Substance use Flashcards
Diagnoses possible with substance related and addictive disorders
Substance use disorders Substance intoxication Substance withdrawal Substance induced ->psychotic ->Bipolar ->depressive ->anxiety ->OCD ->sleep ->sexual dysfunction ->delirium ->neurocognitive
Define harmful use
Pattern/quantity of substance use which causes adverse effects, without dependance
- > Love
- > Livelihood
- > Liver
- > Law
Define hazardous use
Use that places person at risk of adverse effects without dependance
Use disorder criteria
Pattern of use leading to clinically significant impairment or distress with 2 of following w/i 12 months
- Larger/longer than intended
- +Effort/desire to cut back
- +Time spent in activities to obtain/use/recover
- Craving
- Recurrent use resulting in failure to fulfill roles
- Use despite negative consequences on social/interpersonal
- Important social/occupational/recreational activities givem up
- Recurrent use in dangerous situations
- Use despite knowledge of the recurrent physical/psychological problems
- Tolerance
- >Needing more for intoxication/desired effect
- >Diminished effect with same amount - Withdrawal
- >Withdrawal syndrome of substance
- >Substance taken to avoid withdrawal
Calculating units of alcohol
1 UNIT OF ALCOHOL (10ml pure alcohol) = 1⁄2 pint of beer (248ml) (3.5% ABV) or 1 small glass of wine (125ml) (8% ABV) or 1 measure of spirits (25ml) (40% ABV)
Calculating units of alcohol
You can calculate units by multiplying alcohol by
volume (in%) with volume (in litres),
e.g. ABV x vol = units
For instance, a pint (568ml) of 5.3% ABV continental
lager would contain 5.3 x 0.568 = 3 units
Differential
- There is a primary psychiatric illness and patient is using substance
- Symptoms entirely due to substance and no primary psychiatric illness
- Psychiatric problems are due to a combination
Features (4) suggesting substance-related psychiatric illness
- Symptoms known to be caused by substance
- Temporal relationship between use of substance and development of symptoms
- Recovery of symptoms on cessation of substance use
- No other explanation
History
CAGE and AUDIT Substances used Pattern Features of dependance Symptoms and relationship to substance, recovery of symptoms on cessation of substance use, temporal relationship Consequences->family, relationships, law, work, psychiatric health PHx psychiatric/substance use Gambling Family history MSE Suicidality Insight
CAGE
- Have you ever felt you ought to Cut down on your
drinking? - Have people ever Annoyed you by criticizing your
drinking? - Have you ever felt Guilty about your drinking?
- Have you ever needed an ‘Eye-opener’ (a drink first
thing in the morning to steady your nerves or get rid
of a hangover)?
Examination
Should focus on:
1. Evidence of acute use or intoxication (e.g. pupil constriction with opiate use; incoordination and slurred
speech with alcohol use).
2. Signs of withdrawal (e.g. tremulousness, sweating,
nausea and vomiting, tachycardia and pupil dilatation
with alcohol withdrawal).
3. Immediate and short-term medical complications of
substance use (e.g. head injury following alcohol intoxication, infection caused by intravenous drug use).
4. Long-term medical complications (e.g. alcoholrelated
liver disease, hepatitis B or C or HIV infection
with intravenous drug use).
Investigations
Depends on presentation, but may include UDS->essential FBC UEC LFTs Clotting/PLTs ECG Hepatitis serology HIV CT/imaging
Etiology of dependance
Socio-cultural->price, acceptability and availability
Pharmacology of the drug->pleasurable effects, rapid oset
Individual characteristics
Learning and conditioning
Individual characteristics predisposing to dependance
Disturbed ego function Concurrent psychiatric illness Genetic->+sensitivity to neurotransmitter Upbringing: poor coping strategies Personality: at risk children ->parental use ->impaired peer relationships ->poor academic ->limited problem solving skills ->poor impulse control ->negative mood states
Mechanism of learning and conditioning in relation to substance use
Behaviour maintained by consequences
1. Can ameliorate noxious/aversive states:
pain, anxiety, depression
2. Positive reinforcement
3. Alleviates disturbed effects of withdrawal
4. in withdrawal: the behaviours/environment that
was associated w. the addiction can trigger
withdrawal/craving. Example: watching someone use
or light a lighter etc.
5. Paraphernalia and behaviour becomes secondary reinforcements ++activity in limbic system
Features of cannabis use (4)
Conjunctival injection
Increased appetite
Dry mouth
TachyC
Features of cannabis withdrawal
Irritability Nervous/anxiety Sleep disturbance \+Appetite/wt loss Restless Depressed mood Abdominal pain, shakiness, sweaty, fever, chills, HA
Features of PCP intoxication (8)
Vertical/horizontal nystagmus HTN/Tachy Numb/reduced response to pain Dysarthria Ataxia Muscle rigid Seizure/coma Hyperacusis
Features of hallucinogen intoxication
Paranoia Impaired judgement Perceptual changes in wakefullness->derealise, hallucination Pupillary dilation Tachy Sweaty Palpitations Blurring of vision Tremor Incoordination
Features of inhalant intoxications
Beligerent Apathy Assaultiveness Dizziness Nystagmus Unsteady gait Slurred speech Psychomotor retardation Blurred vision/diplopia Tremor Generalised weakness Lethargy Reduced reflexes Stupor/coma Euphoria
Features of opioid intoxication
Euphoria Apathy Dysphoria Impaired judgement Drowsiness/coma SLurred speech Impaired attention/memory Pupillary constriction
Features of opioid withdrawal
Pupillary dilation/piloerection/sweating Dysphoric mood Nausea or vomiting Muscle aches Macrimation or rhinorrhea Diarrhea Yawning Fever Insomnia Goose bumps
Features of sedative intoxication
Inappropiate behaviour Slurred speech Unstead gait Incoordination Nystagmus Impaired cognition Stupor or coma
Features of sedative withdrawal
Autonomic hyperA Tremor Insomnia NV Transient hallucinations Psychomotor agitation Anxiety Tonic clonic seizures
Features of stimulant intoxication
Euphoria Hypervigilance Anxiety Anger Impaired judgement Tachy/Brady Pupillary dilation \+/-ve BP Perspiration/chills NV Wt loss Psychomotor Muscle weakness, respiratory depression, chest pain, arrythmias Confusion, seizures, dyskinesia, dystonias, coma
Features of stimulant withdrawal
Dysphoric mood Fatigue Vivid dreams Insomnia/hypersomnia \+appetite Psychomotos
Features of nicotine withdrawal
Irritability/anger Anxiety Poor concentration \+appetite Restlessness Depressed mood Insomnia
Management of opioid withdrawal
- Supportive therapy->fluids, ibuprofen for muscle aches, loperamide and promethazine for diarrhea, NV
- Buprenorphine (partial agonist)
- Diazepam 5-20mg 4 times daily
- CBT, social, counselling
- Methadone, Buprenorphine (+naloxone) programs in long term->requires specialist
