1/6. Trustworthiness as a clinical variable: the problem of trust in the management of chronic, nonmalignant pain.The subjective nature of pain leads to many treatment difficulties. These problems can often be resolved if we know that the patient is trustworthy. Trustworthiness should be assessed as a distinct clinical variable. This is more easily achieved if we examine the three components of trustworthiness: the patient's subjective reports, which we call testimony; the reason that the patient seeks treatment, which we call motive; and the patient's adherence with efforts to get well, which we call responsibility. Because of difficulties with assessing testimony and motive, we propose that establishing the patient's responsibility is the key to assessing trustworthiness.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/6. From basic concepts to clinical reality. Unresolved issues in the diagnosis of dependence.This chapter discusses clinical and conceptual issues pertaining to the diagnosis of alcohol and drug dependence. Emphasis is given to the difficulties involved in moving from diagnostic concepts, such as those contained in the major psychiatric classification systems, to the clinical situation where diagnostic decisions are made. To illustrate how diagnostic concepts approximate clinical reality, a set of case histories is used to organize a discussion of unresolved issues in the diagnosis of dependence. These issues include the putative syndrome nature of dependence, the problem of diagnosing polysubstance use, the primary-secondary distinction, the presence of other psychopathology, and the use of multiaxial evaluation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/6. candida endophthalmitis after intravenous drug abuse.patients with endogenous candida endophthalmitis associated with intravenous (IV) drug abuse may manifest ocular and systemic signs different from those seen in other forms of endogenous candida endophthalmitis. There may be a sparcity of evidence of systemic candidiasis, including negative serology and normal physical examination results. Anterior uveitis and extensive vitreous involvement are common and do not necessarily have associated typical retinal lesions, which are more commonly seen in the compromised host. This may occur either because of the more transitory nature of choroidal or retinal lesions or because these patients often seek treatment at later stages. Even with a typical clinical picture, it is difficult to get culture confirmation of the diagnosis. Material obtained by vitrectomy must be concentrated before inoculation of media because of the known difficulty of culturing candida from the vitreous cavity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/6. Hodgkin's disease in hiv-infected patients.Eight patients with Hodgkin's disease who were seropositive to human immunodeficiency virus (hiv), 6 of them being heroin addicts and one a homosexual, were studied. Histological examination showed 4 cases of lymphocytic depletion, 2 cases of mixed cellularity, 1 nodular sclerosis, and one not classifiable. There were five cases of stage IV-B and 3 IIIs-B. The response to treatment was poor, with disproportionate cytopenia and severe infectious complications. We suggest that the atypical nature of Hodgkin's disease in patients who are seropositive for hiv might be considered to be a part of the acquired immunodeficiency syndrome (AIDS).- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/6. Primary phycomycosis of the brain in heroin addicts.Two heroin addicts had fatal primary phycomycosis of the brain. The first case is unique. A 28-year-old man displayed unusual symptoms of unilateral hydrocephalus confirmed by both computed tomography (CT) scanning of the brain and craniotomy. The nature of the fungal granuloma was verified histopathologically. The second case, a 40-year-old man, possessed bilateral basal ganglionic lesions in which the CT scanning suggested abscesses. Postmortem examination confirmed the presence of phycomycotic abscesses. There was no evidence of systemic mycoses in both cases. review of the clinical features of this fatal complication in drug abusers and narcotic addicts disclosed that hemiparesis and facial weakness are common. brain or CT scan along with brain biopsy are necessary for rapid diagnosis and prompt treatment.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/6. role reversals in families of substance misusers: a transgenerational phenomenon.Fifty adult methadone maintained opiate misusers were seen with their spouse and/or family of origin in outpatient therapy as part of a veterans Administration research project supported by NIDA. Family treatment was offered in an attempt to improve and enhance family relationships/social supports and to aid in the decrease or cessation of drug use. In this study, 42 of the 50 patients had parents who were substance misusers. The subjects were evaluated by constructing a Three-Generational Family Tree to define and clarify the nature of problems across the generations. Success or failure was measured by the Addiction Severity Index (ASI) which assessed drug use, problems with family, health, social relationships, legal difficulties, and employment as well as psychiatric symptoms. A recurrent problem of the "absent father" was identified across both generations studied. Thirty of the 50 opiate misusing men had absent fathers (usually due to alcohol or other drug misuse) and 27 of these 30 became absent fathers (also usually due to substance misuse) when they had children of their own. The absence of a father produced major developmental problems seen in these families. Particularly important was the "Parentified child," forced to prematurely assume adult responsibilities. This age inappropriate role assumption was common in both the patients and their children, and was seen as a contributor to the initiation of drug misuse. A structured clinical intervention is described using the three-generational family tree to bring out these relationship issues, followed by supportive family therapy to restructure wounded family relationships from the family of origin and to bring about appropriate role expectations in the marital families. The findings suggest an improvement in legal difficulties, drug use, and psychiatric symptoms.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |