Substance-related disorders Flashcards
What 3 or more features are required, over the course of at least 1 year, to be Dx with substance dependence?
- Strong desire or compulsion to use substance
- Difficulty in controlling substance-taking behaviour
- Withdrawal state if substance not used
- Evidence of tolerance
- Neglect of alternative activities
- Persistent use despite evidence that substance is harmful and having negative consequences
What are the obstetric consequences of alcohol?
1) Foetal alcohol syndrome - increased risk of still-birth, growth retardation, developmental delay and facial abnormalities
What are the psychiatric consequence of alcohol?
1) Othello syndrome - pathological jealousy that places partners at risk of harm
What are the neurological consequences of alcohol?
1) Peripheral neuropathy
2) Seizures
3) Wernicke’s
4) Korsakoff’s
5) Dementia
What are the endocrine consequences of alcohol?
1) Testicular atrophy
2) Amenorrhoea/sub-fertility
What are the hepatobillary consequences of alcohol?
1) Cirrhosis
2) Fatty liver
3) Alcoholic hepatitis
4) Portal HTN
5) Carcinoma
6) Acute/chronic pancreatitis
What are the GI consequences of alcohol?
1) GORD
2) Gastritis
3) Mallord-Weiss tear
4) Oesophageal varices
What are the metabolic consequences of alcohol?
1) Hypoglycaemia
2) Hyperuricaemia
3) Osteoporosis
What are the cardiovascular consequences of alcohol?
1) HTN
2) Cardiomyopathy
3) Arrhythmia
What are the haematological consequences of alcohol?
1) B12 deficiency
2) Folate deficiency
3) Disordered clotted
What causes Wernicke’s encephalopathy?
Thiamine (B1) deficiency
How does Wernicke’s present?
Classic trial (but only seen in 10%) =
1) Acute confusional state
2) Ocular signs – nystagmus + opthalmoplegia (paralysis of muscles within or surrounding the eye, usually CNVI palsy)
3) Ataxic gait (unsteady/staggering)
Associated 4) peripheral neuropathy and 5) tachycardia
How should Wernicke’s be treated?
IV B1 replacement – 2 ampoules over 30 mins, BD for 3-7 days
How does Korsakoff’s differ from Wernicke’s?
Both due to B1 deficiency HOWEVER, where Wernicke’s is reversible if treated early, Korsakoff’s is not. Korsakoff’s is defined by an anterograde amnesia - i.e. an inability to lay down new memories. Unlike in Wernicke’s there is no evidence of an acute confusional state
What is the CAGE alcohol-use tool?
C - have you ever thought about CUTTING DOWN your alcohol intake?
A - do you ever get ANNOYED when you have been criticised regarding your drinking?
G - do you ever feel GULITY about the amount you drink?
E - ‘EYE-OPENER’ - do you have a drink first-thing in a morning
A reducing dose of what is used in alcohol detox?
BZD - chlordiazepoxide
In whom might ‘controlled drinking’ be feasible?
<40y/o Early detection No psychiatric co-morbidity Social stability Compliance
In whom would abstinence be the only option?
>40y/o Long duration Dependance evident Medical/psychiatric problems Poor social support Poor compliance
What aversive drug might be prescribed for alcohol addiction?
Disulfiram - inhibits alcohol dehydrogenase, results in the accumulation of acetaldehyde on drinking alcohol = unpleasant S/Es and thus acts as a deterrent
What anti-craving drugs might be prescribed for alcohol addiction?
Acamprosate - GABA receptor agonist
Naltrexone - opioid receptor antagonist
What are the 4 alcohol withdrawal syndromes?
- Uncomplicated alcohol withdrawal syndrome
- Alcohol withdrawal syndrome with seizures
- Alcoholic hallucinosis
- DT
When does uncomplicated alcohol withdrawal syndrome usually occur?
Between 4-12 hours after the last drink. Worst at 48 hours and resolves within 2-5 days
Hoes should seizures in alcohol withdrawal syndrome with seizures be treated?
Magnesium sulfate or carbemazepine
How is alcoholic hallucinosis distinguished from DT?
AUDITORY hallucinations that occur in CLEAR CONSCIOUSNESS. Visual hallucinations may also occur (as in DT)
What type of hallucinations may be experienced by patients with DT?
Formication - ‘lilliputian’ hallucinations - tactile hallucinations of crawling insects/small animals (also seen in cocaine use)
Whom is at increased risk of DT?
- Pre-existing liver damage
- Severe dependance
- Co-morbid infection
What are the differentials for DT?
- Head injury
- Pneumonia
- Wernicke’s
- Acute psychotic episode
- Hepatic encephalopathy
Which hallucinogenic is most likely to result in patients becoming violent?
PCP - withdrawal form intoxication can also cause sudden-onset homicidal violence
What are the life-threatening complications associated with cocaine intoxication?
- Coronary artery vasoconstriction ‘ ‘cocaine chest pain’ - which can cause an MI
- Placental abruption
What are some examples of opiates?
Heroin; methadone; codeine; morphine
What are the signs of opiate OD?
- Pinpoint pupils - un-reactive to light
- Hypotension
- Bradycardia
- Severe drowsiness/unconsciousness
- Respiratory arrest (with pulse)
How is an opiate OD managed?
Naloxone - an opiate antagonist - IV
What are the consequences of IVDU?
- Infection - endocarditis; HIV; hepatitis; skin abscess/brain abscess
- Arrythmia
- Embolism risk
- Sclerosis risk - which may lead to limb amputation
How should a sedative OD be managed?
Flumazenil
