0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

772

Alcoholism has a genetic

component: Close relatives of

alcoholics have four times

the riskof alcoholism.

CAGE:

Have you ever felt that

you should Cut down

on your drinking?

Have people ever

Annoyedyou by

criticizing your

drinking?

Have you ever felt bad

orGuiltyabout your

drinking?

Have you ever had a

drink first thing in the

morning to steady

your nerves or get rid

of a hangover? (Eye

opener)

■ Withdrawal:Signs and symptoms opposite of intoxication when drug is

discontinued.

■ Abuse:Social or medical problems that result from substance use (rela-

tionship problems, liver disease from alcohol use) but without presence of

dependence.

■ Dependence

■ Physical dependence: Presence of toleranceor emergence of withdrawal

symptoms.

■ Psychological dependence: The cravingexperienced or drug-seeking

behavior.

A 55-year-old man is brought in by EMS after being “found down” on the

street. There are no signs of trauma and there is a strong odor of alcohol

on his breath. What laboratory abnormalities are associated with heavy

alcohol use?

Increased GGT, increased MCV, AST > ALT, coagulopathy.

Alcohol

Alcohol use is very prevalent in society. Lifetime risk for the general popula-

tion is 15%.

RISKFACTORS

Male sex, ages 25–34, psychiatric disorder(antisocial personality disorder,

mania, and schizophrenia), homelessness

The Medical Cost of Alcoholism

■ Alcoholics have a 10- to 15-year shorter life span.

■ Cardiac: Decreased occurrence of CAD, but increased risks of hyperten-

sion, dilated cardiomyopathy, arrhythmias

■ Endocrine: Pancreatic insufficiency (glucose intolerance), increased ACTH,

glucocorticoid, or catecholamine release, decreased testosterone synthesis

(male hypogonadism)

■ Metabolic: Hyperlipidemia, hypoglycemia, gout, immune compromise,

electrolyte imbalance, vitamin deficiencies, coagulopathy

■ GI:Most common cause of liver failurein the United States and world-

wide from alcoholic hepatitis and cirrhosis; can also get gastritis, stomach

or duodenal ulcers, esophageal varices causing GI bleeds

■ Cancer: Increased risk of esophageal, stomach, pancreatic, and breast cancer

■ Neuro: Peripheral neuropathy, cognitive deficits, memory impairment,

Wernicke-Korsakoff syndrome

■ Women: More prone to cirrhosis, and pregnant women have an increased

risk of IUGR and fetal alcohol syndrome (FAS)

SYMPTOMS/EXAM

Screening for Alcoholism

CAGE screening tool is an internationally recognized tool for identifying

alcoholics.

Score<or= 1 →further assessment, or = > 2 →highly specific for alcohol

dependence

Standardized tests such as

CAGE have been found to

have higher sensitivity than

BAC, breath smell, patient self-

report, or patient complaint.