Substance-Related Disorders
What does the motivational enhancement therapy (MET) model for addiction treatment emphasize?
The role of ambivalence in the process of change.
Which substance causes long-term inhibition of new serotonin synthesis and a decrease in serotonin terminal density?
Methylenedioxymethamphetamine (MDMA).
What is the unique feature for the diagnosis of polysubstance dependence?
A patient must meet dependency criteria for substances as a group, but not for any particular substance.
It is not that they meet criteria for dependency for more than one or two substance(s), or one dependency substance along with one or two abusing substance(s).
What role does levomethadyl acetate hydrochloride (LAAM) play in the management of opioid dependence?
The elimination of the need to take home doses.
Which area of the brain is most associated with the reward effects of cocaine?
Nucleus accumbens.
What are the purposes of pharmacologic treatment for alcoholism, and what agents are used to achieve them?
To reduce craving: Opioid antagonists (naltrexone, nalmefene), acamprosate, along with selective serotonin reuptake inhibitors (fluoxetine, citalopram), lithium, bromocriptine.
Withdrawal: Benzodiazepines (or barbiturates if benzodiazepines are not available).
Adverse conditioning: Disulfiram.
What is the characteristic electrophysiologic finding in alcoholic neuropathy?
Attenuated sensory and motor amplitudes.
What abnormalities in hepatic function tests are most likely to be associated with chronic alcohol abuse?
The γ-glutamyl transferase level is elevated in 80% of patients.
Serum glutamic oxaloacetic-transaminase (SGOT) and serum glutamic-pyruvic transaminase (SGPT) are both elevated, but SGOT is higher than SGPT.
Mean corpuscular volume is increased in 60% of patients.
What is idiosyncratic alcohol intoxication?
It is a severe behavioral syndrome that develops rapidly after a person consumes a small amount of alcohol that would have minimal behavioral effects on most people.
The patient can be confused and disoriented, and can have illusions, transitory delusions, and visual hallucinations, as well as displaying labile affect, slurred speech, and intoxicated behavior, with greatly increased psychomotor activity and impulsive, aggressive behavior that may be dangerous. The serum alcohol level is usually low (e.g., under 50 ng/dL).
This syndrome usually occurs in persons with high levels of anxiety or of advancing age, or with sedative-hypnotic drug use and a feeling of fatigue. The behavior tends to be atypical. This diagnosis is still debatable, but is important in the forensic arena.
Which subtype of anxiety disorder is most commonly associated with alcoholrelated disorder?
Panic disorder.
What psychotic symptoms may present with alcohol withdrawal? What treatment is indicated?
Alcohol withdrawal may typically present with transient visual, tactile, or auditory hallucinations.
First-line treatment is a benzodiazepine. Low-dose, short treatment with antipsychotic agents may be needed.
What medication decreases the incidence of relapse in alcohol-dependent patients?
Naltrexone, but not disulfiram.
What are the mechanisms of action of disulfiram in reducing alcohol intake?
Disulfiram inhibits the alcohol-degrading enzyme acetaldehyde dehydrogenase, and therefore raises acetaldehyde levels in the blood and tissues. It also inhibits dopamine β-hydroxylase.
Its clinical effects last for up to 2 weeks after the last dose.
What are some characteristics of women with alcoholism?
Women with alcoholism are more likely to have onset at a later age, to have mood disorders, and to use other drugs.
What research data support the concept of hereditary factors in alcoholism?
The presence of hereditary factors for alcoholism were found in studies of adopted siblings. The famous Danish adoption studies of familial determinants of alcoholism demonstrated that biologic sons of alcoholic individuals were at higher risk of alcoholism than were biologic sons of nonalcoholic individuals.
What is the mission of Alcoholics Anonymous (Al-Anon)?
To help relatives cope with an alcoholic’s drinking problem.
What drugs could be used to treat a patient who is in alcohol withdrawal who also has impaired liver function?
Oxazepam (Serax), lorazepam (Ativan), and temazepam (Restoril), because they do not have intermediate metabolic by-products that require further metabolism by the liver.
TOL—Tolerated by Our Liver.
What is the CAGE questionnaire?
A questionnaire used to screen patients for alcoholism. Its components have the meanings provided below:
Cut: Have you ever felt you should cut down on your drinking?
Annoyed: Have people annoyed you by criticizing your drinking?
Guilt: Have you ever felt guilty about your drinking?
Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover?
What is delirium tremens (DT)?
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