substance misuse psychiatry Flashcards
benzodiazepine symptoms
extremely anxious
restless
visibly sweating
noticeable tremor
managing benzo withdrawal?
what is the use of benzodiazepines
sedation, hypnotic, anxiolytic, anticonvulsant, muscle relaxant
* They should only be used for a short time (2-4 weeks) due to addictive potential
epilepsy
benzodiazepine withdrawal can be lethal t/f?
true
what do benzo target?
GABA- A
gaba a targeting drugs?
alcohol
z drugs
benzos
GHB
baclofen
withdrawal features of benzoz?
anxiety
irritibilitiy
tremor
sweating
insomnia
appetite
confusion
convulsion
psychosis
benzodiazepine toxicity?
drowsy
ataxia
slurred speed
reduced consciousness
severe can lead to hypotension and bradycardia
overdose = resp depression
how to manage benzo addiction?
manage by GP/addiction
convert to diazepam equivalent dose once daily
diazepam 40mgOD
reduce by no more than 10% every 2 weeks
what can counteract benzos overdose?
flumazenil 200microgram
psychoactive substance defn?
substance that has an effect on CNS
substance dependence
continued misuse of a psychoactive substance
ICD 10 diagnostic criteria
strong desire / compulsion
difficulties in controlling substance taking behaviour
physiological withdrawal state
tolerance
progressive neglect of alternative pleasures / interests
persisiting with substance
ICD-11 dependence criteria
impaired control over substance use
increased precedence of substance use over toher aspects of life
physiological features indicating neuroadaptation
stages of change model who was this made by?
prochaska and DiClemente
Prochaska and DiClemente’s stages of change model
The five stages of change are precontemplation, contemplation, preparation, action, and maintenance.
can enter and renter again and again
So each relapse is a framework to learn!
FRAMES
feedback
responsibility for change
advice - to change
menu- of alternative
empathic
self-efficacy
screening tool for alcohol use
CAGE
audit
fast
Ix for alcohol dependence?
Bloods: FBC, LFT, B12, folate, U&E, clotting screen, glucose
* Blood alcohol level or breathalyser
* Urine drug screen
* Rating scale (e.g. AUDIT, CIWA-Ar, APQ)
* Severity of Alcohol Dependence Questionnaire (SADQ)
charity that can help with alcohol addiction?
AA
SMART recovery
change
grow
therapy for alcohol addiction
Offer psychological intervention (e.g.CBT, behavioural therapy, social network and
environment-based) focused on alcohol-related cognitions
DT
signs of altered mental status : hallucinations
persecutory auditory
confusion
delusions
severe agitation
dt mx
short term
Acamprosate
Acamprosate was thought to be slightly more effective at helping people with alcohol use disorder remain off alcohol
reduces craving
Naltrexone
reduces dopamine release
wernickes and korsakoff
vit b1 deficiency
wernickes is reversible
wernickes symptoms
triad
confusion
opthamoplegia
ataxia
korsakoff
excessive anterograde and retrograde amnesia
frontal lobe dysfunction > confabulation
psychotuc symptoms : may require institutionalisation
Community-based assisted withdrawal (best option)
- This can be done through organisations like CGL (Change, Grow, Live)
- Usually 2-4 meetings in the first week
- If complex, may need up to 4-7 days per week over a 3-week period
acute mx of opiate overdose?
abc approach
airway and IV fluids
IV nalozone > short acting antagonist prevents opiates binding
opiate substitution therapy
buprenorphine
methadone
methadone
long acting
half life 24 hours
s/e lethargy
buprenorphine
partial agonist
long half life
competes with opiates in brain
risk of respiratory depression
less sedating
less euphoric
less risk of respiratory depression
opiate withdrawal is it lethal
no
flu like
tremor
tachy and hypertension
hot / cold
gi: nausea, diarrhoea, vomiting
dilated pupils
joint pain
anxiety
goosebumps / piloerection
recommended alcohol intake?
drink no more than 14 units of alcohol a week
6 medium glasses of wine
6 pints of beer
across 3 days at least
what is binge drinking?
5 or more drinks in 2 hours
4 or more in 2 hours
> 35 units per week
