3MB Psychiatry: Addiction and Substance Misuse
This flashcard set outlines the ICD-10 criteria for substance dependence, highlights the role of the mesolimbic dopaminergic pathway in reward and addiction, and explains how dopamine release reinforces pleasurable behaviours and motivates repetition.
List the ICD-10 criteria for dependence
Strong desire to take the substance
Difficulty in controlling substance use
Withdrawal state
Neglect other pleasures
Persistence despite evidence of harm
Key Terms
List the ICD-10 criteria for dependence
Strong desire to take the substance
Difficulty in controlling substance use
Withdrawal state
Neglect other pleasures
Persis...
Which dopaminergic pathway, associated with reward, is involved in addiction?
Mesolimbic pathway
What is the effect of dopamine release upon behaviour?
Motivates us to repeat behaviour
Involved in pleasurable experience
What effect do drugs like amphetamine and cocaine have on dopamine?
Increase release of dopamine
If dopamine receptors are repeatedly stimulated, what can eventually develop?
Tolerance
due to downregulation/decreased sensitivity of receptors
What is the consequence of developing tolerance in addiction?
Threshold for feeling reward is increased; normal pleasurable experience don’t evoke enough of a reward response
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| Term | Definition |
|---|---|
List the ICD-10 criteria for dependence | Strong desire to take the substance Difficulty in controlling substance use Withdrawal state Neglect other pleasures Persistence despite evidence of harm |
Which dopaminergic pathway, associated with reward, is involved in addiction? | Mesolimbic pathway |
What is the effect of dopamine release upon behaviour? | Motivates us to repeat behaviour Involved in pleasurable experience |
What effect do drugs like amphetamine and cocaine have on dopamine? | Increase release of dopamine |
If dopamine receptors are repeatedly stimulated, what can eventually develop? | Tolerance due to downregulation/decreased sensitivity of receptors |
What is the consequence of developing tolerance in addiction? | Threshold for feeling reward is increased; normal pleasurable experience don’t evoke enough of a reward response |
Frontal lobe areas associated with executive functioning develop before those areas associated with emotion. True/False? | False Other way around! |
Which parts of the brain are associated with memory learning? | Amygdala Hippocampus |
Which parts of the brain are associated with inhibitory motor control? | Prefrontal cortex Anterior cingulate gyrus |
Which parts of the brain are associated with motivation/drive? | Orbito-frontal cortex Subcallosal cortex |
Which parts of the brain are associated with reward? | Nucleus accumbens |
How many ml of alcohol = 1 unit? | 10ml |
What is the equation for calculating no. of units of alcohol? | [% x volume]/10 |
What are the current guidelines for low risk alcohol drinking? | No more than 14 units per week, ideally spread over 3 or more days |
What are the parameters of increased risk alcohol drinking? | Regular consumption of 15-35 units a week |
What are the parameters of high risk alcohol drinking? | Regular consumption of over 35 units a week |
Which marker can be an indicator of alcoholic liver injury? | GGT |
Which marker identifies men who have been drinking 5+ units of alcohol a day for a year or more? | Carbohydrate deficient transferin |
What is the most common cause of a raised MCV? | Alcoholism |
| Inhibits action of glutamate receptors |
What effect does alcohol have on inhibitory GABA ion channels? | Potentiates action of GABA receptors |
Alcohol withdrawal leads to less/more glutamate activity and less/more GABA activity | Alcohol withdrawal leads to more glutamate activity and less GABA activity |
List clinical features of alcohol withdrawal | Restlessness, tremor Sweating Anxiety Loss of appetite and sleep Tachycardia Seizure, delirium tremens |
Which drugs are used to manage alcohol withdrawal? | Benzodiazepine Thiamine (parenteral) |
Which drug is the 1st line agent for alcohol detox relapse prevention? | Naltrexone |
Which drug should be started as soon as alcohol detox is complete? | Acamprosate |
Which alpha-2-receptor agonist can help with opiate detox? | Lofexidine |
What are the 2 main detox agents used for opiate misuse? | Methadone | Bruprenorphine |
What effect does mephedrone have on neurotransmitters? | Inhibits reuptake of serotonin, noradrenaline and dopamine |
What are the user effects of taking mephedrone? | Feeling of ecstasy, openness | Increased confidence and desires |
Taking mephedrone increases susceptibility to ladybird attacks. True/False? | True |
List the main categories of legal highs | Stimulants Empathogens Psychedelics Dissociatives Cannabinoids Depressants Opioids |
What is sympathetic toxidrome and which drug is it related to? | Amphetamines | Range of toxic autonomic effects e.g. tremor, sweating, pain, confusion, vomiting etc. |
What is serotonin syndrome? | Excess serotonin causes hypomania, agitation, myoclonus and hyperactive autonomic state |
Which drugs can cause serotonin syndrome? | Antidepressants Cough medication Tramadol Antibiotics Herbal products |
What effect on neurotransmission does methamphetamine have? | Inhibits reuptake of noradrenaline and dopamine |
Synthetic cannabinoids can be more potent than cannabis. True/False? | True | 800x more potent! |
Which legal high causes a detachment from reality, including depersonalisation and derealisation? | Ketamine |