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Mental Health > Substance Misuse > Flashcards

Substance Misuse Flashcards

1
Q

How to assess alcoholism?

A

CAGE
Cut down - has anyone asked you
Annoyed - when people ask you to stop
Guilt
Eye opener - start mornings with a drink

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2
Q

Score on CAGE that is concerning

A

More than 2

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3
Q

What score do you use after CAGE to gauge severity of alcoholism?

A

AUDIT-C

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4
Q

What questions ask in AUDIT-C?

A

How often did you have a drink containing alcohol in the past year? - Never, monthly or less, 2-4 x a month, 2-3 x a week, 4+ x a week (+4)
How many drinks containing alcohol did you have on a typical day when you were drinking in the past year? - 1 or 2 drinks = 0, 3 or 4, 5 or 6, 7- 9, 10+ = 4 points
How often did you have six or more drinks on one occasion in the past year? - never, less than monthly, monthly, weekly, daily or almost (+4)

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5
Q

How long does it take to metabolise a unit of alcohol?

A

one hour

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6
Q

Classical drinking HbA1c?

A
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7
Q

Anaemia in alcoholism

A

B12/folate
Macrocytic
Fe deficient - iron absorption not done properly

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8
Q

What is concordant with alcohol misuse in females vs males off AUDIT c?

A

Females > 3
Males >4

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9
Q

Specific liver test for alcohol function

A

GGT

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10
Q

What does GGT test for?

A

Liver inflammation

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11
Q

What can you do in emergency situation for alcohol?

A

Blood alcohol level

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12
Q

What does a score over 5 from AUDIT C mean?

A

Alcohol misuse, possible liver damage

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13
Q

What do when alcoholics come in?

A

Refer to self help groups
Explore reasons behind it

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14
Q

What can you give to alcoholics in withdrawal adn DTS

A

Chlordiazapoxide
Banana bag - with vitamins to support them
Benzodiazapines
(Delirium tremens - IV fluids, antipsychotic meds, anticonvulsants, paracetemol)

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15
Q

What to tell people about stopping alcohol?

A

Do not stop cold turkey

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16
Q

What can immediate cessation of alcohol cause?

A

Alcohol withdrawal syndrome Wernickes/Brocas
Seizures

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17
Q

What classifies as heavy drinking?

A

Men >15 drinks per week
Women > 8 drinks per week

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18
Q

Alcohol affects on neurotransmitters

A

GABA increased
Glutamate decreased

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19
Q

What causes alcohol withdrawal syndrome?

A

Unnaturally low GABA levels
Glutamate spikes

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20
Q

Mild symptoms of withdrawal

A

Anxiety
Irritability
Headache
Shakiness
Sweating
Depression
Mood swings
Loss of appetite
Mild confusion
N+V

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21
Q

Moderate symptoms comon with alcohol withdrawal

A

12 - 24 hours after last drink
Confusion
Disorientation
Hallucinations
Seizures

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22
Q

Severe symptoms common with alcohol withdrawal and when occurs

A

High BP
Increase HR, RR, pulse
Extreme confusion and agitiation
Persistent hallucinations (visual, auditory, tactile)
Seizures
Tremors (DTS)
Fever

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23
Q

What is delirium tremens?

A

Psychotic condition involving tremors, hallucinations, anxiety, disorientation

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24
Q

Phases of alcohol withdrawal?

A

Stage 1 - 6-24 hours
Stage 2 - 24-48 hours
Stage 3 - 48-96 hours

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25
Q

Stage 1 alcohol withdrawal

A

N+V
Heachaes
Insomnia
Anxiety

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26
Q

Stage 2 alcohol withdrawal

A

24-48 hours
Heightened HR, BP, elevate body temo, seizures, hallucinations

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27
Q

Stage 3 acohol withdrawal

A

48-96 hours
Seizures and tremors
Mood changes and agitation
Severe adn allucinations

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28
Q

Stage 3 acohol withdrawal

A

48-96 hours
Seizures and tremors
Mood changes and agitation
Severe adn allucinations

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29
Q

AUDIT vs AUDTI-C

A

AUDIT-C is 3 qs gives indication if need to ask 10 qs of AUDIT

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30
Q

Risk factors for delirium tremens

A

Cirrhosis
Alcoholuc cardiomyopathy
Alcoholic neuropathy
Presence of co-occurring mental disorders

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31
Q

Questions to ask about delirium tremens

A

When did the person last have a drink?
How much does the person typically drink per day?
Since when does he or she drink?
Has he or she ever had delirium tremens before, including a seizure?
Has he or she tried to stop drinking before? If so, were there any withdrawal symptoms?
Does the person have a mental or physical disorder? Are they getting treatment for it?
Do they take illegal drugs or prescription medication?

