The basics
This four-question alcohol screening instrument uses the themes Cut down, Annoyed, Guilty, and Eye-opener
What is CAGE?
Alcohol metabolism produces this toxic intermediate, which is responsible for the unpleasant reaction caused by disulfiram
What is acetaldehyde?
A patient with severe alcohol use disorder stops drinking abruptly. Approximately how many hours after the last drink do early withdrawal symptoms such as tremor, anxiety, diaphoresis, and tachycardia typically begin?
What is 6–24 hours?
This medication for alcohol use disorder blocks opioid receptors and helps reduce heavy drinking and alcohol-related reward.
What is naltrexone?
A 40-year-old patient with severe AUD presents to the emergency department with slurred speech, ataxia, impaired coordination, and horizontal gaze nystagmus. His blood alcohol concentration is 280 mg/dL. He is somnolent but arousable, without tremors or autonomic instability. What is the most likely diagnosis?
What is acute alcohol intoxication?
A patient has 5 DSM-5 AUD criteria during the past year. This is the correct diagnostic severity specifier.
What is moderate alcohol use disorder?
Chronic ethanol exposure produces compensatory changes in two major neurotransmitter systems. These adaptations explain the CNS hyperexcitability seen during abrupt alcohol cessation. Identify both systems and the direction of their adaptations
What are decreased GABAergic inhibitory function and increased glutamatergic/NMDA excitatory function?
A 45-year-old patient with severe AUD experiences a generalized tonic-clonic seizure approximately 24 hours after his last drink. What is the most likely cause, and which medication class is first-line for preventing recurrent withdrawal seizures?
What are alcohol withdrawal seizures, treated with benzodiazepines?
A patient with AUD has recently achieved abstinence and wants medication to help maintain sobriety. Name this medication.
What is acamprosate?
A patient with AUD states, "I know my drinking is affecting my marriage, but I'm not sure I'm ready to stop." According to the transtheoretical model of change, which stage is the patient demonstrating?
What is the contemplation stage?
A patient develops auditory hallucinations after stopping heavy alcohol use but remains fully oriented with preserved attention. Name this diagnosis.
What is alcoholic hallucinosis?
Alcohol's reinforcing effects are partly mediated by increased dopamine release within this mesolimbic structure, which receives projections from the ventral tegmental area.
What is the nucleus accumbens?
A 52-year-old patient develops agitation, visual hallucinations, disorientation, tachycardia, and severe diaphoresis approximately 72 hours after stopping alcohol. What is the most likely diagnosis?
What is delirium tremens?
A patient taking medication for AUD develops flushing, nausea, vomiting, and tachycardia after drinking alcohol. Which medication is most likely responsible?
What is disulfiram?
A 55-year-old patient with severe AUD requests outpatient detoxification. The patient has minimal withdrawal symptoms currently but reports having experienced delirium tremens during a previous hospitalization. What historical factor places this patient at increased risk for complicated withdrawal?
What is a previous history of delirium tremens?
A psychiatrist suspects a patient has resumed drinking despite denying alcohol use. Which direct blood biomarker may detect ethanol exposure over approximately the preceding two to four weeks?
What is phosphatidylethanol (PEth)?
A patient develops marked facial flushing, palpitations, nausea, and headache after consuming relatively small amounts of alcohol. Genetic reduction in the activity of which enzyme best explains this presentation?
What is aldehyde dehydrogenase (ALDH)?
A patient with severe AUD and cirrhosis develops alcohol withdrawal. Which benzodiazepine is generally preferred over diazepam because it is less dependent on hepatic oxidative metabolism?
What is lorazepam?
A psychiatrist considers an off-label medication for AUD that may help with alcohol-related insomnia and anxiety during early recovery. The medication is also commonly used for neuropathic pain.
What is gabapentin?
A 54-year-old patient with chronic heavy alcohol use has an AST of 180 U/L and ALT of 65 U/L. Which characteristic laboratory pattern raises suspicion for alcohol-associated liver injury?
What is an AST-to-ALT ratio greater than 2:1?
A hospitalized patient with AUD develops paranoia, visual hallucinations, impaired attention, and fluctuating orientation. Which two examination findings most strongly distinguish delirium from primary psychosis?
What are impaired attention and fluctuating awareness?
A 49-year-old patient reports that earlier attempts to stop drinking caused only mild tremor, but more recent attempts resulted in severe withdrawal and generalized seizures despite similar alcohol consumption. What neurobiological phenomenon best explains this progressively severe withdrawal?
What is the kindling phenomenon?
A patient undergoing alcohol withdrawal treatment remains severely agitated, tachycardic, and hypertensive despite repeated benzodiazepine doses. Which barbiturate may be considered for severe or benzodiazepine-resistant withdrawal under close medical monitoring?
What is phenobarbital?
A 42-year-old patient with severe alcohol use disorder and schizophrenia expresses interest in disulfiram to maintain abstinence. He has a history of recurrent psychotic episodes. What is an important contraindication to disulfiram treatment?
What is active psychosis?
A 46-year-old patient with severe AUD presents after several days of heavy drinking followed by vomiting and minimal oral intake. Laboratory testing reveals an anion-gap metabolic acidosis, elevated serum beta-hydroxybutyrate, and a glucose level of 110 mg/dL. What is the most likely diagnosis?
What is alcoholic ketoacidosis?