Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Substance misuse > Flashcards

Substance misuse Flashcards

1
Q

Biological factors in aetiology of substance misuse

A

Genetic predisposition (up to 50% heritability)

Neurobiological differences in EEG activity

Differences in receptor systems (e.g. DA) in brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Psychological factors in aetiology of substance misuse

A

Personality: Anxious (incl disorder, esp social anxiety), Impulsive (e.g. in ADHD)

Psychiatric Hx (esp childhood): depression, PD

Positive reinforcement: Drugs lead to behaviours that increase their use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Social factors in aetiology of substance misuse

A

Social network: Key component of recovery, peer pressure, FHx of substance use

Legal: Price/availability/illegal status

Social norms: Acceptability

Social status: Isolation, unemployment, relationship issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ICD-10 criteria for substance dependence

A

3 or more of the following:

Tolerance

Withdrawal/drinking to stop withdrawal

Compulsion to drink

Persistent drinking in the face of harm

Loss of ability to control drinking (reinstatement after abstinence)

Neglect of other activities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

ICD-10 criteria for ‘harmful use’ of substances

A

Clear evidence of harm to physical/mental health of user (i.e. already caused harm)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

5 stages of change for stopping subtance abuse

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Threshold for ‘lower risk’ drinking

A

<14 units per week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Threshold for higher risk drinking

A

>50 units pw for males

>35 units per week for females

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Receptor systems affected by alcohol

A

GABA: Acts as agonist, responsible for most effects

NMDA: Antagonist, reduces glutamate transmission

Opioid/DA: To lesser extents

Net effect: GABA > glutamate (acutely)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Psychopharmacology of chronic alcohol dependence

A

Compensatory increase in glutamate –> imbalance (glutamate >>> GABA) during withdrawal –> excitotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Screening tools for alcohol dependence

A

CAGE

FAST (4-question)

AUDIT (10 question)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the CAGE questionnaire?

A

Screening tool for alcohol dependence

Have you ever felt you should Cut down?

Annoyed by people criticizing your drinking?

Guilty about your drinking?

Eye-opener drink in the morning?

2+ = CAGE +ve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Assessment for alcohol use

A
  • Type of drink + quantity
  • Duration
  • Withdrawal/dependence signs
  • Full neuro, cognitive + liver (abdo exam)
  • LFTs (esp GGT), FBC (esp MCV, anaemia), Urate (in men), Carbohydrate-deficient transferrin
  • AUDIT, CIWA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

FAST questions

A
  1. How often have you consumed >8/>6 units of alcohol in one sitting in the last year?
  2. How often have you failed to do what was expected of you due to drinking in the last year?
  3. How often were you unable to remember what happened the night before due to drinking in the last year?
  4. Has a relative, friend, or healthcare professional ever been concerned about your drinking or suggested you cut down?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Blood test changes associated with alcohol misuse

A

Unexplained macrocytosis

Unexplained LFT disturbance

Reduced platelets

Raised carbohydrate-deficient transferrin (identifies drinking in past 1-2 weeks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Medical harm from alcohol

A

Liver: Damage, cirrhosis

CV: Cardiomyopathy, HTN

GI: Pancreatitis, varices, peptic ulcer

Cancer: Mouth, throat, oesophagus, liver

Blood: Macrocytosis, anaemia, haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Neurological harm of alcohol misuse

A

Blackouts

Epilepsy

Wernicke/Korsakoff syndrome

Neuropathy

Cerebellar degeneration

Dementia

Fetal alcohol syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Psychiatric harm of alcohol misuse

A

Alcoholic hallucinosis: auditory, occurs in clear consciousness c.f. withdrawal

Suicide (10% of alcohol dependent)

Anxiety

Depression

Pathological jealousy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Features of acute alcohol withdrawal

A

Tremors

Sweating

Nausea/vomiting

Agitation/anxiety

Seizures

Auditory hyperacusis

Visual disturbances

Delirium tremens (5%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Screening tool for alcohol withdrawal

A

CIWA-Ar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Onset of alcohol withdrawal symptoms

A

4-12h after last drink, lasts 2-5d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Rationale for pharmacological detox during acute alcohol withdrawal

A

Give benzodiazepine (usually chlordiazepoxide) for 5-7d in reducing dose to allow GABA/GLU balance to normalise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Chlordiazepoxide alternative in severe liver failure

