Nottinghamshire Primary Care Alcohol Misuse Guidelines
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The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines
The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines World Health Organization F10 - F19 Mental and behavioural disorders due to psychoactive substance use Overview of this block F10. – Mental and behavioural disorders due to use of alcohol F11. – Mental and behavioural disorders due to use of opioids F12. – Mental and behavioural disorders due to use of cannabinoids F13. – Mental and behavioural disorders due to use of sedative hypnotics F14. – Mental and behavioural disorders due to use of cocaine F15. – Mental and behavioural disorders due to use of other stimulants, including caffeine F16. – Mental and behavioural disorders due to use of hallucinogens F17. – Mental and behavioural disorders due to use of tobacco F18. – Mental and behavioural disorders due to use of volatile solvents F19. – Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances Four- and five-character codes may be used to specify the clinical conditions, as follows: F1x.0 Acute intoxication .00 Uncomplicated .01 With trauma or other bodily injury .02 With other medical complications .03 With delirium .04 With perceptual distortions .05 With coma .06 With convulsions .07 Pathological intoxication F1x.1 Harmful use F1x.2 Dependence syndrome .20 Currently abstinent .21 Currently abstinent, but in a protected environment .22 Currently on a clinically supervised maintenance or replacement regime [controlled dependence] .23 Currently abstinent, but receiving treatment with -
Alcohol Withdrawal
Alcohol withdrawal TERMINOLOGY CLINICAL CLARIFICATION • Alcohol withdrawal may occur after cessation or reduction of heavy and prolonged alcohol use; manifestations are characterized by autonomic hyperactivity and central nervous system excitation 1, 2 • Severe symptom manifestations (eg, seizures, delirium tremens) may develop in up to 5% of patients 3 CLASSIFICATION • Based on severity ○ Minor alcohol withdrawal syndrome 4, 5 – Manifestations occur early, within the first 48 hours after last drink or decrease in consumption 6 □ Manifestations develop about 6 hours after last drink or decrease in consumption and usually peak about 24 to 36 hours; resolution occurs in 2 to 7 days 7 if withdrawal does not progress to major alcohol withdrawal syndrome 4 – Characterized by mild autonomic hyperactivity (eg, tachycardia, hypertension, diaphoresis, hyperreflexia), mild tremor, anxiety, irritability, sleep disturbances (eg, insomnia, vivid dreams), gastrointestinal symptoms (eg, anorexia, nausea, vomiting), headache, and craving alcohol 4 ○ Major alcohol withdrawal syndrome 5, 4 – Progression and worsening of withdrawal manifestations, usually after about 24 hours from the onset of initial manifestations 4 □ Manifestations often peak around 50 hours before gradual resolution or may continue to progress to severe (complicated) withdrawal, particularly without treatment 4 – Characterized by moderate to severe autonomic hyperactivity (eg, tachycardia, hypertension, diaphoresis, hyperreflexia, fever); marked tremor; pronounced anxiety, insomnia, -
Recovery Center of America
CERTIFICATE OF NEED APPLICATION INTERMEDIATE CARE FACILITY 4620 Melwood Road Upper Marlboro, Maryland Applicant: 4620 Melwood Road OPCO, LLC March 27, 2015 Table of Contents Page PART I - PROJECT IDENTIFICATION AND GENERAL INFORMATION ................................... 1 1. FACILITY ............................................................................................................ 1 2. NAME OF OWNER ............................................................................................. 1 3. APPLICANT ........................................................................................................ 1 4. NAME OF LICENSEE OR PROPOSED LICENSEE ........................................... 2 5. LEGAL STRUCTURE OF APPLICANT ............................................................... 2 6. PERSON(S) TO WHOM QUESTIONS REGARDING THIS APPLICATION SHOULD BE DIRECTED ............................................................ 2 7. TYPE OF PROJECT ........................................................................................... 4 8. PROJECT DESCRIPTION .................................................................................. 4 A. Executive Summary of the Project ........................................................... 4 B. Comprehensive Project Description ......................................................... 5 9. BED INVENTORY ..............................................................................................14 10. COMMUNITY BASED SERVICES .....................................................................14 -
