1/20. Reflections on volatile substance dependency treatment. negotiating the boundary between inner and outer reality.A brief review of the causal and treatment literature relating to volatile substance dependency suggests the interaction between individual and system requires careful attention and understanding. A model is tentatively and provisionally adumbrated to help clarify the main factors involved from a dynamic biopsychosocial perspective. Ego boundary disturbances emerge from and reciprocally influence behaviour and social interactions. These disturbances can be avoided temporarily, although inevitably deepened in the long-term, by substance dependence. Two case examples, selected because they differ in many respects, including relative treatment effectiveness, illustrate this integrative perspective. The discussion focuses on explaining the differing outcomes in terms of the extent to which the inner-outer boundary is open to modification and how far it can be successfully negotiated and clarified. A major factor in differentiating between inside and outside is thought to be causal perceptions or "attributions." Successful differentiation tends to facilitate change, as opposed to reinforcing maladaptive homeostasis. Key issues for therapists overlap with addictions treatment in general, including emotional blocks or barriers in patients, difficulty engaging systems in a strategic manner, and countertransference problems. It is argued that these difficulties in therapy might respond to integrative psychotherapeutic responses, provided the differences in perspective are sufficiently understood.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
2/20. Treatment of drug addiction in traumatised refugees. A case report.The comorbidity of post-traumatic stress disorder (PTSD) and drug addiction is quite often overlooked in refugees. However, the simultaneous treatment of both disorders is of elemental importance for a positive outcome in addicted and traumatised refugees. Furthermore, mutual misinterpretations of habits, behaviours and reactions through negligence of the distinct sociocultural context of patient and clinician often leads to unfavourable developments. These observations are exemplified in this case report.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
3/20. An investigation of solvent-induced neuro-psychiatric disorders in spray painters.An index case of chronic toxic encephalopathy is described in a 28 year old male spray painter with eleven years of exposure to solvents at work. The patient had progressive affective symptoms following repeated past episodes suggestive of acute solvent intoxication. He also showed impaired performance on tests of auditory memory, perceptual speed, visual scanning, and manual dexterity, as well as electromyographic evidence of prolongation of distal terminal latency and slowing of conduction velocities. The case investigation was followed up with an epidemiological study of the factory where he worked, to determine if other spray painters might have similar excessive complaints of neuropsychiatric symptoms and/or objective neurobehavioural deficits. This involved 15 other male spray painters employed for at least five years, and a sex- and age-matched group of 15 control workers not exposed to solvents. The spray painters reported significantly more numbers of neurobehavioural symptoms than the controls. There were little differences in neurobehavioural test results, except for aiming test (psychomotor co-ordination) and Benton visual retention test (visual memory). Spray painters with four or more neurobehavioural symptoms also performed more poorly on Digit Symbol (perceptual speed) compared with those with less number of symptoms. The epidemiological results provide strong circumstantial basis for the diagnosis of chronic toxic encephalopathy in the patient, and also indicates a need for vigilance of the hazards of central nervous system disorders in workers with chronic exposure to solvents in singapore.- - - - - - - - - - ranking = 4keywords = behaviour (Clic here for more details about this article) |
4/20. Magnetic resonance studies on brain dysfunction induced by organic solvents.A 38-year-old layer of parquet flooring was referred because of memory impairment, tiredness and diffuse headaches. His work involved using several neurotoxic organic solvents. Extensive laboratory, neuropsychological, clinical neurophysiological, neuroadiological, magnetic resonance (MR) imaging and spectroscopy studies were performed. The neuropsychological and behavioural assessments showed an organic brain syndrome. MR imaging and CT scanning of the brain revealed enlarged ventricles and generalized atrophy. 31P and 1H MR spectroscopic measurements did not show any abnormalities. Owing to recent improvements regarding sensitivity and facilitated assignment, MR spectroscopy may provide in the near future significant additional information on brain metabolism in patients with brain dysfunction presumably induced by organic solvents.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