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32
Q

What domains does the AUDIT test?

A
  1. alcohol intake;
  2. potential dependence on alcohol, and;
  3. experience of alcohol-related harm.
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32
Q

What domains does the AUDIT test?

A
  1. alcohol intake;
  2. potential dependence on alcohol, and;
  3. experience of alcohol-related harm.
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33
Q

How is the AUDIT scored?

A

Out of 40
10 questions each 0-4

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34
Q

What AUDIT score suggests a harmful or hazardous alcohol consumption?

A

8-14

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35
Q

What AUDIT score suggests a harmful or hazardous alcohol consumption?

A

8-14

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36
Q

What does a score of 15 or more on the audit suggest?

A

Likelihood of alcohol dependence - modersate-severe alcohol use disorder

37
Q

What level of risk factor is alcohol in UK for death and disability?

A

Third after smoking and obesity

38
Q

What can alcohol be a causal factor in?

A

Over 60 medical conditions including:
-Liver disease
-Mouth
-Throat, stomach, liver and breast cancers, heart disease and depression

39
Q

What is caused by drinking in pregnancy?

A

Foetal alcohol spectrum disorder

40
Q

What to do if audit score 8-15

A

Hazardous drinking - brief inervention

41
Q

What to do if audit score 16-19

A

Harmful drinking
Extended brief interventionn
Review and refer to speicalist if noimprovenent

42
Q

What to do if audit score over 20

A

Probably alcohol dependencce
Withdrawaal assessment/specialtist assessment

43
Q

How sensitice is GGT to dirnking?

A

Low sensitivity and specificit y

44
Q

What biomarker has the best sensitivity and sensitivity for alcohol use?

A

Carbohydrate deficient transferrin

45
Q

Alchol withdrawal syndromes

A

Uncomplicated alcohol withdrawal syndrome
Alcohol withdrawal syndrome with seizures
Delirium tremens

45
Q

Alchol withdrawal syndromes

A

Uncomplicated alcohol withdrawal syndrome
Alcohol withdrawal syndrome with seizures
Delirium tremens

46
Q

When is carbohydrate deficient transferrin used?

A

Rarely in clincial practise
In community to prove someone is no longer drinking over long period of time

47
Q

When does uncomplicated alcohol withdrawal syndrome occur?

A

4-12 hours after last drink

48
Q

What happens in uncomplicated alcohol withdrawal syndrome?

A

Coarse tremor
Nausea and vomitting
Sweating
Insomnia
Tachycardia
Agitation
Anxiety
Hallucinations

49
Q

What % of withdrawal syndromes are with seizure?

A

5-15%

50
Q

Delirium tremens additional features

A

Clouding of consciousness
Amnesia of recent events
Psychomotor agitiation
Disorientation
Tactile/visual hallucinations
Heavy sweating
Paranoid Delusions
Raised temperature
Sudden cardiovascular collapse

51
Q

Detailed assessment for people with harmful drinking and dependence

A

Quantitiy, frequency and pattern of consumption
Severity of dependence Alochol related problems
Use of other drugs
Physical or mental health co-morbidity
Risk to self or others
Family hisotry
Motivation or readiness to change
Sociodemographic favtprs

52
Q

Plannning treatment for alcohol addictionn

A

Make diagnosis - hazardous, harmful, dependent etc
Assess stafe of change - pre-contemplatice
Gial of intervation - continue current drinking pattern, change to a safer one, abstinence
Family support
Strategies

53
Q

What is brief intervention used fir?

A

Hazardous and harmful drinkers
Infographics eg compared to general pop, consequences of drinking at the level that they are

53
Q

22What is brief intervention used fir?

