Alcohol misuse
Rising problem in Africa 8% of patients presenting to the psychiatric clinic in Kumasi One unit of alcohol is 8g alcohol, and equivalent to a glass of wine, shot of spirit or pint of beer ( 1/4 litre). Safe: 14 units women, 21 units men.
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Effects of alcohol
Physical
Cirrhosis Gastric ulcer Carcinomas Cardiomyopathy Pancreatic disease Head injury Aspiration lung abscess
Psychological
Depression, anxiety, Hallucinosis, dementia Delirium tremens, Wernicke-Korsakoff syndrome
Social
Unemployment Family breakdown Aggression Financial Crime
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Delirium tremens
48-72 hours after last drink Seizures and autonomic instability can kill the patient Treat
Diazepam 5-10mg qds and reduce over 5-7 days Thiamine Wernicke-Korsakoff
nystagmus, opthalmoplegia, ataxia, clouding of consciousness- NEED THIAMINE leading to an irreversible dementia if untreated
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Treatment
Treat any underlying condition Educate: encourage to reduce or stop Self help groups Support from community e.g. church Motivational interviewing
Drugs
What do people use? What problems do they cause? Cannabis and psychosis