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Block 4 PSYCH Exam -- Substance-related Disorders


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What are three phases of motivated behavior
Consummatory behavior
Decrease in drive, and replacement
What percentages of men and women have Alcohol Abuse in their lifetime?

What about Alcohol Dependence?
20% men, 10% women (Abuse)

10% men, 5% women (Dependence)
Decline in what induces withdrawal?
Decline in blood or tissue concentrations
No significant withdrawal is seen after use of what drugs (2)?
What is relapse?
A condition returning after discontinuation of medication

(Assumes that pt. had a pre-existing medical condition that was under control)

This does NOT tend to get better without treatment
What is rebound?
When an underlying condition becomes WORSE than baseline
(due to abrupt stoppage of meds)

Unlike relapse, this tends to get better, even without treatment
Narrow DSM-IV definition of physiologic dependence
Development of tolerance and/or withdrawal
Substance Abuse is manifested by one or more of the following (4)
Failure to fulfil major role obligations
Use in situations in which physically hazardous
Recurrent substance-related legal problems
Use despite persistent/recurrent substance-related problems
What is the time window for something to qualify as substance abuse?
One or more of the requirements must occur within a 12 month window
What component of the nervous system does withdrawal depend upon?
Noradrenergic output from the locus ceruleus
What is positive reinforcement?
A pleasurable reward following a behavior
What is negative reinforcement?
Removal of an unpleasant state following a behavior
What part of life does substance dependence typically begin in?
What is the time "hump" to get over when fighting substance dependence?
2 years

Of those abstinent for 2 years, 90% are substance free at 10 years
In what time frame is the highest rate of relapse when trying to quit drinking?
In the first 12 months
What effect does Naltrexone have in treating substance dependence?
Blocks the euphoria of alcohol and opiates
What effect does Disulfiram have in treating substance dependence?
Makes it so that it is physically miserable to drink

Blocks negative reinforcement
When does UNcomplicated alcohol withdrawal begin?

How long does it last?
Several hours after the last drink

Lasts about a week
(Some symptoms last several weeks)
In uncomplicated alcohol withdrawal, when does postural tremor begin?

When does it peak?
6-8 hours

Peaks at 24 - 48 hours
In COMPLICATED alcohol w/d, when do seizures usually onset?
24 hours (range 8-40 hours)
In COMPLICATED w/d, when does psychosis usually onset?

How long does it last?
8-12 hours

Lasts about a week
Complicated alcohol w/d-induced psychosis responds to what meds (2)?
How long after the last drink to DTs usually take to set in?
3 days
What part of life are DTs most common in?
30s - 40s

(After 5-15 years of drinking)
What type of drugs are most commonly used for alcohol withdrawal?

Which ones?

Ativan (when liver injury expected)
How are clonidine and beta-blockers used in treating alcohol withdrawal?
For autonomic symptoms
How does Topiramate work to maintain abstinence from alcohol?
(mechanism of action)
Acts on both GABA and glutamate systems

Facilitates GABA
Antagonizes excitatory effects of glutamate
Pupillary response to opioid intoxication vs. OD
Intoxication -- pupillary constriction

OD -- pupillary dilation
Complications of opioid use from opioid itself
Dry mouth/nose
Pupillary constriction (can decrease visual acuity)
How long does it take for opioid withdrawal to kick in?

When does it peak?

How long does it last?
Only takes about 10 hours after the last dose (short-acting agent)

Peaks within 1-3 days

Gradually subsides over 5-7 days
Presentation of opioid withdrawal can mimic what other ailment?
The flu

(it presents as the opposite of opioid intoxication)
This drug is used to ease opioid withdrawal symptoms

NOTE: can be mixed with naltrexone to provide rapid detox
Differences between methadone and heroin (3)
Methadone doesn't have euphorogenic effects
Has slower onset
Has longer half-life

NOTE: methadone still has withdrawal
Mechanism of Buprenorphine
PARTIAL opiate receptor agonist

Blocks withdrawal and satisfies cravings

Less likely to cause OD
Withdrawal is very mild and short
Antagonizes effects of other opiates
What is "speedball"
Cocaine mixed with heroin
What is free-basing?
Heating cocaine with a volatile solvent to extract the "free base"
What is "crack" cocaine?
Alkaloid form of cocaine extracted from the hydrochloride salt
What is cocaine's DOA?
Short, only 15 - 30 minutes
Physiological responses to cocaine intoxication (7)
Pupillary dilatation
Elevated BP
Weight loss
Respiratory depression

NOTE: some people have paranoid delusions
What are the 3 phases of cocaine withdrawal?
Acute "crash"
Depression lessens, craving returns
Chronic "abstinence syndrome"
How long does the acute "crash" of cocaine withdrawal last?
Up to 3 days

Pts. can become suicidal
Pts. have an intense urge to sleep
What is the mechanism of action of amphetamines?
Inhibit catecholamine reuptake
Also, lead to increased catecholamine release
How is amphetamine intoxication different than cocaine intoxication (2)?
Lasts longer
Has lower risk of arrhythmias or seizures
Two main components of Substance dependence
(in addition to neuroadaptation)
Impaired control over use of drug
Increased salience of drug
What is the mechanism of action of nicotine?
Activates ACh receptors on DA neurons in ventral tegmental area
Causes mesolimbic DA release

Receptors activated, then quickly desensitized (limits "rush")
Receptors recover after a few seconds
Which cigarette in a given day is usually the "best"?
The first one

Smokers develop acute tolerance for each cigarette and over the course of a day
How long after stopping does nicotine withdrawal start?

When does it peak?
Within 12 hours of stopping

Peaks within 3 days
What nicotine withdrawal treatment is best for preventing craving?
Nicotine patch
(substitution therapy)
Long-term hallucinogen dependence can lead to a syndrome resembling what?
Negative symptoms of schizophrenia
What is the most commonly used illicit drug in America?
How long does cannabis intoxication last?
2 - 4 hours

NOTE: metabolites of THC are very fat soluble
(half-life of ~50 hours)
What PE signs may show up when intoxicated by cannabis (3)?
Dry mouth
Conjuctival injection ("bloodshot")
PE signs of PCP intoxication may be suggestive of what type of injury?
Cerebellar injury

Signs -- ataxia, dysarthria, nystagmus
How is PCP intoxication treated?
Antipsychotics, BDZs for sedation
Activated charcoal
Acidifying urine
What is the mechanism of action of PCP?
Effects at opiate receptor
Negative allosteric modulator of glutamate(NMDA) receptor

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