Substance Misuse Flashcards
What are the ICD-10 types of substance misuse?
Acute intoxication Harmful use Dependence syndrome Withdrawal state Psychotic disorder Amnesic syndrome Residual disorder
What is acute intoxication?
Acute, usuall transient, effect of the substance
What is harmful use?
Recurrent misuse associated with physical, psychological and social consequences without dependence
What is dependence syndrome?
Prolonged compulsive substance use leading to addiction, tolerance and withdrawal
What is withdrawal state?
Physical/psychological effects from cessation of substance after prolonged use
What is psychotic disorder?
Onset of psychotic symptoms within 2 weeks of substance use. Must last >48 hrs
What is amnesic syndrome?
Memory impairment in recent memory and ability to recall past experiences
What is residual disorder?
Specific features due to substance misuse
Features
- flashbacks
- personality disorder
- affective disorder
- dementia
- persisting cognitive impairment
What are the main classes of drugs abused?
Opiates Cannabinoids Sedative-hypnotics Stimulants Hallucinogens
What are examples of opiates?
Morphine
Heroin
Codeine
What are the physical effects of opiate use?
Respiratory depression
Hypoxia
Hypotension
Hypothermia
What are the psychological effects of opiate use?
Apathy
Disinhibition
Psychomotor retardation
Impaired judgement
What are the signs of opiate withdrawal?
Craving Rhinorrhea Lacrimation Myalgia N+V
What is an example of an cannabinoid?
Cannabis
What are the physical effects of cannabis?
Increased appetite
Dry mouth
Tachycardia
What are the psychological effects of cannabis?
Euphoira
Disinhibition
Agitation
Paranoid ideation
What are the signs of cannabis withdrawal?
Anxiety
Irritability
Tremor of outstretched hands
What are examples of sedative-hypnotics?
Benzodiazepines
Barbiturates
What are the physical effects of sedative-hypnotics?
Unsteady gait
Slurred speech
Hypotension
Nystagmus
What are the psychological effects of sedative-hypnotics?
Euphoris Disinhibition Apathy Aggression Labile mood
What are the signs of sedative-hypnotics withdrawal?
Tremor - hands, tongue, eyelids
N+V
Tachycardia
Postural hypotension
What are examples of stimulants?
Cocaine Crack cocaine Ecstasy MDMA Amphetamine
What are the physical effects of stimulants?
Tachycardia
Sweating
Hypertension
Arrhythmias
What are the psychological effects of stimulants?
Euphoria Increased energy Grandiosity Aggressive Labile mood
Whar are the signs of stimulant withdrawal?
Dysphoric mood
Lethargy
Psychomotor agitation
Craving
What are examples of hallucinogens?
LSD
Magic mushrooms
What are the physical effects of hallucinogens?
Tachycardia/palpitations
Sweating
Tremor
Blurred vision
What are the psychological effects of hallucinogens?
Anxiety Illusions Hallucinations Depersonalisation Paranoia
What are the signs of hallucinogen withdrawal?
None
What are the physical complications of drug misuse?
Death
Infection - BBV
Endocarditis
Superficial thrombosis
What are the psychological complications of drug misuse?
Craving
Anxiety
Cognitive disturbance
Drug-induced psychosis
What are the social complications of drug misuse?
Crime
Imprisonment
Homelessness
Relationship problems
How is drug dependence defined?
> 3 over 1 month
- strong compulsion
- preoccupation with substance use
- withdrawal state
- inability to control use
- tolerance
- persisting despite harm
How is opiate dependence managed?
Methadone
What is alcohol abuse?
Consumption of alcohol at a level sufficient to cause physical, psychological or social harm
What is binge drinking?
Drinking over twice the recommended level of alcohol per day in one session
What is harmful use?
Drinking above safe levels with evidence of alcohol related problems
What is the UK recommended maximum intake?
14 units per week
What is 1 unit?
10ml alcohol
How is units calculated?
% (ABV) x volume (ml) / 1000
What are the medical effects of alcohol consumption?
Hypertension Hepatitis Pancreatitis Peptic ulcers Varices
What are the psychological effects of alcohol consumption?
Mood disorders
Anxiety disorders
Self-harm
What are the social effects of alcohol consumption?
Domestic violence Drink driving Financial problems Relationship problems Employment problems
What are the features of alcohol intoxication?
Slurred speech
Labile affect
Impaired judgement
Poor coordination
What are the features of alcohol dependence?
Subjective awarenss of need to drink Avoidance/relief of withdrawal symptoms Withdrawal symptoms Drink-seeking behaviour Restarting drinking after trying to stop Increased tolerance Narrowing of repetoire
What are the early signs of alcohol withdrawal?
Tremor
Swating
Nausea
Anxiety
What are the late signs of alcohol withdrawal?
Delirium tremens
Disorientation
Hallucinations
When does delirium tremens occur?
24hrs -> 1 week after cessation
What are the features of delirium tremens?
Dehydration Electrolyte disturbances Cognitive impairment Vivid perceptual abnormalities Paranoid delusions Marked tremor Autonomic arousal
How is delirium tremens managed?
Benzodiazepines
Haloperidol
IV pabrinex
What is Wernicke’s encephalopathy?
Thiamine deficiency
How does alcohol abuse cause thiamine deficiency?
Poor nutritional intake
Alcohol destroys thiamine pump
What are the features of Wernicke’s?
Nystagmus
Ataxia
Ophthalmoplegia
How is Wernicke’s managed?
IV thiamine
What is Korsakoff’s psychosis?
Profound memory loss due to alcohol
What are the features of Korsakoff’s?
Short term memory loss
Confabulation
Disorientation to time
How is alcohol withdrawal managed?
Oral/IV thiamine
Chlordiazepoxide
How is alcohol dependence managed?
Biological
- disulfiram
- Acamprosate
Psychological
- motivational interviewing
- CBT
Social
- AA