Chapter 31-32

Addiction

Continued substance use despite negative consequences

Tolerance

Need higher dosage for same effect of drug

Dependence

Body adapts to a substance, causing withdrawal symptoms if stopped

Substance Use Disorder criteria

Pattern of problematic substance use leading to impairment or distress with at least 2 criteria within a 12 month period (loss of control, social impairment, risky use, physical dependence)

Substance-Induced Disorders

Mental or physical problems caused directly by the use of a substance or medication for other conditions (e.g., intoxication, withdrawal, psychotic disorders)

Detoxification

Medically supervised process of safely removing substance from the body while managing withdrawal symptoms or substituting with low doses (methadone)

Cravings

Strong, often uncontrollable urges to use a substance, usually triggered by cues or stress

Cut down

Have you ever felt you should cut down on your drinking?

Annoyed

Have people annoyed you by criticizing your drinking?

Guilty

Have you ever felt guilty about your drinking?

Eye opener

Do you ever need a drink first thing in the morning to steady your nerves or get going?

Wernicke’s Encephalopathy

Acute brain disorder from thiamine deficiency from chronic alcohol use → ophthalmoplegia, ataxia, low BP, confusion, and coma

Karsakoff Syndrome

Chronic neurocognitive disorder that follows untreated Wernicke’s encephalopathy → memory impairment (forming new memories), confabulation, disorientation

Confabulation

Filling memory gaps with plausible but false or imagined stories to compensate for memory loss

Alcohol Withdrawal

Reduction or cessation of heavy alcohol use → restlessness, severe anxiety, depression, strong cravings, drug-seeking behavior; can lasts weeks

Delirium Tremens

Severe life-threatening form of alcohol withdrawal with confusion, hallucinations, tremors, and autonomic hyperactivity (tachycardia, sweating, high BP)

Clinical Institute Withdrawal Assessment for Alcohol (CIWA)

Standardized tool used to assess, score, and monitor the severity of alcohol withdrawal symptoms and guide treatment decisions (>10 requires medications)

CIWA assessment

-N/V

-Tactile disturbances

-Tremors

-Auditory hallucinations

-Paroxysmal sweats

-Visual disturbances

-Anxiety

-Headache or fullness in head

-Agitation

-Orientation and clouding of sensorium (confusion, disorientation)

CAGE questionnaire

Brief screening tool for alcohol use disorder consisting of 4 questions

Cocaine

Intense CNS stimulation and euphoria with rapid onset and short duration; psychosis, cardiac arrest, cocaethylene toxicity with alcohol

Amphetamines

Causes prolonged stimulation and alertness (hallucination in high doses), often with more insomnia and decreased appetite

Opioids

Pain-relieving CNS depressant that causes euphoria, pain relief, and sedation with risk of respiratory depression

Withdrawal Signs of Stimulants

Fatigue, depression, hypersomnia, increased appetite, strong cravings, slowed thinking/movement

Withdrawal Signs of Opioids

Yawning, lacrimation, rhinorrhea, sweating, NVD, muscle aches, insomnia, anxiety

FRAMEs

Feedback, Responsibility, Advice, Menu of options, Empathy, Self-efficacy

Lanugo

Fine, soft body hair that grows as a response to malnutrition or starvation in an attempt to preserve heat (anorexia)

Disordered Eating

Unhealthy eating behaviors toward food and body image (restricting, binging, purging, or excessive concern for weigh)t; doesn’t meet full criteria for eating disorder

Anorexia Nervosa

Eating disorder characterized by intense fear of gaining weight, severe restriction of food intake, and significant low body weight

Restricting type Anorexia Nervosa

Subtype where weight loss is achieved through dieting, fasting, or excessive exercise without binge-eating or purging

Binge-eating/purging type Anorexia Nervosa

Subtype where person restricts food intake and has episodes of binge eating and/or purging behaviors (vomiting, laxatives, diuretics)

Psychiatric Complication of Anorexia Nervosa

Depression, anxiety, increased risk of suicide

Body Image and Anorexia Nervosa

Distorted body image → sees self as overweight despite being underweight → extreme restriction/over-exercise → self-worth tied to weight/shape → reinforces disorder (relapse risk)

Bulimia Nervosa

Eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors (vomiting, laxative use, fasting, or excessive exercise to prevent weight gain

Medical Complications of Bulimia Nervosa

Electrolyte imbalance, dehydration, dental erosion and cavities, esophageal inflammation, cardiac arrhythmias, swollen salivary glands

Binge Eating Disorder

Eating disorder characterized by recurrent episodes of uncontrolled excessive eating with feelings of guilt, shame, or distress; weight can vary

Obesity

Physical condition of having excess body fat (BMI >30), which may or may not involve binge eating or psychological distress

Medical Complications of Binge Eating DIsorders

HTN, T2DM, obesity-related sleep apnea, dyslipidemia, MSK pain, GI issues