Summary: Addiction Psychiatry

Read the summary and the most important questions on Addiction Psychiatry

• 1 Alcohol Use Disorder

• 1.1 Alcohol complications

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• How does Alcohol changes the biological process in the brain?

  Alcohol causes the release of dopamine in the ventral tegmental area, which is a part of the reward pathway.
  
  Alcohol also affects other reward systems, such as the endogenous opioid system, γ-aminobutyric acid (GABAergic) system, glutamate, and serotonin. 

• What is the temporal relationship between AUD and psychiatric disorder?

  
  AUD and other psychiatric disorders often share genetic risks and environmental vulnerabilities such as trauma and adverse childhood experiences

• 1.3 Alcohol Sexual Dysfunction

• Alcohol related Sexual Dysfunction in Males

  erectile dysfunction
  reduced libido
  delayed ejaculation.
  ▪ Severity often increases with duration and amount of alcohol use.

• Alcohol related sexual Dysfunction in Females

  vaginal dryness
  painful intercourse
  difficulty reaching orgasm.  
  Emotional detachment and poor partner choice may also be seen.

• Pathophysiology of Sexual dysfunction related to Alcohol use

   ▪ It suppresses the hypothalamic-pituitary-gonadal axis, reducing testosterone.
  ▪ Low testosterone leads to reduced sexual desire and poor performance.
  
  Chronic alcohol use damages brain regions linked to sexual behavior.
  ▪ This includes the hypothalamus, limbic system, and frontal cortex.
  ▪ Damage affects emotional intimacy, desire, and arousal regulation.
  
  • Peripheral nervous system and blood flow are also impaired.
  
  ▪ Alcohol induces peripheral neuropathy, reducing genital sensation. ▪ It also impairs nitric oxide–mediated vasodilation needed for erection.

• 1.4 Biological Marker for Alcohol use

• What are the traditional biomarkers used in Alcohol use

  1. Serum AST/ALT used to identify chronic abuse, heavy drinking
  2.  Serum GGT useful for monitoring abstinence
  3.  Serum MCV Screening for heavy drinking
  4.  Serum CDT Screen for alcohol dependence, heavy drinking and relapse

• What are the new biomarkers used in Alcohol use

  1. Serum/Urine EtG and EtS assess current alcohol intake with longer recognition span
  2.  Fatty Acid Ethyl Esters post mortem marker for alcohol consumption (internal organ) 
  3.   Urine 5HTOL rises after alcohol drink
  4.  Serum PEth Detect long term or binge drinking

• 1.5 Alcohol harm reduction

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• Goal of Harm Reduction

  to reduce the negative consequences of drug abuse, not to eliminate the use of licit or illicit drugs 

• Principals of harm reduction

  1. Targeted at Risks and Harms
  2. Evidence-Based and Cost-Effective
  3. Incremental Approach - Small steps, immediate safety, individual needs.

• WHO Strategies for Harm reduction in Alcohol use

  SAFER initiate were introduced 2018
  Strengthen restriction in Alcohol availability
  Advance and enforce drink driving counter measures
  Facilitate access to screening , brief intervention and treatment
  Enforce bans on alcohol advertising, sponsorship and promotion
  Raise alcohol price