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Addiction

Differential Diagnosis Schema 🧠

Substance Use Disorders

  • Alcohol Use Disorder: Chronic alcohol consumption, withdrawal symptoms, tolerance, and impact on social/occupational functioning
  • Opioid Use Disorder: Dependence on opioids, withdrawal signs, history of opioid prescriptions or illicit use
  • Stimulant Use Disorder: Use of amphetamines or cocaine, signs of intoxication or withdrawal
  • Sedative/Hypnotic/Anxiolytic Use Disorder: Use of benzodiazepines or similar drugs, tolerance, and withdrawal

Behavioral Addictions

  • Gambling Disorder: Preoccupation with gambling, repeated unsuccessful efforts to control gambling
  • Internet Gaming Disorder: Excessive time spent on gaming, leading to impairment in social or occupational functioning
  • Food Addiction: Compulsive overeating, particularly of high-sugar or high-fat foods, leading to obesity and related health issues

Psychiatric Disorders

  • Major Depressive Disorder: Persistent low mood, anhedonia, sleep disturbance, and possible substance use as self-medication
  • Bipolar Disorder: Episodes of mania or hypomania, high risk of substance misuse during manic episodes
  • Generalized Anxiety Disorder: Excessive worry, use of substances like alcohol or benzodiazepines to alleviate anxiety symptoms
  • Personality Disorders: Especially borderline personality disorder, where impulsivity can lead to substance misuse

Key Points in History πŸ₯Ό

Presenting Complaint

  • Onset, duration, and nature of symptoms (e.g., cravings, withdrawal)
  • Impact on daily functioning (e.g., work, relationships)
  • Attempts to reduce or stop the addictive behavior
  • Triggers or patterns related to the behavior

Background

  • Past Medical History: Relevant conditions like depression, anxiety, chronic pain
  • Drug History: Current and past use of prescription or illicit drugs, including dosages and durations
  • Family History: Family members with addiction or psychiatric conditions
  • Social History: Employment status, housing, relationships, and social support
  • Lifestyle: Use of alcohol, tobacco, and other substances

Possible Investigations 🌑️

Blood Tests

  • Liver function tests (LFTs): To assess for alcohol-related liver damage
  • Full blood count (FBC): To check for anemia or infection, commonly seen in chronic alcohol or drug users
  • Electrolytes: Imbalances may indicate chronic vomiting, poor nutrition, or other complications related to substance misuse
  • Toxicology screen: To identify substances that may not be disclosed in history

Imaging

  • CT/MRI of the brain: To rule out structural abnormalities in cases of cognitive impairment or unexplained neurological symptoms
  • Ultrasound of the liver: In cases of suspected alcohol-related liver disease

Screening Tools

  • AUDIT (Alcohol Use Disorders Identification Test): To assess alcohol consumption, drinking behaviors, and alcohol-related problems
  • CAGE questionnaire: A shorter screening tool for problematic alcohol use
  • ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test): A screening tool for a broader range of substance use
  • Gambling Severity Index: A tool to assess the severity of gambling problems

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