According to Jellinek’s classification of alcoholism, which of the following types refers to a person who has developed physical and psychological dependence but still maintains the ability to abstain if necessary?
C. According to Jellinek, drinking behaviour is heterogeneous. He described fi ve species of alcoholism. Type alpha represents a purely habitual use without loss of control. A person with alpha alcoholism retains the ability to abstain. Type beta refers to development of physical complications without physical or psychological dependence. Type gamma represents acquired tissue tolerance leading to physical dependence and loss of control. They still maintain the ability to abstain if necessary. Type delta shares the three features of gamma, but the inability to abstain becomes prominent. Type epsilon refers to dipsomania or periodic alcoholism. More recently, various investigators have come up with different classifications, which overlap each other.
Which of the following is NOT a criterion for alcohol dependence syndrome as described by Edwards and Gross?
E. In 1976, Edwards and Gross proposed that not all people who drink too much are dependent on alcohol. They suggested the criteria for an alcohol dependence syndrome. This model forms the basis for the current ICD-10 classification. They noted that dependence was not an ‘all or none’ phenomenon, but lay on a spectrum of severity. The criteria were based on the clinical observation that some of the heavy drinkers manifested an interrelated clustering of signs and symptoms. The criteria are narrowing of repertoire; salience of drinking; increased tolerance to alcohol; withdrawal symptoms; relief drinking; subjective awareness of compulsion to drink; reinstatement after abstinence. Not all the elements need always be present, nor always present with the same intensity.
Which of the following is NOT a diagnostic criterion for alcohol dependence according to DSM-IV?
A. ICD-10 includes six items under dependence, most of which are similar to DSM-IV. For a diagnosis of dependence, three or more items should have occurred in the past year. The ‘strong desire or sense of compulsion to take the substance’ is viewed as a central descriptive characteristic of dependence in ICD-10. This compulsive-use indicator is not included in the concept of dependence described by DSM-IV. DSM-IV also allows categorization of substance dependence with or without physiological dependence depending on the presence of tolerance and withdrawal symptoms.
The mortality rate in a person being treated for alcohol withdrawal delirium is:
A. Alcohol dependence occurs in 15–20% of hospitalized patients in some settings. Hence withdrawal from alcohol is also a common presentation in this population. Withdrawal symptoms are minor in most cases, but they can be considerable and even fatal in some. Alcohol withdrawal delirium, commonly known as delirium tremens or ‘DTs’, is the most serious manifestation of alcohol withdrawal syndrome. Classic studies quote a mortality of around 15%, but with advances in treatment, mortality rates have fallen, and more recent studies indicate a mortality of 0 to 1% in treated cases.
What is the typical time period in which withdrawal delirium appears in an alcohol-dependent person who has stopped drinking?
C. Clinical features of alcohol withdrawal syndrome can appear within hours of the last drink (usually 6–12 hours) but alcohol withdrawal delirium typically does not develop until 2–3 days after cessation of drinking. Delirium tremens usually lasts 48–72 hours, but can last longer in some cases. Current diagnostic criteria for withdrawal delirium include disturbance of consciousness, change in cognition or perceptual disturbance developing in a short period, and the emergence of symptoms during or shortly after withdrawal from heavy alcohol intake. The classic clinical presentation also includes hyperpyrexia, tachycardia, hypertension, and diaphoresis. The neurobiological basis for withdrawal is a gradual up-regulation of N-methyl-D-aspartate receptors under the influence of chronic alcohol use.
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