Alcohol dependent syndrome

ADS

1. ALCOHOL DEPENDENCE SYNDROME SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

2. ALCOHOL DEPENDENCE SYNDROME Alcohol dependence was previously called as Alcoholism . “ First the man takes a drink, then the drink takes a drink, and then the drinks takes the man.” SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

3. History 2067 – 2025 B.C. King Hammurabi of Babylonia The word Alcoholism was first used by Magnus Huss The word was derived from the Arabic word ‘ Alkuhl ’ = “essence” SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

4. ALCOHOL DEPENDENCE SYNDROME It is a pattern of pathological use of alcoholic beverages for at least a month that causes damage to individual, society or both and also impaires the social and/or occupational functioning. SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

5. Etiology Biological factors Psychological factors Social factors SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

6. ICD-10 CRITERIA A strong desire to take the substance Difficulty in controlling the substance taking behaviour A physiological withdrawal state Development of tolerance Progressive neglect of alternative pleasures or interests Persisting with substance use despite clear evidence of harmful consequences. SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

7. Types According to Jellinek : on the basis of the patterns of use Alpha, Beta, Gamma, Delta, Epsilon According to Cloninger : on the basis of relative importance of genetic and environmental factors Type I and Type II SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

8. Alpha Excessive and inappropriate drinking to relieve physical and/or emotional pain No loss of control Ability to abstain present SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

9. Beta Excessive and inappropriate drinking Physical complications due to cultural drinking patterns and poor nutrition No dependence SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

10. Gamma(malignant alcoholism) Progressive course Physical dependence with tolerance and withdrawal symptoms Psychological dependence, with inability to control drinking SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

11. Delta Inability to abstain Tolerence Withdrawal symptoms The amount of alcohol consumed can be controlled Social disruption is minimal SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

12. epsilon Dipsomania(compulsive-drinking) Spree-drinking SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

13. Cloninger’s classification Factors Type I Type II Synonyms Milieu -limited Male -limited Gender Both sexes Mostly in males Age of onset > 25 years < 25 years Aetiological factors Genetic factors important; strong environmental influences are contributory Heritable; environmental influences are limited Family history May be positive Parental alcoholism and antisocial behavior usually present Loss of control Present Absent Other features Psychological dependence and guilt are present Drinking followed by aggressive behavior;spontaneous alcohol seeking Pre –morbid Personality traits Harm-avoidance;high reward dependance Novelty -seeking SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

14. Clinical features Secretive behaviour Nutritional deficiency Poor personal hygiene Untreated injuries Other minor complaints Denial and rationalization of problem High tolerance for sedatives and opioids SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

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16. Diagnosis Blood alcohol concentration(≥200 mg/dl) GGT(≥40 IU/L) MCV(˃92fl) Other lab markers(ALP,TGL,CK,uric acid) Breath analyser MAST(Michigan Alcoholism Screening Test) CAGE questionnaire SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

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18. Complications Medical complications Social complications Psychological complications SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

19. Medical complications Gastrointestinal complications Central nervous system complications Miscellaneous SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

20. Social complications Increased accidents Job troubles Financial difficulties Marital disharmony(separation or divorce) Increased incidence of drug dependence Criminality SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

21. Psychological complications Acute intoxication Withdrawal syndrome Alcohol-induced amnestic disorders Alcohol-induced psychiatric disorders SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

22. 1. Acute intoxication Develops during or shortly after alcohol ingestion. Characterized by clinically significant maladaptive behaviour or psychological changes. SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

23. Acute intoxication Inappropriate sexual or aggressive behaviour Mood lability Impaired judgement Slurred speech Incordination Unsteady gait Nystagmus Impaired attention and memory Blackouts Stupor/coma SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

24. 2. Withdrawal syndrome Simple withdrawal syndrome Delirium tremens SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

25. Withdrawal syndrome Simple withdrawal syndrome Mild tremors Nausea Vomiting Weakness Irritability Insomnia Anxiety SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

