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Flashcards in Substance Use d/o Deck (22)
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1

Substances related to Psychotic disorders

-alcohol intoxication/withdrawal
-Cannabis intoxication
-Hallucinogen- PCP intoxicaition, other hallucinogens incl with persisting perception d/o
-inhalant intoxication
-sedatives, hypnotics or anxiolytics intoxication
-stimulants (incl amphetamine, cocaine and other)- intoxication
-other I/W

2

Substances related to Bipolar d/o's

-alcohol intoxication/withdrawal
-hallucinogen-- PCP and other intoxication
-sedative/hypnotics or anxiolytics-- intoxication/withdrawal
-stimulatnts (amphetamines, cocaine, other)- intoxication/withdrawal
-other I/W

3

substance related to depressive disorders

-alcohol intoxication/withdrawal
-hallucinogens- PCP and other- intoxication
-inhalants- intoxication
-opiods- intoxication or withdrawal
-sedatives. hypnotics or anxiolytics- intoxication or withdrawal
-stimulants- intoxication/withdrawal
-other I/W

4

substances related to Anxiety disorders

-alcohol I/W
-caffeine intoxication
-Cannabis I
-hallucinogen- PCP and other- I
-inhalants- I
-opiods- W
-sedative, hypnotics, anxiolytics- W
-stimulants- I/W
-other I/W

5

substances related to OCD disorders

-stimulants- intoxication/withdrawal
-other/unknown- I/W

6

substances related to sleep disorders

-alcohol I/W
-caffeine I/W
-cannabis I/W
-opiods I/W
-sedatives, hypnotics and anxiolytics- I/W
-stimulants I
-other I/W

7

substances related to sleep disorders

-alcohol I/W
-opiods I/W
-sedative, hypnotic, anxolyitc I/W
-stimulants I
-other I/W

8

substance diagnoses related to delirium

-alcohol- I/W
-Cannabis I
- PCP/other hallucinogens - I
-inhalants- I
-opiods I/W
-sedative, hypnotics, anxiolytics- I/W
-stimulants- I
others- I/W

9

substance diagnoses related to NCD

-alcohol- I/W/persistent
-inhalants- I/persistent
-sedatives- I/W/persistent
-other- I/W

10

substance diagnoses related to SUDs

-alcohol
-cannabis
-hallucinogens (PCP, other)
-inhalants
-opiods
-sedatives, hypnotics or anxiolytics
-stimulants
-tabacco
-other
(NOT caffeine)

11

substance intoxication

everything: alcohol, caffeine, cannabis, hallucinogens (PCP, other), inhalants, opiods, sedatives, hypnotics or anxiolytics, stimulants, tabacco, others

12

substance withdrawal

(everything EXCEPT hallucinogens- PCP and other and inhalants)
alcohol, caffeine, cannabis, opiods, sedative/hypnotics/anxiolytics, stimulants, tobacco and other

13

General Substance Use D/O criteria

A. Problematic use of substance for the last 12 months causing significant impairment and distress and 2 of:
-1-4 impaired control: using more than intended, persistnt efforts and failures to decrease/quit, requires significant time to obtain/use/recover, cravings
-Criteria 5-7: Social impairment: use results in failure to meet major role obligations at work, school, or home, use continues despite persistent social/IP problems, giving up significant activities
-criteria 8-9: Risky use-- use results in physical hazards, continued use despite persistent physical or psychological problem
-Criteria 10-11- Pharmacologic-- tolerance (increased dose of substance for effect), withdrawal

14

Substance use d/o specifiers

mild- 2-3 symptoms
moderate- 4-5 sx
severe- 6 or more sx
-also related to changing use patterns
-in early remission-- full criteria (except craving) not met for 3 months, but less than 12 months
-in sustained remission- full criteria not met for 12 months
-on maintenance therapy-- opiod use d/o-- taking agonist medication and not meeting criteria (except for tolerance/withdrawal for agonist) (also includes partial agonist or naltrexone - full antagonist)
-in a controlled environment- criteria not met when in environment that restricts the substance

