6/12s if abstinent, if longer suspicion of schizophrenia
Hallucinations usually last less than one week
Normally respond well to antipsychotics, prognosis good if abstinent

Question 6

Delerium tremens

Answer 6

Medical emergency
Acute or rapid cessation of alcohol with chronic use
Normally 72-96hrs after last drink, develops rapidly

Global confusion; hallucinations (v/t/a), tremor.
Agitation
Delusions
Autonomic hyperactivity
Insomnia

20% mortality untreated

Question 7

Alcohol dependence

Answer 7

ICD

3 out of following for 12 months

1. Narrowed repetoire of drinking
2. Salience of alcohol
3. Tolerance
4. Experiencing withdrawals if not taking
5. Using alcohol to relieve the withdrawals
6. Intense desire to drink
7. Difficulty to control the onset, termination and level of drinking

Question 8

Neuroadaption

Answer 8

No drug seeking behaviour, however have discontinuation, loss of effect, relief of discontinuation symptoms taking the same drug

Question 9

Tolérance

Answer 9

Can even occur in intermittent use
In benzos, more withdrawal anxiety and not much tolérance for anxiolytic effects, although tolérance of hypnotic

Question 10

Diminished tolerance

Answer 10

When drinking alcohol after a period of abstinence, tolerance can revert to normal and cause quick intoxication

Question 11

Time course of alcohol withdrawal

Answer 11

Shakes - in 4-12 hours
Perceptual disturbance- 8-12 hours
Seizure - 12-24 hrs, peak 48 hours
Delerium - 72-96 hours

Question 12

Alcohol

Answer 12

Causes decreased NMDA sensitivity and increase in GABA sensitivity (loss of gaba-ergic inhibition and glutamate surge in withdrawal)

Alcohol down regulates calcium channels and unregulates nicotone-regulated sodium channels

Question 13

Early symptoms of opioid withdrawal

Answer 13

Agitation, anxiety, muscle ache, insomnia, sweating, rhinorrhea, yawning

Question 14

Amphetamine withdrawal

Answer 14

Fatigue, sleep ++, hungry, unpleasant dreams, agitation or retardation