Substance misuse

Question 1

Alcohol misuse (history)

Answer 1

• Clarify HPC (understanding, onset, course, typical day)
• Core features (control, tolerance, withdrawal - shakes, seizures, Hns)
• Other features (primacy, eye-opener, abstinence)
• Complications (daily life, physical health, work, relationships, finances, Police)
• Mental state (mood, enjoyment, sleep, appetite, hallucinations, delusions)
• Risk (self, others)
• Insight and readiness for change

Question 2

Alcohol dependence (d/w family)

Answer 2

• Clarify concerns
• Explain complications of alcohol use (liver, withdrawal, depression/anxiety, dementia, Police)
• Medical management (diazepam, thiamine, Antabuse)
• Psychological management (CBT, groups)
• Prognosis (insight, family support)
• Questions and leaflets

Question 3

Opioid dependence (history)

Answer 3

• Clarify HPC (substances, onset, course, typical day, route)
• Dependence symptoms (tolerance, control, cravings, withdrawal)
• Complications (physical health, work, relationships, finance, Police)
• Mental state (mood, enjoyment, sleep, appetite, hallucinations, delusions)
• Risk (self, others, pregnancy)
• Insight and readiness for change

Question 4

Substance use in pregnancy (history)

Answer 4

• Clarify HPC (substances, onset, course, typical day, route)
• Dependence symptoms (tolerance, control, cravings, withdrawal)
• Pregnancy (planned, attitude)
• Social history (work, finances, relationships, help)
• Risk (self, others, child)

Question 5

Methadone in pregnancy (explanation)

Answer 5

• Clarify concerns
• Explain risk of drug use in pregnancy (stillbirth, prematurity, LBW, use of methadone)
• Neonatal abstinence syndrome
• Management (withdrawal in 2nd trim or dose adjustment in 3rd trim)
• Breastfeeding (fine if <20mg per day, other meds)
• Social services

Question 6

Delirium tremens (d/w consultant)

Answer 6

• Case summary
• Differential diagnosis (DTs, other delirium, other psychosis)
• Environmental management (orientation, quiet room, familiar staff, use of MHA)
• Drug management (IV Pabrinex tds, CIWA protocol with diazepam or chlordiazepoxide, haloperdiol)
• Psychological management (addictions services)