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Psychiatry > Substance misuse (alcohol and drugs) > Flashcards

Substance misuse (alcohol and drugs) Flashcards

1
Q

What is the recommended units of alcohol consumed within a week for men and women?

A

14 for both

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2
Q

What is the prevalence of alcohol use disorders within the UK in men and women?

A

Men: 6%
Women: 2%

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3
Q

What proportion of men and women drink in a harmful and hazardous way?

A

Men: 1/3
Women: 1/6

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4
Q

What neurotransmitters does alcohol have an effect on?

A

Gamma aminobutyric acid (GABA)
Dopamine
Serotonin
Glutamate

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5
Q

What neurotransmitters cause the reinforcing effect of alcohol?

A

GABA
Dopamine
Serotonin

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6
Q

What effects happen in terms of neurotransmitters in alcohol dependence and what happens when you withdraw alcohol?

A

Compensatory up-regulation of glutamate to counterbalance the GABAergic CNS depressant effects of alcohol.

Suddenly withdrawing alcohol therefore leads to symptoms of CNS hyperexcitation

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7
Q

What are the seven key features of alcohol dependence?

A
  1. Compulsion to drink or craving
  2. Primacy of drinking over other activities
  3. Stereotyped pattern of drinking, e.g. narrowing of drinking repetoire
  4. Increased tolerance to alcohol, i.e. needing more and more to produce the same effect
  5. Repeated withdrawal symptoms
  6. Relief drinking to avoid withdrawal symptoms e.g ‘eye opener’ first thing in the morning
  7. Reinstatement after abstinence
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8
Q

How do you get diagnosed with alcohol dependence in the ICD-10?

A

At least three from a list of features occurring at any time during a 12-month period.

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9
Q

What are the symptoms of alcohol withdrawal?

A

Range from mild anxiety and sleep disturbance to life-threatening delirium tremens.

Agitation
Tremor
Perspiration
Nausea
Vomiting

Most likely to occur first thin in the morning

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10
Q

In how many people with alcohol dependence will delirium tremens occur?

A

Its a medical emergency that occurs in 5% of people after one-to-three days without alcohol

Untreated mortality is rate is around 10%

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11
Q

How is delirium tremens characterised?

A 
Clouding of consciousness
Disorientation of recent memory
Impairment of recent memory
Fear, agitation, and restlessness
Vivid hallucinations (most commonly visual) and delusions (most commonly paranoid)
Insomnia
Autonomic disturbances (tachycardia, hypertension, hyperthermia, perspiration, dilated pupils)
Coarse tremor
Nausea and vomiting
Dehydration and electrolyte imbalances
Seizures
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12
Q

What are the important differential diagnoses of delirium tremens?

A 
Hypoglycaemia
Drug overdose
Other causes of delirium (UTI)
Alcohol hallucinosis
Wernicke's encepholopathy
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13
Q

How do you treat delirium tremens?

A

Benzodiazepines
Correction of fluid and electrolyte imbalances
Treatment of concurrent infections
Parenteral multivitamin injections

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14
Q

What is Wernicke’s encephelopathy?

A

It is a medical emergency. It is a disorder of acute onset that results from thiamine (vitamin B1) deficiency, most commonly secondary to alcohol dependence.

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15
Q

What are the symptoms of Wernicke’s encephelopathy?

A 
Impaired consciousness
Confusion
Episodic memory impairment
Ataxia
Nystagmus
Abducens and conjugate gaze palsies
Pupillary abnormalities
Peripheral neuropathy

Classic triad - Confusion, ataxia, ocular palsy

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16
Q

What are the other causes of thiamine deficiency?

A

Starvation
Malabsorption
Hyperemesis
Carbon monoxide poisoning

17
Q

What is the treatment for Wernicke’s encephelopathy?

A

Parenteral thiamine

18
Q

What are the differential diagnoses for Wernicke’s encephelopathy?

A

Hypoglycaemia
Hepatic encephelopathy
Subdural haemorrhage

19
Q

What are the results of treatment in Wernicke’s? How many recover, die and what happens to the rest?

A

20% recover
10% die from haemorrhages in the brainstem and hypothalamus
The rest develop Korsakov syndrome

20
Q

What causes Korsakov syndrome?

A

Neuronal loss
Gliosis
Haemorrhage in the mamimillary bodies
Damage to the dorsomedial nucleus of the thalamus

21
Q

What is Korsakov syndrome?

A

An irreversible amnestic syndrome characterised by impairment of recent and, to a lesser extent, remote memory (memories from years ago.
Confabulation
Immediate recall, perception, and other cognitive functions are usually intact.

22
Q

What are the psychiatric complications of alcohol misuse and dependence?

A 
Mood and anxiety disorders
Suicide and deliberate self-harm
Partially reversible cognitive impairment
Alcoholic hallucinosis
Othello syndrome
Pathological intoxication
23
Q

What are the neurological complications of alcohol misuse and dependence?

A 
Episodic anterograde (short term) amnesia
Seizures
Peripheral neuropathy
Cerebellar degeneration
Optic atrophy
24
Q

What are the gastrointestinal complications of alcohol misuse and dependence?

A 
Oesophagitis 
Oesophageal varices
Gastritis
Peptic ulceration
Acute and chronic pancreatitis
Alcoholic hepatitis
Cirrhosis: 10-20% of dependents
Cancer of the oesophagus, stomach and liver
25
Q

What are the cardiovascular complications of alcohol misuse and dependence?

A

Hypertension
Cardiac arrhythmias
Cardiomyopathy

26
Q

What are the other medical complications of alcohol misuse and dependence?

A 
Episodic hypoglycaemia
Vitamin deficiencies and anaemia
Accidents, especially head injury
Hypothermia
Respiratory depression
Aspiration pneumonia
Increased susceptibility to infections
Sexual problems: decreased libido, impotence
27
Q

What are the social complications of alcohol misuse and dependence?

A 
Family and marital difficulties
Employment difficulties
Financial problems
Vagrancy and homelessness
Crime and its repercussions
28
Q

What three tests are usually raised in heavy drinkers and can be useful in diagnosis?

A 
Gamma-glutamyltransferase (GGT) - raised in 80%
Alkaline phosphatase (ALP) - raised in 60%
Mean corpuscular volume (MCV) - raised in 50%
29
Q

Which of the three tests has the highest specificity for alcohol misuse?

A

MCV, but owing to the long half-life of red blood cells (120 days) may remain elevated for a long time after the patient has stopped drinking.

30
Q

When alcohol dependence has been established detoxification is required. What does this involve?

A

Reducing course of a benzodiazepine in lieu of alcohol.

Chlordiazepoxide 20mg QDS reducing daily over 5-7 days and supplemented with thiamine 200m OD.

31
Q

What should be advised after the patient has stopped drinking alcohol and how can it aided?

A

Aid abstention rather than controlled drinking as has a higher success rate
Can be encouraged by maintenance treatments such as naltrexone, acamprosate, or disulfiram

32
Q

What are the psychosocial interventions for alcohol dependence?

A 
Groups run by the community drug and alcohol service
Alcoholic Anonymous 
Supportive therapy
Cognitive behavioural therapy
Marital and family therapy
33
Q

How many people in England and Wales between the ages of 16-59 have tried an illicit drug and how many have taken a class A?

A
  1. 7% - tried

15. 5% - Class A

Psychiatry (22 decks)

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