Substance Use d/o Flashcards
Substances related to Psychotic disorders
- alcohol intoxication/withdrawal
- Cannabis intoxication
- Hallucinogen- PCP intoxicaition, other hallucinogens incl with persisting perception d/o
- inhalant intoxication
- sedatives, hypnotics or anxiolytics intoxication
- stimulants (incl amphetamine, cocaine and other)- intoxication
- other I/W
Substances related to Bipolar d/o’s
- alcohol intoxication/withdrawal
- hallucinogen– PCP and other intoxication
- sedative/hypnotics or anxiolytics– intoxication/withdrawal
- stimulatnts (amphetamines, cocaine, other)- intoxication/withdrawal
- other I/W
substance related to depressive disorders
- alcohol intoxication/withdrawal
- hallucinogens- PCP and other- intoxication
- inhalants- intoxication
- opiods- intoxication or withdrawal
- sedatives. hypnotics or anxiolytics- intoxication or withdrawal
- stimulants- intoxication/withdrawal
- other I/W
substances related to Anxiety disorders
- alcohol I/W
- caffeine intoxication
- Cannabis I
- hallucinogen- PCP and other- I
- inhalants- I
- opiods- W
- sedative, hypnotics, anxiolytics- W
- stimulants- I/W
- other I/W
substances related to OCD disorders
- stimulants- intoxication/withdrawal
- other/unknown- I/W
substances related to sleep disorders
- alcohol I/W
- caffeine I/W
- cannabis I/W
- opiods I/W
- sedatives, hypnotics and anxiolytics- I/W
- stimulants I
- other I/W
substances related to sleep disorders
- alcohol I/W
- opiods I/W
- sedative, hypnotic, anxolyitc I/W
- stimulants I
- other I/W
substance diagnoses related to delirium
-alcohol- I/W
-Cannabis I
- PCP/other hallucinogens - I
-inhalants- I
-opiods I/W
-sedative, hypnotics, anxiolytics- I/W
-stimulants- I
others- I/W
substance diagnoses related to NCD
- alcohol- I/W/persistent
- inhalants- I/persistent
- sedatives- I/W/persistent
- other- I/W
substance diagnoses related to SUDs
-alcohol
-cannabis
-hallucinogens (PCP, other)
-inhalants
-opiods
-sedatives, hypnotics or anxiolytics
-stimulants
-tabacco
-other
(NOT caffeine)
substance intoxication
everything: alcohol, caffeine, cannabis, hallucinogens (PCP, other), inhalants, opiods, sedatives, hypnotics or anxiolytics, stimulants, tabacco, others
substance withdrawal
(everything EXCEPT hallucinogens- PCP and other and inhalants)
alcohol, caffeine, cannabis, opiods, sedative/hypnotics/anxiolytics, stimulants, tobacco and other
General Substance Use D/O criteria
A. Problematic use of substance for the last 12 months causing significant impairment and distress and 2 of:
- 1-4 impaired control: using more than intended, persistnt efforts and failures to decrease/quit, requires significant time to obtain/use/recover, cravings
- Criteria 5-7: Social impairment: use results in failure to meet major role obligations at work, school, or home, use continues despite persistent social/IP problems, giving up significant activities
- criteria 8-9: Risky use– use results in physical hazards, continued use despite persistent physical or psychological problem
- Criteria 10-11- Pharmacologic– tolerance (increased dose of substance for effect), withdrawal
Substance use d/o specifiers
mild- 2-3 symptoms
moderate- 4-5 sx
severe- 6 or more sx
-also related to changing use patterns
-in early remission– full criteria (except craving) not met for 3 months, but less than 12 months
-in sustained remission- full criteria not met for 12 months
-on maintenance therapy– opiod use d/o– taking agonist medication and not meeting criteria (except for tolerance/withdrawal for agonist) (also includes partial agonist or naltrexone - full antagonist)
-in a controlled environment- criteria not met when in environment that restricts the substance
Warnicke- Korsakoff Syndrome
Warnicke triad: nystagmus (6th nerve palsy), ataxia, confusion (delerium)
