Brainscape's Knowledge GenomeTM

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


See full index

Phase 1b - Psychiatry > Substance Misuse & Addiction > Flashcards

Substance Misuse & Addiction Flashcards

1
Q

Which substances can cause addiction (14)?

A
  • Alcohol
  • Nicotine
  • Cannabis
  • Stimulants
    • Amphetamine
    • Cocaine
  • Crack
    • Ecstasy
  • Opioids (prescribed, OTC)
    • Heroin, fentanyl
    • DF118
  • Ketamine
  • Solvents
  • G-drugs
    • GHB, GBL
  • Benzodiazepines
  • Psychedelics
    • LSD
    • Magic mushrooms
  • Nitrous oxide
  • Khat
  • ‘Novel psychoactive substances’
    • ~950 synthetic (UNODC);
    • new: ~1/wk
    • Categories:
    • Depressant, stimulant, hallucinogenic. cannabinoid
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 3 categories of reasons that one may experiment with addictive substances for recreational reasons?

A
  • Positive reinforcement
  • Negative reinforcement
  • ‘Normal’

Experimental/‘recreational’ use: causing no/limited difficulties (majority of population)

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

Give examples of positive reinforcement in terms of alcohol / drug use (4).

A
  • Escapism
  • Stay awake
  • Get high
  • Like it
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Give examples of negative reinforcement in terms of alcohol / drug use (4).

A
  • Boredom
  • To get to sleep
  • Reduce anxiety
  • Feel better
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give examples of ‘normal’ reasons in terms of alcohol / drug use (5).

A
  • To fit in
  • Why not?
  • Rebel
  • Everyone does
  • Curious
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define intoxication.

A
  • A transient syndrome due to recent substance ingestion that produces clinically significant psychological or physical impairment
  • These changes disappear when the substance is eliminated from the body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define withdrawal state.

A
  • A group of symptoms and signs that occur when a drug is reduced in amount or withdrawn entirely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define tolerance.

A
  • A state in which after repeated administration, a drug produces a decreased effect
    • Increasing doses are therefore required to produce the same effect
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define harmful use.

A
  • A pattern of psychoactive substance use that is causing damage to health (physical or mental)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the requirement to diagnose dependence syndrome (6)?

Classification: ICD 10

A

3 or more of the following in past year:
* A strong desire or sense of compulsion to take a substance.
* Difficulties in controlling substance-taking behaviour in terms of its onset, termination, or levels of use.
* A physical withdrawal state when substance use has ceased or been reduced (This is mainly relevant to alcohol, opiates, benzodiazepines, G-drugs).
* Tolerance (ie. need to take more of the substance to get the same effect).
* Progressive neglect of alternative pleasures or interests because of substance use, increased amount of time necessary to obtain or take alcohol or to recover from its effects.
* Persisting with substance use despite clear evidence of overtly harmful consequences.

A client/patient CANNOT have a diagnosis of BOTH harmful use AND dependence

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

What are the requirements to diagnose harmful use (4)?

Classification: ICD 10

A
  • A pattern of substance use that causes damage to health.
    • The damage may be: (1) physical or (2) mental (This criterion MUST be present if harmful use is diagnosed).
  • Adverse social consequences.
  • Harmful use includes bingeing on substances. Does not include ‘hangover’ alone.
  • Does not fulfil any other diagnosis within substance use e.g. dependence

A client/patient CANNOT have a diagnosis of BOTH harmful use AND dependence

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

What are the differences between harmful use (ICD 10) and harmful use (ICD 11) (2)?

A
  • A new category to denote single episodes of harmful use from a pattern of harmful use
  • Harm to health of others.
    • This includes any form of physical harm, including trauma, or mental disorder that is directly attributable to behaviour related to substance use on the part of the person to whom the diagnosis of Harmful pattern of use of the substance/alcohol applies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the requirements to diagnose dependence (3)?

Classification: ICD 11

A
  • Impaired control over substance use (i.e. onset, frequency, intensity, duration, termination, context).
  • Increasing precedence of substance use over other aspects of life (e.g. repeated relationship disruption, occupational or scholastic consequences, negative impact on health).
  • Physiological features indicative of neuroadaptation to the substance, (e.g. tolerance, withdrawal, use of pharmacologically similar substances to prevent or alleviate withdrawal symptoms.

The features of dependence are usually evident over a period of at least 12 months but the diagnosis may be made if use is continuous (daily or almost daily) for at least 3 months.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the criteria to diagnose opioid use disorder?

Classification: DSM 5

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the course of behaviour for individuals with harmful use of alcohol / drugs?

