1/7. Parental hostage takers.Three men presented to a single regional secure psychiatric unit over a twelve-month period, after taking their youngest child hostage in their own homes because of a threatened separation from the family. In each case the episode had escalated because of hostility to police involvement in what for them was a typical domestic upheaval. All cases ended without injury. In each man, substance abuse, a family history of domestic violence and fears of rejection were prominent, and the recent birth of a child may have been an added precipitant. There may be a common family structure which predisposes to such situations. Psychiatric intervention was deemed appropriate, with some evidence of benefit for the two men who engaged in treatment.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
2/7. Misperceptions and inadequate pain management in cancer patients.This article examines misperceptions and barriers to adequate pain relief in cancer patients. Healthcare professionals have gaps in their knowledge of opioid drugs as well as misconceptions concerning tolerance, physical dependence, and addiction that often lead to the underprescribing of these agents. The pervasiveness of the "say no to drugs" message in our society and the fear of addiction on the part of patients and their families creates yet another barrier to the legitimate use of opioids to treat cancer pain. Legal and regulatory documents filled with arbitrary and ill-defined labels meant to promote the legitimate use of these drugs and curtail their misuse may instead intimidate healthcare professionals and negatively influence prescribing habits. Increased educational efforts for pharmacists and other healthcare professionals as well as the development of clinical role models and state cancer pain initiatives are cited as means to break down these barriers in order to achieve adequate pain relief for all cancer patients.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
3/7. Benzodiazepine abuse and dependence: misconceptions and facts.benzodiazepines can be prescribed for a number of medical conditions. Many physicians are reluctant to prescribe benzodiazepines out of fear of producing dependence in patients and incurring the disapproval of their peers. Studies of psychotropic drug use and abuse demonstrate that individuals using benzodiazepines for treatment of a medical illness rarely demonstrate tolerance to the therapeutic action of the medication or escalate the dose. Eighty percent of benzodiazepines are prescribed for 6 months or less, and elderly women are the most common long-term users of low-dose benzodiazepines. In contrast, recreational use of benzodiazepines is associated with polysubstance abuse, lack of medical supervision, rapid tolerance to the euphoric or sedating side effect, and escalation of dose. Most recreational users of benzodiazepines are young men. documentation of indication for use, collection of drug-abuse history, close monitoring, and drug holidays can improve the management of this class of medication.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
4/7. pain management in a drug-oriented society.A drug-oriented society promotes drug treatment of illness but responds with restrictive legislation and mores when faced with serious drug abuse by the populace. narcotics are currently controlled because of their history of abuse and associated crime, and when their use, for whatever purpose, is suspected of abuse. Inadequate treatment of cancer pain with narcotics may stem, in part, from these events. Its major causes are confusion of legitimate and illegitimate narcotics use by society in general and health care providers in particular, combined with undefined terms (e.g., addicts, habitual users) primarily in state statutes, which should be revised and standardized. These factors intimidate physicians from prescribing rationally. For example, a prescription for an extremely large dose, and ordering an adequate quantity of a drug to have at home for a reasonable period of time, as is often required for the control of severe pain, may be perceived as an invitation for investigation of the physician's legitimacy. The real or imagined fear of an investigation encourages him or her to write prescriptions for multiple narcotics, each at the "acceptable" dosage, rather than for single narcotics in larger doses, which is simpler for the patient and preferable from a medical standpoint. Drug abuse is not generally a problem among cancer patients with pain. physicians should strive to change social attitudes toward pain control with narcotics by enlisting the support of colleagues and, if necessary, by political activism.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
