Summary: Substance Misuse
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1 Substance Misuse
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ICD-10 Dependency Criteria
Tolerance
Compulsion
Withdrawal (either syndrome or use to not have the syndrome)
Problems controlling use
Continued use despite harm
Salience
Reinstatement after abstinence
Narrowing of the repertoire -
Clinical Presentation of Intoxication
Relaxation
Euphoria
at higher levels irritable, aggressive, weepy, disinhibited
Speech slurred
Gait ataxic
Sedation, confusion
coma -
Clinical Presentation of Withdrawal
Headache
Nausea
Retching
Vomiting
Tremour
Sweating
Insomnia (can take weeks to get back to normal)
If dependent then GABA pathways hyper-excited and seizures can occur -
Symptoms of Delirium tremens
Confusion
Hallucinations (usually visual)
Affective changes (extreme fear)
Gross tremor (hands especially)
Autonomic disturbance (sweating, tachycardia, hypertension, dilated pupils, fever)
Delusions -
Management of Delirium tremens
Benzodiazepine regine
Parenteral thiamine
Manage fluids -
Triad of Symptoms for Wernicke's encephalopathy
Confusion
Ataxia
Ophthalmoplegia -
Investigations for alcohol misuse
FBC (macrocytic anaemia)
LFT (raised GGT)
Must investigate other symptoms for organic cause. Then put down the issues to alcohol. -
What can a Urine Drug Screen tell you?
Amphetamine (2 days)
Heroin (2 days)
Cocaine (5-7 days)
Methadone (7 days)
Cannabis (1 month) -
Clinical presentation of Heroin intoxication
Intense rush/buzz
Euphoria
warmth
well-being
Then sedation and analgesia
Some vomit or are dizzy first time
Bradycardia and respiratory depression occur
Pinpoint pupils
(Note: Non IV is milder)
Constipation
anorexia
Decrease libido -
Clinical Presentation of Heroin withdrawal
6 hours after last injection (peaks at 36-48 hours)
Dysphoria
Nausea
Insomnia
Agitation
EVERYTHING RUNS (diarrhoea, vomiting, lacrimation, rhinorrhoea)
Fever
Abdominal cramps and aching joints
Lots of yawning and pupils dilate
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