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Toni's Psych > Substance Misuse > Flashcards

Substance Misuse Flashcards

1
Q

What is harmful use?

A

A pattern of use likely to cause physical or psychological damage

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2
Q

What is dependency?

A

A cluster of physiological, behavioural and cognitive symptoms in which use of a substance takes on a much higher priority than other behaviours that once had grater value

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3
Q

What is withdrawal?

A

A transient state occurring while readjusting to lower levels of the drug in the body

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4
Q

What is the classical conditioning theory of dependence?

A

Cravings become conditioned to cues

So that a cue itself can trigger a craving and thus cause drug seeking behaviour

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5
Q

What is the operant conditioning theory of dependence?

A

Behaviours rewarded are repeated: positive reinforcement

Behaviours are repeated if they relieve unpleasant experiences: negative reinforcement

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6
Q

What are features of dependence?

A 
Tolerance
Compulsion
Withdrawal
Problems controlling use
Continued use despite harm
Salience
Reinstatement following abstinence
Narrowing of the repertoire
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7
Q

What is tolerance?

A

Larger doses required to gain the same effect experienced previously

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8
Q

What is compulsion?

A

Strong desire to use the substance

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9
Q

What is salience?

A

Obtaining and using the substance becomes so important that other interests are neglected

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10
Q

What is narrowing the repertoire?

A

Loss of variation in use of the substance?

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11
Q

What is the social learning theory of dependence?

A

AKA vicarious learning

We learn by copying behaviours of others
Substance misuse can result from peer pressure

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12
Q

What is the neurobiological model for addiction?

A

All drugs if abuse affect the dopaminergic reward pathway in the brain:
Ventral tegmental area -> prefrontal cortex and lambic system
Prefrontal cortex has a role in motivation + planning
Dopamine release in nucleus accumbens= sensation of pleasure

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13
Q

How do cocaine and amphetamines give pleasure?

A

Block dopamine reuptake

= increased synaptic dopamine levels

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14
Q

Aetiology of alcohol misuse

A

Some genetic susceptibility: supported by adoption studies
Occupation: stressful work + socially sanctioned drinking
Social background: difficult childhood, poor educational achievement
Psychiatric illness: assoc with personality disorders, mania, depression, and anxiety disorders

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15
Q

1 unit of alcohol:

A 
1/2 pint normal beer
Small 125ml glass wine
One measure (25ml) spirit
One measure (50ml) fortified win

Units= vol in ml x % alcohol /1000

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16
Q

What are safe levels of alcohol consumption?

A

Women: 2-3/day, 14/week
Men: 3-4/day, 21/week

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17
Q

What are harmful levels of alcohol consumption?

A

Women: >6 /day, >35 /wk
Men: >8 /day, >50 / wk

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18
Q

Delerium tremens

A

48hrs into abstinence, lasts 3-4 days
Symptoms:
Confusion, hallucinations, affective changes, gross tremor, autonomic disturbance, delusions
Mortality rate 5% (30% with sepsis)
Management: reducing benzodiazepine regime and parenteral thiamine, management of potentially fatal dehydration and electrolyte disturbance

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19
Q

What is Wernicke’s encephalopathy

A

Due to acute thiamine (vit B1) deficiency
Confusion, ataxia, opthalmoplegia
Medical emergency!
Treat with parenteral thiamine

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20
Q

What is korsakoff’s syndrome?

A

Cause by untreated Wernicke’s encephalopathy
Irreversible antegrade amnesia
Can register new events but cannot recall them
Patients may confabulated to fill in gaps in memory

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21
Q

What is intoxication?

A

Transient state of emotional and behavioural change following drug use, dose dependent and time limited

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22
Q

How would you investigate a patient with apparent alcohol misuse?

A

FBC: macrocytic anaemia (incr MCV) due to B12 deficiency
LFTs: gammaGT rises with recent heavy alcohol use, raised transaminases indicate hepatocellular damage
UDS: if suspect drug misuse too
Hepatitis screen: if suspect IV drug use

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23
Q

What can a UDS: urine drug screen detect?

A 
Amphetamine: 2 days
Heroin: 2 days
Cocaine: 5-7 days
Methadone: 7 days
Cannabis: up to 1 month
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24
Q

How do you assess a patients’ motivation to change?

A

The stages of change model:
Pre-contemplation, Contemplation, Preparation, Action, Maintenance, Relapse
Identify support needed, set realistic goals e.g.
Short term: reduce consumption
Medium term: undergo detoxification
Long term: attend college