A
  • There is a shift in motivational desire, as the urgency & necessity increases (regular use → period of stress where the euphoric effects subside the fears)
    • It is reversible
  1. Experimental / recreational use, cause no / limited difficulties
  2. Want: Increasingly regular use (fewer people) (harmful)
  3. Need: Spiralling: dependence (smaller number) (majority of population) (Like)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does alcohol do to the brain’s inhibitory system?

A
  • Alcohol behaves as a modulator of GABA-benzodiazepine coupling leading to an enhanced inhibitory system
    • Concerns the GABA-A receptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which receptor is predominantly involved in terms of the brain’s inhibitory system?

A
  • GABA-A receptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Which receptors are concerned with the excitatory glutamate system?

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

What impact does alcohol have on NMDA receptors?

A
  • Alcohol alters the coupling and modulatory sites of the receptor, impairing the excitatory system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What neuroadaptations take place due to chronic alcohol exposure?

A
  • GABA-A receptor subunit becomes less sensitive to alcohol - there is a reduced function in the inhibitory function - tolerance, given that alcohol consumption retains a GABAergic balance
  • Chronic alcohol consumption also leads to an upregulation in the excitatory system (NMDA receptors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the appearance & behaviour signs in a mental state examination of alcohol harmful use / dependency (4)?

A
  • Nil abnormal movements
  • Dressed in casual clothing
  • Good eye contact and rapport
  • Slightly defensive in manner
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the physical effects of alcohol harmful use / dependency?

There are a lot, learn 5.

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

What are the symptoms of alcohol withdrawl?

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

What are the speech signs in a mental state examination of alcohol harmful use / dependency (2)?

A
  • Normal RRT
  • Nil thought disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the mood signs in a mental state examination of alcohol harmful use / dependency (1)?

A
  • Irritable
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are the thoughts signs in a mental state examination of alcohol harmful use / dependency (2)?

A
  • Nil delusions / obsessions / overvalued ideas
  • In denial / ignorant of alcohol intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are the perception signs in a mental state examination of alcohol harmful use / dependency (1)?

A
  • Nil hallucinations in all modalities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What are the cognition signs in a mental state examination of alcohol harmful use / dependency (1)?

A
  • Oriented in Time Place and Person (TPP)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are the insight signs in a mental state examination of alcohol harmful use / dependency (1)?

A
  • Full insight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the appearance & behaviour signs in a mental state examination of drug (heroin) harmful use / dependency (6)?

A
  • Nil abnormal movements
  • Dressed in tracksuit
  • Reasonable rapport
  • Looks downcast
  • Collapsed veins (described)
  • Restless
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What aspects of history taking are specific to alcohol harmful use / dependency?

A
  • History of:
    • Alcohol related seizures, Delirium Tremens, Alcohol psychosis, haematemesis, melaena
  • Examination:
    • Comment on the presence of jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT
  • Investigations:
    • Fibro scan / Ultrasound
    • Bloods (LFT, GGT, Lipids, U&E, amylase)
    • Breathalyser
    • Urine Drug Screen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What’s the scoring of the alcohol use disorder identification test (AUDIT)?

A
  • 0-7: low risk
  • 8-15: increasing risk
  • 16-19: higher risk
  • >20: possible dependence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Which drugs are used to help boost GABA function in patients in the withdrawal state of chronic alcohol exposure?

A
  • Benzodiazepines
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are the symptoms of opiate withdrawl (11)?

A
  • Tachycardia
  • Sweating
  • Restlessness
  • Gooseflesh skin
  • Dilated pupils
  • Bone aches
  • Runny nose
  • Anxiety / Irritability
  • GI upset
  • Tremor
  • Yawning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What happens to patients in an alcohol withdrawal state?

A
  • There is an upregulation of the excitatory system:
    • An increase in calcium dynamics is toxic, leading to hyperexcitability (seizures) & atrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the pattern of glutamate release in patients with alcohol withdrawal?

A
  • There is a significant increase in glutamate (Both metabolic and synaptic) due to upregulation of excitatory neurones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What drugs are used to treat patients with alcohol withdrawal (2)?

A
  • Lorazepam
  • Diazepam (benzodiazepines)
38
Q

What is the effect of acamprosate in alcohol - dependent individuals?

A
  • Reduction in MRS glutamate & NMDA function → Downregulate the excitatory system
39
Q

What are the signs of harmful use / dependency of drugs (heroin) (6)?

A
  • Injecting for 1 year, x3 per day
  • Withdrawal features: feel sick, shivers, gooseflesh
  • Craving
  • Loss of control
  • Restricted interests / preoccupied with getting heroin
  • Distressed if cannot get heroin
40
Q

What are the speech signs in a mental state examination of drug (heroin) harmful use / dependency (3)?

