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Medicine Notes Psychiatry Notes

Alcohol Dependence Notes

Updated Alcohol Dependence Notes

Psychiatry Notes

Psychiatry

Approximately 43 pages

Clinically-relevant notes for medical finals. Includes all the common psychiatric conditions along with notes on dementia and child psychiatry. Colour coded per topic. Easy to follow and breaks down the main presenting features and treatments (both drugs, psychological therapies and ECT)
Very useful for finals revision....

Available here

The following is a more accessible plain text extract of the PDF sample above, taken from our Psychiatry Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Alcohol Dependence

Dependence

  • Psychological

    • Intense drive or craving for substance whose effects the user feels are necessary for a sense of well-being

  • Physical

    • Adaptive state – physical disturbance when drug is halted

Categorizing patients according to units of alcohol drank per week

Normal Male <21 a week Female <14 a week
At risk Male >21 a week Female >14 a week
Binge drinker Male >10 in one session regularly Female >7 in one session regularly
Heavy drinker Male >50 a week Female >35 a week

Problem drinker = alcohol has caused a problem to health > 1 month

Dependence = 3 x symptoms over 12 months

Questions to ask in history

  • What are they drinking?

  • Drinking history (longitudinal drinking history since teenage years)

  • UNITS (% x volume in litres)

  • Timing of drinking (have to have a drink in the morning?)

  • What has it cost them? (biopsychosocial)

  • Insight into drinking

Other

  • Most recent drink – how many hours ago? (assess for withdrawal)

  • Concomitant drug use

  • Previous experience of withdrawal

  • Medical/psychological disorders

Full physical examination for withdrawal symptoms/symptoms of liver disease

Bloods/ECG/CXR if indicated (prior to detox)

Clinical features of dependence

Edwards and Gross Criteria

Social

  • Quantity (drinking increased amounts to stave off symptoms)

  • Diminished variability (drinking the same thing all the time)

  • Drink repertoire narrowed into complete abstinence + round the clock drinking (one or the other)

  • Drinking despite consequences (social, society, family – what drinking has taken away)

Psychological

  • Reinstatement after abstinence (after detox if they go back to drink, will need the same high level to stave off withdrawal)

  • Craving

  • “Drink centredness” – won’t go out/do anything unless alcohol is available

Physical

  • Withdrawal

  • Maintenance of blood alcohol level to avoid withdrawal

Psychiatric complications of alcohol dependence

  • Depression

    • Usually resolves within 2 weeks of stopping drinking

    • Only those who are depressed after abstinence will benefit from medication

  • Suicide

    • 10% of alcoholics die by suicide

  • Alcoholic hallucinosis

    • Command type 3rd person auditory

    • Clear consciousness (no delirium)

    • Occur after/during heavy alcohol abuse

  • Alcoholic Dementia

    • Chronic alcoholism can cause cerebral atrophy particularly affecting frontal lobes

    • Many return to full cognition following abstinence but a proportion continue to dementia

  • Wernicke’s encephalopathy

    • Due to thiamine (vitamin B1) deficiency (unable to absorb and less intake)

      • Ataxia, nystagmus, opthalmoplegia (weakness in...

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