1/12. Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.BACKGROUND: It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems. methods: We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically. RESULTS: The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. CONCLUSIONS: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/12. Changes in P300 latency during the early withdrawal period in chronic alcohol-dependent patients: two case reports.AIMS: The present study focused on changes in P300 of the event-related potential (ERP) in two patients with alcohol dependence recorded throughout their alcohol withdrawal period. RESULTS: As a result of this investigation, the peak latency of P300 in each patient was significantly shorter 2 or 3 days after abstinence from alcohol, when marked neurological manifestations appeared, compared to that of the control obtained from 8 to 10 days after cessation of drinking. CONCLUSIONS: It seems reasonable to conclude that the shortening of P300 latency reflects the enhancement of brain activity during the early withdrawal period and that an investigation of changes in P300 would be helpful to clarify the nature of neural activity in the brain associated with alcohol withdrawal.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/12. Complex pain consultations in the pediatric intensive care unit.The assessment and management of pain in children is not always easy and it is clearly more difficult in the critical care setting. pain management is further complicated in this vulnerable population by the nature of their critical condition, the complexity and multidimensionality of their illness or injuries, and the intensity of emotions in this environment. A variety of pain syndromes are encountered in the pediatric intensive care unit, and the staff there may not be familiar with or comfortable managing these cases. Pain assessment and treatment can be more appropriately managed when guided by the experts of a multidisciplinary pediatric pain service.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/12. Protracted withdrawal syndromes from benzodiazepines.The benzodiazepine withdrawal syndrome is a complex phenomenon which presents serious difficulties in definition and measurement. It is particularly difficult to set out precise limits on its duration. Many withdrawal symptoms are a result of pharmacodynamic tolerance to benzodiazepines, some mechanisms for which are discussed. Such tolerance develops unevenly in different brain systems and may be slow to reverse. Withdrawal symptoms occurring in the first week after cessation of drug use tend to merge with more persistent symptoms that may last for many months. These prolonged symptoms do not necessarily constitute "true" pharmacological withdrawal symptoms, but are nevertheless related to long-term benzodiazepine use. Such symptoms can include anxiety, which may partly result from a learning deficit imposed by the drugs, and a variety of sensory and motor neurological symptoms. The protracted nature of some of these symptoms raises the possibility that benzodiazepines can give rise not only to slowly reversible functional changes in the central nervous system, but may also occasionally cause structural neuronal damage.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/12. Non-convulsive status epilepticus after abrupt withdrawal of hypnotic-sedative drugs.Four patients with severe addiction to sedative-hypnotics and with acute withdrawal symptoms of these drugs are described. They developed latent confusional states with characteristic EEG patterns (bilateral slow and sharp waves of high amplitude). Following small doses of benzodiazepines the EEG became normal together with a reduction in the clinical symptoms. It is suggested that the confusional states were of an epileptic nature.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/12. Benzodiazepine dependence--aetiological factors, time course, consequences and withdrawal symptomatology: a study of five cases.The development and time course of benzodiazepine (BZD) dependence is reported for five case histories. The underlying psychiatric disorders, life-events as potential initiators of BZD use/abuse and psychosocial consequences are discussed. The abstinence symptoms appearing during a course of standardized withdrawal therapy are described in detail. The case reports clearly demonstrate the chronic nature of the development of BZD dependence and of the tendency to increase the dosage which may occur only after years of intake and the gradual appearance of negative effects of chronic BZD intake.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/12. lorazepam-related withdrawal seizures.lorazepam is a new member of a constantly growing benzodiazepine family. It has been demonstrated to be an effective anxiolytic agent, but as with use of other drugs of this nature, tolerance and dependence may occur. These unwanted effects can constitute a serious clinical problem. We report on two patients with grand mal seizures, which were thought to be secondary to abrupt withdrawal of lorazepam. Because these types of agents are the most widely used drugs in medical practice, their potential risks must be emphasized.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/12. Propoxyphene dependence: an update.Despite the initial claims that propoxyphene (Darvon) provides analgesia without risk of dependence, there is growing international recognition of its addictive potential, with documentation of both psychological dependence and physical withdrawal symptoms. However, many physicians remain uninformed of the true nature of the drug and its potential for abuse and addiction. In terms of frequency of addiction among users, propoxyphene may be less dangerous than most narcotics, but it is more available by prescription and less expensive then illegal opiates, making it a prime target for both abuse and addiction. At present, increased caution by prescribing physicians is indicated. patients now taking the drug should be carefully monitored for signs of abuse or dependence.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/12. Biopsychosocial changes associated with cessation of cannabis use: a single case study of acute and chronic cognitive effects, withdrawal and treatment.A 35 year old male was cognitively assessed prior to cessation of 18 years of daily cannabis use and monitored for several weeks post cessation. brain event-related potential (ERP) measures of selective attention reflecting a difficulty in filtering out complex irrelevant information showed no indication of improvement over 6 weeks of abstinence. In contrast, when tested in the acutely intoxicated state prior to cessation of use, a dramatic normalisation of the ERP signature of this individual was observed. A treatment program based on supportive-expressive psychotherapy was administered and depression, anxiety and general psychological health were monitored over the course of withdrawal from cannabis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/12. Topical corticosteroid 'addiction'. A cause of perioral dermatitis.Acne rosacea, perioral dermatitis, and telangiectasia are all local side effects that can flare up when potent topical corticosteroids used on the face are withdrawn. The two cases of perioral dermatitis described here illustrate the nature of the addictive cycle caused by long-term use of these agents. To prevent side effects of topical corticosteroids used on the face, physicians need to avoid long-term prescriptions and shun superpotent agents entirely for this area. pharmacists should not refill topical corticosteroid prescriptions without authorization. Patient education must emphasize the transient nature of flare-ups of itching and rash that occur when these agents are withdrawn. Systemic and topical antibiotics and corticosteroid-free antipruritics are the mainstays of therapy.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
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