Substance Misuse Flashcards
Externalising disorders
Abuse of alcohol and drugs from a psychological perspective
- also includes conduct disorders and antisocial disorder
The tendency to act out about their problems
As opposed to internalising disorders such as depression and anxiety
Classification of alcohol dependence
Withdrawal
Cravings - strong desire to drink
Drinking despite negative consequences
- on physical or mental health
- on social or work life
Tolerance increased
Priority in life - neglecting other activities
Loss of control
Rapid-reinstatement in people who have stopped drinking
Narrowing of repertoire - range of alcohol and drinking habits
Alcohol - harmful misuse
Occurs when the consequences of alcohol involve social, physical or psychological harm to a person
Alcohol - safe limits
Men and women
<14 units per week
<3 units per day
Alcohol - aetiology
Genetics - risk regardless of upbringing
Psychological factors
- impulsive, aggressive and hyperactive
Anxiety - alcohol relaxes
Occupation
- journalist, armed forces, entertainer and doctor are common
Cultural - e.g. less likely in Muslim community
Availability of alcohol
Alcohol - effects on CNS
CNS depressant - enhances the effect on GABA (inhibitory neurotransmitters)
- initial depression of inhibitory neurons
- gradual global CNS depression
Alcohol - effects on CVS
Increases BP - due to increased catecholamine sensitivity
Arrhythmia
Alcoholic cardiomyopathy
Vasodilation, so patient feels warm but they are losing heat
Alcohol - effects on liver
Increased conversion of glucose to lactic acid, causing hypoglycemia and fatty liver disease
Cirrhosis
Oesophageal varices
Hepatitis
Alcohol - effects on GI system
Gastritis
Chronic/acute pancreatitis
Alcohol - effects on sexual function
Damage to Leydig cells, causing decreased libido, infertility and decreased male body hair
Alcohol - neuropsychiatric effects
Peripheral neuropathy due to decrease in B12 and thiamine
Impaired memory
Depression/anxiety (both a cause and effect)
Stages of change
Precontemplation Contemplation Preparation Action Maintenance - full recovery
Withdrawal - early clinical features
Tremor Nausea Sweating Tachycardia Palpitations Agitation - autonomic overactivity All are caused by the lack of inhibitory effect provided by alcohol
Withdrawal - late clinical features
Delusions Confusion Diarrhoea Convulsions Auditory hallucinations Delirium tremors (>48 hours)
Delirium tremors - signs and symptoms
Restlessness Scared/paranoid Confused Ataxia/tremor Autonomic features Visual hallucinations - usually scary and accompanied by formication Auditory hallucinations - persecutory
Delirium tremors - management
Medical emergency
Benzodiazepines - sedative and anticonvulsant
B-vitamins - reduce encephalopathy
Fluid
Dextrose - avoid hypoglycemia
Be aware of infection and head/self injury
Delirium tremors - cause
Long-term changes alcohol has on the brain (total GABA receptors decrease, so there is no inhibition once withdrawn)
- CNS overactivity
Wernicke’s encephalopathy
Acute syndrome caused by thiamine deficiency
Signs and symptoms
- eye signs (nystagmus, ophthalmoplegia)
- ataxic gait
- confusion and memory problems
- nausea
Can occur due to any cause in reduced thiamine - e.g. pernicious anaemia
Korsakov’s
A state of impaired memory function that is present after signs of Wernicke’s encephalopathy subside
Anterograde memory disorder
- new memories can’t be consolidated
Confabulation
- make up events due to their lack of memory of recent events
Peripheral neuropathy
Can access events from before the syndrome
Korsakov’s - Differential diagnosis
Acute brain syndrome of miscellaneous causes (has no neuro effects)
Delirium tremors - no neuro signs
Chronic brain syndromes
- long-term memory is also affected
- can also be caused by chronic alcohol intake
Wernicke’s - treatment
Thiamine and other B vitamins
Sedation if required
Fluid/electrolytes
Korsakov’s - management
Lifelong chronic illness with no cure
Palsies and ataxia are likely to resolve with treatment
Neuropathy and amnesia fairly permanent
CAGE questions
Cut down
Annoyed anyone by drinking
Guilty about drinking
Eye opener
Opiate overdose - Clinical features
Pinpoint pupils
Low BP
Track marks
Benzo overdose - Clinical features
Gives impression of intoxication, but not drunk
Psychostimulants overdose - Clinical features
Rapid speech Large pupils Agitation Restlessness Hypertension
Withdrawal from drugs - clinical features
Opiates
- dilated pupils, hypertension, sweaty, cramps and runny nose
Benzos
- depersonalisation, hyper-reflexia/sensitivity
Psychostimulants
- agitated and restless
Management of harmful misuse of alchol
Methods to moderate drinking without total abstinence (controlled drinking)
Self-help materials
Alcohol dependence - management
Total abstinence advised
Detox
- home (if no psych issues or medication)
- medical ward
Benzo for sedation and anticonvulsant
Thiamine and vitamin B substitutes
Fluid replacement
Disulfiram
- inhibits acetaldehyde dehydrogenase, so causes nasty side effects when alcohol is consumed
Acamproste
- inhibits glutamate (excitatory amino acid) seen in cravings
Patient needs to motivated or it wont succeed
