Alcohol dependence

From Ganfyd

Alcohol dependence

(AKA alcoholism, alcoholic state.) See description of dependence syndromes.

Diagnosis

History

Special Questionnaires

• FAST test^[1][2][3]
• CAGE and other tests^[4]
• Alcohol Use Disorders Identification Test (AUDIT) test^[5]

Clinical examination

Laboratory tests

[e.g. Gamma GT]

Predisposing Factors

• Genetics
  • Higher concordance in MZ twins than DZ
  • Adoption studies show higher­ rates in adopted children from alcoholic parents
• Personality
• Advertising
• Peer group pressures
• Psychiatric illness
  • Depression
  • Anxiety disorders
  • Phobic disorders
  • Schizophrenia (more rarely)
  • Bipolar affective disorder (particularly when hypomanic/manic)
• Social factors
  • Religion
  • Tradition / cultural factors
  • Economic factors (cheap price leads to greater­ consumption)
  • Occupation
    • Availability of alcohol (Landlords, bartenders etc)
    • Stress of job (Doctors!)

Complications of Alcohol Dependence

• Liver problems in 50% of alcoholics
  • Fatty liver (reversible; may progress to cirrhosis); Hepatitis (80% progress to cirrhosis); Cirrhosis; Jaundice; increased risk of hepatocellular carcinoma
• CNS/nerve/muscle disorders
  • Poor memory/cognition; Cortical atrophy; Retrobulbar neuropathy; Dementia; Fits; Falls; Wide-based gait; Neuropathy; Korsakoff’s encephalopathy; Wernicke’s encephalopathy; Myopathy; Cerebellar degeneration; Epilepsy; Optic atrophy; Central pontine myelinolysis; Marchiafava-Bignami disease
• GI tract
  • Nausea & Vomiting (particularly in the morning; can be prevented by drinking more alcohol); Obesity; Diarrhoea; Gastric erosions; Peptic ulcer disease; Mallory-Weiss tears; Oesophageal varices; Pancreatitis (acute/chronic/calcific); Malnutrition due to poor diet, GI disorders; folate deficiency; Vitamin K deficiency
• Blood
  • Macrocytic anaemia; Bone marrow depression; Haemolysis; Sideroblastic anaemia; Impaired clotting; Reduced platelet function
• Cardiovascular
  • Arrhythmias; **prolongation of QTc interval; Hypertension; Cardiomyopathy; Sudden death in binge drinkers
• Genito-urinary
  • Men - Erectile dysfunction; Delayed ejaculation; Low libido; reduced size of testes & penis; Loss of body hair; Gynaecomastia
  • Women - Abnormalities of menstruation; Loss of breast tissue; Vaginal dryness; Fetal alcohol syndrome in children
• Cancer
  • Oropharynx; Oesophagus; Pancreas; Liver; Lung
• Psychiatric
  • Depression; increased ­risk of suicide (x 50); Deterioration in personality; Short-term amnesia (blackouts); Psychosexual disorders; Pathological jealousy; Fugue state
• Social morbidity
  • Family/relationship breakdown; Effect on children; Poor performance at work; Crime; Accidents & trauma

References