Psych 4.2 Flashcards

Binges=remaining ______ throughout the day for at least ______ days

DSM-5 diagnostic criteria for alcohol intoxication:

• Evidence of recent ingestion of _______
• _______ behavior
• At least _______ of several possible physiologic correlates of intoxication

A patient repeatedly tries to control drinking by “going on the wagon” and restricting alcohol to certain times of day, but relapses into heavy use. This behavior most directly reflects:
A. Successful harm reduction
B. Physiologic dependence only
C. Normal social drinking strategy
D. Inability to cut down

Which behavior is a severity marker specifically noted for alcohol use disorders?
A. Drinking only with meals
B. Drinking nonbeverage alcohol
C. Switching from beer to wine
D. Avoiding alcohol at work

In most U.S. states, the legal definition of intoxication for driving generally corresponds to:
A. 0.02 g/dL blood ethanol
B. 0.08–0.10 g/dL ethanol
C. 0.15–0.20 g/dL ethanol
D. 0.30 g/dL blood ethanol

Someone has a blood ethanol level around 150 mg/dL but shows little motor or mental impairment. The best inference is:
A. Lab error is most likely
B. They metabolize ethanol faster
C. Significant pharmacodynamic tolerance
D. Concurrent stimulant intoxication

Alcohol withdrawal can include _____ and _____ hyperactivity

Which factor can predispose to or aggravate alcohol withdrawal symptoms?
A. Hyperthyroidism
B. High-protein diet
C. Mild seasonal allergies
D. Malnutrition

Which factor can predispose to or aggravate alcohol withdrawal symptoms?
A. Hypothyroidism
B. High-protein diet
C. Physical illness
D. Malnutrition

Which factor can predispose to or aggravate alcohol withdrawal symptoms?
A. Depression
B. High-protein diet
C. Allergies
D. Malnutrition

Which factor can predispose to or aggravate alcohol withdrawal symptoms?
A. Fatigue
B. High-protein diet
C. Allergies
D. Malnutrition

DSM-5 criteria for ______ require:

• Cessation or reduction of ______ use that was heavy and prolonged
• Presence of ______ physical or neuropsychiatric symptoms

Tremor alcohol withdrawal can be similar to physiologic tremor or familial tremor

• Physiologic = continuous tremors of high amplitude of _____ than 8 Hz
• Familia = bursts of tremor activity _____ than 8 Hz

are these symptoms of alcohol withdrawal or intoxication?

• Anxiety
• Arousal
• Sweating
• Facial flushing
• Mydriasis
• Tachycardia
• Mild HTN

Alcoholic withdrawal ______ classifications:

• Stereotyped
• Generalized
• Tonic-clonic

Alcohol withdrawal seizures are typically:
A. Generalized tonic–clonic
B. Focal motor with aura
C. Absence with staring spells
D. Atonic drop attacks

Wernicke–Korsakoff lesions are noted to involve the:
A. Mammillary bodies
B. Caudate nucleus only
C. Primary motor cortex only
D. Optic chiasm exclusively

Even with alcohol history, seizures should prompt evaluation for:
A. Carpal tunnel syndrome
B. Head injuries
C. Lactose intolerance
D. Seasonal allergies

Even with alcohol history, seizures should prompt evaluation for:
A. Otitis externa
B. Tendinitis
C. CNS neoplasms
D. Gallstones

Which abnormality may occur with severe alcohol abuse?

A. Hyperglycemia

B. Euglycemia

C. Hypoglycemia

D. Glucosuria

Which abnormality may accompany severe alcohol abuse?

A. Hypernatremia

B. Hyponatremia

C. Hyperkalemia

D. Hypocalcemia

Which abnormality may accompany severe alcohol abuse?

A. Hypermagnesemia

B. Hypocalcemia

C. Hyperphosphatemia

D. Hypomagnesemia

What is the most severe alcohol withdrawal syndrome?

A. Alcohol withdrawal delirium

B. Alcohol-induced dementia

C. Alcoholic hallucinosis

D. Amnestic disorder

What is another name for alcohol withdrawal delirium?

