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Toni's Psych > Substance Misuse > Flashcards

Substance Misuse Flashcards

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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
Q

How is detoxification managed?

A

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
Q

What methods are used to support relapse prevention?

A

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
Q

How does heroin give pleasure?

A

A mu opiate agonist it stimulates brain and spinal cord receptors usually acted on by endogenous endorphins

28
Q

How is heroin taken?

A

Initially often smoked
IV injection: antecubital fossa -> feet, backs of hands, groin
Veins become damaged
Subcutaneous ‘skin popping’ or IM

29
Q

What are local complications of IVDU?

A

Abscess
Cellulitis
DVT: femoral injection damages valves slowing venous return
Emboli: can cause gangrene and consequently amputation

30
Q

What are systemic complications of IVDU?

A

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
Q

What are the features of opiate intoxication?

A 
Intense rush, euphoria, warmth, well being
Sedation, analgesia
Vomiting dizziness
Bradycardia, respiratory depression
Pinpoint pupils
SE: constipation, anorexia, decr libido
32
Q

What is the process in opiate withdrawal?

A

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
Q

What is neonatal abstinence syndrome?

A

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
Q

What harm reduction strategies are used in the treatment of opiate users?

A

Sterile needle provision
Vaccination and testing for blood borne viruses
Information and advice

35
Q

What is substitute prescribing?

A

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
Q

What is naltrexone?

A

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
Q

What is methadone?

A

Full opiate agonist
Longer half life than heroin
Longer milder withdrawal

38
Q

What is buprenorphine?

A

Partial agonist at mu receptor
Blocks euphoric effects
Prevents withdrawal sx

39
Q

What is the psychoactive compound in cannabis?

A

Delta-9-tetrahydrocannabinol
Aka THC
Acts on cannabinoid receptors in the brain

40
Q

What are the features of cannabis intoxication?

A

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
Q

ICD10 criteria for dependence

A 
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
Q

What is flumazenil

A

Treatment for benzo OD

43
Q

How does disulfiram work?

A

Acetaldehyde dehydrogenase inhibitor
Unpleasant effects with alcohol:
Nausea, vomiting, flushing due to acetaldehyde build up
To help maintain abstinence

44
Q

How does acamprosate work?

A

Blocks NMDA glutamate receptors -> enhances GABA transmission
Reduces alcohol craving
Discontinue with regular drinking!

45
Q

How does chlordiazepoxide work?

A

Relieves alcohol withdrawal sx

Prevents withdrawal seizures

46
Q

Where can patients undergo alcohol detox?

A

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
Q

When do sx of alcohol withdrawal present?

A

6 - 12 hrs

48
Q

When do seizures present during alcohol withdrawal?

A

36 hrs

49
Q

When does delerium tremens present during alcohol withdrawal?

A

72 hrs

50
Q

What is delerium tremens?

A

Reduced GABA inhibition
Increased NMDA glutamate transmission

Manage:
Benzos
Carbamazepine
DON’T give phenytoin for seizures

51
Q

Neuronal degeneration in the mammillary bodies secondary to thiamine deficiency

A

Wernicke-Korsakoff’s syndrome

52
Q

Alcoholic who become paralysed

A

Central pontine myelinolysis

53
Q

Pinpoint pupils
Bradycardic
Resp depression
Constipation

A

Cocaine / opioids

54
Q 
Lasts 72 hrs
Depersonalisation
Illusions
Synaesthesia
Visual hallucinations
Dilated pupils
Hyperthermia
Tachycardia
SM contraction
A

LSD

55
Q

Caffeine

A 
Headache
Anxiety
Confusion
Tremors
Arrhythmia
Nausea + vom
56
Q

Drowsiness
Confusion
Reduced anxiety

A

Benzos

57
Q

Psilocybin/psilocin

Aka magic mushrooms

A 
Visual disturbances 
Enhanced perceptions
Euphoria
Relaxation
6hr duration 
Awkward postures, don't feel fatigue or sense of time
58
Q 
Reckless activity
Nystagmus
 Loss of balance
Raised T
Angel dust
A

PCP

59
Q

Short lived hallucinations
Absence of sensory stimulation
Dizziness
Sense of detachment

A

Ketamine

60
Q 
Dilated pupils
Euphoria
Grinding teeth
Dehydration
Loss of appetite 
Clubbing
A

MDMA aka ecstasy

61
Q

Mild euphoria
Hyperactivity
Excitement
Chewed

A

Khat

Toni's Psych (14 decks)

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