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substance misuse

richard laugharne kumasi november 2006

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.

Effects of alcohol
Cirrhosis Gastric ulcer Carcinomas Cardiomyopathy Pancreatic disease Head injury Aspiration lung abscess

Depression, anxiety, Hallucinosis, dementia Delirium tremens, Wernicke-Korsakoff syndrome

Unemployment Family breakdown Aggression Financial Crime

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

Alcohol dependency syndrome

Craving Primacy Stereotypy Withdrawals Tolerance Eyeopener Reinstatement

Treat any underlying condition Educate: encourage to reduce or stop Self help groups Support from community e.g. church Motivational interviewing

What do people use? What problems do they cause? Cannabis and psychosis

Cannabis and psychosis

Evidence not entirely clear May be aetiological May precipitate illness in people prone to psychosis