What are the effects of alcohol at low doses?
- euphoria
- reduced anxiety
- relaxation
- sociability
What are the effects of alcohol at 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
What is harmful use?
- pattern of use causing damage to physical or mental health.
- Use >1 month or repeatedly over 12 months
What is alcohol dependence according to the ICD-10?
3 or more of the following for >1month or repeatedly over 12 months:
WTC DNP
– Withdrawal - Physiological withdrawal on reduction/cessation
– Tolerance
– Cravings/compulsions to take
– Difficulty controlling use
– Neglect of other activities
– Persistence despite harmful consequences
What is a 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 are the signs of alcohol withdrawal state?
- Tremor
- weakness
- nausea
- vomiting
- anxiety
- seizures
- confusion
- agitation
- death
- Delirium Tremens
Some signs of alcohol withdrawal state include;
- Tremor
- weakness
- nausea
- vomiting
- anxiety
- seizures
- confusion
- agitation
- death
- Delirium Tremens
What is delirium tremens? When does it occur?
- 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
What negative impacts can alcohol have on mental health?
- Anxiety
- Depression
- Sleep disruption
- Morbid Jealousy
- Alcoholic hallucinosis
- Deliberate self-injury
- Suicidal thoughts/acts
Chronic alcoholism can cause Wernicke’s encephalopathy.
What are the signs?
Is it reversible?
Signs
- Confusion
- ataxia
- opthalmoplegia
- nystagmus
–Reversible
What is the relation between Wernicke’s encephalopathy development as a consequence of alcoholism and Korsakoff’s psychosis?
–If Wernicke’s encephalopathy is not treated 80% go onto develop Korsakoff’s psychosis
Must treat with Thiamine ASAP!!
If Wernicke’s encephalopathy is not treated, 80% go onto develop Korsakoff’s psychosis.
What are the signs?
Is it reversible?
- 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
- not reversible
In alcoholism, what is the cause of Wernicke’s encephalopathy and Korsakoff’s psychosis?
Thiamine Deficiency
Vitamin B1
–Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism
In alcoholism, what is the cause of Wernicke’s encephalopathy and Korsakoff’s psychosis?
Thiamine Deficiency
Vitamin B1
–Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism
Wernicke’s Encephalopathy and Korsakoff’s Psychosis are caused by a deficiency in which vitamin?
Vitamin B1
Thiamine deficiency
–Poor intake and absorption, poor hepatic function, increased requirement for alcohol metabolism
How might alcoholism affect relationships?
- Aggression
- Verbal
- Physical
- Marital difficulties
- Morbid jealousy
- Poor parenting/neglect +/- loss of parenting rights
- Loss of friendships and social supports
- Othello disorder – delusional belief that spouse is being unfaithful
What are the screening tools for alcoholism?
- 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)
What is the broad management of alcoholism?
- Practical advice, education, harm reduction
- Holistic/bio-psycho-social approach
- Support for patient and family
- Psychological help (e.g. CBT, group therapy)
- Social work input (benefits, housing, child protection)
- Skills training
- Community Support (eg AA, ADA)
- Inpatient or residential treatment
- Medication
What medication should you give for the prevention of Wernicke-Korsakoff Syndrome?
Thiamine - vitamin B1
Which medications should you give for the management of alcohol withdrawal?
Benzodiazepines
- commonly Chlordiazepoxide
What medication can you give to deter alcoholics from drinking?
Disulfiram (Antabuse)
– prevents the breakdown of alcohol = causes severe hypotension, nausea, vomiting – unpleasant symptoms
Disulfiram can be used to deter alcoholics from drinking.
How does it work?
prevents the breakdown of alcohol
Disulfiram can be used to deter alcoholics from drinking.
it prevents the breakdown of alcohol.
What are the effects?
- causes severe hypotension
- nausea
- vomiting
– unpleasant symptoms
What are the anti-craving medications used for alcoholism?
- Acamprosate (Campral) – GABA agonist
- Naltrexone – long acting opioid antagonist
- Nalmefene – long acting opioid antagonist
- (Baclofen)
What is alcohol dependence according to the ICD-10?
3 or more of the following for >1month or repeatedly over 12 months:
WTC DNP
– Withdrawal - Physiological withdrawal on reduction/cessation
– Tolerance
– Cravings/compulsions to take
– Difficulty controlling use
– Neglect of other activities
– Persistence despite harmful consequences
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History, MSE and Diagnosis31
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Affective Disorders49
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Psychological Approaches to Mental Health Problems17
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Legal Aspects of Psychiatry12
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Antidepressants54
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Mood Stabilizers36
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Antipsychotics29
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Anxiolytics6
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Alochol26
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Science of Addiction12
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Drug misuse16
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Case: Depression12
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Case: Mania and Bipolar7
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Schizophrenia17
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Personality Disorder15
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Anxiety Disorders19
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Child Psychiatry7
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Old Age Psychiatry16
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Eating Disorders17
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Psychiatric History6
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MSE5
