Substance Use Disorders Practice Questions

Q: Chronic disorder characterized by compulsive use of drugs, resulting in physical, psychological, and social harm, and continued use despite evidence that it is harmful is called.

Drug addiction. ***Drug addiction*** - This definition accurately describes **drug addiction** as a chronic disorder involving compulsive drug use despite harmful consequences across physical, psychological, and social domains. - Key components include the **compulsive nature** of use, the **harmful outcomes**, and the persistence of use even with awareness of these harms. *Substance intoxication* - **Substance intoxication** refers to the acute, reversible effects of a substance on the central nervous system, leading to clinical changes in perception, mood, and behavior. - It does not encompass the chronic, compulsive use or the long-term physical, psychological, and social harms characteristic of addiction. *Drug abuse* - **Drug abuse** is a pattern of harmful use of a psychoactive substance, but it doesn't necessarily include the compulsive, chronic nature and the concept of continued use despite acknowledging harm that defines addiction. - The term "abuse" is often considered outdated in favor of "substance use disorder" in clinical contexts to better reflect the chronic disease model. *Drug dependence* - **Drug dependence** refers to a physiological state where the body adapts to a substance, leading to **withdrawal symptoms** if the substance is stopped and **tolerance** to its effects. - While it is a component of addiction, it does not fully capture the compulsive drug-seeking behavior or the broader psychological and social harms that define addiction itself.

Q: An alcoholic is brought to the casualty, 3 days after quitting alcohol, with complaints of irrelevant talking. On examination, he is found to be disoriented to time, place, and person, and also exhibits visual illusions and hallucinations. There is no history of head injury. What is the most probable diagnosis?

Delirium tremens. ***Delirium tremens*** - This patient's symptoms, including **disorientation, irrelevant talking, visual illusions, and hallucinations**, occurring 3 days after quitting alcohol, are classic features of **delirium tremens (DTs)**. - DTs represent the most severe form of alcohol withdrawal, typically manifesting 48-96 hours after the last drink, and are a medical emergency. *Schizophrenia* - Schizophrenia is a **chronic psychiatric disorder** characterized by a breakdown in thought processes and poor emotional responsiveness. - While it can involve hallucinations and delusions, its onset is typically more gradual, not acutely precipitated by alcohol cessation, and patients are often younger or with a long history of mental illness. *Dementia praecox* - **Dementia praecox** is an older term for what is now known as **schizophrenia**. - As with schizophrenia, it does not typically present as an acute withdrawal syndrome with rapid onset after substance cessation. *Korsakoff psychosis* - **Korsakoff psychosis** (also known as Korsakoff syndrome) is a chronic neurological disorder caused by severe **thiamine deficiency**, often associated with alcoholism. - Its primary symptoms include **severe memory impairment (anterograde and retrograde amnesia)**, confabulation, and apathy, rather than acute disorientation, illusions, and hallucinations seen in the acute withdrawal phase.

Q: Which of the following is NOT typically associated with Korsakoff's psychosis?

Immediate/Working Memory Loss. ***Immediate/Working Memory Loss*** - Korsakoff's psychosis is primarily characterized by **profound anterograde amnesia** (inability to form new long-term memories) and significant **retrograde amnesia** (loss of past memories). - **Immediate/working memory** (the ability to hold information for seconds, such as digit span) is **relatively preserved** in Korsakoff's syndrome, unlike the severe deficits in forming and retrieving long-term memories. - The core deficit is the inability to transfer information from working memory to long-term storage (consolidation failure), not impairment in immediate recall itself. - This preservation of immediate memory with profound long-term memory loss is a key distinguishing feature of the syndrome. *Confabulation* - **Confabulation** (fabrication of memories without intent to deceive) is a **classic and common symptom** of Korsakoff's psychosis. - Patients spontaneously generate false narratives to fill in memory gaps, arising from severe anterograde and retrograde amnesia. - This is a pathognomonic feature used in clinical diagnosis. *Long Term Memory Loss* - **Severe long-term memory loss** (both anterograde and retrograde) is the **defining hallmark** of Korsakoff's psychosis. - Anterograde amnesia prevents formation of new long-term memories, while retrograde amnesia causes loss of previously stored memories, typically with a temporal gradient. - This profoundly impacts daily functioning and is central to diagnosis. *Mammillary Bodies Involved* - Damage to the **mammillary bodies** and **dorsomedial nucleus of the thalamus** due to **thiamine (B1) deficiency** is the **neuropathological basis** of Korsakoff's psychosis. - These structures are critical components of the **Papez circuit** (hippocampus-fornix-mammillary bodies-thalamus-cingulate-hippocampus), essential for memory consolidation. - Often preceded by Wernicke's encephalopathy (acute confusional state, ataxia, ophthalmoplegia).

