Part XII Substance Use and Abuse
Terms in this set (28)
What is behavioral dependence?
Substance-seeking activities and related evidence of pathological use patterns are emphasized
What kind of dependence refers to the physical episodes of substance use?
Psychological dependence is characterized by continuous or intermittent craving for the substance to avoid dysphoric state. What else is this known as?
What is the difference btwn abuse and misuse?
Abuse is usually by self-administration and misuse applies to the drugs prescribed by physicians that are not used properly
A patient you have known for quite some time has been calling the office to get refills on his pain medication. After much convincing, he finally comes in to the office. You can see that his physical and mental demeanor is not right as well as symptoms of distress. He is irritated and says, "Just give me my meds doc!" What stage of substance abuse is the patient in?
What are the three primary reasons family members, friends, etc. may feel they have no control over "enabling"?
Social pressures for protecting and supporting family members or because of pathological interdependencies, or both, enabling often resists modification!
What does "coaddiction" or "codependence" refer to?
Used to refer family members affected by or influencing the behavior of the substance abuser
What does enabling mean?
The enabler facilitates the abuser's addictive behavior and it means to include the unwillingness of a family member to accept addiction as a medical-psychiatric disorder or to deny that person is abusing a substance
What is a reversible syndrome caused by a specific substance,that affects 1 or more of the following mental functions: memory, orientation, mood, judgement, and behavioral, social, or occupational functioning?
What is tolerance?
Phenomenon in which, after repeated administration a given dose of drug produces a decreased effect of increasingly larger doses must be administered to obtain the effect observed with the original dose.
What is behavioral tolerance?
Ability of the person to perform tasks despite the effects of the drug
What is withdrawal?
A substance- specific syndrome that occurs after stopping or reducing the amount of the drug or substance that has been used regularly over a prolonged period. The syndrome is characterized by physiological signs and symptoms in addition to psychological changes, such as disturbances in thinking, feeling, and behavior. Also called abstinence syndrome.
A man walks in to your practice with an unsteady gait, slurred speech, and smells of alcohol. He says he is dizzy. Physical exam shows double vision present, nystagmus, dazed, and cannot recall a majority of events. Based on these symptoms, what state do you expect the patient to be in regarding substance use?
A classmate claims he has something to help raise your PBL grade. The "herbal remedy" will heighten your external sensitivities as well as reveal new details. He warns you that your motor skills will be slightly off. What is he talking about and how are these symptoms brought forth?
Intoxication of marijuana
A 55 y/o, post-menopausal woman was recently involved in a car accident. You are going to prescribe hydrocodone for pain relief. What are the side effects of this if she were to become intoxicated on this?
maladaptive behavior changes and specific physical symptoms of opioid use. In general altered mood, psychomotor retardation, drowsiness, slurred speech, and impaired memory and attention in the presence of other indicators of recent opioid use strongly suggest a diagnosis.
Describe the intoxication effects of sedatives, hypnotic and anxiolytic drugs?
Similar to each other, includes incoordination, dysarthria, nystagmus, impaired memory, gair disturbance, and in severe cases: stupor, coma or death
If someone intoxicates on stimulants, what are the clinical key points you can note on the physical exam?
Mydriasis; psychomotor agitation or retardation; tachycardia or bradycardia; perspiration or chills; cardiac arrhythmias or chest pain; elevated or lowered blood pressure; dyskinesias; weight loss; dystonias; nausea or vomiting; muscular weakness; respiratory depression; confusion, seizures, or coma
The same patient that came in intoxicated in alcohol, is transported to the ER later. Report stated that the bartender called 9-11 after the patient started trembling when the patient was denied a drink due to lack of expenses. The next day, he comes back and was denied again. He then has a seizure. What is you likely diagnosis?
After drug testing a couple of LECOM students, their urine was positive for marijuana. They were told to "become clean" or get kicked out. What are some withdrawal symptoms associated with marijuana sudden cessation?
withdrawal symptoms within 1-2 weeks of cessation. Symptoms: irritability, cannabis cravings, nervousness, anxiety, insomnia, disturbed or vivid dreaming, decreased appetite,, weight loss, depressed mood, restlessness, headache, chills, stomach pain, sweating, and tremors.
There are 4 requirements for withdrawal syndrome of opioids. What are they?
A. Presence of either of the following:
1. Cessation of opioid use that has been heavy and prolonged
2. Administration of an opioid antagonist after a period of opioid use
B. Three or more of the following developing within minutes to several days after A:
1. Dysphoric mood
2. nausea or vomiting
4. Lacrimation or rhinorrhea
5. pupillary dilation, piloerection, or sweating
C. The signs or symptoms in B cause clinically significant distress or impairment in social occupational, or other important areas of functioning
D. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication or withdrawal from another substance.
A patient comes in complaining of mood swings and difficulty in understanding simple things. She finds her self becoming restless, irritable, with obsessive rumination. When asked about medications she says, "I was on clonazepam, but I lost my insurance. I just finished my last bottle a week ago." Physical exam shows tachycardia, hyperreflexia, and hypertension. What is your diagnosis?
What is the most serious withdrawal symptom of stimulants?
If you want to treat alcohol withdrawal symptoms, what can you give the patient?
(Full details are on the drive)
Demi Lovato was recently involved in an heroin overdose. How was she treated back to a conscious state? What drug is used as a substitute for heroin and taken orally?
Ensure an adequate airway. Patient should be ventilated mechanically until naloxone (72 hours), a specific opioid antagonist, can be given
What drug can be given to prevent seizures and other sedative withdrawal syndromes and should be gradually reduced?
Benzodiazepines or carbamezapine
What is the penobarbital dose test?
It is for barbiturates, Test dose of 200 mg of penobarbital every hour until a mild intoxication occurs but withdrawal symptoms are absent.
What does "amotivational syndrome" refer to?
A controversial cannabis-related syndrome. Person's unwillingness to persist in a task- be it at school, at work, or in any setting that requires prolonged attention or tenacity. Persons are described as becoming apathetic and anergic, usually gaining weight, and appearing slothful.
What are the comorbidity rates of "substance use problems" with other psychiatric disorder?
up to 50% of addicts have a comorbid psychiatric disorder. A range of 35-60 percent of patients with substance abuse or substance dependence also meets the diagnostic criteria for antisocial personality disorder. About 1/3- ½ of all those with opioid abuse or opioid dependence and about 40% of those with alcohol abuse or alcohol dependence meet the criteria for major depressive disorder sometime during their lives. Persons who abuse substances are about 20 times more likely to die by suicide than the general population. About 15 percent of persons with alcohol abuse or alcohol dependence have been reported to commit suicide. This frequency of suicide is second only to frequency in patients with major depressive disorder.
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