A. Korsakoff syndrome

B. Delirium tremens

C. Wernicke encephalopathy

D. Hepatic encephalopathy

A withdrawing patient becomes severely agitated and violent. Which syndrome is most concerning?

A. Alcoholic dementia

B. Simple withdrawal

C. Delirium tremens

D. Amnestic disorder

Untreated delirium tremens has approximately what mortality?

A. 2%

B. 5%

C. 10%

D. 20%

What is the essential feature of alcohol withdrawal syndrome?

A. Hallucinations without confusion

B. Delirium after alcohol reduction

C. Chronic short-term amnesia

D. Progressive cerebral atrophy

Withdrawal delirium typically occurs within what interval?

A. One week

B. One month

C. Six hours

D. Three weeks

DT episodes commonly begin during which age range?

A. Teens and twenties

B. Twenties and thirties

C. Thirties and forties

D. Fifties and sixties

DTs commonly follow approximately how many years of heavy binge drinking?

A. 1–3 years

B. 5–15 years

C. 20–30 years

D. Over 40 years

Recent-memory difficulty in alcoholic dementia occurs with what?

A. Isolated language loss

B. Global cognitive impairment

C. Pure motor dysfunction

D. Preserved overall cognition

What brain imaging finding occurs in many alcoholic dementia patients?

A. Reduced ventricular size

B. Enlarged ventricles

C. Cerebellar calcification

D. Basal ganglia hemorrhage

Which cortical change may accompany alcoholic dementia?

A. Narrowed cerebral sulci

B. Cerebral sulcal shrinkage

C. Absent cortical folds

D. Thickened cerebral cortex

Brain changes from alcoholic dementia may improve after what?

A. One week abstinence

B. One month abstinence

C. Six months abstinence

D. One year abstinence

How reversible are these alcohol-related brain changes?

A. Wholly or partially reversible

B. Always completely irreversible

C. Never structurally apparent

D. Progressively worsening despite abstinence

Alcohol-induced persisting amnestic disorder primarily impairs what?

A. Long-term procedural memory

B. Short-term memory

C. Visual fields

D. Speech production

What typically causes alcohol-induced persisting amnestic disorder?

A. Single alcohol exposure

B. Prolonged heavy alcohol use

C. Brief alcohol withdrawal

D. Acute alcohol intoxication

Korsakoff syndrome is a late neuropsychiatric manifestation of what disease?

What are the symptoms of Wernicke encephalopathy?
____
____
____
____

What three symptoms are present in Korsakoff syndrome?

Irreversible _____ loss
_____
_____ changes

fetal alcholol syndrome:

Impaired migration of ____ and ____ cells

What conditions characterize the most severe form of fetal alcohol syndrome?

Heart-lung _____
_____

What limb abnormality is associated with fetal alcohol syndrome?

What craniofacial findings are characteristic of fetal alcohol syndrome?

[Macrocephaly/Microcephaly]
Small palpebral ______
Smooth ______
[Thick/Thin] vermillion border

What best describes an alcohol-related blackout?

A. Retrograde memory loss

B. Anterograde amnesia

C. Global cognitive decline

D. Persistent delirium

Alcohol-related blackouts occur during what?

A. Alcohol intoxication

B. Alcohol abstinence

C. Chronic dementia

D. Delirium tremens

Alcohol blackouts resemble which condition?

A. Dissociative fugue

B. Korsakoff syndrome

C. Transient global amnesia

D. Delirium tremens

What memory deficit occurs during alcohol blackouts?

A. Long-term memory loss

B. Procedural memory loss

C. Remote memory loss

D. Short-term memory deficit

During a blackout, patients may forget events from approximately when?

A. Previous 5–10 minutes

B. Previous 1–2 days

C. Previous several months

D. Previous several years

How may a patient appear during an alcohol blackout?

A. Deeply sedated

B. Grossly delirious

C. Normal to observers

D. Severely aphasic

During an alcohol blackout, patients may be able to perform what?

