Chapter 37 - RCSI Psychiatry Course Book XIII (23-24) (1) p1

It is responsible for contracting the lateral rectus muscle to abduct the eye.

Haloperidol.

Typically over a period of at least 12 months, but can be diagnosed if use is continuous for at least three months.

A subjective sensation of urge or craving to use alcohol.

It irreversibly inhibits acetaldehyde dehydrogenase, causing acetaldehyde accumulation.

Administration of IV glucose.

Examples include optic atrophy, hypertension, oesophagitis, liver cirrhosis, and pancreatitis.

At least 12 months for episodic use or at least one month for continuous use.

Approximately 5%.

They are less likely to be involved with the legal system and may be reluctant to admit substance use due to social attitudes.

It is a screening test for alcohol dependence, but not a definitive diagnostic tool.

1. Have you ever felt you should cut down on your drinking? 2. Have people annoyed you by criticizing your drinking? 3. Have you ever felt bad or guilty about your drinking? 4. Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

Stupor and coma may occur, with levels above 250 mg/dL potentially causing respiratory depression, cardiac arrhythmias, and death.

Clinically significant harm to physical health or exacerbation of a pre-existing mental disorder.

Autonomic hyperactivity, increased hand tremor, nausea, vomiting, insomnia, anxiety, and psychomotor agitation.

Aftershave lotions or colognes that contain alcohol.

Laxatives, growth hormone, erythropoietin, and non-steroidal anti-inflammatory drugs.

Higher in males than females, but the gap narrows in countries where women are more active in the workforce.

Mild to moderate symptoms.

Due to sex-related differences in body mass and composition.

Diplopia (double vision).

Recent memory is affected more than remote memory.

Fourteen classes or groups.

It produces pleasant or appealing psychoactive effects that are rewarding and reinforcing with repeated use.

Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), and mean corpuscular volume (MCV).

Continuous, recurrent, or sporadic use causing clinically significant damage to physical or mental health.

Within 6 to 12 hours after the last use of alcohol.

The Clinical Institute Withdrawal Assessment for Alcohol (CIWA).

5 - 10%.

Injuries from impulsive behavior, acute health problems like overdose, and exacerbation of chronic health issues.

They become desensitized and reduced in number, leading to tolerance and physical dependence.

It can precipitate or exacerbate thiamine deficiency.

Helps to maintain abstinence from alcohol.

Magnesium and potassium.

They can produce dependence.

An acute confusional state secondary to alcohol withdrawal.

Route of administration, absorption, dose, half-life, and duration of action of the substance.

Decreases craving for alcohol, aiding in achieving abstinence.

It is an opioid antagonist that antagonizes the effects of endogenous endorphins released by alcohol consumption.

Used with people who have already achieved abstinence to remain abstinent.

Presence of seizures.

All diagnostic requirements for delirium must be met, with evidence that the neurocognitive disturbance is caused by alcohol use.

Clouded.

10-15%.

The familial association is strongest for the son of an alcohol-dependent father.

5 to 7 days after the last drink.

Carbamazepine.

Transient disturbances in consciousness, cognition, perception, affect, behavior, or coordination after alcohol consumption.

Impaired attention, inappropriate behavior, mood lability, impaired judgment, poor coordination, unsteady gait, and slurred speech.

It varies substantially by substance; for example, caffeine or nicotine intoxication is less likely to cause harm.

A clinically significant cluster of symptoms, behaviors, and/or physiological features upon cessation or reduction in alcohol use.

Conditions include conduct disorder, ADHD, impulse control disorders, PTSD, anxiety disorders, mood disorders, and personality disorders.

It may progress to Korsakoff’s psychosis or may be fatal.

48 - 72 hours after the last drink.

The disinhibiting effects of alcohol are associated with an increased risk of attempted and completed suicides.

Occupational issues, financial problems, accidents, family difficulties, and homelessness.

More information about symptoms, behaviors, and physiological features indicating neuroadaptation.

Usually generalized tonic-clonic seizures.

Auditory hallucinations in clear consciousness.

Yes.

It declines with increasing age.

Dopamine transporter (DAT) polymorphism.

