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Pysch 2 > Substance use & Addiction > Flashcards

Substance use & Addiction Flashcards

1
Q

what is the typical course of alcohol/drug use, harmful use and addiction?

A

recreational use, no difficulties
want/need becomes increasingly regular use (harmful use)
need - spiralling dependence (addiction)

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2
Q

what is harmful use of drugs/alcohol?

A

actual damage caused to mental/physical health in the absence of diagnosis of dependence syndrome

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3
Q

what is dependence?

A

strong desire or compulsion to take drug
difficulties in controlling taking drug - onset, termination, levels of use
physiological withdrawal state when stopped/reduced
evidence of tolerance
progressive neglect of alternative interests
persisting with substance use despite evidence of consequences

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4
Q

what drug causes the most harm in the UK?

A

alcohol in both harm to users and harm to others

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5
Q

what is addiction vs dependence?

A

addiction is compulsive drug use despite harmful consequences
dependence is a physical and biological adaption to a substance

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6
Q

what factors affect addiction?

A

social, environmental factors
specific drug factors
personal factors (genetic, personality etc)

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7
Q

how does alcohol acutely affect brain chemistry?

A

blocks NMDA receptor (blocks excitatory)
therefore impaired memory
boosts GABA-A receptor (boosts inhibitory)
therefore anxiolysis, sedation

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8
Q

how does alcohol chronically affect brain chemistry?

A

upregulation of excitatory system to adapt to NMDA receptor being blocked chronically
reduced function in inhibitory system as GABA-A switches subunits to be less sensitive to alcohol

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9
Q

how do you treat alcohol withdrawal?

A

benzodiazepines to boost GABA function

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10
Q

how does alcohol withdrawal affect brain chemistry?

A

NMDA receptor upregulated, increase of Ca2+ leading to hyperexcitability (seizures) cell death

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11
Q

how is addiction reinforced?

A

reward deficiency - positive reinforcement
overcoming adverse state e.g anxiety/withdrawal - negative reinforcement
impulsivity and compulsivity

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12
Q

what is the reward pathway in the brain?

A

ventral striatum dopamine system

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13
Q

how do cocaine and amphetamines impact dopamine rewards?

A

block reuptake - prolonged effect of dopamine
-amp also enhances dopamine release

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14
Q

How does other drugs like alcohol etc affect the dopa pathway

A

increase ventral tegmental pathway firing

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15
Q

levels of what can predict extent of reinforcing/rewarding brain responses?

A

levels of D2 receptors in the brain

higher D2 leads to less pleasurable responses

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16
Q

what change in brain chemistry makes some addicts more likely to relapse?

A

blunted response to anticipation of reward in ventral striatum

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17
Q

what regions of the brain are involved in bingeing/intoxication?

A

dorsal striatum

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18
Q

what regions of the brain are inolved in withdrawal?

A

brainstem, hypothalamus

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19
Q

what regions of the brain are involved in craving? PHIB

A

prefrontal cortex,
hippocampus,
insula,
basolateral amygdala

20
Q

how does reinforcement change over the course of addiction?

A

change from positive to negative reinforcement - avoiding bad effects so aggression, fear when unable to access it

21
Q

what regions are targets for addiction withdrawal drugs?

A

reward system: dopamine and mu opioid
stress system: kappa opioid, noradrenaline and CRF
amygdala

22
Q

what are the brain chemistry changes to compulsions from voluntary to habitual drug use?

A

transition from striatal control over drug taking
ventral to dorsal striatum
both to form habits
memory in hippocampus drives cravings

23
Q

what drugs are used to support alcohol withdrawal?

A

benzodiazapines

24
Q

what drugs are used to support abstinence and neuroprotection in alcoholism?

A

acamprosate
disulfiam
naltrexone
namphiene

25
Q

what drugs are used to modulate reward system in alcoholism and block heroin use in opioid addicts?

A

naltrexone
naloxone

26
Q

what are questions to test the signs of harmful use/dependency in alcoholism?

A

CAGE - cut down, angry, guilty, eye opener

27
Q

how do you perform a mental state examination?

