nicotine-related disorders answers obtained from dsm-iv-tr and the ajp supplement of august, 2006,...
TRANSCRIPT
![Page 1: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/1.jpg)
Nicotine-related disorders
Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on
substance abuseAs of 1Sep08.
![Page 2: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/2.jpg)
Percentage of population
Q. Percentage of population that smokes?
![Page 3: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/3.jpg)
Percentage of population
Ans. DSM-IV has 30%. Right answer is probably closer to 21% today. The slow decrease per year has ceased and the percentage has become constant in the past few years.
![Page 4: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/4.jpg)
Survey instrument
Q. What is the name of the survey instrument used to measure level of smoking addiction
![Page 5: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/5.jpg)
Survey instrument
Ans. Fagerstrom Tolerance Questionnaire.
![Page 6: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/6.jpg)
Other mental illness
Q. Of individual with a mental illness, what percentage smoke?
![Page 7: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/7.jpg)
Other mental illness
Ans. 55 to 90%, with the 90% pertaining to people with schizophrenia.
![Page 8: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/8.jpg)
Withdrawal
Q. List the 8 DSM signs of nicotine withdrawal.
![Page 9: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/9.jpg)
Withdrawal
Ans. 1] sad2] insomnia3] irritable4] anxious5] can’t concentrate6] restless7] decrease pulse8] increased appetite
![Page 10: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/10.jpg)
Lab findings
Q. What are the sleep and chemical lab findings during withdrawal?
![Page 11: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/11.jpg)
Lab findings
Ans. During withdrawal:
EEG slowing
Decrease catecholamine level
Decrease cortisol level
REM changes
Neuropsychological testing impairments
Decreased metabolic rate
![Page 12: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/12.jpg)
First line medications
Q. Besides nicotine replacement meds, what other meds are regarded as a first line option?
![Page 13: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/13.jpg)
First line medications
Ans.
Bupropion.
Varenicline
![Page 14: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/14.jpg)
Bupropion dosing
Q. What is the typical bupropion dosing schedule?
![Page 15: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/15.jpg)
Bupropion dosing
Ans. Begin with 150 mg SR 7 days before quit date, then 150 mg bid SR 2 days before stop date.
![Page 16: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/16.jpg)
Varenicline dosing
Q. What is typical varenicline dosing?
![Page 17: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/17.jpg)
Varenicline
Ans. Varies somewhat, of course, but the following is typical:
0.5 mg/d x 3 days
0.5 mg/d x 4 days
Dc smoking on 7th day
1 mg/d x 12 weeks
Can go to 2 mg/d
![Page 18: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/18.jpg)
Combination
Q. Can you prescribe varenicline and bupropion in the same pt?
![Page 19: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/19.jpg)
Combination
Ans. Can use both.
![Page 20: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/20.jpg)
Nicotine replacements
Q. Nicotine replacements come in what forms?
![Page 21: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/21.jpg)
Nicotine replacements
Ans.
-- patch
-- gum
-- lozenge
-- nasal spray
-- inhaler
![Page 22: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/22.jpg)
Combinations
Q. Any advantage to combining meds?
![Page 23: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/23.jpg)
Combinations
Ans. Yes, may improve results, including two nicotine replacement meds, in addition to prescribing both nicotine replacement and bupropion and varenicline.
![Page 24: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/24.jpg)
Best results
Q. Very generally, best results are achieved with?
![Page 25: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/25.jpg)
Best results
Ans. Combine meds with psychosocial approach.
![Page 26: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/26.jpg)
Second-line agents
Q. Besides nicotine replacement, varenicline, and bupropion, what other two meds are used?
![Page 27: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/27.jpg)
Second-line meds
Ans.
Nortriptyline
Clonidine
![Page 28: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/28.jpg)
Nortriptyline dosing
Q. Typical dosing schedule for nortriptyline?
![Page 29: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/29.jpg)
Nortriptyline dosing
Ans. Start at 25 mg/d 10 – 14 days before quit day, and increase to 75 mg/d by the quit day.
![Page 30: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/30.jpg)
Clonidine dosing
Q. What is typical clonidine dosing?
![Page 31: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/31.jpg)
Clonidine dosing
Ans. 0.1 to 0.4 mg/d on quit day for 2 to 6 weeks.
![Page 32: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/32.jpg)
FDA
Q. Has the FDA approved any meds?
![Page 33: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/33.jpg)
FDA
Ans.
Nicotine replacement meds
Bupropion
Varenicline
![Page 34: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/34.jpg)
Acupuncture
Q. Status of acupuncture?
![Page 35: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/35.jpg)
Acupuncture
Ans. Not been proven to be effective.
![Page 36: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/36.jpg)
Psychosocial formats
Q. Four general psychosocial approaches are?
![Page 37: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/37.jpg)
Psychosocial formats
Ans.
-- individual
-- group
-- telephone
-- self-help
![Page 38: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/38.jpg)
Psychosocial approaches
Q. Regardless of format, what four psychosocial approaches have value?
![Page 39: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/39.jpg)
Psychosocial approaches
Ans.
-- motivational enhancement therapy
-- behavior therapies
-- CBT
-- social supports
![Page 40: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/40.jpg)
Behavior therapy
Q. What does behavior therapy consists of?
![Page 41: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/41.jpg)
Behavior therapy
Ans.
-- contingency management
-- cue exposure
-- “rapid smoking” aversion
![Page 42: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/42.jpg)
12-step-oriented groups
Q. Has 12-step-oriented groups been effective?
![Page 43: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/43.jpg)
12-step-oriented groups
Ans. Have not been shown to be effective.
![Page 44: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/44.jpg)
Hypnosis
Q. Hypnosis effectiveness in this disorder?
![Page 45: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/45.jpg)
Hypnosis
Ans. Has not been shown to be effective.
![Page 46: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/46.jpg)
Stop date
Q. As part of the psychosocial approach, is abrupt cessation or gradual cessation preferred?
![Page 47: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/47.jpg)
Stop use
Ans. Once date is set to cease, better that cessation be abrupt.
![Page 48: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/48.jpg)
Caffeine use
Q. Advice as to caffeine use after stop date begins.
![Page 49: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/49.jpg)
Caffeine use
Ans. Best to avoid.
![Page 50: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/50.jpg)
Alcohol use
Q. After stop date has begun, advice as to alcohol use?
![Page 51: Nicotine-related disorders Answers obtained from DSM-IV-TR and the AJP Supplement of August, 2006, on substance abuse As of 1Sep08](https://reader036.vdocuments.net/reader036/viewer/2022081515/56649e415503460f94b33ffa/html5/thumbnails/51.jpg)
Alcohol use
Ans. Best to avoid.