Symp 3 - Diagnosis and Treatment of Alcohol Problems Flashcards
what are the effects of alcohol in low doses?
euphoria, reduced anxiety, relaxation, sociability
what are the effects of alcohol in higher doses?
intoxication (the pathological state produced by a drug, serum, alcohol or any toxic substance; poisoning
impaired attention and judgement, unsteadiness, flushing, nystagmus, mood instability, disinhibition, slurring, stupor, unconsciousness
Make choices that they wouldn’t make when not under the influence of alcohol
diagnosis:
what is harmful use of alcohol?
pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months
diagnosis:
what is alcohol dependence?
•3 or more of the following for >1month or repeatedly over 12 months:
- Cravings/compulsions to take
- Difficulty controlling use
- Primacy (neglect of other interests)
- Increased tolerance (increased amount of alcohol required over time to achieve the same affect)
- Physiological withdrawal on reduction/cessation
- Persistence despite harmful consequences
diagnosis:
what is teh withdrawal state?
Group of symptoms of variable clustering and severity on complete/relative withdrawal of a psychoactive substance, after persistent use of that substance
what things are experienced in the Alcohol Withdrawal State?
•Tremor, weakness, nausea, vomiting, anxiety, seizures, confusion, agitation, death
Delirium Tremens:
- Profound confusion, tremor, agitation, hallucinations, delusions, sleeplessness, autonomic over-activity
- Mortality in DTs = 5%
- Death: cardiovascular collapse, infection, hyperthermia, seizures or self injury
Usually 48-72 hours after alcohol stopped
When taking a alcohol history – want to know if they have ever experienced this
(Delirium tremens (DTs) is a rapid onset of confusion usually caused by withdrawal from alcohol)
Alcohol Problems: what sort of different problems can it cause?
- Physical Health
- Mental Health
- Relationships
- Employment, Financial
- Legal
how can alcohol affect your mental health?
- Anxiety (Anxiety and depression normally come together so when screening for one screen for both)
- Depression (Hard to tell if alcohol is causing depression or vice versa)
- Sleep disruption
- Morbid Jealousy (more common in males, male partner has a delusion belief that partner is unfaithful, not very common but does happen)
- Alcoholic hallucinosis (often males but can be female, hallucinations in clear consciousness, treatment is ultimately to stop drinking)
- Deliberate self-injury
- Suicidal thoughts/acts
how does alcohol affect your physical health?
Alcohol effects every bit of your body
Alcohol can be attributed to a partial cause of most malignancies
accidental injury, violence, cancer (mouth, oesophagus, liver), neurological ( fits, confusional state, Korsakoff’s/Wernicke’s)
does alcohol affect the brain?
Brain is a big thing
Alcohol related brain damage
Lots of brain volume loss
Frontal deficits – required for executive decisions
Personality of someone can really change if they have this presentation
Alcohol Problems:
what is Wernicke’s Encephalopathy?
Confusion, ataxia, opthalmoplegia, nystagmus
Wernicke encephalopathy (WE) is an acute neurological condition characterized by a clinical triad of ophthalmoparesis with nystagmus, ataxia, and confusion. This is a life-threatening illness caused by thiamine deficiency, which primarily affects the peripheral and central nervous systems
Alcohol Problems:
what is Korsakoff’s Psychosis
Prominent impairment of recent and remote memory, preservation of immediate recall, no general cognitive impairment, retrograde and anterograde memory, impaired learning and disorientation, may exhibit nystagmus and ataxia
Korsakoff psychosis is a late complication of persistent Wernicke encephalopathy and results in memory deficits, confusion, and behavioral changes. Korsakoff psychosis occurs in 80% of untreated patients with Wernicke encephalopathy; severe alcoholism is a common underlying condition
what causes Wernicke’s Encephalopathy and Korsakoff’s Psychosis?
•Caused by thiamine (vitamin B1) deficiency:
- Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism
People drinking heavily tend not to eat well and alcohol is directly toxic to gut lining so absorption is affected and liver is affected
how does alcohol affect relationships?
- Aggression - Verbal, Physical
- Marital difficulties - Morbid jealousy
- Poor parenting/neglect +/- loss of parenting rights
- Loss of friendships and social supports
(No just SO, all the family and children)
what screening tools are avaliable?
•CAGE (2 or more = likely alcohol problem)
- Have you tried to Cut down?
- Have you felt Annoyed by people criticising your drinking?
- Have you felt Guilty about drinking?
- Have you felt the need to have an Eye-opener?
- AUDIT (Alcohol Use Disorders Identification Test)
- FAST (4 questions)
- PAT (Paddington Alcohol Test; used in A&Es)
