1 / 54

Alcohol-related disorders

Alcohol-related disorders. Unless otherwise indicated, all answers are taken from DSM-IV-TR, from APA Practice Guideline on Substance Abuse Disorders, Supplement to AJP, August, 2006, or Kaplan & Sadock [2007] As of 27March08. . Alcohol intoxication DSM criteria.

yair
Download Presentation

Alcohol-related disorders

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Alcohol-related disorders Unless otherwise indicated, all answers are taken from DSM-IV-TR, from APA Practice Guideline on Substance Abuse Disorders, Supplement to AJP, August, 2006, or Kaplan & Sadock [2007] As of 27March08.

  2. Alcohol intoxicationDSM criteria Q. Four basic criteria for this dx?

  3. Alcohol intoxicationDSM-IV criteria Ans. 1. recent ingestion of alcohol 2. after ingestion, maladaptive behavior or impaired functioning 3. after ingestion, one or more neurological signs [slurred speech, incoordination, unsteady, nystagmus, cognitive deficits] 4. not better accounted for as part of another disorder/illness

  4. Alcohol withdrawalDSM criteria Q. Four basic criteria?

  5. Alcohol withdrawalDSM criteria Ans. 1] occurs during cessation of heavy use of alcohol. 2] two or more of signs of withdrawal [P and Temp elevated; tremor; insomnia; nausea; hallucinations or illusions; agitation; anxiety; seizures] 3] distressed or impaired 4] not better accounted for as part of another disorder

  6. Amnestic syndrome Q. The amnesia of alcohol amnestic syndrome [Korsakoff’s] is anterograde or retrograde?

  7. Amnestic syndrome Ans. Anterograde.

  8. Wernicke’s Q. What are the signs of Wernicke’s encephalopathy.

  9. Wernicke’s Ans. ataxia vestibular dysfunction confusion ocular motor motility abnormalities

  10. Treatment of Wernicke’s Q. What is treatment of Wernicke’s?

  11. Wernicke’s treatment Ans. 100 mg of thiamine IV* and followed by thiamine 100 mg TID for two weeks. *Give more if needed until eye motility signs disappear.

  12. Gender prevalence Q. Gender breakdown of pts with alcoholism?

  13. Gender prevalence Ans. Men two to one.

  14. ICU admissions Q. Roughly what fraction of ICU admissions are alcohol related [includes trauma to which alcohol was a factor]?

  15. ICU admissions Ans. 1/5

  16. Alcohol-related auto fatalities Q. Approximately how many auto fatalities are alcohol related?

  17. Alcohol-relatedauto fatalities Q. 1/2

  18. Homicides Q. Approximately what proportion of homicides are alcohol-related?

  19. Homicides Ans. 1/2

  20. Lab testsmost sensitive Q. Name the two most sensitive lab tests to suggest heavy drinking.

  21. Lab testsmost sensitive Ans. 1] Gamma-glutamytransferase [GGT], > 30 units 2] carbohydrate deficient transferrin [CDT]. > 20 units

  22. Lab testsother findings Q. In addition to the GGT and CDT, what other lab tests are associated with heavy drinking?

  23. Lab testsother findings Ans. 1] high normal red cell MCV 2] liver function tests [e.g., ALT] can suggest liver damage secondary to alcoholism. 3] elevated lipids, e.g. triglycerides

  24. Lab testsmonitor for abstinence? Q. Can these lab tests be used to monitor for abstinence?

  25. Lab testsmonitor for abstinence Ans. GGT and CDT return to, or at least toward, normal within days of discontinuing drinking – as so can be used to monitor. Other tests results, e.g. MCV, change too slowly to be of use. The pt could have ceased drinking and, still, weeks later, the MCV might suggest the pt has not ceased.

  26. Low aldehyde dehydrogenase Q. Low levels of aldehyde dehydrogenase and consumption of alcohol lead to?

  27. Low aldehyde dehydrogenase Ans. Very unpleasant flushing and palpitations.

  28. Aldehyde dehydrogenaselow in populations Q. Low levels of this enzyme are found in what populations?

  29. Aldehyde dehydrogenaselow in populations Ans. Chinese, Japanese or Korean is probably what the examiner expects. Low in about half those populations.

  30. Gender and blood alcohol Q. Blood alcohol level levels different in men and women who weigh the same and have the same number of drinks?

  31. Gender and blood levels A. Even when they weigh the same and have the same number of drinks, women have higher blood levels.

  32. Women and blood levels Q. Why do women have higher blood levels?

  33. Women and blood levels Ans. Higher blood levels because: 1] Less water/pound 2] more fat/pound 3] metabolize alcohol less rapidly because less aldehyde dehydrogenase in the gut.

  34. Alcohol dependenceprevalence Q. What is life-time US prevalence of alcohol? What is US prevalence at any one time?

  35. Alcohol dependenceprevalence Ans. Life-time prevalence: 15% Current prevalence: 5%

  36. Alcohol intoxicationfirst episode Q. In people who later become alcoholics, what age is the first episode of alcohol intoxication?

  37. Alcohol intoxicationfirst episode Q. mid-teens

  38. Alcohol dependenceonset Q. When does the onset of alcohol dependence peak?

  39. Alcohol dependenceonset Ans. 20s to mid-30s.

  40. Metabolize alcohol Q. How long does it take the body to metabolize one can of beer?

  41. Metabolize alcohol Ans. About one hour to metabolize a drink, e.g. can of beer.

  42. Familial pattern Q. What are the chances of someone whose brother is an alcoholic becoming an alcoholic v. someone from a family in which no one has alcohol dependence?

  43. Family pattern Ans. Three to four times higher if a family member is an alcoholic.

  44. Withdrawal signs Q. Withdrawal signs during alcohol withdrawal usually have what course, that is: Onset after how many hours? Peaks at which day? And when do the signs disappear if no meds are provided to treat the withdrawal?

  45. Withdrawal signs Ans. Onset in 4 – 12 hours, peaks during the second day and is resolved in the 5th day.

  46. Hospitalize for withdrawal Q. Suggestive that you will need to hospitalize someone who is in alcohol withdrawal?

  47. Hospitalize for withdrawal Ans. Hospitalization is suggested with: 1] Hx of TDs. 2] Very heavy consumption of alcohol 3] Concurrent use of other drugs 4] Severe comorbid other medical illness 5] Repeated failures of other outpt detoxifications, i.e., very high recidivism level.

  48. Withdrawal - meds Q. Meds for moderate to severe alcohol withdrawal?

  49. Withdrawal – meds - 1 Ans. Restore glucose and fluids if needed. • Thiamine • Benzodiazepines, e.g.: -- chlordiazepoxide, 50 mg/ 2 – 4 hours -- diazepam, 10 -20 mg/ 2 – 4 hours -- lorazepam, 1 – 4 mg/ 1 – 4 hours -- oxazepam, 60 mg/ 2 – 4 hours See next slide

  50. Withdrawal – meds - 2 Ans. Continued. To prevent seizures, use anticonvulsant To treat delirium or psychosis, use antipsychotic

More Related