Psycho active substance abuse and case

https://geekymedics.com/alcohol-history/

^ alcohol history taking

Marror

Casebook

YouTube

Dirty medicine

Add from ward classes done below

Alcoholism /Substance abuse Dds of alcohol is head injury but alcohol can lead to head injury. For physical examination must check head to toe cirrhosis.

In alcohol history taking objectives - substance there or not, withdrawal or not, complicated or not, dependant or not, medical and psychiatric comorbiditied, relapse prevention strategies, setting of treatment...

setting of treatment depends on various factors like complicated or uncomlicated, alone or close at home, previous withdrawal attempts => home, psyhciatric ward, medical ward hdu. if comorbid sbstance use then must admit

symptoms of complicated withdrawal - confusion, ataxia, haemetemsis, melaena

history of typical day - whether tale alcohol in small bottle etc LAST INTAKE TIME VERY IMPORTANT. BZD misuse or already on BZDs

comrbities and complications can be medical or psychiatric

Must know types of cannabis. KJ, ganja, tanamalwilla. And every recreational drug in SL. Apple, Ice, Forms of heroin/kudu - most popular is inhaled. Crack cocaine is mainly injected. Even benzhexol (nilla soya) is abused after being prescribed for EMS symptoms.

Units of alcohol - can of beer (3), bottle of wine (12), bottle of tody (30 but we take it as 28 to make it easy to divide) - ask our consultant about the units

must first treat in medical ward and then transfer to pschiatric ward

very important delusion in alcohol - morbid jealousy - ask what you think about wife, any relationship issues, supportive or not. WIFE can be affected.

detoxification drugs vs relapse prevention. in relapse prevention ust inquire about past attempts in abstinence and about trigger points. can be stressors like wife (then need family counseeling) or situations like family gatherings (which needs replacement)

Collinger's types of alochol dependance has two types. type 1 (old man who lives far away) vs type 2 - antisocial heavy genetic load

in premorbid persoality must assess coping styles as important in counselling. education of care giver. in personal history must check impact on wife and kids.

risk assessment - malnutrition, peripheral neuropathy, driving, rape, suicidal risk

thought content in alcoholism - persecutory or ideas of references, grandiose delusions, depressive cognitions

stages of use - whether to put under thought content or insight

Personalitty Borderline personality disorder mostly female and antisocial mostly males but they are not opposites

General

Physical examination - CVS in anxiety, thyroid in depression, neuro in dementia, cirrhosis in alcohol. Good practice to do neuro and meningeal examination to exclude organic pathology.