5/7. Neuropsychological sequelae of methyl bromide: a case study.Methyl bromide (MB) is a pesticide used primarily as a fumigating agent for homes, storage vehicles and soil. Chronic exposure to MB is known to cause damage to the central nervous system and other organs. Previously published post-mortem studies have also revealed significant brain abnormalities in patients whose deaths were attributed to MB. Only one study to date has examined the neuropsychological effects of this potential neurotoxin. The present case report documents the events surrounding an incident of acute and subacute MB exposure following home fumigation and the neuropsychological after-effects associated with that exposure. Behavioural and cognitive correlates of CNS dysfunction revealed by the neuropsychological testing included impairments in concentration, information processing, learning and memory. Emotional sequelae appeared to be a secondary problem associated with fears over physical well-being and impaired cognition. The cognitive symptomatology did not abate after completion of litigation and award of compensation.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
6/7. Complications following butane inhalation and flash fire.Solvent inhalation is a well-documented form of drug abuse that can cause euphoria and hallucinations. Sudden death involving a volatile substance is most commonly caused by cardiac arrythmias, asphyxia, direct drug effects, and trauma. The victim in this paper suffered superficial partial thickness (12% total body surface area) burns from a flash fire that occurred when lighting a match after inhaling butane in an enclosed vehicle. The victim was admitted to the hospital for 2 days of observation but did not develop any respiratory symptoms under 2 days following her release. The victim died during her readmission, 9 days after the flash fire. Postmortem examination showed extensive epithelial injury from the upper airway and trachea to the terminal bronchioles, most likely due in part to both the initial inhalation injury and the resulting adult respiratory distress syndrome (ARDS) and staphylococcal infection. Many victims with superficial burn injuries may not seek medical attention owing to either embarrassment or fear of legal prosecution. Even those who do seek medical assistance may not reveal solvent abuse as the cause of their injuries. It is possible that delayed death may occur at home following volatile substance abuse but may remain unrecognized even with a thorough scene investigation.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |
7/7. New strategies for old problems: tardive dyskinesia (TD). review and report on severe TD cases treated with clozapine, with 12, 8 and 5 years of video follow-up.Tardive dyskinesia (TD) is the most feared and troublesome extrapyramidal side-effect of prolonged neuroleptic (NL) treatment. We present a review of TD. Its pathophysiology remains elusive, although extrapyramidal symptoms (EPS) increase the liability for TD. Nowadays, therefore, avoidance of all EPS remains the best preventive strategy, as it is not possible to predict which liable patients will develop TD, or of what type or severity. TD frequently includes dystonic features, and is more disabling when these dystonias are present. clozapine (CLZ) has been reported to be effective in suppressing nearly 60% of TD syndromes, specially those with dystonic features. Based on the few reports in the literature on CLZ and TD by the early 1980s, we started to videotape the first severe TD patient treated with CLZ in 1984. We present the first three case reports of severe TD, with prominent disabling dystonic features, treated with CLZ and videotaped since pretreatment and then periodically for 12, 8 and 5 years of follow-up, respectively. The patients' current diagnosis, gender and age are: Case 1, DSM-IV schizophrenia Residual Type, male, 39 years; Case 2, DSM-IV Polysubstance Related Disorder, borderline personality disorder, female, 28 years; Case 3, DSM-IV Schizoaffective Disorder, male, 40 years. Two of them presented with a recurrence of TD because of CLZ interruption within the first 2 months of treatment, with no further breakthrough to date. The first two cases have complete remission of TD; the third case is still improving after 5 years of CLZ treatment, with only minor dystonic features persisting that constitute no impairment for work or daily routines at present. All patients, independent of their psychiatric primary diagnosis, have shown significant and progressive improvement in both motor and psychosocial aspects. None of them has been rehospitalized. Long-term treatment and follow-up is required to avoid TD recurrence and to assure full assessment of treatment effectiveness. Ideally, periodic video recording with standardized examination is advisable for long-term follow-up and outcome assessment. At present, CLZ could be regarded as the drug of choice for patients with TD, specially for those with disabling and or dystonic features and who require ongoing NL therapy. The use of novel antipsychotic agents for TD treatment and prevention, with their low EPS liability, is promising, but has yet to be tested.- - - - - - - - - - ranking = 1keywords = fear (Clic here for more details about this article) |