A 
appearance + behaviour
speech
mood
thoughts
perceptions
cognition
insight
28
Q

what is the clinical opiate withdrawal scale? COWS

A 
heart rate
sweating
restlessness
pupil size
bone/joint aches
runny nose/tears
GI upset
tremor (outstretched hands)
yawning
anxiety/irritability
goosebumps
29
Q

what are the ICD-10 requirements for dependency syndrome?

A

3+ in past year:
strong desire/sense of compulsion
difficulties in controlling behaviour around substance
physical withdrawal
tolerance
neglect of interests/pleasures/social life
persisting with use despite harmful effects

30
Q

what are the ICD-10 requirements for harmful use classification?

A

a pattern of substance use causing damage to health
adverse social consequences
bingeing
no other diagnosis e.g dependency syndrome

31
Q

what assessments are done for alcohol abuse?

A

note history of seizures, delirium tremens, psychosis, haematemesis, melaena
examine for jaundice, anaemia, clubbing, cyanosis, oedema, ascites, lymphadenopathy, DVT
investigations: fibroscan/ultrasound, bloods (LFTs, GGT, lipids, U&E, amylase), breathalyser, urine drug screen

32
Q

what assessments are done for opioid ab/use?

A

examination for collapsed veins/track marks, endocarditis, skin abscesses, hep/HIV, pneumonia
investigations: bloods (LFTs, U&E, GGT, glucose), breathalyser, urine drug screen, sexual health screening/BBV

33
Q

what are the immediate effects of alcohol?

A

CNS - impaired reaction time, motor coord/sedation, coma, death
stomach - nausea, inflammation, bleeding
skin - flushing, sweating, heat loss and hypothermia, formation of broken capillaries
sexual - reduced erection response in men, reduced vaginal secretion in women

34
Q

what are the chronic effects of alcohol?

A

CNS - damaged/destroyed brain cells, reduced brain size, impaired memory, limb sensation loss
cardiovascular - weakened muscle, high BP, irregular heartbeat, risk of stroke
immune system - less resistance to disease
digestive - cirrhosis, stomach/pancreas inflammation, risk of lip/mouth/larynx/eosophagus/liver/rectal/stomach/pancreatic cancers, kidney failure, obesity, nutrient deficiencies
reproductive - menstrual irregularities, impotence and testicular atrophy
bone - risk of osteoporosis, risk of fractures and falls

35
Q

what are the minor effects of alcohol withdrawal?

A 
tremulousness
diaphoresis (sweats)
fever
anxiety
agitation
nausea/vomiting/retching
36
Q

when do alcohol withdrawal symptoms often start?

A

onset after 6hrs from last drink

37
Q

what is DT in alcohol withdrawal?

A

delirium tremens

38
Q

what is delirium tremens?

A

auditory/visual hallucinations, confusion, hypertension, agitation, tachycardia, fever, tremor in hands and body
medical emergency - mortality 15-20%

39
Q

what are the effects of opioids?

A

analgesic effect

sense of euphoria

40
Q

what are the symptoms of an opioid overdose?

A 
not moving/cant be woken
slow/not breathing
choking/gargling/snoring
tiny pupils
clammy or cold skin
blue lips+nails
41
Q

how is an opioid overdose managed?

A

naloxone injection/nasal spray
repeat if no response after 3 mins
recovery position

42
Q

How does brain function transition as voluntary drug use changes to more habitual and compulsive drug use? (4)

A
  • Transition from prefrontal to striatal control over drug taking
    • i.e. prefrontal ‘top-down’ control is diminished with greater striatal reward drive
  • Relationship between dorsal striatum & frontal cortex becomes dysregulated
  • Ventral (limbic or emotional) to dorsal (habit) striatum
  • Role for memory (e.g. hippocampus) in craving the substance
43
Q
  • What are the 3 types of opioid receptor?
A
  • Mu
    • Delta
    • Kappa
44
Q
  • What are signs of opioid overdose? (6)
A
  • Not moving and can’t be woken
    • Slow or no breathing
    • Choking, gurgling or snoring
    • Tiny pupils
    • Clammy or cold skin
    • Blue lips and blue nails
45
Q

How to weane off benzos

A

diazapam

46
Q
  • Opioids absitinence? (2)
A
  • Methadone
    • Buprenorphine

Pysch 2 (6 decks)

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