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Phase 2 Psychiatry > Substance Misuse > Flashcards

Substance Misuse Flashcards

1
Q
  1. What is alcohol use disorder?
  2. What is a problem drinker?
  3. What is alcohol dependence?
A
  1. chronic psychiatric disorder associated with tolerance, withdrawal, impaired control of drinking behaviour and continued use of alcohol despite adverse consequence
  2. person who causes/experiences physical, psychological and/or social harm as a consequence of drinking alcohol. Many problem drinkers are not physically addicted to alcohol
  3. physical dependence on or addiction to alcohol. the use of a substance (or class of substance) takes on a much higher priority for a given individual than other behaviours that once had higher value
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2
Q
  1. What is the age of onset of alcohol use disorder?
  2. What is the pattern of alcohol use disorder in females?
  3. Name populations in which there are higher rates of alcohol problems and disorders (7)
A
  1. late teens-20s for males; later in females
  2. drink alone; delay seeking help; have co-morbid depression; stronger genetic predisposition; develop physical complications
  3. urban populations
    homeless
    divorced/separated
    those involved in the manufacture/sale of alcohol
    commercial/frequent overseas travellers
    entertainers, doctors, journallists
    north american, afro-caribbean; irish
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3
Q
  1. How can alcohol dependence result from positive and/or negative reinforcement?
  2. Name social factors associated with alcohol dependence?
  3. Name co-morbidities associated with alcohol dependence?
A
  1. positive reinforcement - seeking out pleasant effects from alcohol
    negative reinforcement - removing negative effects of alcohol withdrawal
  2. adverse life events; occupational groups (unskilled manual labour; unemployment)
3. chronic pain
    terminal illness
    anxiety and affective disorders
    PTSD
    schizophrenia
    personality disorders (particularly those related to poor impulse control)
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4
Q

Describe the personality of:
1. Type 1 Alcoholics

  1. Type 2 Alcoholics
A
  1. more dependent, anxious, rigid, less aggressive, more guilty; mother or father an alcoholic; use of alcohol to manage anxiety
  2. early onset, severe problems, socially detached, distractable, confident; behaviour linked to a similar pattern in biological father. Can be seen as secondary to antisocial personality disorder.
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5
Q

Describe the pathophysiology of alcohol dependence

A
  • Long term exposure to alcohol causes down regulation of inhibitory GABA receptors and up regulation of excitatory glutamate receptors, alongside increased central NA activity.
  • Discontinuation of alcohol ingestion leaves the excitatory state unopposed, leading to hyperactivity and dysfunction of the nervous system, leading to characteristics of alcohol withdrawal.
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6
Q

Describe 7 key features of alcohol dependence

A
  1. compulsion to drink
  2. SALIENCE - primacy of drinking over other activities
  3. stereotyped pattern of drinking
  4. increased tolerance to alcohol
  5. repeated withdrawal symptoms
  6. relief drinking to avoid withdrawal symptoms
  7. reinstatement after abstinence
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7
Q
  1. What are the components of the CAGE questionnaire?
  2. What other questionnaire can be used for the assessment of alcohol dependence?
  3. Name the components of a longitudinal and cross sectional hx into alcohol dependence/substance abuse
A
  1. have you ever felt the need to Cut down on drinking?
    have people ever Annoyed you by asking about your drinking?
    have you ever felt Guilty about your drinking?
    have you ever had an Eye opener to steady nerves/get rid of a hangover?
  2. AUDIT questionnaire
3. Age of onset
    type of substances used
    progression of substance use
    possible precipitating and perpetuating factors
    current pattern of use
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8
Q
  1. Name 2 psychological treatments useful in the management of alcohol abuse/dependency
  2. Name 2 drugs used to help maintain abstinence in combo with psychological therapy
A
  1. CBT (using motivational interviewing)
    12 step facilitation (used by AA)
  2. Naltrexone (opioid antagonist)
    Acamprostate (acts on GABA, NA and 5-HT receptors)
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9
Q

Name 8 common features of alcohol withdrawal syndrome

A
  1. hand tremor
  2. minor hallucinations
  3. insomnia
  4. anxiety, agitation, disorientation
  5. sweating and flushing
  6. tachycardia
  7. convulsions
  8. nausea, vomiting, diarrhoea, anorexia
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10
Q
  1. When do alcohol related seizures usually occur?