A. Only simple reflexes

B. Complicated tasks

C. No purposeful activity

D. Only repetitive movements

Which brain structure is involved in alcohol blackouts?

A. Cerebellum

B. Amygdala

C. Basal ganglia

D. Hippocampus

What is the most common auditory hallucination?

A. Music

B. Voices

C. Bells

D. Footsteps

Alcohol-related auditory voices are commonly what?

A. Friendly and reassuring

B. Neutral and repetitive

C. Malingering, reproachful, threatening

D. Musical and rhythmic

Alcohol-related hallucinations usually last how long?

A. Several months

B. More than one year

C. Several weeks

D. Less than one week

Alcohol-induced mood disorder may resemble which condition?

A. Major depressive disorder

B. Bipolar disorder

C. Schizophrenia

D. Delirium tremens

In alcohol-induced mood disorder, intense sadness improves with what?

A. Continued drinking

B. Abstinence

C. Sleep deprivation

D. Caffeine intake

Alcohol-induced depressive symptoms may improve within what period?

A. Several months

B. One year

C. Several days to one month

D. More than two years

About what percentage of alcoholics report intense depression?

A. 20%

B. 40%

C. 60%

D. 80%

How long should clinicians generally wait before starting antidepressants?

A. 1–2 days

B. 1 week

C. 2–4 weeks

D. 2–3 months

Why delay antidepressants in alcohol-induced mood disorder?

A. Depressive symptoms may improve with abstinence

B. Antidepressants cause withdrawal seizures

C. Alcohol blocks all absorption

D. Depression always becomes mania

About what percentage of alcoholics report panic attacks during withdrawal?

A. 10%

B. 30%

C. 50%

D. 80%

Tremulousness during alcohol withdrawal is also called what?

A. Shakes or jitters

B. Rum fits

C. Horrors

D. Blackouts

Alcoholic hallucinosis is also called what?

A. Rum fits

B. Horrors

C. Jitters

D. Blackouts

Withdrawal seizures are also called what?

A. Horrors

B. Shakes

C. Rum fits

D. Jitters

Delirium tremens is also called what?

A. Horrors

B. Rum fits

C. Jitters

D. Shakes

A patient suspected of Wernicke-Korsakoff syndrome fails thiamine therapy. What diagnosis should be considered?

A. Alcoholic pellagra encephalopathy

B. Alcoholic hallucinosis

C. Alcohol-induced mood disorder

D. Delirium tremens

Alcoholic pellagra encephalopathy is especially considered after failure of what treatment?

A. Benzodiazepines

B. Thiamine

C. Antidepressants

D. Antipsychotics

Which psychiatric diagnosis is strongly associated with alcohol-related disorders?

A. Other substance-related disorders

B. Somatic symptom disorder

C. Dissociative identity disorder

D. Neurocognitive disorder

Which personality disorder is associated with alcoholism?

A. Avoidant personality disorder

B. Antisocial personality disorder

C. Dependent personality disorder

D. Schizotypal personality disorder

Antisocial personality disorder is especially common in which alcoholics?

A. Older women

B. Adolescents

C. Men

D. Elderly patients

Which mood disorder commonly accompanies alcohol-related disorders?

A. Cyclothymic disorder

B. Persistent depressive disorder

C. Premenstrual dysphoric disorder

D. Major depressive disorder

Among alcoholics, depression is more common in whom?

A. Men

B. Women

C. Adolescents

D. Elderly patients

Persistent depressive symptoms after sobriety warrant what?

A. Antipsychotic treatment

B. Electroconvulsive therapy

C. Antidepressant therapy

D. Stimulant therapy

Patients with bipolar disorder may drink alcohol to self-medicate what?

A. Manic episodes

B. Depressive episodes

C. Panic attacks

D. Psychotic symptoms

Alcohol-related disorders carry what suicide risk?

A. Lower than population

B. Equal to population

C. Markedly higher

D. Slightly lower

Which factor predicts successful abstinence?