26. Withdrawal syndrome Delirium tremens Disordered mental activity with clouding of consciousness and disorientation in time and place. Poor attention span Vivid visual/tactile hallucinations Severe psychomotor agitation, shouting and evident fear Truncal ataxia Autonomic disturbances Abnormal blood results Dehydration Sleep disturbances Death SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

27. 3. Alcohol-induced amnestic disorders Wernicke’s encephalopathy Korsakoff’s psychosis SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

28. Alcohol-induced amnestic disorders Wernicke’s encephalopathy Ocular signs Higher mental function disturbances Peripheral neuropathy Serious malnutrition SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

29. Alcohol-induced amnestic disorders Wernicke’s encephalopathy Ocular signs Nystagmus Ophthalmoplegia Pupillary irregularities Retinal haemorrhages Pappiloedema Vision impairement SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

30. Alcohol-induced amnestic disorders Wernicke’s encephalopathy Higher mental function disturbances Disorientation Confusion Recent memory disturbances Poor attention span Distractibility Apathy Ataxia SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

31. Alcohol-induced amnestic disorders Korsakoff’s psychosis Gross memory disturbance Disorientation Confusion Confabulation Poor attention span and distractibility Impairement of insight SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

32. 4. Alcohol-induced psychiatric disorders Alcohol-induced dementia Alcohol-induced mood disorders Alcohol-induced anxiety disorders Alcohol withdrawal seizures (Rum fits) Alcoholic Hallucinosis Suicidal behaviours Pathological jealousy Impaired psychosexual function SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

33. TREATMENT Detoxification Alcohol dependance SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

34. TREATMENT I. Detoxification It is treatment first step in the treatment of alcohol dependence. Aim of detoxification is symptomatic management of emergent withdrawal symptoms. Drug of choice for detoxification are usually benzodiazepines. (Chlordiazepoxide and diazepam) Usual duration is 7-14 days In addition,vitamins (vitamin B1-Thiamine)should also be administered. Care of hydration(Thiamine+ Dextrose 5%) SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

35. Detoxification Treatment Chlordiazepoxide(80-200mg/day in divided doses) Diazepam(40-80mg/day in divided doses) A typical dose of Chlordiazepoxide in moderate alcohol dependance is..... DAY DOSE FREQUENCY 1 20mg QID 2 15mg QID 3 10mg QID 4 5mg QID 5 5mg BD 6 NONE SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

36. Detoxification Treatment Vitamin administration A preparation of vitamin B containing 100mcg of thiamine should be administered parenterally,twice everyday for 3-5 days. It should be followed by oral administration of Vitamin B1 for atleast 6 months. Care of hydration Thiamine+ Dextrose 5% SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

37. Alcohol Dependance Treatment II.Behaviour therapy Others: Covert sensitisation, relaxation techniques, self-control skills, positive reinforcement. SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

38. Alcohol Dependance Treatment III. Psychotherapy Group and individual psychotherapy Motivational enhancement therapy with or without cognitive behavior therapy Lifestyle modification SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

39. Alcohol Dependance Treatment Group therapy Alcoholics Anonymous(AA) – a voluntary self-help group SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

40. Alcohol Dependance Treatment Deterrent therapy Disulfiram Other deterrent agents SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

41. Disulfiram : mode of action SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

42. Alcohol Dependance Treatment Deterrent therapy Disulfiram Other deterrent agents: Citrated calcium carbamide Metronidazole Animal charcoal SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

43. Alcohol Dependance Treatment Anti-craving agents Acamprosate Naltrexone SSRIs(fluoxetine) SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

44. Alcohol Dependance Treatment Other medications Benzodiazepines Antidepressants Antipsychotics Lithium Carbamazepine narcotics SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

45. Alcohol Dependance Treatment Psychosocial rehabilitation This Photo by Unknown Author is licensed under CC BY-SA-NC SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

46. NURSING MANAGEMENT This Photo by Unknown Author is licensed under CC BY-SA SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT

47. T H A N K Y O U . . . ! SUHANYARAJ V,LECTURER,MENTAL HEALTH NURSING DEPARTMENT