The Alcohol Withdrawal Syndrome
Downloaded from jnnp.bmj.com on 4 September 2008 The alcohol withdrawal syndrome A McKeon, M A Frye and Norman Delanty J. Neurol. Neurosurg. Psychiatry 2008;79;854-862; originally published online 6 Nov 2007; doi:10.1136/jnnp.2007.128322 Updated information and services can be found at: http://jnnp.bmj.com/cgi/content/full/79/8/854 These include: References This article cites 115 articles, 38 of which can be accessed free at: http://jnnp.bmj.com/cgi/content/full/79/8/854#BIBL Rapid responses You can respond to this article at: http://jnnp.bmj.com/cgi/eletter-submit/79/8/854 Email alerting Receive free email alerts when new articles cite this article - sign up in the box at service the top right corner of the article Notes To order reprints of this article go to: http://journals.bmj.com/cgi/reprintform To subscribe to Journal of Neurology, Neurosurgery, and Psychiatry go to: http://journals.bmj.com/subscriptions/ Downloaded from jnnp.bmj.com on 4 September 2008 Review The alcohol withdrawal syndrome A McKeon,1 M A Frye,2 Norman Delanty1 1 Department of Neurology and ABSTRACT every 26 hospital bed days being attributable to Clinical Neurosciences, The alcohol withdrawal syndrome (AWS) is a common some degree of alcohol misuse.5 Despite this Beaumont Hospital, Dublin, and management problem in hospital practice for neurologists, Royal College of Surgeons in substantial problem, a survey of NHS general Ireland, Dublin, Ireland; psychiatrists and general physicians alike. Although some hospitals conducted in 2000 and 2003 indicated 2 Department of Psychiatry, patients have mild symptoms and may even be managed that only 12.8% had a dedicated alcohol worker.6 In Mayo Clinic, Rochester, MN, in the outpatient setting, others have more severe addition, few guidelines exist promoting the USA symptoms or a history of adverse outcomes that requires initiation of clear and uniform AWS treatment 7–9 Correspondence to: close inpatient supervision and benzodiazepine therapy. -
Pharmacological Treatments Protocols of Alcohol and Drugs Abuse
Pharmacological Treatments Protocols of Alcohol and Drugs Abuse 1 Purpose of the protocols: Use and abuse of drugs and alcohol is becoming common and can have serious and harmful consequences on individuals, families, and society. Care with a tailored treatment program and follow-up options can be crucial to success. Treatment should include both medical and mental health services as needed in managing withdrawal symptoms, prevent relapse, and treat co- occurring conditions. Follow-up care may include community- or family-based recovery support systems. These protocols have been developed to guide medical practitioners and nurses in the use of the most effective available treatments of alcohol and drug abuse in the in-patient and out- patient settings and serve as a framework for clinical decisions and supporting best practices. Targeted end users: • Psychiatry and Addiction Medicine Consultants, Specialists and Residents • Nurses • Psychiatry clinical pharmacists • Pharmacists 2 TABLE OF CONTENTS 1. Chapter (1) Alcohol 4 3.1 Introduction 4 3.2 Intoxication 4 3.3 Withdrawal 7 2. Chapter (2) Benzodiazepines 21 2.1 Introduction 21 2.2 Intoxication 21 2.3 Withdrawal 22 3. Chapter (3) Opioids 27 3.1 Introduction 27 3.2 Intoxication 28 3.3 Withdrawal 29 4. Chapter (4) Psychostimulants 38 2.1 Introduction 38 2.2 Intoxication 39 2.3 Withdrawal 40 5. Chapter (5) Cannabis 41 3.1 Introduction 41 3.2 Intoxication 41 3.3 Withdrawal 43 6. References 46 3 CHAPTER 1 ALCOHOL INTRODUCTION Alcohol is a Central Nervous System (CNS) depressant. Its’ psychoactive properties contribute to changes in mood, cognition and behavior. -
An Overview of Outpatient and Inpatient Detoxification