Nystagmus, ophthalmoplegia, ataxia, peripheral neuropathy, disorientation, retrograde and anterograde amnesia.

It increases stimulation, promoting central nervous system depression.

Physical harm, such as trauma from impaired driving, or mental disorders like PTSD from assaults.

A pattern of recurrent use of alcohol with impaired regulation, evidenced by two or more specific criteria such as impaired control, precedence of alcohol use, and physiological features indicative of neuroadaptation.

Disorders that result from a single occasion or repeated use of substances with psychoactive properties, including certain medications.

Explicit evidence of harm to physical or mental health, or harm to others due to intoxication.

Thiamine (vitamin B1) administered initially IV.

Sex, reflecting differences in body weight and composition.

They suggest heavy alcohol use by detecting toxic effects on organ systems or body chemistry.

Tolerance refers to needing increasing amounts of alcohol to achieve the same effect, and it varies based on individual factors.

Impaired coordination and judgment due to alcohol intoxication.

Flushing, headache, nausea, vomiting, tachycardia, hyperventilation, hypotension, sweating, anxiety, and confusion.

Symptoms should not be better accounted for by another medical condition or mental disorder.

Numerous forms of harm to both mental and physical health.

The course of delirium includes onset, trajectory of symptoms, and eventual remission with elimination of the substance from the body.

A severe syndrome characterized by confusion, disorientation, delusions, and prolonged hallucinations.

While features are similar in men and women, the intensity and duration of use necessary for dependence may differ by sex.

A separate diagnosis of alcohol-induced delirium.

Another medical condition or mental disorder, including another disorder due to substance use.

Mood symptoms that develop during or soon after intoxication or withdrawal from alcohol, with intensity or duration exceeding typical symptoms.

Petechial hemorrhages and atrophy of the mammillary bodies.

It varies by substance, frequency, intensity, and duration of use.

Alcohol-induced mood and psychotic disorders, memory blackouts, alcohol dementia, and delirium tremens.

Approximately 2%.

Chlordiazepoxide (a long-acting benzodiazepine).

Agitation, amnesia, delirium, delusions, disorientation, irritability, mood fluctuations, and hallucinations.

To reduce alcohol consumption in people with alcohol dependence.

Thiamine (vitamin B1) deficiency.

Anxiety symptoms that develop during or soon after intoxication or withdrawal from alcohol, with intensity or duration exceeding typical anxiety symptoms.

The symptoms are not a manifestation of another medical condition and cause significant distress or impairment in functioning.

Examples include alcoholic cirrhosis, infective endocarditis, and HIV/AIDS.

Clinically significant damage to a person’s physical or mental health.

Seizures can complicate alcohol withdrawal and usually occur within 6 to 48 hours after last use.

3 to 7 days after cessation of alcohol use.

Hypertension, hyperthermia, palpitations, sweating, tachycardia, tachypnoea.

Males, particularly those aged 45 - 65.

Dietary deficiency, malabsorption, persistent vomiting, and certain foods.

Symptoms should not be better accounted for by another mental disorder.

11 standard drinks (11 units) spread over a week with at least two alcohol-free days.

3-5%.

Confusion, disorientation, delusions, and prolonged visual, tactile, or auditory hallucinations.

Any form of physical harm or mental disorder directly attributable to behavior due to alcohol intoxication.

For individuals with high drinking risk levels without physical withdrawal symptoms, and who do not require immediate detoxification.

Psychotic symptoms that develop during or soon after intoxication or withdrawal from alcohol, with intensity or duration exceeding typical disturbances.

Psychotic symptoms preceding alcohol use or persisting for a substantial period after cessation of alcohol use.

17 standard drinks (17 units) spread over a week with at least two alcohol-free days.

A single base pair change in exon 12 of the ALDH2 gene, leading to a loss of ALDH2 activity.

Behavior related to intoxication, direct or secondary toxic effects on body organs, or a harmful route of administration.

The worsening of withdrawal symptoms with repeated episodes, aging, or comorbid medical conditions.

Exposure to alcohol-associated cues.

No, drinking any amount of alcohol increases the risk of health damage.

Many Asians, due to a genetic intolerance that protects against alcohol dependence.