A. Age alone

B. Alcohol preference

C. Life stability

D. Withdrawal severity

Which factor also predicts maintained abstinence?

A. Education level

B. Sex

C. Hospital duration

D. Motivation level

Which social factor affects abstinence prognosis?

A. Quality of social support

B. Number of medications

C. Geographic location

D. Dietary preferences

Severe drug problems generally have what effect?

A. Improve abstinence odds

B. Reduce abstinence odds

C. Eliminate withdrawal

D. Prevent relapse

Depressant withdrawal syndrome commonly resembles what?

A. Severe pneumonia

B. Acute appendicitis

C. Meningitis

D. Mild influenza

What is first-line treatment for alcohol-related seizures?

A. Carbamazepine

B. Benzodiazepines

C. Antipsychotics

D. Beta blockers

Optimal withdrawal relief begins with what strategy?

A. Immediate medication cessation

B. Antipsychotic monotherapy

C. Adequate initial brain depressant

D. Beta-blocker monotherapy

Which benzodiazepine is short acting?

A. Lorazepam

B. Diazepam

C. Chlordiazepoxide

D. Clonidine

Which benzodiazepine is long acting?

A. Lorazepam

B. Diazepam

C. Midazolam

D. Alprazolam

Which other long-acting withdrawal drug is used?

A. Lorazepam

B. Propranolol

C. Chlordiazepoxide

D. Clonidine

How should benzodiazepine dosing generally begin?

A. High dose, then taper

B. Low dose, then increase

C. Single dose only

D. Alternate-day dosing

Which anticonvulsant can match benzodiazepine efficacy for withdrawals?

A. Valproate

B. Carbamazepine

C. Phenytoin

D. Lamotrigine

What advantage does carbamazepine have over benzodiazepines?

A. Faster absorption

B. Longer half-life

C. Greater sedation

D. Minimal abuse liability

Which beta blocker can reduce sympathetic symptoms?

A. Propranolol

B. Metoprolol

C. Atenolol

D. Labetalol

Which alpha blocker can reduce sympathetic symptoms?

A. Prazosin

B. Clonidine

C. Doxazosin

D. Tamsulosin

Propranolol and clonidine primarily target what issue in withdrawals?

A. Seizure threshold

B. Delirium directly

C. Sympathetic hyperactivity

D. Alcohol craving

A patient with severe alcohol withdrawal develops delirium tremens. How should treatment be adjusted?

A. Increase doses of withdrawal medications
B. Reduce doses of withdrawal medications
C. Use antipsychotic therapy alone
D. Stop withdrawal medications immediately

What is the best treatment for delirium tremens?

A. Antipsychotics

B. Carbamazepine

C. Beta blockers

D. Prevention

Once severe withdrawal delirium appears, treatment requires what?

A. Higher standard-withdrawal doses

B. Lower medication doses

C. Antipsychotics alone

D. Immediate drug cessation

What diet is essential during severe withdrawal?

A. Low-calorie ketogenic diet

B. High-calorie high-carbohydrate diet

C. High-protein low-carbohydrate diet

D. Clear-liquid diet

A patient with severe alcohol withdrawal develops agitation. Why should antipsychotics be used cautiously in this patient?
A. They worsen alcohol cravings
B. They cause severe hypoglycemia
C. They prolong alcohol intoxication
D. They increase seizure risk

Which psychological intervention is essential in DTs?

A. Warm supportive psychotherapy

B. Exposure therapy

C. Psychoanalysis

D. Aversion therapy

Which symptoms may persist after acute withdrawal?

A. Hallucinations and seizures

B. Anxiety and insomnia

C. Aphasia and paralysis

D. Mania and catatonia

What autonomic symptom may persist after withdrawal?

A. Severe bradycardia

B. Complete autonomic failure

C. Mild autonomic overactivity

D. Persistent hypotension

Which factor supports choosing inpatient alcohol rehabilitation over outpatient treatment?

A. Previous outpatient treatment failure

B. Stable housing alone

C. Mild alcohol cravings

D. Strong social support

A patient with alcohol use disorder has severe psychiatric illness. Which rehabilitation setting may be more appropriate?