A

Oxazepam, lorazepam (shorter half-life –> less liver accumulation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Pharmacological management of acute alcohol withdrawal

A

10-30mg chlordiazepoxide qds (up to 50 for severe dependence) in reducing dose for 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Autonomic features of delirium tremens

A

Autonomic:

  • Sweating
  • Pupil dilation
  • Hypertension, tachycardia, instability
  • Insomnia
  • Dehydration + electrolyte disturbance –> fatal arrhythmia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Neurological features of delirium tremens

A

Coarse tremor

Delirium - confusion, disorientation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Psychiatric featurers of delirium tremens

A

Classic triad:

  • Transient persecutory delusions, paranoia
  • Visual hallucinations
  • Fear/agitation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Onset of delirium tremens

A

24-48 hours (but up to 7d) after cessation of drinking, usually with intercurrent illness (e.g. UTI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Management of delirium tremens

A

Physical:

  • ECG + electrolytes –> fluid/haemodynamic management
  • Treat inter-current illness

Pharmacological:

  • Oral/IM lorazepam for sedation
  • Optimise detox medication (raise dose)

General:

  • Low-lit, quiet environment
  • 1:1 nursing
  • Inform security
  • MCA assessment + plan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Pathophysiology of wernicke’s syndrome

A

Acute encephalopathy due to vitamin B1 deficiency leading to degeneration of mamillary bodies + frontal lobe white matter

31
Q

Features of wernicke’s syndrome

A

Delirium

Ataxia

Ophthalmoplegia/nystagmus

Hypothermia/hypotension, tachycardia

Neuropathy

32
Q

Treatment of wernicke’s encephalopathy

A

IV thiamine (Vitamin B1) for 3-7d (beware risk of anaphylaxis)

Oral thiamine for 1/12

33
Q

Prognosis for Wernicke’s

A

20% mortality

80% of survivors develop Korsakoff’s

34
Q

Differential causes of Wernicke’s

A

Brain tumour

Prolonged vomiting: hyperemesis gravidarum in pregnancy, chemotherapy

Malabsorption syndromes

35
Q

Clinical features of Korsakoff’s

A

Anterograde amnesia

Some retrograde amnesia –> islands of memory

Confabulations

Due to damage of hippocampus/mamillary bodies

36
Q

Management of Korsakoff’s

A

Thiamine for 2 years

OT assessment + ongoing support

37
Q

Prognosis of Korsakoff’s

A

20% complete recovery

25% significant recovery

55% no change

38
Q

How should you treat hypoglycaemia in alcohol-dependent patient

A

Give IV thiamine first to prevent precipitating Wernicke’s

39
Q

Role of acamprosate in treatment of alcohol misuse

A

Enhances GABA transmission

Reduces cravings but pt must not be drinking

Started on day 1 of detoxification

40
Q

Role of naltrexone in alcohol misuse treatment

A

Blocks opioid –> reduces reward from alcohol

Can be taken while not abstaining (e.g. prophylactically before big night)

41
Q

Role of disulfiram in alcohol abuse treatment

A

Blocks acetaldehyde dehydrogenase –> increase acetaldehyde –> flushing + headache + hypotension

Threat of unpleasant consequences –> -ve reinforcement of alcohol drinking

Should not be used in severe liver damage, recent heart disease, suicidal ideation

42
Q

Prognosis of relapse in alcohol misuse

A

50% relapse within 6 months

43
Q

FRAMES approach to drinking interventions

A

Feedback about drinking

Responsibility of pt for change emphasised

Advice on how to stop drinking given

Menu of options for stopping drinking

Empathy

Self-efficacy of patient –> empowering

44
Q

Management of alcohol dependence, biological

A
  • Withdrawal: Inpatient detox, community detox with benzo/thiamine
  • Relapse prevention: Bio
    • Pharmacological: Disulfiram, acamprosate, naltrexone, nalmefene
    • Vitamin supplementation
45
Q

Management of alcohol dependence, psychological

A

Psychoeducation: Family, patient, safe drinking/withdrawal advice, self-help guidance

Consultation: FRAMES, motivational interviewing (decisional balance, readiness ruler)

Outpatient f/u: screen for co-morbid psychiatric condition

Turning point

Marital/family therapy

46
Q

Management of alcohol dependence, social

A

Employment, social support

Residential/therapeutic communities (e.g. AA)