A
  • Normal Repeat - Recal test (RRT)
  • Nil thought disorder
  • Softly spoken
41
Q

What are the mood signs in a mental state examination of drug (heroin) harmful use / dependency (1)?

A
  • Low, mildly flat affect
42
Q

What are the thought signs in a mental state examination of drug (heroin) harmful use / dependency (2)?

A
  • Nil delusions / obsessions / overvalued ideas
  • Preoccupied with seeking drug
43
Q

What are the perception signs in a mental state examination of drug (heroin) harmful use / dependency (1)?

A
  • Nil hallucinations in all modalities
44
Q

What are the cognition signs in a mental state examination of drug (heroin) harmful use / dependency (1)?

A
  • Oriented in Time Place and Person (TPP)
45
Q

What are the insight signs in a mental state examination of drug (heroin) harmful use / dependency (1)?

A
  • Full insight
46
Q

What aspects of history taking are specific to drug (heroin) harmful use / dependency?

A
  • Examination
    • Collapsed veins / track marks
    • Endocarditis
    • Skin abscesses
    • Hepatitis / HIV
    • Pneumonia
  • Investigations:
    • Bloods (LFT, U&E, GGT, Glucose)
    • Breathalyser
    • Urine Drug Screen
    • Sexual health screening / BBV
47
Q

Name some examples of natural rewards (2):

A
  • Sex
  • Food
48
Q

Which hormone is associated with natural rewards?

A
  • Dopamine
49
Q

Which region of the brain is concerned with natural rewards?

A
  • Ventral striatum
50
Q

Which pathway is concerned with the pleasure - reward motivation system?

A
  • Dopamine pathway
51
Q

Which hormone is a key modulator in the opioid system?

A
  • Mu opioid
52
Q

What impact is exhibited by mu opioids?

A
  • Mediates pleasurable effects, leading to an endorphin rush
53
Q

What type of reward state is exhibited by patients with addiction?

A
  • Reward deficient state
54
Q

What impact does cocaine, and amphetamines have on the dopaminergic system (2)?

A
  • Blocks dopamine transport re-uptake proteins, elevating concentrations of dopamine within the synaptic cleft
  • Amphetamine also enhances the release of dopamine
55
Q

How is opiate overdose managed?

A
  • Naloxone: Inject into upper arm or thight or nasal spray. If no response after 3 mins, repeat. Provide airway support.
56
Q

What impact does nicotine, opiates and alcohol have on the dopaminergic system?

A
  • Increase dopamine neurone firing in the ventral tegmental area
57
Q

What is the proposed relationship between D2 receptors and drug use?

A
  • Low levels of D2 receptors predispose subjects to use drugs
58
Q

What is the relationship between ventral striatum activity and problematic drug use?

A
  • There is a reward deficiency thus activity in the ventral striatum
59
Q

Which cerebral structure is associated with preoccupation and craving?

A
  • Prefrontal cortex
60
Q

Which cerebral structure is concerned with negative reinforcement?

A
  • Amygdala
61
Q

Which type of reinforcement develops and dominates in patients with dependence?

A
  • Negative reinforcement
62
Q

Which hormones are released in a stressed system (3)?

A
  • Kappa opioids (dynorphine)
  • NA
  • CRF
63
Q

Which system is dysregulated in alcohol addiciton?

A
  • Amygdala
64
Q

What is the pattern of amygdala regulation in patients with polydrug addiction compared to alcoholism?

A
  • In polydrug, there is a heightened response to aversive stimuli
65
Q

What are the 3 types of opioids?

A
  • Natural
  • Synthetic
  • Semi-synthetic
66
Q

Name 4 natural opioids.

A
  • Opium
  • Morphine
  • Codeine
  • Thebaine
67
Q

Name 4 synthetic opioids.

A
  • Fentanyl
  • Pethidine
  • Methadone
  • Tramadol
68
Q

Name 4 semi-synthetic opioids.

A
  • Heroin
  • Hydrocodone
  • Oxycodone
  • Hydromorphone
69
Q

What are G drugs (GHB-gamma hydroxybutynate & GBL-gamma butyrolactone)?

A
  • Depressant drugs which can produce a high with small doses, and cause sedation with only slightly higher doses (Very easy to overdose)
    • Euphoric
    • Loss of inhibitions
    • Increased confidence
    • Higher sex drive
70
Q

What is gambling disorder defined as?

A
  • Behavioural addiction in DSM-5
71
Q

What is internet gaming disorder?

