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Substance misuse (Risk factors (Psychiatric disorder ADH, learning…
Substance misuse
Risk
factors
Psychiatric disorder
ADH, learning disorder
Conduct disorder
Mood disorder, PD
Life events
Neglect, abuse
Death, family breakdown
Deprivation
Demographics
Gender, age
Social
Poor family relationships
Substance using peers
Low SEC
Pathophysiology
Dependence
Strong uncontrollable desire to take
Involves, craving, difficulty controlling use,
withdrawal, tolerance, neglect of interests,
persisting use despite harms
Addiction
Biological factors (FH, chronic illness, psychiatric illness)
Psychological (life events, PD)
Social (family, abuse, neglect, unemployment, poor support)
Positive reinforcement and neuroadaptations
Early
Social use, problematic use
Withdrawal
Symptoms occurring on cessation of use
Anxiety, tremors, sweats, N+V, palpitations, DT
Epidemiology
Common
Alcohol>cigarettes>cannabis
amphetamines>opiates
Cannabis commonest drug,
ecstasy commonest class A
Clinical
presentation
Harmful use
Damage to mental and physical
health and social functioning
Dependence syndrome
Pysiological, behavioural and cognitive phenomena
where use of substance takes on hgh priority
Acute intoxication
Reduced conciousness
Changes in mood
Altered behaviour
Perceptual change (psychosis)
Diagnosis
Examination
General - track marks, abscesses
MSE
Investigations
Bedside - obs, ECG
Bloods - standard, BBV?
Imaging - as needed
History
PC: psychosis, mania, nasal discharge,
tremor, red eyes
PPH: substance misuse, mood, PD
DH: current and prev use, IVDU, HIV risk,
previous tx, aims of tx
Social: crime, poor support, unemployment,
abuse/neglect, negative life events
Management
Initial ABCDE
Definitive
Conservative
BBV risk (clean needles, needle exchange, safe sex)
Street drugs advice (types, purity, mixers)
Social - shelters, resources, narcotics anonymous
Medical
Per specific drug
Definition