An Overview of Outpatient and Inpatient Detoxification Motoi Hayashida, M.D., Sc.D. lcohol detoxification can be defined as a period facility, where they reside for the duration of of medical treatment, usually including counsel- treatment, which may range from 5 to 14 days. A ing, during which a person is helped to overcome The process of detoxification in either setting initially physical and psychological dependence on alcohol (Chang involves the assessment and treatment of acute with- and Kosten 1997). The immediate objectives of alcohol drawal symptoms, which may range from mild (e.g., detoxification are to help the patient achieve a substance- tremor and insomnia) to severe (e.g., autonomic free state, relieve the immediate symptoms of withdrawal, hyperactivity, seizures, and delirium) (Swift 1997). and treat any comorbid medical or psychiatric conditions. Medications often are provided to help reduce a patient’s These objectives help prepare the patient for entry into withdrawal symptoms. Benzodiazepines (e.g., diazepam long-term treatment or rehabilitation, the ultimate goal of detoxification (Swift 1997). The objectives of long- and chlordiazepoxide) are the most commonly used term treatment or rehabilitation include the long-term drugs for this purpose, and their efficacy is well estab- maintenance of the alcohol-free state and the incor- lished (Swift 1997). Benzodiazepines not only reduce poration of psychological, family, and social interven- alcohol withdrawal symptoms but also prevent alcohol tions to help ensure its persistence (Swift 1997). withdrawal seizures, which occur in an estimated 1 to Alcohol detoxification can be completed safely and 4 percent of withdrawal patients (Schuckit 1995). -
What Works in Alcohol Use Disorders? Jason Luty APT 2006, 12:13-22
What works in alcohol use disorders? Jason Luty APT 2006, 12:13-22. Access the most recent version at DOI: 10.1192/apt.12.1.13 References This article cites 0 articles, 0 of which you can access for free at: http://apt.rcpsych.org/content/12/1/13#BIBL Reprints/ To obtain reprints or permission to reproduce material from this paper, please write permissions to [email protected] You can respond http://apt.rcpsych.org/cgi/eletter-submit/12/1/13 to this article at Downloaded http://apt.rcpsych.org/ on February 18, 2014 from Published by The Royal College of Psychiatrists To subscribe to Adv. Psychiatr. Treat. go to: http://apt.rcpsych.org/site/subscriptions/ Advances in PsychiatricWhat worksTreatment in alcohol (2006), use vol. disorders? 12, 13–22 What works in alcohol use disorders? Jason Luty Abstract Treatment of alcohol use disorders typically involves a combination of pharmacotherapy and psychosocial interventions. About one-quarter of people with alcohol dependence (‘alcoholics’) who seek treatment remain abstinent over 1 year. Research has consistently shown that less intensive, community treatment (particularly brief interventions) is just as effective as intense, residential treatment. Many psychosocial treatments are probably equally effective. Techniques for medically assisted detoxification are widespread and effective. More recent evidence provides some support for the use of drugs such as acamprosate to prevent relapse in the medium to long term. There has been much recent debate and criticism of Unfortunately there are many uncertainties in the UK alcohol policy (Drummond, 2004; Hall, 2005). evidence base for treatment of alcohol use disorders Over the past 20 years, per capita alcohol consump- – not least of which is the cost-effectiveness of tion in Britain has increased by 31%, leading to large therapy. -
Treatment for Cocaine Addiction