2. What type of seizures are they commonly?

A
  1. within 12-48 hours of alcohol cessation (rare beyond 48 hour)
  2. grand mal
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11
Q
  1. What is delirium tremens?

2. Describe clinical features of delirium tremens

A
  1. most serious withdrawal state; medical emergency; occurs in 5% of patients undergoing alcohol withdrawal, usually occuring within 2-5 days of alcohol cessation. Life threatening.
2. severe tremor
    delusions
    tachycardia
    delirium
    clouding of consciousness
    confusion and disorientation
    agitation and/or violent behaviour
    fever
    severe hallucinations
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12
Q

How is alcohol withdrawal managed?

A
  • hospital admission
  • chlordiazepoxide - every 2 hrs PRN; after 24 hr assessment period, should be switched to a 5 day reducing regimen
  • parenteral pabrinex (thiamine)
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13
Q
  1. What is Wernicke’s encephalopathy caused by?
  2. What is the triad of symptoms?
  3. How is it managed?
A
  1. thiamine deficiency associated with prolonged alcohol ingestion
  2. ataxia, opthalmoplegia; confusion
  3. pabrinex
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14
Q
  1. Name examples of stimulants

2. What are the effects of stimulants?

A
  1. amphetamines (speed); cocaine; methamphetamines (crystal meth); MDMA (ecstasy)
  2. alertness, endurance, diminished need for sleep, sense of wellbeing
    Patients can present with mania-like features, as well as a paranoid psychosis
    Psychological rather than true physical dependence occurs
    Overdoses cause death through myocardial infarction, cerebrovascular disease, hyperthermia and arrhythmias
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15
Q
  1. Name examples of hallucinogens

2. What are the effects of hallucinogens?

A
  1. cannabis; LSD; synthetic cannaboids (spice; black mamba)
  2. Produce distortions and intensifications of sensory perceptions and frank hallucinations
    Psychosis is a long-term complication
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16
Q

Describe the stages of change

A
  1. PRE-CONTEMPLATION - user does not recognise that problem use exists
  2. CONTEMPLATION - user may accept there is a problem and begins to consider both positive and negative aspects of continued drug use
  3. DETERMINATION - point at which user decides on whether to continue drug use or accept change
  4. ACTION - point of motivation where the user accepts change
  5. MAINTENANCE - a stage of maintaining gains and attempting to improve areas of life harmed by drug use
  6. RELAPSE - a return to previous behaviour, but with the possibility of gaining useful strategies to extend the maintenance period on the user’s next attempt at change
17
Q

Describe the 4 main roles of a therapist in motivational interviewing

A
  1. express empathy
  2. develop discrepancy - point out disparity between what they are doing and what their goals are
  3. roll with resistance
  4. support self efficacy
18
Q

Describe the tasks for the therapist in Motivational interviewing when the patient is at different stages of change

A
  1. PRECONTEMPLATION - promote engagement and positive relationship; provide information
  2. CONTEMPLATION - weigh pros and cons of continuing substance use; exploration of possible alternatives
  3. DETERMINATION - discuss options and treatments; arrange start dates
  4. ACTION - understand factors and strategies supporting the new behaviour; offer reinforcement and support
  5. MAINTENANCE - support and encourage; design relapse prevention plans; skills development
  6. RELAPSE - re-engage with services and support; explore reasons for relapse and learn from experience; review of relapse prevention plans
19
Q
  1. What is harm reduction?

2. Name examples of harm reduction

A
  1. method of managing drug users in terms of reducing mortality and morbidity, without necessarily insisting on abstinence
  2. safer drugs/routes of administration
    advice regarding safer injection practice
    advice regarding safe sex
    prescription of maintenancemnopiates/benzodiazepines
    engagement with other sources of help
20
Q

Describe some physical consequences of substance abuse

A
  • direct adverse effects of substances
  • injury - associated with drug administration or that which occurs during intoxication
  • increased violent reactions
  • overdose
  • loss of hygiene and normal routine
  • teratogenic effects
21
Q

Describe some psychological and personal consequences of substance

A
  • can induce/exacerbate mental health conditions
  • impacts relationships
  • financial problems
  • homelessness
  • criminal activity
  • suicide
22
Q

Describe the impact on society that substance misuse can have

A
  • high disease burden
  • economic impacts - high costs associated with crime, healthcare and loss of productivity
  • harm - crime, injury, family adversity
  • child protection issues

Phase 2 Psychiatry (11 decks)

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