A. Self-directed treatment

B. Intensive inpatient rehabilitation

C. Brief outpatient counseling

D. No structured rehabilitation

What is the main goal of relapse-prevention counseling?

A. Eliminate all alcohol memories

B. Identify high-risk situations

C. Avoid discussing previous drinking

D. Replace counseling with medication

After identifying high-risk relapse situations, what should counseling emphasize?

A. Avoiding all social contact

B. Immediate hospitalization

C. Developing effective coping strategies

D. Starting antidepressants routinely

An essential part of relapse prevention is teaching patients how to view what?

A. Medication side effects

B. Family disagreements

C. Withdrawal hallucinations

D. Occasional slips during recovery

Which medication used with CBT is an opioid antagonist?

________

How does naltrexone help patients with alcohol use disorder?

A. Decreases alcohol craving

B. Causes alcohol aversion

C. Blocks alcohol absorption

D. Prevents alcohol metabolism

Naltrexone may also reduce which effect of alcohol?

A. Gastric absorption

B. Reward from drinking

C. Hepatic metabolism

D. Withdrawal hallucinations

Which medication used with CBT is an NMDA receptor antagonist?

_______

Acamprosate may reduce which symptoms during recovery?

A. Severe psychosis and seizures

B. Hypertension and tachycardia

C. Hallucinations and aggression

D. Mild anxiety and mood swings

Acamprosate may also improve which persistent symptom?

A. Sleep difficulties

B. Visual hallucinations

C. Grand mal seizures

D. Severe delirium

Which medication is described as an alcohol-sensitizing agent?

_______

A patient develops hallucinations during alcohol withdrawal. What treatment should be tried first?

A. Antipsychotics

B. Physical restraints

C. Benzodiazepines

D. Lithium

Besides benzodiazepines, what supportive treatment is appropriate for withdrawal hallucinations?

A. Fluid restriction

B. Fasting

C. Sleep deprivation

D. Adequate nutrition and fluids

A patient’s alcohol-withdrawal hallucinations persist despite benzodiazepines, nutrition, and fluids. What should be added?

A. Antipsychotic medication

B. Lithium therapy

C. Naltrexone therapy

D. Disulfram therapy

A patient with idiosyncratic alcohol intoxication becomes dangerously assaultive. What may initially be necessary?

A. Group counseling

B. Physical restraint

C. Naltrexone treatment

D. Relapse prevention

After restraining an assaultive intoxicated patient, which medication may control aggression?

________

According to the provided material, what is the most common psychiatric disorder in the Western world?

A. Major depressive disorder

B. Panic disorder

C. Bipolar disorder

D. Alcohol use disorder

What is the standard form of drinkable alcohol?

A. Methanol

B. Isopropanol

C. Ethanol

D. Ethylene glycol

Where is most consumed alcohol absorbed?

A. Small intestine

B. Stomach

C. Colon

D. Esophagus

A patient has the same blood alcohol level on two occasions but feels more intoxicated while the level is rising. What explains this?

A. First-pass metabolism

B. Mellanby effect

C. Alcohol tolerance

D. Gastric adaptation

Approximately what proportion of alcohol metabolism occurs through hepatic oxidation?

A. 10%

B. 25%

C. 50%

D. 90%

Which enzyme converts ethanol into acetaldehyde?

A. Alcohol dehydrogenase

B. Aldehyde dehydrogenase

C. Acetylcholinesterase

D. Monoamine oxidase

Which enzyme converts acetaldehyde into acetic acid?

A. Alcohol dehydrogenase

B. Aldehyde dehydrogenase

C. Cytochrome oxidase

D. Monoamine oxidase

Disulfram inhibits which alcohol-metabolizing enzyme?

A. Alcohol dehydrogenase

B. Catalase

C. Aldehyde dehydrogenase

D. Monoamine oxidase

What is the product of alcohol dehydrogenase activity?

A. Acetic acid

B. Carbon dioxide

C. Pyruvate

D. Acetaldehyde

What is the product of aldehyde dehydrogenase activity?

