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Substance misuse categories
- - Intoxication
- - Harmful use
- - Dependency
- - Withdrawal
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Features of dependency
(8, or 6 bigger)
- 1.a Compulsion
- 1.b Difficult controlling use - starting, stopping, or amounts used
2. Tolerance
- 3. Withdrawal - physiological withdrawal state
- a) characteristic withdrawal state
- b) substance use to prevent/relieve withdrawal symptoms
- 4.a. Continued used despite harm
- 4.b. Salience (primacy)
- stinence
- 5. Narrowing of repertoire
6. Reinstatement after ab
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Neurological models: all drug uses affect/
Dopaminergic 'reward' pathway in the barin.
Cocain and amphetamine block dopamine reuptake. Alcohol and opiates also increase dopamine.
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Alcohol 'flush reaction'
Ethanol is metabolised to acetaldehyde, by aldehyde dehydrogenase.
East Asian, a variant enzyme -> acetaldehyde accumulates, causing flushing, palpitations and nausea.
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Calculate exact alcohol content
units = (volume of drink in mL x % alcohol)/1000
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Levels of alcohol consumption: safe and harmful
- Safe
- - women: 2-3/day, 14/w
- - men: 3-4/day, 21/w
- Harmful
- - women: >6, >35
- - men: > 8, >50
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Withdrawal of alcohol
ALcohol is a CNS depressant, stimulate GABA inhibitory system to reduce brain excitability.
Suddenly stop drinking -> neural pathway become hyper-excitable and seizures
Delirium tremens
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DDx for alcohol and drugs
- 1. Organic
- (not to assume: confusion, ataxia, or psychotic symptoms are solely due to s misuse;
- Beware: head injury, subdural haematoma)
- 2. Psychiatric illness: primary or comorbid
- dual diagnosis
- DDx
- - depression/mania
- - functional psychosis
- - anxiety disorder
- personality disorder
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Distinguish subtance misuse from psychiatric prob
- - Which problem came first?
- - Do the psychiatric symptoms 'fit' with known symptoms of that substance?
- - Have psy symptoms continued after abstinence?
- - Is there a FHx or prev diag?
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Pharm mx of alcohol
1. Detoxication of alcohol
2. Prevention
- - Long acting benzodiazepines
- - Thiamine
- Prevention:
- - Disulfiram (mimic flush reaction)
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Opiates (heroin, morphine, codein): notable
1. intoxication px
2. withdrawal
3. overdose
4. substitute prescribing
5. prevention
- 1. pinpoint pupils
- 2. 'runs' (diarrhoea, vomitting, lacrimation, and rhinorhoea)
- 3. Naloxone - opiate antagonist
- 4. Methadone (full agonist) & buprenorphine (partial agonist)
- 5. Naltrexone - opiate antagonist
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Cocaine users may experience
Formication - sensation of insects crawling on/below skin, also known as cocaine bugs
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Snorting cocaine causes?
Cocaine is a powerful vasoconstrictor and snorting it damages the nasal mucosa, causing necrosis and septal perforation.
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Benzodiazepines overdose
Treated with flumazenil, a benzo anatagonist
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