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ALCOHOL RELATED DISORDERS

ALCOHOL RELATED DISORDERS. Dr. Y R Bhattarai TMU. Alcoholism: epidemiology. The most costly health problem in USA. Alcohol is the most abused drug for all ages. Alcoholism rates are higher for the low socioeconomic groups.

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ALCOHOL RELATED DISORDERS

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  1. ALCOHOL RELATED DISORDERS Dr. Y R Bhattarai TMU

  2. Alcoholism: epidemiology • The most costly health problem in USA. • Alcohol is the most abused drug for all ages. • Alcoholism rates are higher for the low socioeconomic groups. • In USA alcohol use has been implicated in 15% of all auto accidents, 50% of all homicides & hospital admissions. • Asians less likely to develop alcoholism than Americans! • Family history of alcoholism increases likelihood of unipolar depression. • Alcoholism is a complex, multifaceted disorder which has long been recognized to run in families.

  3. CRITERIA OF ALCOHOL DEPENDENCE • Narrowing of the drinking repertoire • Priority of drinking over other activities • Tolerance of effects of alcohol • Repeated withdrawal symptoms • Relief of withdrawal symptoms by further drinking • Subjective compulsion to drink • Reinstatement of drinking behaviour after abstinence.

  4. CAGE questions • Have you ever tried to Cut down on alcohol intake and not succeeded? • Have you ever been Annoyed about criticism concerning your drinking? • Have you ever felt Guilt about your drinking behavior? • Have you ever had to take a drink as an Eye opener in the morning to relieve the anxiety and shakiness?

  5. DSM-IV Diagnostic Criteria for Alcohol Intoxication • Recent ingestion of alcohol. • Clinically significant maladaptive behavioral or psychological changes that developed during, or shortly after, alcohol ingestion. • One (or more) of the following signs, developing during, or shortly after, alcohol use: • slurred speech • incoordination • unsteady gait • nystagmus • impairment in attention or memory • stupor or coma • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder

  6. DSM-IV Diagnostic Criteria for Alcohol Withdrawal • Cessation of alcohol use that has been heavy and prolonged. • Two (or more) of the following, developing within several hours to a few days after if - • autonomic hyperactivity (e.g., sweating or pulse rate greater than 100) • increased hand tremor • insomnia • nausea or vomiting • transient visual, tactile, or auditory hallucinations or illusions • psychomotor agitation • anxiety • grand mal seizures • The symptoms clinically significant distress or impairment in social, occupational, or other important areas of functioning. • The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder.

  7. Laboratory Markers For Alcoholism IncreasedDecreased ALT Calcium AST Phosphorous Amylase WBC count Uric acid Platelet count Triglyceride Hematocrit Cholesterol • Breath analyzer • MAST(Michigan Alcoholism Screening Test)

  8. Problems caused by alcohol Social problems absenteeism from work, unemployment, marital tensions, child abuse, financial difficulties, and problems with law such as violence and traffic offences.

  9. Problems caused by alcoholMEDICAL • Cirrhosis • Alcoholic hepatitis • Pancreatitis • Gastric or duodenal ulcer • Esophageal varices • GI cancer • Hypertension • Peripheral neuropathy • Cardiomyopathy • CVA • Erectile dysfunctions • Vitamin deficiencies • Pernicious anemia • Wernicke-korsakoff syndrome

  10. Problems caused by alcoholPSYCHOLOGICAL • Depression, attempted suicide and complicated suicide • Anxiety is relieved by alcohol, conversely, alcohol withdrawal increases anxiety • Alcoholic hallucinosis especially auditory • Alcohol withdrawal • Delirium tremens

  11. Problems caused by alcohol… • Acute intoxication • euphoria, flushed face, ataxia, slowed reaction time, impaired motor performance, slurred speech, poor concentration; in higher doses behavioral changes – disinhibition of sexual and aggressive impulses, increased suicidal and homicidal behaviour • Pathological intoxication • sudden change of consciousness with aggressive behaviour and amnesia

  12. Contd… • Dependence syndrome: • increased tolerance to alcohol, morning drinking, alcohol bouts, blackouts, deterioration in occupational and marital life, behavioural changes, withdrawal symptoms • Withdrawal state: • tremor, anxiety, easy getting startled, agitation, insomnia, nausea, sweating, epileptic seizures and delirium tremens

  13. Delirium tremens • Acute organic brain syndrome • usually starts in evening hours and is characterized by– clouding of consciousness with disorientation in time and place, severe agitation, anxiety and perceptual distortion, marked autonomic disturbances with tachycardia, fever, sweating, hypertension and pupillary dilation, dehydration with electrolyte imbalance. • Most severe alcohol withdrawal syndrome • a state seriously endangering patient's life • Death if occurs is often due to cardiovascular collapse, infection, hyperthermia or self inflicted injury. • recovery after several days, retrograde amnesia

  14. Other psychotic disorders: Alcohol-Induced Mood Disorder Alcohol-Induced Anxiety Disorder Alcohol-Induced Sleep Disorder

  15. Fetal Alcohol SyndromeThe leading known cause of mental retardation (down syndrome is second!)

  16. Alcohol & Pregnancy Do Not Mix ALCOHOL IS A TERATOGENIC DRUG & PRENATAL EXPOSURE CAN CAUSE: Small Growth Miscarriage & & Stillbirth Brain Damage & Mental Retardation THE DAMAGE MAY NEVER BE OUTGROWN Face & Joint Deformities Learning & Speech Problems Hyperactivity & Behavior Problems

  17. When Mom Drinks, Baby Drinks!!!

  18. Management • Young and socially stable patients have a better prognosis • Advice about the harmful effects of alcohol and safe levels of consumption. • In more serious cases, advise to alter leisure activities or change jobs if these are contributing to the problem. • Supportive psychotherapy to help the patient in changing lifestyles. • Psychological treatment for patients who have recurrent relapses in specialized centers, also provided by alcoholics anonymous. • Treatment can be divided into four phases: • Assessment and referral • Detoxification and withdrawal management • Active treatment • Continuing care

  19. Management…. • Psychological • Twelve step programs • Motivational interviewing • Cognitive behavioral therapy • Social • Residential Programs : total control of adolescents environment • Intensive outpatient programs • Program characteristics associated with better outcomes include: • longer duration of Rx • available follow-up care • family involvement • social services

  20. Pharmacologic treatment…. Disulfiram (antabuse) • Effective for short treatment only • Must be used with psychotherapy or 12 step program • by resisting sudden impulses to drink. • Interaction with alcohol produces very unpleasant symptoms of nausea, chest pain , hyperventilation, tachycardia and vomiting. • Dosage 200-400mg daily

  21. Acamprosate • Helps prevent relapse • Lowers the activity of the receptors for glutamate (increased in chronic alcoholics) • Dosage 666mg 8 hourly Naltrexone • Given to recovering alcoholics • Reduces craving, drinks don’t taste good! Helps them stop after first drink.

  22. Prevention • Public health education campaigns • Successful prevention programs: • target salient risk factors • skills-oriented • follow-up available • culturally-oriented towards the targeted community

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