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I. Addiction Psychiatry
Alcohol
Epidemiology: One year prevalence rates of alcohol misuse & dependence have been found
to be 7 to10%, and one year incidence rates are around 14 ­20%. Rates of alcohol misuse and
dependence are higher in men compared to women. In the recent years drinking by women…

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This is based on Edwards and Gross's 7 key features described in 1976.
Consequences of alcohol misuse include physical, psychological and social.
Physical consequences include:
Neurological:
Polyneuropathy.
Alcoholic myopathy.
Alcohol increases the amount of REM sleep and decreases the amount of stage 4
sleep, hence alcohol induced sleep may be…

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Infertility
Testicular atrophy
Other:
Foetal Alcohol syndrome occurs in some children born to mothers who drink
excessively during pregnancy. Features include facial abnormality, small stature, low
birth weight, low intelligence & overactivity. There is also an excess of stillbirths
Accidents
Psychiatric/psychological sequelae include:
Delirium tremens occurs 2 to 4 days…

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or contemplation stage through to action stage. Usually non directive, non prescriptive,
aimed at enabling the patient to go through the pros and cons of substance use, and improve
the patients own perceptions of risk rather than tell them about the risks of substance use.

The management of alcohol dependence…

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Opioids
Includes Heroin, morphine, codeine, methadone and pethidine (last two are synthetic
analogues, while the others are naturally occurring substances). Heroin is the most abused
opiate. Heroin is around three times more potent than morphine, and causes euphoriant
effects within seconds ­ minutes of usage. Side effects of acute intoxication…

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motivation interviewing, CBT, group therapy). Cochrane review in 2005 concluded that no
available treatment has been shown to be effective in the treatment of amphetamine
withdrawal. Of greatest potential benefit are those medications that increase dopamine,
noradrenaline and/or serotonin activity, although SSRIs have been shown to have no
efficacy.

Cocaine…

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times the rest of the population.
Buproprion works on dopamine and/or noradrenaline neurones to reduce craving during
nicotine withdrawal. Trials show 1 year abstinence rates of 30% with buproprion, 16% with
nicotine patches and 15% for placebo. Combination of buproprion and nicotine patches
increased abstinence rate to 35%. 16
Benzodiazepines…

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