W01 - PSYCH: Addictions & Alcohol Flashcards
Discuss the distinctions between harmful use, dependence and addiction.
harmful use = pattern of use causing damage to physical or mental health. Use >1 month or repeatedly over 12 months
dependence = 1mos+ or rptdly over 12mos
- cravings
- difficulty to control
- primacy
- tolerance
- withdrawal
- persistence
withdrawal state = group of symptoms variable clustering and severity on complete/relative withdrawal of psychoactive substance
Discuss the ways in which substance misuse may impact on the individual, his social nexus and wider society.
- issues of risk: purity, administration, legalities, comorbid conditions, dependency, purchase, drug related deaths
- alcohol
+heroin/opiate misues
+ benzos misuse
+ cocaine/crack cocaine misue - cannabis misuse
- increasing drug-related-deaths
Differentiate between the physical and psychological aspects of addiction.
Physical dependence develops as a consequence of tolerance to the drug and the intrinsic desire in avoiding withdrawal effects of a drug.
Craving = psychological desire for stimulants that increase dopamine levels and kickstart the reward centre creating feelings of pleasure etc.
Explain the concept of physical drug tolerance and drug dependence.
*
Describe the location and function of the reward centre and recognise that activation of the reward centre by addictive drugs causes the psychological symptom of craving.
- dopamine (ventral tegmental area neurones) released = reward
- projects to nucleus accumbens & prefrontal cortex
- activated by eating, drinking, sex dt evolutionary benefits
- different substances affect the dopamine levels in diff ways
Recognise that there may be a genetic basis for variation in the strength of the reward centre between individuals.
- assoc of A1 allele of D2 receptor with severe alcoholism
Mechanisms of Tolerance and consequencing effect
DISPOSITIONAL TOLERANCE - less drug reaches the active site, decreased abs., increased metab to inactive metab. etc.
PHARMACODYNAMIC TOLERANCE = drug haas less action @ active site, down regulation/internalisation of available receptors.
= reduced transmitter = increased sens to transmitteer
= lead to withdrawal symptoms (often acute opposite effect of drug)
= give rise to physical dependence in order to avoid withdrawal effects
To develop an awareness of screening tools used
CAGE (2+ = alcohol problem)
Cut down?
Annoyed when criticised?
Guilty?
Eye-open (desire to)
AUDIT
FAST
PAT
Tx Options
> Support for patient and family
> psych: CBT, group
> Social work input
> Skills training, community support
> Medication
- benzos for acute withdrawal
- thiamine suppl.
- DISULFIRAM = deterrent
- Naltrexone = anti-craving
To recognise the broad-ranging impact that alcohol problems have on an individual’s physical and mental health and their social functioning
physical
- WERNICKE’S ENCEPHALOPATHY
confusion, ataaxia, opthalmoplegia, nystagmus
dt thiamine def
- malnutrition
- GI symptoms
- liver decompensation
- liver ca. & sequelae
- LFT: GGT raised. AST indicative of more worse.
- FBC: raised MCV
mental
-KORSAKOFF’S PSYCHOSIS
impairment of remote memory, retrograde and anterograde memory impairment
dt thiamine def.
-morbid jealousy
social
Cocaine
- most potent natural stimulant, less desire to sleep,
- powder or crack = smoked
- inhibits reuptake = increased dopamine, sertononin, NA
- varied time of effect
- combination w/ alcohol = cocaethylene, severely affects clearance dt alcohol presence
= longer dosage, slowed clearance, cardiotoxic, greater risk of death - convulsions w/ resp failure
- arrythmias, MI, HT, CVA
- toxic confusion
- paranoid psychosis
Amphetamine
- similar to cocaine, longer lasting
- toxic confusion, convulsions, death
- PSYCHOSIS in heavy chronic use
Opiates
opium, morphine, heroin, methadone, codeine
> NALOXONE: opiate antagonist
Heroin
- ‘gear’ ‘brown’, smooking, injection
- mu receptors = mood, euphoria
- delta, kappa receptors = analgesia
- analgeisa, euphoria
- pin point pupils
- itching/sweating
- constipation, decreased libido
- reduced cough reflex, nausea initially
OD: resp depression, snoring risk, bradycard., hypoT, death
+ augmented risk if mixed w/ other depressant
> NALOXONE opiate antagonist
Opiate Withdrawal Syndrome
craving
insomnia
yawning
muscle pain and cramps
increased salivary, nasal, lacrimal secretions
dilated pupils
piloerection
> Methadone
Methadone Maintenance
f you’re dependent on heroin or another opioid, you may be offered a substitute drug, such as methadone.
This means you can get on with your treatment without having to worry about withdrawing or buying street drugs.
- decriminalises drug use
- normalisation
- reduces IV misuse
- leakage onto illicit market
Benzodiazepines
-pams
- easily accessible, internet main route for misusers
- GABA agonists
- anxiolytics, sedative
MDMA
relaxed euphoric state without hallucinations
majority of all ‘ecstasy tabs.’ contain no MDMA
instead nil active , LSD, amphetamine , ketamine
- euphoria followed by calm
- increased sociability
- inability to distinguissh desirable vs non-desirable
- 2-4hrs
sfx: dry mouth, HT aand pyrexia, dehydration risk, aanxiety and panic, psychosis
Cannabis
- resin form, oil form, skunk (high THC)
- THC = psychoactive agent
- THC = psychedelic hallucinatory effect
- CBD = anxiolytic and antipsychotic
- balance
- stimulant, euphoriant, sociability hilarity, increased appetite, time perception
Novel Psychoactive Substances
- legal highs
Performance and Image Enhancing Drugs
- anabolic steroids: used in hypogonadism, dystrophy, anemias, AIDS wasting
- testosterone.
sfx: acne, stretch marks, baldness
cholesterol!, HT!, growth deficits!, liver disease!
anger!, mania +hypomania, depression on withdrawal - growth hormone
*. injectable tanning agents - risk of effet, admin., access
Alcohol Withdrawal State
Tremor, weakness, nausea, vomiting, anxiety, seizures, confusion, agitation, death
=> Delirium Tremens
profound confusion, hallucinations
great mortality, death dt cardiac, infection, hyperthermia, seizure
Benefits of alcohol abstinence
- can bring fatty liver back to normal
Acute Alcoholic Hepatitis
Alcohol intake > 6u / day
Jaundice with Bilirubin > 80mg/dl
No other aetiology for Liver inflammation
Very high Mortality / No specific treatment yet
Significance of AFP
A high level of AFP might mean that a patient has liver cancer. However, sometimes the AFP is high when there is active liver disease but no cancer.
+ USS
+ CT
Significance of Thiamine in alcoholic ketoacidosis
Thiamine acts as a cofactor
If you do not give thiamine, , and give glucose without it in the malnourished or thiamine deficient patient, you risk driving Wernicke’s Encephalopathy.