A

Hazardous and harmful drinkers
Infographics eg compared to general pop, consequences of drinking at the level that they are

54
Q

Alcohol psych

A

Depression
Insomnia
Suicide
Anxiety
Personality change
Pscyhotic changes
Amnesia
Hallcuinations
Delirium tremens
Morbid jealousy - obsession about partner cheating

55
Q

Social disintegration

A

Financial difficulties, homelessness

56
Q

Risk factors

A

FH addiction
depression and anxiety

57
Q

Types of harmful drinking

A

ICD-11
One episode eg binge drinking
Repeated pattern of harmful use

58
Q

Acute intpxication

A

Transient confition after intake psychoactive substance -> disturbance of consciousness, cognition, perception or behaviour

59
Q

Dependence ICD-11

A

> 2 of
Control - lack of/powerless - onset, intensity, termination, frequency, context
Precedence - over otjher aspects of healh
Physiological
Time - over 3 months

59
Q

Dependence ICD-11

A

> 2 of
Control - lack of/powerless - onset, intensity, termination, frequency, context
Precedence - over otjher aspects of healh
Physiological
Time - over 3 months

60
Q

Alcohol MOA

A

Enhances GABA
Downregulates NMDA and glutamate

61
Q

why get withdrawal

A

decrease GABA
over active CNS
Increase glutamate - excitatory, sympathetic overdrive

62
Q

What can cause fatality in withdrawal

A

Seizures

63
Q

Symptoms of alcohol withdrawak

A

Sweating
Tremor hands, tongue, eyelids
Agitation/anxiety
Tachy
Fever
Nausea, vommitting, diarrhoea
HPTN
Hallucination - tactile - spiders/bugs etc

64
Q

Delirium tremens vs withdrawal

A

Hallucinations or psychosis - visual
Significant tremor

65
Q

What hallucinations in alchol withdrawal

A

Auditory and visual
Often still remian orientated

66
Q

What is severity of withdrawal determined by?

A

How much alcohol drinking not length

67
Q

What is the problem with chlordiazapine with addicts?

A

Its a benzo eg can be addictive

68
Q

When is AUDIT used to screen for alcohol?

A

On admission to mental health hospital

69
Q

When is AUDIT used to screen for alcohol?

A

On admission to mental health hospital

70
Q

Alcohol hisotry

A

A typical days drinking - max in one day, frequenct etc
Presnce/severity of cdependence
Alcohol related physical, pscyhological and social probkems incl forensic hisotry
Risk
Previous interventions for problem and outcome
Patients expectations

71
Q

What is the cycle of change

A

Prochaska and Diclemente
Precontemplation, contemplation, prep, action, maintenance, termination
OR relaspse -> contemplation again

72
Q

Alcohol exam

A

Face
Hands and body
CNS
CVS
Abdo

73
Q

Bloods in alcohol dependence

A

Raised LFTs
High GGT, ALT, AST
B12 and folate low
FBC - low Hb, High MCV

74
Q

Controlled drinking

A

Below 40, detect ealy
No minimal
No major medical complications
No psych comorbidity
No impulsicity
Social stability
Patients choice

75
Q

Controlled drinking

A

Below 40, detect ealy
No minimal

76
Q

Pharmacotherapy options for alcohol addiciton - deterrent, anti craving, adjunctive

A

Deterrent - disulfiram - nasty sympotms after take
Anti craving - acamprosate
Adjunctive - antidepressants
Others - naltrexone

77
Q

What interviewing use with alcohol problems?

A

Motivational interviewing

78
Q

Assisted alcohol withdrawal

A

> 15 units a day or scroe over 20 on audit

79
Q

Why is thiamine deficient in alcoholism

A

Helps break down carbs - alcohol is carbs, more thiamine needed
Alcohol stops thiamine absorption
Poor diet/malnourishment

80
Q

How many people with wernickes go on to develop

A

80%
20% die

81
Q

Treat wernickes

A

IV pabrinex for 5 days

82
Q

What precedes korsakoffs

A

Wernickes

83
Q

Symptoms of korsakoffs

A

Loss short term memory - anterograde
Hallucinations
Receptive aphasia
Confabulation

84
Q

Recovery from korsakoffs

A

25% recover
50% improve but dont fully recover

85
Q

Cocaine symptoms

A

Wired, dilated pupils, tremor

86
Q

Presentation of heroin

A

Lethargic, sleepy

87
Q

Presentation of opiate misuse

A

Pinprick pupils
Drowsy
Reduced respiratory rate

88
Q

Drugs that can be targets of drug seeking behaviour

A

Tramadol
Cyclizine
Gabapentin
Pregabalin

Mental Health (57 decks)

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