A
  • In the DSM-5 is under “Conditions for Further Study”
    • Added to ICD-11 under addictive disorders
72
Q

What type of use is this case:
Drinks four pints of Stella most evenings. Says his drinking doesn’t cause problems.

A
  • Hazardous alcohol use
73
Q

What type of use is this case:
Drinks a bottle of wine most evenings, more at the weekends. Occasionally misses work because of hangovers.

A
  • Harmful alcohol use
    • Consequences: Physical, psychological, social impact
74
Q

What pattern of drinking is this case:
Drinks cider first thing each morning to stop himself shaking. Regards drink as a medicine, believes he wouldn’t get by without it. Doesn’t tend to get drunk.

A
  • Addiction / dependence
75
Q

What type of drug use is this case:
Broke her ankle 6 months ago which healed well and is back to playing football. Is still taking her opioid painkillers which are on repeat prescription

A
  • Likely biologically dependent as has been taking opioids for many months; no evidence of taking more than is prescribed (ie suggesting ‘abuse’) however need to ask if this is the case and why it is on repeat – has it just happened through error/lack of review or has she requested it?
76
Q

What type of drug use is this case:
Broke his ankle 3 months ago and says he is still in pain. Is still taking his opioid painkillers and often requests his prescription earlier.

A
  • Likely biologically dependent as has been taking opioids for many months; is taking more than is prescribed so need to ask why – for pain or to deal with withdrawal or “likes how it makes him feel”
  • Consider harmful use, ask about any other addiction behaviours to clarify if addicted
77
Q

What psychiatric disorders have an early onset (<18 y/o) (10)?

A
  • Depression
  • Anxiety
  • Somatisation disorder
  • Attention Deficit Hyperactivity Disorder
  • Autism Spectrum Disorder
  • Tic disorder/Tourette Syndrome
  • Obsessive Compulsive Disorder
  • Eating Disorders
  • Substance misuse
  • Self-harm and suicide
78
Q

How does one calculate units in alcohol?

A

Units = % strength x ml /1000

79
Q

What does CAGE stand for in alcohol use disorder?

Can help tell if you have a substance use disorder

A
  • Have you ever felt you needed to Cut down on your drinking?
  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt Guilty about drinking?
  • Have you ever felt you needed a drink first thing in the morning (Eye-opener)
80
Q

What does one assess in a Mental State Examination (MSE)?

A
  • Appearance & behaviour
  • Speech
  • Mood and affect
  • Thoughts
  • Perception
  • Cognition
  • Insight
81
Q

What are the tools used in alcohol use disorder assessment?

A
  • CAGE screening
  • Alcohol use disorder identification test (AUDIT)
82
Q

What are the character of the symptoms of alcohol withdrawl?

A
  • Worsening pattern of symptoms
  • Onset usually from 6 hours
  • Hallucinations can occur any time
  • Delirium tremens is a late sign and a medical emergency
83
Q

What are the tools used in opioids use disorder assessment?

A
  • Clinical Opiate Withdrawl Scale (COWS)
84
Q

What do Opioids do?

A
  • Relieve pain – analgesic effect
  • Create a sense of euphoria

Opioid receptors mu, delta, kappa effected by opioid agonists (heroin, methadone, fentanyl, codeine), partial agonists (Buprenorphine), antagonists (Naltrexone)

85
Q

What are the different types of opioids (4/4/4)?

A
  • Natural (Alkaloids) (Opiates)
    • Opium
    • Morphine
    • Codeine
    • Thebaine
  • Synthetic
    • Fentanyl
    • Pethidine
    • Methadone
    • Tramadol
  • Semi-synthetic
    • Heroin
    • Hydrocodone
    • Oxycodone (Oxycontin)
    • Hydromorphone
86
Q

How is opioid overdose managed?

A
  • Naloxone: inject into upper arm or thigh (400mcg), or nasal spray (50% each nostril)
    • If no response after 3 mins, repeat.
  • Provide airway support, recovery position
87
Q

What medication is used in the abstinence of alcohol (4)?

A
  • Acamprosate
  • Disulfiram (Antabuse)
  • Naltrexone
  • Nalmefene
88
Q

What medication is used in the abstinence of opioids (2)?

A
  • Methadone
  • Buprenorphine
89
Q

What medication is used in the detox regimes of alcohol?

A
  • Chlordiazepoxide
90
Q

What methods is used in the detox regimes of opioids?

A

Maintenance treatment, for at least 12 months to sustain changes in lifestyle, before dose reduction over several months.

Phase 1b - Psychiatry (8 decks)

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