Preparation for Child Psych PRITE and Boards
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===Alcohol use in adolescents=== | ===Alcohol use in adolescents=== | ||
| − | According to large epidemiological study 35% of adolescents (12-17) had used alcohol in the last year; 16% of those who had used alcohol met criteria for an alcohol use disorder (abuse or dependence). Thus the prevalence of alcohol use disorders in adolescents is around 5%. By comparison, 13% of adolescents smoked marijuana | + | According to large epidemiological study 35% of adolescents (12-17) had used alcohol in the last year; 16% of those who had used alcohol met criteria for an alcohol use disorder (abuse or dependence). Thus the prevalence of alcohol use disorders in adolescents is around 5%. By comparison, of the 13% of adolescents smoked marijuana, a quarter went to develop a drug use disorder. The prevalence of marijuana use disorder and analgesic opioids use disorders were (3.4%) and (1.2%) respectively. (1) |
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==Diagnosis according to DSM-IV-TR== | ==Diagnosis according to DSM-IV-TR== | ||
Revision as of 19:16, 28 November 2011
Contents
Introduction and Terms
Alcohol
Alcohol use in adolescents
According to large epidemiological study 35% of adolescents (12-17) had used alcohol in the last year; 16% of those who had used alcohol met criteria for an alcohol use disorder (abuse or dependence). Thus the prevalence of alcohol use disorders in adolescents is around 5%. By comparison, of the 13% of adolescents smoked marijuana, a quarter went to develop a drug use disorder. The prevalence of marijuana use disorder and analgesic opioids use disorders were (3.4%) and (1.2%) respectively. (1)
Diagnosis according to DSM-IV-TR
Managing acute intoxication
Chronic management
Diagnostic pearls
Etiological subtypes (based on Cloninger’s Alcoholism Typology)
- Type 1 (also type A) alcoholism (75%) is characterized by adult onset and drinking to relieve depression and anxiety; alcoholics often feel guilty about drinking. Patients quickly develop behavioral tolerance
- Type 2 (also type B) alcoholism (25%) is characteized by early onset and antisocial and risk-taking behavior while intoxicated; it has been termed male-limited alcoholism due to perceived transmission from fathers to sons
Laboratory tests
- Markers of heay use: GGT (same as GGTP) gamma-glutamyl transferase (or transpeptidase) and CDT (carbohydrate-deficient transferrin). GGT is also elevated in DM, HTN, chronic liver disease (low specificty)
- Elevated AST and ALT with classic ratio of 2:1
- Elevated MCV, a finding also seen in macrocytic and Folate/Vitamin B12 anemias
- Blood alcohol level (BAL)
Clinical pearls
Distingwsuish between a "hangover" and withdrawal