5/20. Paramethoxyamphetamine (PMA) poisoning; a 'party drug' with lethal effects.Among young people in norway the recreational use of amphetamine derivatives seems to be increasing. Methylenedioxymethamphetamine (MDMA), known as ecstasy, is the dominant substance, having both stimulant and psychedelic properties. Depending on the illegal source of these so-called 'party drugs' the content and purity can vary. This case report describes the first lethal case of paramethoxyamphetamine (PMA) and paramethoxymethamphetamine (PMMA) intoxication reported in norway. A 16-year-old male was admitted to a local hospital in a coma with seizures and hyperthermia after he had been found undressed and barefooted in a local forest (temperature 2 degrees C). He was intubated and given supportive care. blood chemistry revealed hypoglycaemia, hypocalcaemia and hyperkalaemia. Shortly after transfer to the central hospital he developed bradycardia with continuous seizures and asystole. Adverse effects of MDMA are well described and include serotonergic and sympathomimetic symptoms with hyperthermia, coagulopathy, rhabdomyolysis and acute kidney and liver failure. case reports of PMA deaths collectively suggest PMA to be more toxic than MDMA. A delayed effect after intake of PMA compared with MDMA can lead to increased intake. Hypoglycaemia and hyperkalaemia may be specific to PMA poisoning. Increased thermo genesis will result in a search for cooling, which explains the attempt to undress and a desire to submerge in water. In a cool climate this behaviour itself can be lethal. Measures to treat seizures, hypoglycaemia, electrolyte anomalies and hyperthermia are the therapeutic goals. No specific treatment is available.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
6/20. Sexual trauma associated with fisting and recreational drugs.There is a rising trend in high risk sexual behaviour among men who have sex with men (MSM), with concomitant use of recreational drugs. Activities include fisting and unprotected anal intercourse with a partner who is hiv serodiscordant or of unknown status. We describe three cases of hiv positive MSM who have recently attended our unit as a result of complications secondary to fisting.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
7/20. Driving under the influence of chlormethiazole.This article describes a case of driving under the influence of the sedative-hypnotic-anticonvulsant drug chlormethiazole. The suspect, who was a physician, was driving dangerously on a busy highway and caused a traffic collision. When apprehended by the police, the man had bloodshot and glazed eyes and pupil size was enlarged. He could not answer the questions properly and his gait was unsteady. A roadside breath-alcohol screening test was positive but an evidential breath-alcohol test conducted about one hour later was below the legal limit for driving of 0.10 mg/L (10 microg/100 mL or 0.021 g/210 L). Because of the special circumstances of the traffic crash and the man's appearance and behaviour, the police suspected that drugs other than alcohol were involved and obtained a venous blood sample for toxicological analysis. The blood contained 0.23 mg/g alcohol, which is above the legal limit for driving in sweden 0.20 mg/g (20 mg/100 mL or 0.020 g/100 mL), and codeine was also present at a therapeutic concentration of 0.02 mg/L. The conflict between the clinical signs of impairment and the toxicology report prompted a reanalysis of the blood sample with major focus on sedative-hypnotic drugs. Analysis by capillary GC-NPD identified chlormethiazole at a concentration of 5mg/L, the highest so far encountered in traffic cases in sweden. In 13 other impaired driving cases over 10 years the mean (median) and range of concentrations of chlormethiazole were 1.6 mg/L (1.6 mg/L) and 0.3-3.3 mg/L. This case report underscores the need to consider clinical observations and the person's behaviour in relation to the toxicology report when interpreting and testifying in drug-impaired driving cases.- - - - - - - - - - ranking = 2keywords = behaviour (Clic here for more details about this article) |
8/20. Dependence on zolpidem: two case reports of detoxification with flumazenil infusion.Zolpidem is a hypnotic drug that is chemically distinct from benzodiazepines (BDZ). It has been suggested that it acts selectively on gamma-aminobutyric acid receptors. However, recent evidence has shown that the behavioural effects of zolpidem are generally similar to those of BDZs. flumazenil is usually considered to be a BDZ antagonist. Nonetheless, in chronic BDZ users, it acts as a partial, bland agonist. We describe two cases of zolpidem dependence that were detoxified by the use of flumazenil infusion. BDZ dependence is usually treated with tapering of the medication. As an alternative, abrupt discontinuation of the medication and rapid detoxification using flumazenil has been used. flumazenil may represent an alternative to detoxification treatment by employing a tapering approach, or by replacement therapy with BDZs with a long half-life, particularly where patients are hard to treat or have low compliance to treatment.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
9/20. levodopa addiction. A case study.A case is presented of a young woman with a serious addiction to levodopa who over the years developed an extrapyramidal syndrome and chronic paranoid psychotic behaviour. The possible pathophysiological mechanism is discussed.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
10/20. carbamazepine-lithium toxicity in brain-damaged adolescents.For several years carbamazepine has been used to treat intractable mania and it is frequently used in combination with lithium. Reports of toxicity have appeared in the past 2 years and some risk factors have been suggested. This paper reports four cases of brain-damaged adolescents treated with carbamazepine and lithium for both seizure and behaviour control who developed this reported neurotoxic phenomenon.- - - - - - - - - - ranking = 1keywords = behaviour (Clic here for more details about this article) |
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