A. Acetic acid

B. Acetaldehyde

C. Ethanol

D. Lactate

Alcohol has its most potent effects on which neurotransmitter system?

A. Dopamine receptors

B. GABA complexes

C. Serotonin transporters

D. Glutamate vesicles

Which GABA receptor is most affected by alcohol?

A. GABA-B

B. GABA-C

C. GABA-A

D. GABA-D

What happens to dopamine after acute alcohol use?

A. It markedly decreases

B. It remains unchanged

C. Its synthesis stops

D. It acutely increases

Alcohol-related dopamine changes particularly affect which brain region?

A. Ventral tegmental area

B. Medulla

C. Occipital cortex

D. Cerebellar vermis

Acute alcohol use has what effect on synaptic serotonin?

A. It decreases serotonin

B. It increases serotonin

C. It blocks serotonin release

D. It eliminates serotonin

Acute alcohol use also causes what change in serotonin receptors?

A. Receptor destruction

B. Receptor internalization

C. Receptor upregulation

D. Receptor blockade

Alcohol acutely enhances functioning of which brain system?

A. Cholinergic system

B. Histaminergic system

C. Adrenergic system

D. Opioid-related system

What effect does evening alcohol consumption have on falling asleep?

A. It decreases sleep latency

B. It increases sleep latency

C. It prevents sleep onset

D. It has no effect

How does alcohol affect REM sleep?

A. It increases REM sleep

B. It decreases REM sleep

C. It eliminates stage 1

D. It increases sleep latency

How does alcohol affect deep stage 4 sleep?

A. It increases deep sleep

B. It preserves deep sleep

C. It decreases deep sleep

D. It eliminates REM only

A patient drinks alcohol before bed and awakens repeatedly overnight. Which alcohol-related sleep effect explains this?

A. Increased REM duration

B. Decreased sleep latency only

C. Increased deep sleep

D. Increased sleep fragmentation

Long-term heavy alcohol use may reduce gastric acid production, producing what?

A. Hyperchlorhydria

B. Dyspepsia

C. Reflux

D. Achlorhydria

Which gastrointestinal complications are associated with chronic heavy alcohol use?

A. Esophagitis, gastritis, pancreatitis

B. Appendicitis, colitis, diverticulitis

C. Cholecystitis, hepatitis, ileitis

D. Achalasia, volvulus, intussusception

Long-term heavy alcohol use has what effect on blood pressure?

Heavy alcohol use can disrupt metabolism of which circulating lipids?

A. Cholesterol and phospholipids

B. Lipoproteins and triglycerides

Long-term heavy alcohol use increases the risk of which cardiovascular event?

A. Venous thrombosis

B. Aortic dissection

C. Pericarditis

D. Myocardial infarction

Chronic heavy alcohol use increases the overall risk of what?

A. Cardiovascular disease

B. Restrictive lung disease

C. Renal tubular disease

D. Thyroid disease

A patient presents after acute alcohol intoxication with confusion and diaphoresis. Which metabolic abnormality should be considered?

A. Hypernatremia

B. Hypoglycemia

C. Hypercalcemia

D. Hypermagnesemia

Alcohol intake has what effect on estradiol levels in women?

A. Decreases estradiol

B. Eliminates estradiol

C. Raises estradiol

D. Has no effect

Approximately what proportion of alcohol-use-disorder risk is explained by genetic influences?

A. 20%

B. 30%

C. 40%

D. 60%

What does evidence suggest about modest drinking introduced at home during childhood?

A. It clearly prevents alcoholism

B. It has little proven impact

C. It greatly increases alcoholism

D. It eliminates heavy drinking

Which childhood diagnosis increases the risk of later alcohol-related disorders?

A. ADHD

B. Specific phobia

C. Separation anxiety

D. Tic disorder

Which childhood behavioral disorder increases later alcohol-related-disorder risk?

A. Panic disorder

B. Conduct disorder

C. Somatic disorder

D. Adjustment disorder