(19) TZZ¥_Z_T (11) EP 3 170 499 A1 (12) EUROPEAN PATENT APPLICATION (43) Date of publication: (51) Int Cl.: 24.05.2017 Bulletin 2017/21 A61K 31/27 (2006.01) A61K 31/16 (2006.01) A61P 25/00 (2006.01) (21) Application number: 16204193.3 (22) Date of filing: 31.08.2011 (84) Designated Contracting States: (72) Inventors: AL AT BE BG CH CY CZ DE DK EE ES FI FR GB • LEDERMAN, Seth GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO New York, NY 10022 (US) PL PT RO RS SE SI SK SM TR • HARRIS, Herbert New York, NY 10022 (US) (30) Priority: 01.09.2010 US 379095 P (74) Representative: Bassil, Nicholas Charles et al (62) Document number(s) of the earlier application(s) in Kilburn & Strode LLP accordance with Art. 76 EPC: 20 Red Lion Street 11832859.0 / 2 611 440 London WC1R 4PJ (GB) (71) Applicant: Tonix Pharmaceuticals, Inc. Remarks: New York, NY 10022 (US) This application was filed on 14.12.2016 as a divisional application to the application mentioned under INID code 62. (54) TREATMENT FOR COCAINE ADDICTION (57) A novel pharmaceutical composition is provided therapeutic dose application or a single dose of a com- for the control of stimulant effects, in particular treatment bined therapeutically effective composition of disulfiram of cocaine addiction, or further to treatment of both co- and selegiline compounds or pharmaceutically accepta- caine and alcohol dependency, including simultaneous ble non-toxic salt thereof. EP 3 170 499 A1 Printed by Jouve, 75001 PARIS (FR) 1 EP 3 170 499 A1 2 Description and MDMA (3,4-methylenedioxymethamphetamine), better -
Phenomenology Epidemiology
Phenomenology DEFINITIONS Intoxication: reversible, substance-specific physiological and behavioral changes due to recent exposure to a psychoactive substance. Addiction: compulsion to use a drug, usually for its psychic, rather than therapeutic, effects Tolerance: the decline in potency of an opioid experienced with continued use, so that higher doses are needed to achieve the same effect. This is a receptor mediated effect, typical of many psychoactive drugs. Physical Dependence: refers to the development of withdrawal symptoms once a drug is stopped. Withdrawal: a physiological state that follows cessation or reduction in the amount of a drug used. Generally these effects are the opposite of the drugs normal effects. Substance Dependence (DSM version): A maladaptive pattern of substance use with adverse clinical consequences. Substance Abuse (DSM version): A maladaptive pattern of use that causes clinically significant impairment. Alcoholism: A repetitive, but inconsistent and sometimes unpredictable loss of control of drinking which produces symptoms of serious dysfunction or disability. Clearly there is a wide range of findings possible on the mental status exam, however any exam should look for typical signs of regular substance use. Epidemiology Use of psychoactive substances is common in society, and is often socially acceptable or at least tolerated. Historically, psychoactive substance has served a variety of purposes, including medicinal, social, recreational and religious. In the U.S., 90% people report some alcohol use, 80% report some caffeine use, 25% report use of tobacco products, and 37% report having used illicit substances (at least once in life). Dependence and Abuse are also very common (13.6% in ECA). Over 10 million Americans are alcoholics, over 8 million are "Problem drinkers." Only 3% of alcoholics are on skid row. -
Alcoholic Liver Disease Your Role Is Essential in Preventing, Detecting, and Co-Managing Alcoholic Liver Disease in Inpatient and Ambulatory Settings
Preventing drinking relapse in patients with alcoholic liver disease Your role is essential in preventing, detecting, and co-managing alcoholic liver disease in inpatient and ambulatory settings Gerald Scott Winder, MD lcohol use disorder (AUD) is a mosaic of psychiatric and Assistant Professor medical symptoms. Alcoholic liver disease (ALD) in its acute Department of Psychiatry University of Michigan Health System and chronic forms is a common clinical consequence of long- Ann Arbor, Michigan A standing AUD. Patients with ALD require specialized care from pro- Jessica Mellinger, MD, MSc fessionals in addiction, gastroenterology, and psychiatry. However, Clinical Lecturer medical specialists treating ALD might not regularly consider medi- Department of Internal Medicine University of Michigan Health System cations to treat AUD because of their limited experience with the Ann Arbor, Michigan drugs or the lack of studies in patients with significant liver disease.1 Robert J. Fontana, MD Similarly, psychiatrists might be reticent to prescribe medications for Professor of Medicine AUD, fearing that liver disease will be made worse or that they will Division of Gastroenterology cause other medical complications. As a result, patients with ALD Department of Internal Medicine University of Michigan Health System might not receive care that could help treat their AUD (Box, page 24). Ann Arbor, Michigan Given the high worldwide prevalence and morbidity of ALD,2 gen- Disclosures eral and subspecialized psychiatrists routinely evaluate patients with Dr. Winder and Dr. Mellinger report no financial AUD in and out of the hospital. This article aims to equip a psychia- relationships with any company whose products are mentioned in this article or with manufacturers of trist with: competing products. -
