Substance Use Disorders   Alcohol Use Disorders Identification Test (AUDIT)  Developed by the WHO, the total number of items is 10, the maximum score of each item is 4 and the minimum is 0, so the total score is 10x4=40, and the minimum 0. Item 0 to 8 has a scoring of 0,1,2,3,4 i.e. five anchors while item 8 and nine has 3 anchors each with scoring of 0,2,4.  It is used to assess alcohol consumption, drinking behaviours, and alcohol-related problems. It is most suited for primary care physicians and shows good sensitivity and specificity. If the score is above 8.  Download

Important Points about the History of Drug Use Regular or intermittent Amount (know the units) Pattern dependence/withdrawal  Impact on work, relationships, money, police  Screening questionnaires e.g. CAGE

WHO 2012 Guidelines to treat Alcohol Withdrawal Clinicians should advise supported withdrawal in patients before beginning treatment. The World Health Organization recommends benzodiazepines as front-line medication for the management of alcohol withdrawal.  Long-acting benzodiazepines are superior to shorter-acting ones, except in cases of impaired hepatic metabolism.  Clinicians should determine the dose and duration individually.  The duration of benzodiazepine treatment should be 3 to 7 days. Clinicians should not use antipsychotic medications as stand-alone medications for the management of alcohol withdrawal.  Advise Benzodiazepines , and not anticonvulsants, following an alcohol withdrawal seizure. Clinicians should dispense psychoactive medication in small doses.   Patients at risk of severe withdrawal, or who have concurrent serious physical or psychiatric disorders, or who lack adequate support, should preferably remain in an inpatient setting.  As part of withdrawal manag

What interventions are safe and effective for the management of alcohol withdrawal, including treatment for alcohol withdrawal seizures and prevention and treatment for acute Wernicke's encephalopathy? Alcohol withdrawal can be uncomfortable and occasionally life-threatening. Pharmacological management of alcohol withdrawal is an essential component of alcohol dependence. Benzodiazepines (BZDs), non-sedating anticonvulsants, and antipsychotics are commonly used in the treatment of alcohol withdrawal.  Given that they are all potentially toxic medications, what is the evidence that the benefits of their use justify the risks? Which is more effective? Below, I summarize the  WHO 2012 Guidelines to treat Alcohol Withdrawal that explains the answers to these questions. 

Opiate Withdrawal History and Physical Examination   Opiate withdrawal symptoms peak between 36-72 hours. Symptoms run their course in 5-7 days, though craving continues for some time.  Withdrawal from Heroin Withdrawal from heroin may begin up to 8 hours after the last use. During the next few hours, the person experiences muscle pain, sneezing, sweating; tearfulness; yawning excessively.  At 36 hours after the last use, symptoms are most severe. These symptoms include chills, muscle cramps, flushing, sweating, tachycardia, hypertension, inability to sleep, vomiting & diarrhoea . Symptoms typically continue for about 72 hours & gradually diminish over 5-10 days. History  This history part is in Urdu/Hindi. I will add the " Objective Opiate Withdrawal Scale"  soon here so anyone can benefit.   For now: COWS  Aap kia istemal karty Akhri bar kab lia hai aap ne Abhi dil chahta ke aap dobara se kar lyn? Kitna had tak?   Gutno ya baqi jorhon mai dard ho raha hai? Baqi

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Disulfiramlike Reaction Disulfiram irreversibly inhibits aldehyde dehydrogenase, by competing with nicotinamide adenine dinucleotide at the cysteine residue. Aldehyde dehydrogenase is a hepatic enzyme of alcohol metabolism converting ethanol to acetaldehyde. At therapeutic doses of disulfiram, alcohol consumption causes elevated serum acetaldehyde, causing manifestations given below. Manifestations • Diaphoresis • Facial flushing • Hypotension • Nausea • Palpitations • Tachycardia • Vertigo We call this constellation of symptoms the disulfiram-alcohol reaction; it discourages alcohol intake. The severity of the reaction is proportional to the dose of disulfiram, and that of alcohol. It is NOT an anti-craving drug and DOES NOT affect the neurobiology of addiction. NICE guidelines on the Use of Disulfiram Disulfiram should be considered in combination with a psychological intervention for patients who wish to achieve abstinence, but for whom acamprosate or naltrexone is not

Psychiatric Disorders Associated with Alcoholism I use the following mnemonic to remember the disorders associated with alcoholism. BADS Bipolar affective disorders Anxiety disorders especially panic and social phobia Depressive disorders, the delusion of infidelity  Schizophrenia and sexual dysfunction