susbtance missuse

Question 1

criteria for substance dependence

Answer 1

at least two of the following:
- Impaired control over substance use
- Increasing priority over other aspects of life or responsibility
- Psychological features suggestive of tolerance and withdrawal

Question 2

what is hazardous drinking

Answer 2

more than 14 units of alcohol a week, which may increase their risk of harm

Question 3

stages of symptoms for alcohol withdrawal

Answer 3

6-12 hours: tremor, sweating, tachycardia, anxiety
12-48 hours: seizures, auditory/tactile hallucinations
76-92 hours: delirium tremens

Question 4

what is problem drinking/ harmful drinking

Answer 4

Pattern of alcohol consumption directly causes physiological complications and illnesses
Consuming more alcohol than is safe to. Or using alcohol for non-recreational purposes

Question 5

what is delirium tremens

Answer 5

Severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.

coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia, agitation.

Question 6

management of delirium tremens

Answer 6

benzodiazepines e.g. chlordiazepoxide

admitted to hospital for monitoring until withdrawals stabilised

Question 7

what other medications may be used is alcohol misuse

Answer 7

Naltrexone
Acamprosate
Disulfiram

Question 8

what is Naltrexone

Answer 8

opiate blocker that makes alcohol less enjoyable and less rewarding
monthly injection or as oral tablet
S/E; n&v, decreased appetite, deranged liver enzymes

Question 9

what is Acamprosate

Answer 9

a medication that increases GABA and decreases excitatory glutamate which reduces cravings. It has a good side effect profile and is generally well tolerated

Question 10

what is Wernicke’s Encephalopathy

Answer 10

Triad of ophthalmoplegia, fluctuant mental state (confusion) and ataxia
due to thiamine (B1) insufficiency

Question 11

management of Wernicke’s Encephalopathy

Answer 11

IV thiamine (pabrinex) for a minimum of 5 days.
After this oral treatment can be continued

Question 12

symptoms of Korsakoff’s Syndrome & Korsakoff’s Psychosis

Answer 12

Amnesia – both antero and retrograde to varying degrees
Loss of orientation in time and space
Apathy and little response to events in the world around them
Mild euphoria
Confabulation

Question 13

management for harmful drinking or mild alcohol depedance

Answer 13

psychological management (such as CBT or behavioural therapies) should be offered first line