-Vitamin B1 (thiamine) deficiency– give thiamine 100mg IM/IV
Korsakoff: anterograde and retrograde amnesia with assoc cognitive deficits incl aphasia, apraxia, agnosia, and/or executive dysfunction
Alcohol withdrawal
DSM V: cessation/reduction in heavy/prolonged alcohol use with 2 or more of : autonomic hyperactivity (sweating, tachycardia), hand tremor, insomnia, N/V, transient visual, tactile or auditory hallucinations, psychomotor agitation, anxiety, generalized TC seizures, causing impairment and not caused by something else
-specify: with perceptual disturbances
-withdrawal- 6-24 h after last drink
-seizures- 24-48h
-DTs- 48-72h
Tx: Thiamine 100mg IV/IM, bentos (ativan, diazepam, chlordiazepoxide) – CIWA +/- scheduled
HEAD SPIN: hand tremor, Experience Hallucinations, Anxiety, Diaphoretic/increased BP, Sz, psychomotor agitation, insomnia, N/V
Cannabis use d/o
Can annual prevalence: 12.3% ages 15+ (15% 15-25 yo, 10% 25+)
Intoxication: conjunctival injection, increased appetite, dry mouth, tachycardia
Withdrawal: about 24 hours with peak at 1 week after d/c persistent use: irritability/anger/aggression, anxiety, insomnia, decreased appetite/weight loss, restlessness, depressed mood, physical sx incl abd pain, tremors, sweating, fever, chills, headache
PCP intoxication
intoxication: vertical/horizontal nystagmus, ataxia, dysarthria, HTN/tachycardia, decreased pain response, muscle rigidity, sz/coma, hyperacusis
- -> serotonin
- -> no withdrawal
Opioid use
Intoxication: pinpoint pupils, drowsiness/coma, slurred speech, impaired attention/memory, psychological changes incl initial euphoria, apathy, dysphoria, psychomotor agitation/retardation
Tx: Naloxone 0.4mg up to 3x
Withdrawal: dysphoric mood, N/V, muscle aches, lacrimation/rhiorrhea, pupillary dilation, piloerection or sweating, diarrhea, yawning, fever, insomnia,
Stimulant use
Intoxication: psychological changes ( paranoia, hallucinations (tactile), euphoria, affective blunting, changes in sociability, hyper vigilance, IP sensitivity, anxiety anger, stereotyped behaviour, impaired judgment), tachycardia/bradycardia, dilated pupils, elevated/lower BP, perspiration/chills, N/V, weight loss, psychomotor agitation/retardation, muscular weakness, respect depression, CP, arrhythmias, confusion, sz, dyskinesias, dystonia or coma
withdrawal- dysphoric mood, fatigue, vivid/unpleasan dreams, insomnia/hypersomnia, increased appetite, psychomotor retardation/agitation
long term effects– cognitive– decreased executive function, cognitive shifting, increased impulsivity, slow processing, impaired memory—> like ADHD
–10% addiction with initial use–> drug acts directly on DA
–usually needs longer residential tx with ++ relapse prevention skills
Gambling Disorder
Diagnosis: persistent, recurrent gabling with impairment/distress with 4 of the following in the last 12 months:
-gambling with increased $ to achieve same excitement
-restless/irritable when try to cut down/stop
-repeated unsuccessful efforts to control/stop
-preoccupied with gambling
-gambles when feeling distressed
-returns after losing money (chasing losses)
-lies to conceal extent of gambling
-jeopardized/lost significant relationship, job, or educationa/career opportunity
-relies on others to provide money to relieve financial distress
Not exclusively in manic episode
specify: episodic, or persistent, early or sustained remission, mild/moderate/severe
Scales for SUDs
Screening: have you ever had a drinking problem?
have you had any alcohol in the last 24h? (y to both– 92% chance of current alcohol problem
AUDIT- positive with 8+ for men and 4+ for women
Drug Abuse Screening Test (DAST 10)- 0- no problem, 2- mild, brief intervention, 5- moderate, further investigation, outpt treatment, 8- substantial problem, intensive tx, 10- severe- intensive tx