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25
How is detoxification managed?
Planned = following period of preparation Unplanned = e.g. after emergency hospital admission Long-acting benzos: prevent withdrawal symptoms incl seizures + DT Gradually withdrawn and stopped Thiamine: parenteral prophylaxis
26
What methods are used to support relapse prevention?
Psychological: CBT + group therapy Medical: Acamprosate, anti craving drug thought to act in midbrain Disulfiram, mimics flush reaction to alcohol making consumption highly unpleasant
27
How does heroin give pleasure?
A mu opiate agonist it stimulates brain and spinal cord receptors usually acted on by endogenous endorphins
28
How is heroin taken?
Initially often smoked IV injection: antecubital fossa -> feet, backs of hands, groin Veins become damaged Subcutaneous 'skin popping' or IM
29
What are local complications of IVDU?
Abscess Cellulitis DVT: femoral injection damages valves slowing venous return Emboli: can cause gangrene and consequently amputation
30
What are systemic complications of IVDU?
Septicaemia: direct injection of bacteria or from abscess/cellulitis Infective endocarditis: tricuspid valve Blood borne infections: hepB, hepC, HIV Increased risk of OD less dose titration than in smoking
31
What are the features of opiate intoxication?
``` Intense rush, euphoria, warmth, well being Sedation, analgesia Vomiting dizziness Bradycardia, respiratory depression Pinpoint pupils SE: constipation, anorexia, decr libido ```
32
What is the process in opiate withdrawal?
Withdrawal from IV heroin typically begins 6 hrs post injection Peaks at 36-48 hrs, unpleasant but rarely life threatening Dysphoria, nausea, insomnia, agitation Diarrhoea, vomiting, lacrimation, rhinorrhoea Feverish, abdo cramps, aching joints and muscles Piloerection, yawning, pupil dilation
33
What is neonatal abstinence syndrome?
Babies born to opiate dependent mothers suffer withdrawal Symptoms incl: High pitched cry, restlessness, tremor, loose stools, vomiting, sweats, fever, hypertonia, convulsions, tachypnoea Treatment: paeds opiate preparations, anticonvulsants, support
34
What harm reduction strategies are used in the treatment of opiate users?
Sterile needle provision Vaccination and testing for blood borne viruses Information and advice
35
What is substitute prescribing?
Deliberate prescription of drugs in a controlled manner Methadone liquid Buprenorphine sublingual tablets Taken in supervised environment Doses gradually titrated to avoid withdrawal symptoms
36
What is naltrexone?
Opiate antagonist: mu + kappa receptors Blocks opiate receptors and thus euphoric effects of opiates Used as a relapse prevention agent - alcohol + opioids Can facilitate rapid detox - opioids
37
What is methadone?
Full opiate agonist Longer half life than heroin Longer milder withdrawal
38
What is buprenorphine?
Partial agonist at mu receptor Blocks euphoric effects Prevents withdrawal sx
39
What is the psychoactive compound in cannabis?
Delta-9-tetrahydrocannabinol Aka THC Acts on cannabinoid receptors in the brain
40
What are the features of cannabis intoxication?
Relaxation, euphoria, paranoia, anxiety, panic Perceptual distortion Hunger pangs Nausea and vomiting Coordination affected Injected conjunctivae, tachycardia, dry mouth Restless and irritability after use common despite lack of withdrawal
41
ICD10 criteria for dependence
``` Narrowing of repertoire Tolerance Loss of control of drinking Compulsion Continued use despite harm Salience/primacy Reinstatement after abstinence Withdrawal 3 or more at any time ```
42
What is flumazenil
Treatment for benzo OD
43
How does disulfiram work?
Acetaldehyde dehydrogenase inhibitor Unpleasant effects with alcohol: Nausea, vomiting, flushing due to acetaldehyde build up To help maintain abstinence
44
How does acamprosate work?
Blocks NMDA glutamate receptors -> enhances GABA transmission Reduces alcohol craving Discontinue with regular drinking!
45
How does chlordiazepoxide work?
Relieves alcohol withdrawal sx | Prevents withdrawal seizures
46
Where can patients undergo alcohol detox?
Normally in the community - give chlordiazepoxide If hx of seizures, W-K sx, comorbid illness, suicidal ideation, lack of stable environment, prev failed outpatient detox: Inpatient detox
47
When do sx of alcohol withdrawal present?
6 - 12 hrs
48
When do seizures present during alcohol withdrawal?
36 hrs
49
When does delerium tremens present during alcohol withdrawal?
72 hrs
50
What is delerium tremens?
Reduced GABA inhibition Increased NMDA glutamate transmission Manage: Benzos Carbamazepine DON'T give phenytoin for seizures
51
Neuronal degeneration in the mammillary bodies secondary to thiamine deficiency
Wernicke-Korsakoff's syndrome
52
Alcoholic who become paralysed
Central pontine myelinolysis
53
Pinpoint pupils Bradycardic Resp depression Constipation
Cocaine / opioids
54
``` Lasts 72 hrs Depersonalisation Illusions Synaesthesia Visual hallucinations Dilated pupils Hyperthermia Tachycardia SM contraction ```
LSD
55
Caffeine
``` Headache Anxiety Confusion Tremors Arrhythmia Nausea + vom ```
56
Drowsiness Confusion Reduced anxiety
Benzos
57
Psilocybin/psilocin | Aka magic mushrooms
``` Visual disturbances Enhanced perceptions Euphoria Relaxation 6hr duration Awkward postures, don't feel fatigue or sense of time ```
58
``` Reckless activity Nystagmus Loss of balance Raised T Angel dust ```
PCP
59
Short lived hallucinations Absence of sensory stimulation Dizziness Sense of detachment
Ketamine
60
``` Dilated pupils Euphoria Grinding teeth Dehydration Loss of appetite Clubbing ```
MDMA aka ecstasy
61
Mild euphoria Hyperactivity Excitement Chewed
Khat

Toni's Psych (14 decks)

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