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Flashcards in Alcohol Symposium - Mental Health Deck (21)
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1
Q

There are 4 sort of “diagnoses” of alcoholism:

A
  • Acute Intoxication
  • Harmful Use
  • Dependence
  • Withdrawal State
2
Q

What is harmful use?

A

A pattern of use leading to physical or mental health damage over 1 month or repeatedly over 12 months

3
Q

What is required to diagnose Dependence on alcohol?

A

3+ of the following criteria over 1 month or repeatedly over 12 months:

  • Craving/compulsion
  • Difficulty controlling use
  • Primacy
  • Tolerance
  • Withdrawal
  • Persistance despite harmful consequences
4
Q

Define the Withdrawal State?

A

A cluster of symptoms that vary in presentation/severity, occurring when a substance is withdrawn after persistant use

5
Q

What are the symptoms of Withdrawal?

A
Tremor
Weakness
N&V
Anxiety
Seizures
Confusion
Agitation 
Death
6
Q

A more “severe” form of withdrawal can also occur, called?

A

DTs
Delirium Tremors

Typically occurs 2-3 days into the withdrawal symptoms

7
Q

What are Delirium Tremors?

A

Profound:

  • Tremor
  • Confusion
  • Agitation
  • Hallucination
  • Delusion
  • Sleepiness
  • Autonomic Overactivity
8
Q

What are the big risks of DTs?

A

They can lead to death in several ways:

  • CV collapse
  • Infection
  • Hyperthermia
  • Seizure
  • Self-injury
9
Q

List some of the major mental health problems that can be related to alcohol use?

A
Anxiety
Depression
Sleep disruption
Self-harm / suicide
Morbid Jealousy
Alcoholic Hallucinosis

Main treatment for all of them is Abstinence

10
Q

What is Wernicke’s encephalopathy?

A

A condition that can occur due to thiamine deficiency in alcoholics

11
Q

What causes Wernicke’s Encephalopathy?

A

Thiamine Deficiency from:

  • Poor Nutrition
  • Poor absorption (due to alcohol damage to gut)
  • Poor hepatic function
  • Use of thiamine for alcohol metabolism
12
Q

How does Wernicke’s Encephalopathy present?

A
Typically with a triad (or mix) of:
- Confusion
- Opthalmoplegia
- ataxia
& Nystagmus
13
Q

Wernicke’s Encephalopathy is bad enough on it’s own, but why is it so important we treat it as early as possible?

A

It can progress to Korsakoff’s Psychosis which can be very disabling and permanent

14
Q

What does Korsakoff’s psychosis do?

A

Impairs recent & remote memory, both anterograde & retrograde (although it leaves immediate recall)

+ Impaired learning & disorientation

sometimes nystagmus & ataxia

15
Q

What screening tools can we use looking for an alcohol problem?

A
  • CAGE questions (2+ = likely)
  • AUDIT (Alcohol Use Disorders Identification Test)
  • FAST = smaller version of AUDIT for use in A&E
  • PAT - Paddington Alcohol Test (also used in A&Es etc)
16
Q

How do we manage alcohol withdrawal?

A

Chlordiazepoxide

Its a benzo very similar to Diazepam

17
Q

Why do we use Chlordizepoxide?

A

It’s not well known meaning patient’s don’t try to get it or sell their prescription like they do with diazepam

18
Q

What meds can we use to prevent Wernicke’s?

A

Thiamine

19
Q

What drugs do we have to help with maintaining abstinence?

A

Aversion meds = Disulfiram

Anti-craving meds = Acamprosate + Naltrexone & Nalmefene

20
Q

How do Naltrexone & Nalmefene work?

A

They block endogenous opioid release, quite specifically to alcohol so doesn’t affect other processes

21
Q

Explain the effect of alcohol on your neurochemistry?

A

Enhances inhibitory GABA A, Glycine & Adenosine

Reduces Excitatory NMDA glutamate & Aspartate

Promotes Endogenous Opioid & Endocannabinoid release