15

Warnicke- Korsakoff Syndrome

Warnicke triad: nystagmus (6th nerve palsy), ataxia, confusion (delerium)
-Vitamin B1 (thiamine) deficiency-- give thiamine 100mg IM/IV
Korsakoff: anterograde and retrograde amnesia with assoc cognitive deficits incl aphasia, apraxia, agnosia, and/or executive dysfunction

16

Alcohol withdrawal

DSM V: cessation/reduction in heavy/prolonged alcohol use with 2 or more of : autonomic hyperactivity (sweating, tachycardia), hand tremor, insomnia, N/V, transient visual, tactile or auditory hallucinations, psychomotor agitation, anxiety, generalized TC seizures, causing impairment and not caused by something else
-specify: with perceptual disturbances
-withdrawal- 6-24 h after last drink
-seizures- 24-48h
-DTs- 48-72h
Tx: Thiamine 100mg IV/IM, bentos (ativan, diazepam, chlordiazepoxide) -- CIWA +/- scheduled
HEAD SPIN: hand tremor, Experience Hallucinations, Anxiety, Diaphoretic/increased BP, Sz, psychomotor agitation, insomnia, N/V

17

Cannabis use d/o

Can annual prevalence: 12.3% ages 15+ (15% 15-25 yo, 10% 25+)
Intoxication: conjunctival injection, increased appetite, dry mouth, tachycardia
Withdrawal: about 24 hours with peak at 1 week after d/c persistent use: irritability/anger/aggression, anxiety, insomnia, decreased appetite/weight loss, restlessness, depressed mood, physical sx incl abd pain, tremors, sweating, fever, chills, headache

18

PCP intoxication

intoxication: vertical/horizontal nystagmus, ataxia, dysarthria, HTN/tachycardia, decreased pain response, muscle rigidity, sz/coma, hyperacusis
--> serotonin
--> no withdrawal

19

Opioid use

Intoxication: pinpoint pupils, drowsiness/coma, slurred speech, impaired attention/memory, psychological changes incl initial euphoria, apathy, dysphoria, psychomotor agitation/retardation
Tx: Naloxone 0.4mg up to 3x
Withdrawal: dysphoric mood, N/V, muscle aches, lacrimation/rhiorrhea, pupillary dilation, piloerection or sweating, diarrhea, yawning, fever, insomnia,

20

Stimulant use

Intoxication: psychological changes ( paranoia, hallucinations (tactile), euphoria, affective blunting, changes in sociability, hyper vigilance, IP sensitivity, anxiety anger, stereotyped behaviour, impaired judgment), tachycardia/bradycardia, dilated pupils, elevated/lower BP, perspiration/chills, N/V, weight loss, psychomotor agitation/retardation, muscular weakness, respect depression, CP, arrhythmias, confusion, sz, dyskinesias, dystonia or coma
withdrawal- dysphoric mood, fatigue, vivid/unpleasan dreams, insomnia/hypersomnia, increased appetite, psychomotor retardation/agitation
long term effects-- cognitive-- decreased executive function, cognitive shifting, increased impulsivity, slow processing, impaired memory---> like ADHD
--10% addiction with initial use--> drug acts directly on DA
--usually needs longer residential tx with ++ relapse prevention skills

21

Gambling Disorder

Diagnosis: persistent, recurrent gabling with impairment/distress with 4 of the following in the last 12 months:
-gambling with increased $ to achieve same excitement
-restless/irritable when try to cut down/stop
-repeated unsuccessful efforts to control/stop
-preoccupied with gambling
-gambles when feeling distressed
-returns after losing money (chasing losses)
-lies to conceal extent of gambling
-jeopardized/lost significant relationship, job, or educationa/career opportunity
-relies on others to provide money to relieve financial distress
Not exclusively in manic episode
specify: episodic, or persistent, early or sustained remission, mild/moderate/severe

22

Scales for SUDs

Screening: have you ever had a drinking problem?
have you had any alcohol in the last 24h? (y to both-- 92% chance of current alcohol problem
AUDIT- positive with 8+ for men and 4+ for women
Drug Abuse Screening Test (DAST 10)- 0- no problem, 2- mild, brief intervention, 5- moderate, further investigation, outpt treatment, 8- substantial problem, intensive tx, 10- severe- intensive tx