Substance Related Disorders

Question 0

Epidemiology of substance abuse

Answer 0

17% prevalence
18-34 y/o
Men>Women
3x more likely to have a psychiatric/ mental disorder

Question 1

CAGE Screening Test for Substance Abuse

Answer 1

C (cut down)
A (annoyed)
G (guilty)
E (eye opener)

Question 2

Impairment syndrome of drug abusers

Answer 2

• Drug use –> Damaged neurotransmitter receptor sites –> Psychiatric symptoms
• Kindling (sites spontaneously fire)
• Cerebral atrophy (apparent on CT scan)

Question 3

Substance Abuse Disorders: Diagnosis

Answer 3

• Urine Toxicology Screen
• Blood Levels
• Breath
• Hair
• Saliva
• Sweat

Question 4

Alcohol at-risk drinking

Answer 4

Men: >4drinks/day; 14drinks/week
Women: >3drinks/day; 7drinks/week

Question 5

How much is too much?

Answer 5

1 drink raises BAL ~30mg/dL
Legal limit for driving= 80mg/dL
N/V @>150mg/dL
Lethal 350-900mg/dL (~11-12 drinks)

Question 6

Alcohol: Clinical Findings

Answer 6

Withdrawal:

• mild
  
  • 8-72hrs after last drink
  • tremor
  • elevated vitals
  • anxiety
• Generalized seizures 24-38 hrs after last drink

Question 7

Wernicke-Korsakoff Syndrome

Answer 7

-Thiamine Deficiency
-Triad:
1. Confusion
2. Ataxia
3. Ophthalmoplegia
-Sequelae:
Anterograde and retrograde amnesia with confabulation

Question 8

Alcohol Diagnosis

Answer 8

Elevated HDL + Elevated GGT –> Heavy Drinking

Question 9

Alcohol: Diagnosis

Answer 9

DDX Withdrawal: 
   -sedative withdrawal 
   -drugs/meds
   -hypoxemia
DDX acute ETOH hallucinosis
   -amphetamine psychosis
   -paranoid schizophrenia
DDX encephalopathy 
   -CA, hypertensive, infectious, metabolic, hyponatremic