Substance Abuse & Psychiatry
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- What serum marker is a sensitive indicator of alcohol use?
- gamma-glutamyltransferase
- When do alcoholics in withdrawal exhibit delirium tremens?
- 2-5 days after last drink
- What are the signs of delirium tremens?
-
1) autonomic hyperactivity (tachycardia, tremors, anxiety)
2) psychotic sxs (hallucinations, delusions)
3) confusion - A man is brought to the ER with severely depressed respirations, pinpoint pupils, and seizures. What is wrong with him?
- Opioid intoxication.
- A man is brought to the ER with fever, rhinorrhea, nausea, stomach cramps, piloerection, and dilated pupils. What is happening?
- Opioid withdrawal. Also have anorexia, insomnia, anxiety, diarrhea, yawning.
- A man is brought to the ER with pupil dilation, HTN, tachycardia, euphoria, prolonged wakefulness, arrhythmia, delusions, and hallucinations. What is wrong?
- Amphetamine overdose.
- A man is brought to the ER with depression, lethargy, HA, stomach cramps, hunger, and hypersomnolence. What is going on?
- Amphetamine withdrawal.
- A man is brought to the ER in a euphoric state, with pupil dilation, HTN, but claims he feels bugs crawling over him. What does he have?
- Cocaine intoxication.
- Overdose with what illegal drug can cause sudden cardiac death?
- Cocaine.
- Withdrawal from cocaine can cause what sxs?
-
- severe depression
- suicidality
- hypersomnolence
- fatigue
- severe psychological craving - Intoxication with what illegal drug causes nystagmus, ataxia, delirium, and homocidality?
- PCP
- What illegal drug causes marked anxiety or depression, visual hallucinations, flashbacks, and pupil dilation?
- LSD
- Which 2 illegal drugs do not have withdrawal sxs?
-
- LSD
- marijuana - What illegal drug causes inc. appetite, euphoria, paranoid delusions, perception of slowed time, and impaired judgement?
- Marijuana
- Barbiturate overdose is manifested by:
- - respiratory depression
- Barbiturate withdrawal can cause life-threatening:
- cardiovascular collapse
- Benzodiazepine overdose causes:
-
- amnesia
- ataxia
- somnolence
- minor respiratory depression
- additive effects w/ETOH - Benzodiazepine withdrawal causes:
-
- rebound anxiety
- seizures
- tremor
- insomnia - Mallory-Weiss syndrome =
- Longitudinal esophageal lacerations at GE junction caused by excessive vomiting. Pain. Complication of alcoholism.
- An alcoholic presents with jaundice, hypoalbuminemia, coagulation factor deficiencies, portal HTN, and asterixis. What is going on with his liver?
- Cirrhosis.
- What is the triad of Wernicke's encephalopathy?
- ophthalmoplegia, ataxia, confusion
- What is Korsakoff's psychosis?
- memory loss, confabulation, personality change, associated with mammillary body hemorrhage
- What vitamin deficiency causes Wernicke-Korsakoff's?
- Thiamine
- Heroin addicts are at high risk for what 6 things?
-
1) overdose
2) right-side endocarditis
3) AIDS
4) hepatitis
5) abscesses
6) hemorrhoids - What are 2 opioid receptor antagonists useful in heroin overdose?
- Naloxone, naltrexone
- What long-acting oral opiate is used for heroin detox or maintenance?
- Methadone
- When is a person delirious?
-
- develops rapidly
- waxing & waning level of consciousness
- disorganized thinking
- hallucinations
- illusions
- disturbed sleep/wake cycle
- cognitive dysfunction - Is delirium reversible?
- Often yes, check for drug and anticholinergic effects.
- When is a person demented?
-
- gradual drop in cognition
- memory deficits
- aphasia, apraxia, agnosia
- loss of abstract thought
- impaired judgement - Is dementia reversible?
- Mostly not.
- How do you know when you're having a major depressive episode?
-
SIGECAPS for > 2 wks:
- sleep disturbance
- lose interest
- guilt
- loss energy
- loss concentration
- change appetite
- psychomotor retardation or agitation
- suicidal thoughts - Lifetime prevalence depression:
-
male - 5-12%
female - 10-25% - Dysthymia =
- mild depression lasting at least 2 yrs
- Munchausen's syndrome =
- chronic Hx of multiple hospitalizations and willingness to receive invasive procedures
- Munchausen's syndrome by proxy =
- illness in a child is caused by parent - child abuse! must report!
- Pseudocyesis =
- false belief of being pregnant
- Conversion =
- motor or sensory sxs suggest disorder but tests & PE negative
- Somatoform pain disorder =
- prolonged pain not explained completely by illness
- Somatization disorder =
- variety of complaints in multiple organ systems but no findings
- Hypochondriasis =
- fear of having illness despite reassurance of contrary
- Asperger disorder =
- Milder form of Autism involving social relationship problems. Normal intelligence. No cognitive defects.
- Rett disorder =
- X-linked, only in girls. Loss of development and mental retardation by age 4. Hand-wringing stereotype.
- Narcoleptic sleep episodes start with ___ sleep.
- REM
- Cataplexy =
- loss of all muscle tone following strong emotional stimulus
- What is the definition of schizophrenia?
- Periods of psychosis and disturbed behavior with decline in functioning > 6 months
- Lifetime prevalence of schizophrenia =
- 1.5% males and females, blacks and whites