Q: What is the primary psychoactive component found in cannabis?

Tetrahydrocannabinol (THC). ***Tetrahydrocannabinol (THC)*** - **THC** is the primary psychoactive cannabinoid in cannabis, responsible for the "high" associated with its use - Exerts its effects primarily by binding to **CB1 receptors** in the brain, influencing mood, perception, and cognition - This is the most abundant and potent psychoactive compound in cannabis *Cannabidiol (CBD)* - **CBD** is a non-psychoactive cannabinoid and does not produce the "high" associated with cannabis - Often studied for its potential therapeutic effects, including anti-inflammatory, anxiolytic, and anti-seizure properties - Does not bind significantly to CB1 receptors *Cannabinol (CBN)* - **CBN** is a degradation product of THC, forming as THC breaks down over time when exposed to heat and light - Has some mild psychoactive properties but is significantly **less potent** than THC - Often associated with sedative effects rather than the typical cannabis "high" *Delta-8 THC* - **Delta-8 THC** is a minor cannabinoid and an isomer of Delta-9 THC (the main psychoactive component) - Psychoactive but generally considered **less potent** than Delta-9 THC, leading to a milder "high" - Found in much smaller quantities in cannabis compared to Delta-9 THC

Q: Most common type of hallucination seen in alcoholic hallucinosis is:

Auditory hallucinations. ***Auditory hallucinations*** - **Auditory hallucinations** are the most characteristic and frequent type of hallucinations experienced in **alcoholic hallucinosis**. - These often involve **voices** that may be threatening, accusatory, or commenting on the patient's actions, leading to significant distress. *Visual hallucinations* - While visual hallucinations can occur, they are **less common** than auditory hallucinations in alcoholic hallucinosis. - Visual hallucinations are more typical of **delirium tremens**, where they might involve small, moving objects or terrifying images. *Tactile hallucinations* - **Tactile hallucinations**, such as the sensation of insects crawling on the skin (formication), are characteristic of **delirium tremens** or severe **cocaine intoxication**. - They are generally **not the predominant type** of hallucination in alcoholic hallucinosis. *Reflex hallucinations* - **Reflex hallucinations** refer to a rare phenomenon where a hallucination is consistently triggered by a specific stimulus in another sensory modality. - This is a **highly unusual** and specific type of hallucination not typically associated with alcoholic hallucinosis.

Q: Which drug is used for long-term maintenance in opioid addiction?

Methadone. ***Methadone*** - **Methadone** is a long-acting opioid agonist used daily for **maintenance therapy** in opioid addiction, preventing withdrawal symptoms and reducing cravings. - Its long half-life allows for once-daily dosing, which helps in stabilizing patients and reducing illicit opioid use. - Along with **buprenorphine** (a partial agonist), methadone is one of the two primary medications used for opioid maintenance therapy. *Naloxone* - **Naloxone** is an **opioid antagonist** used to rapidly reverse opioid overdose by competitively binding to opioid receptors. - It is not used for long-term maintenance but rather as an emergency intervention to counteract life-threatening respiratory depression. *Nalorphine* - **Nalorphine** is an older, mixed opioid agonist-antagonist that was once used for opioid overdose but has largely been replaced by naloxone due to its own opioid agonistic effects. - It does not have a role in current long-term maintenance treatment for opioid addiction. *Butorphanol* - **Butorphanol** is a mixed opioid agonist-antagonist primarily used as an analgesic, particularly for pain management. - It can precipitate withdrawal in opioid-dependent individuals and is not indicated for the treatment or maintenance of opioid addiction.

Q: Korsakoff's psychosis is associated with which of the following conditions?

Chronic alcohol use. ***Chronic alcohol use*** - **Korsakoff's psychosis** is a severe form of **Wernicke-Korsakoff syndrome**, primarily caused by a deficiency of **thiamine (vitamin B1)**. - **Chronic alcohol abuse** is the most common cause of thiamine deficiency in developed countries due to poor nutritional intake and impaired absorption. *Chronic renal failure* - While chronic renal failure can lead to various neurological complications, it is not directly associated with **Korsakoff's psychosis**. - Renal failure can cause uremic encephalopathy or peripheral neuropathy, but not the specific memory deficits seen in Korsakoff's. *Marasmus* - **Marasmus** is a form of severe undernutrition characterized by **energy deficiency and muscle wasting**. - Although it involves nutrient deficiencies, it typically does not lead to the specific neurological syndrome of **Korsakoff's psychosis**, which is linked to thiamine deficiency. *Cirrhosis* - **Cirrhosis** is advanced liver disease, often caused by chronic alcohol use, but it is not the direct cause of **Korsakoff's psychosis**. - While patients with cirrhosis may have nutritional deficiencies, the direct cause of Korsakoff's is **thiamine deficiency**, not the liver damage itself.

