Substance use disorder

Question 1

DSM V substance use disorder

Answer 1

larger amounts/longer time than intended
attempts to cut down/control
time is spent obtaining, using, or recovering
craving/urge
failure to fulfill major role or obligations
use despite social/interpersonal problems
activities given up due to using/recovering
use under hazardous conditions
use despite knowledge of med/psych problem
tolerance
withdrawal

Question 2

substance use disorder severity

Answer 2

MIld: 2-3 symptoms

moderate: 4-5
severe: >=6

Question 3

Substance use disorder remission

Answer 3

early: 3-12 mo; only criteria left may be craving
Sustained: 12 mo or longer - craving may remain
in a controlled environment

Question 4

Agent- risk factors for addiction

Answer 4

availability, cost , rapidity to reach brain, efficacy as a tranquilizer (to relieve withdrawal)

Question 5

Host risk factors fo addiction

Answer 5

genetic predisposition, multi-problem family, co-morbid psych disorders

Question 6

Environmental risk factors for addiction

Answer 6

occupation, peer group, culture, instability

sanctioned use, prohibition, restrictions

Question 7

Agent risk factors for psychosis

Answer 7

amoutn of dopamine stimulation +/ - serotonin stimulation produced
damage to neurons
certain withdrawal states

Question 8

Host risk factors for psychosis

Answer 8

genetic predispositions to addiction/mood/psychotic disorders
previous head injury

Question 9

Environmental risk factors for psychosis

Answer 9

social stressors
nutrition
access to treatment

Question 10

Agent risk factors for movement disorders

Answer 10

Exposure to substances that affect brain dopamine levels and/or damage dopamine neurons in the CNS

Question 11

Host risk factors for movement disorders

Answer 11

genetic predisposition
family history
previous head injury

Question 12

Environmental risk factors for movement disorders

Answer 12

occupational exposure (solvents, heavy metals)
social stressors
access to treatment

Question 13

Dopamine and addiction

Answer 13

hallmark of an addicting substance = increased dopamine in nucleus accumbens
Dopamine/serotonin excess when using stimulants/hallucinogens/alcohol can cause psychosis
Dopamine depletion through lowered set point/damaged neurons can produce movement disorders, and low mood

D2 receptors lower in addiction

Question 14

Alcohol effects

Answer 14

sedative-hypnotic
GABAa/glycine agonist, NMDAr antagonist
Use: increased opiate, dopamine, serotonin, GABA
- decrease in glutamate (from NMDA blockage)

Withdrawal: decrease in inhibitory NTs
increase in excitatory NTs
insomnia, irritation, tremor, risk of seizure

Question 15

Genetics of alcohol

Answer 15

some concordance rates for alcoholism in twin studies
If biological parent was alcoholic, then sons more likely to become alcoholics
Family history positive males tend to report less intoxication from alcohol
Early lack of intoxication in males = 60% risk of later alcohol abuse/dependence, even if afmily history negative

Polymorphism at D4 receptor has been associated with novelty seeking
Genetically high risk individuals: bigger beta-endorphin rise with drinking –> more dopamine

Question 16

Acetaldehyde dehydrogenase in alcohol addiction

Answer 16

Slow ADH and fast ALDH –> little acetaldehyde build up –> high risk for alcoholism
Fast ADH and slow ALDH –> 0% alcoholism

Question 17

Wernicke-Korsicoff’s syndrome

Answer 17

alcohol blocks NMDA, in withdrawal glutamate slams away at NMDA receptor
oculogyric criss, ataxia, tremor

Question 18

Long term use of alcohol

Answer 18

cerebellar cell destructions - ataxia, tremor

peripheral neuropathy - stocking-glove anesthesia/burning, can affect gait

Question 19

Cannabis

Answer 19

endogenous cannabinoid system - infant bonding, regulates dopamine, sleep
CB1 receptors: central; CB2: peripheral
classed as hallucinogens
THC

Question 20

THC

Answer 20

binds to CB1 and CB2
increases DA (dysregulation), stimulant/depressant
often desired - increased appetite, reduced nausea/pain

Question 21

THC vs CBD

Answer 21

Cannabidiol (CBD) natural plant product - protective against psychosis
as marijuana THC content goes up, CBD goes down
NB inhaled cannabis not recommended for medicinal purposes, buccal spray (THC + CBD) 3-4th line for neuropathic pain

Question 22

Psychosis risk with cannabis

Answer 22

heavy users (50+ times) by age 18 were 6x more likely to be admitted to hospital and diagnosed with schizophrenia than non-users
Cannabis use associated with 2x risk of developing future psychotic states/schizophrenia

Question 23

Cannabis, genetics and psychosis

Answer 23

COMT gene:
Alleles MM no increased risk
MV double risk
VV 10x psychosis when using cannabis

Question 24

Cocaine/other stimulants

Answer 24

increase DA, serotonin, noradrenaline
include ritalin and other medications for ADHD
cocaine - reuptake inhibitor of all 3
methamphetamines - increase release of all 3, reverses the transporter

Question 25

Potential adverse effects of stimulant use

Answer 25

alert, powerful, insomnia, anorexia
increased HR/BP, arrhythmias, stroke, fetal loss
anxiety, paranoia, delusions, psychosis, violence
tremor, hyperreflexia,seizure, akathisia, choreiform movements

Question 26

Genetics of cocaine dependence

Answer 26

Genetics/exposure to drug = primary risk factors to develop cocaine dependence
making more endogenous opioids - may be protective against cocaine dependence
if slow to break down dopamine after cocaine use, can become paranoid

Question 27

Stimulate induced movement disorders

Answer 27

Acute use:

• abnormal picking
• tremor
• myoclonic jerking
• akathisia
• choreiform
• seizures

If choreiform movements persist, then dopaminergic pathways may be damaged

Question 28

Stimulant-induced abnormal gait

Answer 28

Dopamine overstimulation: choreiform gait
Dopamine hypofunction: Parkinsonian gait
Acutely dropping dopamine: can produce akathisia, restless legs

Question 29

Serotonin syndrome

Answer 29

stimulant-induced
rigidity
myoclonic jerking
hyperreflexia
vasomotor instability
confusion
disorientation

Question 30

Drug induced psychosis

Answer 30

largely caused by DA dysregulation
if symptoms persist for weeks-mo, then an underlying psychotic disorder likely
Hazard ratios:
- meth: 9
- cannabis: 0
- alcohol, opioids and cocaine: 1.5-2.8