Mental Health Primary Care

MHPC

Bidi, Cigarettes ,Tobacco Charas, bhang, ganja Alcohol Opium, brown sugar, heroin

Alcohol affects brain For getting pleasure To reduce pain, anxiety, tension In continued drinking, tolerance Cutting down or Abstinence causes withdrawal symptoms Withdrawal symptoms go away with drinking. To reduce withdrawal symptoms person feels compelled to drink

 , .

Self Medication Hypothesis

Anxiety disorder Depression Psychosis

Signs and Symptoms

MHPC

Dependence: can not stop drinking, feels compelled to drink Work, occupation, relationship problems Medical disorder or accident Mental disorder,e.g.Depression Legal problems, e.g.violence

Physical Dependence Psychological Dependence Withdrawal effects Craving

Craving

Liking

Non-problematic use

Abuse

Dep

Tremors Excessive perspiration, tachycardia Sleep disturbance Nausea and vomiting Anxiety, irritability Agitation Illusions and hallucinations: visual, Tectile,auditory Convulsions Delirium

AUD: A Major Public Health Problem

Death : Annually
World: 18 lakh India: 2 lakh

Of the drinkers
10% men and 3% women have AUD

1 Unit = 12 Gram Alcohol 1 Unit Alcohol raises blood alcohol level by 15-20 mgm/100ml Body takes I hour to lower blood level 15-20 mgm/100ml

Age:18 - 25 years Male> Female Uneducated> Educated Easy availability Social acceptance Certain occupations

First degree relatives: 4 times greater risk both modeling as well as heredity

1 Unit Alcohol= 720 ml Beer 1 Unit alcohol=240 ml wine 1 Unit Alcohol= 90 ml spirit

, , .
, , . , . .

Causes of death: Suicide Cancer Heart Disease Liver disease

Alcohol is associated with : 50% vehicular Accidents 50% Murders 25% Suicides

Alcohol use disorder shortens life by 10 years

1. Tolerance* 2. Withdrawal* 3. Larger amounts/longer period than intended 4. Inability to, or persistent desire to, cut down or control 5. A great deal of time spent obtaining, using, or recovering 6. Important activities given up or reduced 7. Use despite problems caused or exacerbated by use *Dx: with Physiological Dependence
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Alcohol affects all body organs Heart: high blood pressure, arrythemia,Heart failure Brain: amnesia,Confusion,auditory hallucinations,convulsion,ataxia Liver : hepatitis,cirrhosis,Cancer Muscles: weakness Pancreas:pancreatitis, hemorrhage

Lungs: infections Stomach and intestines: ulcer, bleeding Reproductive system: impotence, testicular atrophy, harm to baby in prenatal period Skin: excess perspiration, non-healing wounds CNS: Accidents, vehicular and with moving machinery- peripheral neuritis

Hooch: Laththo

Methyl alcohol instead of ethyl alcohol Methyl alcohol is toxic : Heart, kidney, liver, brain Blindness Death if not treated early

Anxiety disorder, Depression X 4 Psychotic disorders x 6 Person with psychiatric disorder should cut down drinking Alcohol use may reduce some anxiety in beginning but later worsens Increases risk of suicide and attempted suicide

Safe drinking?

Male: 14 Units /weel Female: 7Units/ week spread over the week Daily drinking increases risk of Alcohol dependence: Keep periods of not drinking

1. 2. 3. 4.

Cut Down Annoyance Guilt Eye opener

If 1 yes, Alcohol use disorder probable If 2 or more yes, AUD Certain

MHPC In Alcohol Use Disorders

MHPC : Alcohol Use Disorders

1. 2. 3. 4. 5.

Reduce Risk of suicide or harm Listening non-judgmentally Giving information and reassurance Encourage professional help Encourage self help

Abuse: Reduce quantity Total Abstinence

Dependence:

Total Abstinence

Psychoeducation Detoxification Treatment of medical and psychiatric comorbid disorders Alcohol deterrent drug like disulfiram Working with family to improve relationships Self help groups

1. 2. 3. 4. 5.

6.

Precontemplation. The person sees no need to change. Contemplation. The person has thought of the pros and cons of their substance use but is not sure about changing. Preparation. The person is ready to take action to change. Action. The person is attempting to change and avoiding situations which might trigger their substance use. Maintenance. The person has changed and is working to prevent themselves from relapsing back to substance misuse. Relapse.In any permanent changes, relapses can happen at first.

Psychiatrist

Withdrawal effects: 1week after quitting alcohol are treated. No need for continuing alcohol use With physical exam and lab investigation can assess physical harm due to alcohol Diagnoses and treats comorbid psychiatric disorders

Alcohol disulfiram reaction

Nausea Headache Vomiting Perspiration Flushing Thirst Palpitations Pain in chest Dizziness Convulsion

Without knowledge of patient

Ahmedabad, Vadodara, Rajkot,Surat, Vapi has AA Groups Abstinent people help others who wish to quit alcohol

Thank You!