Q: Which of the following drugs is given for detoxification of alcohol in chronic alcoholics?

Chlordiazepoxide. ***Correct Option: Chlordiazepoxide*** - **Chlordiazepoxide** is a **benzodiazepine** commonly used for acute alcohol withdrawal syndrome due to its long half-life and efficacy in reducing withdrawal symptoms. - It helps prevent **seizures** and **delirium tremens** by acting on GABA receptors, reducing neuronal hyperexcitability. *Incorrect Option: Haloperidol* - **Haloperidol** is an **antipsychotic** medication primarily used to manage acute psychosis, agitation, or delirium. - It does not directly address alcohol withdrawal symptoms and can potentially lower the **seizure threshold**, which is risky in alcohol withdrawal. *Incorrect Option: Naltrexone* - **Naltrexone** is an **opioid antagonist** used to reduce alcohol cravings and prevent relapse in individuals who have achieved abstinence. - It is not used for acute detoxification or withdrawal management, as it does not alleviate acute symptoms. *Incorrect Option: Buprenorphine* - **Buprenorphine** is a **partial opioid agonist** used primarily in the treatment of opioid use disorder. - It has no role in the detoxification or management of alcohol withdrawal syndrome.

Question 1

Chronic disorder characterized by compulsive use of drugs, resulting in physical, psychological, and social harm, and continued use despite evidence that it is harmful is called.

Accepted Answer

Drug addiction

Answer

Substance intoxication

Answer

Drug abuse

Answer

Drug dependence

Question 2

An alcoholic is brought to the casualty, 3 days after quitting alcohol, with complaints of irrelevant talking. On examination, he is found to be disoriented to time, place, and person, and also exhibits visual illusions and hallucinations. There is no history of head injury. What is the most probable diagnosis?

Accepted Answer

Delirium tremens

Answer

Schizophrenia

Answer

Dementia praecox

Answer

Korsakoff psychosis

Question 3

Which of the following is NOT a feature of delirium tremens?

Accepted Answer

Cranial nerve deficits, such as oculomotor nerve palsy

Answer

Hallucinations, particularly visual

Answer

Tremors, especially coarse

Answer

Confusion or clouding of consciousness

Question 4

A 16-year-old boy suffering from drug abuse presents with a cross-over of sensory perceptions, where sounds can be seen and colors can be heard. Which of the following is the most likely agent responsible for the drug abuse?

Accepted Answer

LSD, a hallucinogen known for causing synesthesia and intense sensory distortions.

Answer

Cocaine, a stimulant that can cause heightened sensory perception and euphoria.

Answer

PCP, a dissociative drug that can cause hallucinations and altered sensory perceptions.

Answer

Marijuana, a psychoactive substance that can alter perception and cause mild hallucinations.

Question 5

Which of the following is NOT typically associated with Korsakoff's psychosis?

Accepted Answer

Immediate/Working Memory Loss

Answer

Long Term Memory Loss

Answer

Confabulation

Answer

Mammillary Bodies Involved

Question 6

What is the primary psychoactive component found in cannabis?

Accepted Answer

Tetrahydrocannabinol (THC)

Answer

Cannabidiol (CBD)

Answer

Cannabinol (CBN)

Answer

Delta-8 THC

Question 7

Most common type of hallucination seen in alcoholic hallucinosis is:

Accepted Answer

Auditory hallucinations

Answer

Visual hallucinations

Answer

Tactile hallucinations

Answer

Reflex hallucinations

Question 8

Which drug is used for long-term maintenance in opioid addiction?

Accepted Answer

Methadone

Answer

Naloxone

Answer

Nalorphine

Answer

Butorphanol

Question 9

Korsakoff's psychosis is associated with which of the following conditions?

Accepted Answer

Chronic alcohol use

Answer

Marasmus

Answer

Chronic renal failure

Answer

Cirrhosis

Question 10

Which of the following drugs is given for detoxification of alcohol in chronic alcoholics?

Accepted Answer

Chlordiazepoxide

Answer

Haloperidol

Answer

Naltrexone

Answer

Buprenorphine

Substance Use Disorders — MCQs

Substance Use Disorders — MCQs

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