3 Regimens for Alcohol Withdrawal and Detoxification
Applied Evidence N EW R ESEARCH F INDINGS T HAT A RE C HANGING C LINICAL P RACTICE 3 Regimens for alcohol withdrawal and detoxification Chad A. Asplund, MD, Jacob W. Aaronson, DO, and Hadassah E. Aaronson, DO Department of Family Practice, DeWitt Army Community Hospital, Fort Belvoir, Va Practice recommendations withdrawal symptoms and no serious psychiatric or medical comorbidities can be safely treated in ■ Patients with mild to moderate alcohol with- the outpatient setting. Patients with history of drawal symptoms and no serious psychi- severe withdrawal symptoms, seizures or deliri- atric or medical comorbidities can be safely um tremens, comorbid serious psychiatric or med- treated in the outpatient setting (SOR: A). ical illnesses, or lack of reliable support network should be considered for detoxification in the ■ Patients with moderate withdrawal should inpatient setting. receive pharmacotherapy to treat their symptoms and reduce their risk of seizures ■ THE PROBLEM OF ALCOHOL and delirium tremens during outpatient WITHDRAWAL detoxification (SOR: A). Up to 71% of individuals presenting for alcohol ■ Benzodiazepines are the treatment of detoxification manifest significant symptoms of choice for alcohol withdrawal (SOR: A). alcohol withdrawal.4 Alcohol withdrawal is a clinical syndrome that affects people accus- ■ ln healthy individuals with mild-to-moderate tomed to regular alcohol intake who either alcohol withdrawal, carbamazepine has decrease their alcohol consumption or stop many advantages making it a first-line drinking completely. treatment for properly selected patients (SOR: A). Physiology Alcohol enhances gamma-aminobutyric acid’s n our small community hospital—with limited (GABA) inhibitory effects on signal-receiving financial and medical resources—we have neurons, thereby lowering neuronal activity, Idesigned and implemented an outpatient alco- leading to an increase in excitatory glutamate hol detoxification clinical practice guideline to pro- receptors. -
Alcohol Detoxification: Inpatient Clinical Algorithm
Alcohol Detoxification: Inpatient Clinical Algorithm CONTENTS 1. BACKGROUND ....................................................................................................................................... 2 2. OVERVIEW OF THE PROCESS ............................................................................................................. 3 2.1. Admission to the Ward ............................................................................................................. 3 2.2. Assessment.................................................................................................................................. 4 2.3. Management using Chlordiazepoxide......................................................................................... 5 3. ASSESSMENT TOOLS............................................................................................................................ 7 3.1. AWS (Alcohol Withdrawal Scale) ............................................................................................ 7 3.2. AUDIT-C and AUDIT (Alcohol Use Disorder Identification Test) ....................................... 8 3.3. Severity of Alcohol Dependence Questionnaire (SADQ) .................................................. 10 3.4. APQ (Alcohol Problem Questionnaire) ............................................................................... 13 3.5. SOCRATES 8A motivational assessment tool ........................................................................... 15 4. ALCOHOL WITHDRAWAL RECORDING FORMS ...............................................................................