47
Q

Positive prognostic factors for alcohol dependence

A

Strong motivation

Strong social/occupational structure

Good insight

48
Q

Indications for inpatient detox

A
  • Alcohol Hx:
    • Past Hx of seizures/DT
    • Hx of failed community detox
    • Severe alcohol dependence
  • Current psych:
    • Symptoms of Wernicke’s-Korsakoff
    • Current confusion/delirium
    • Polysubstance misuse
    • High suicide risk
    • Lack of stable home environment
  • Current physical
    • Severe malnutrition/N+V
    • Concurrent physical/psychiatric illness
    • Older age
49
Q

Effects of cannabis intoxication

A

Anxiety, paranoia

Mellowness, giggling

slurring of speech, reduced coordination

Reddening of eyes

50
Q

Active substances in cannabis

A

THC (main active ingredient) + cannabidiol (mild antagonist to THC, antipsychotic)

Levels vary in different strains

51
Q

Adverse effects of cannabis

A

Increased risk of pneumothorax

Precipitate angina

Worsen schizphrenia prognosis

Precipitate schizophrenia

Cognitive impairment in long-term heavy users

Reduced concentration, memory, motivation

Sleep disturbance

52
Q

Effects of opioids

A

Euphoria

Analgesia

Pupillary constriction

Respiratory depression, hypotension, hypothermia, bradycardia

N+V, constipation

53
Q

Features of opioid withdrawal

A

GI: Vomiting, diarrhoea, abdominal pain

Face: Pupil dilation, runny nose + eyes

Neuromuscular: Restlessness, insomnia, myalgia

Autonomic: Sweating, tachycardia

Onset 6h after last dose, peak 36-48h

54
Q

First-line treatment for symptomatic relief of opioid withdrawal

A

Lofexidine

55
Q

Onset of opioid withdrawal

A

8-12h after last dose

56
Q

Duration of opioid withdrawal

A

10d, with peak at 24-48h

57
Q

Adverse effects of opioids

A

Infection: Phlebitis, HIV, HCV

Psychiatric: 14x risk of suicide

Overdose

Mortality 12x

Social: Crime, poverty, etc..

58
Q

Pharmacological management of opioid dependence

A

Methadone

Buprenorphine

59
Q

Dosing of methadone

A

Oral, start 30mg and increase slowly to reach therapeutic dose (60-120mg)

High risk of overdose!

60
Q

Benefits of buprenorphine over methadone

A

Partial agonist –> ceiling effect –> lower risk of OD + less sedating

May ppt withdrawal during conversion

61
Q

Psychological interventions for opioid dependence

A

Relapse prevention therapy (CBT)

NA programme

Residential programmes (therapeutic communities)

62
Q

Relapse rate opioid dependence

A

40% at 6 months

63
Q

Symptoms of opioid overdose

A

Respiratory depression/arrest

Pinpoint pupils

Bradycardia, hypotension

64
Q

Management of opioid overdose

A

Naloxone until spontaneous ventilation returns

65
Q

Features of stimulant use (amphetamines, cocaine, MDMA)

A

Elevated mood, energy, insomnia

Over-talkativeness

Pupil dilation, tachycardia, high BP, dry mucous membranes

Hyperpyrexia + dehydration (esp MDMA)

66
Q

Features of amphetamine withdrawal

A

Depression, lethargy, suicidality, craving

67
Q

Psychiatric effect of prolonged amphetamine use

A

Paranoid psychosis

Mood swings + depression

Formication (somatic hallucination) –> scabs

68
Q

Management of acute stimulant misuse

A

Benzo and/or antipsychotic

TCA for depression if necessary

69
Q

Effects of ketamine intoxication

A

Euphoria

Synaesthesia, hallucinations

Nausea

Ataxia, slurred speech

70
Q

Adverse effects of ketamine

A

Fatal overdose

Permanent bladder damage (haemmorhagic cystitis)

Physical dependence

Psychosis, depression

Memory impairment

71
Q

Management for harmful substance use, biological

A

Bio:

  • Monitor physical health issues (eg. infx)
  • Substitute prescribing/withdrawal management
  • Contraception, needle exchange
72
Q

Management for harmful substance use, psychological

A

Education

Self-help, SMART goal setting

Treatment of underlying psychiatric conditions

Marital/family therapy

73
Q

Management for harmful substance use, social

A

Employment/accommodation support (assigned social worker)

Help establishing new interests

Peer support group (e.g. NA)

Psychiatry (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions