1/2. Substance abuse: clinical identification and management.Substance abuse is a significant health problem in the adolescent population. Prevention is a formidable challenge, but attempts at discouraging experimentation in early adolescence and the promotion of healthy adult role models may be effective strategies. Questions that may elicit a history suggestive of abuse should be a routine part of the adolescent medical history. Pediatricians should be familiar with the important clinical findings resulting from intoxication with the various substances of abuse and should be able to recognize the "telltale" signs of abuse. Effective management is based on attention to the basics of life support, careful attention to the physical findings, and judicious use of specific therapeutic agents. Above all, a compassionate attitude should prevail if acute-phase recovery and long-term rehabilitation are to be successful.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/2. Psychogenic vomiting complicated by marijuana abuse and spontaneous pneumomediastinum.OBJECTIVE: This case illustrates an unusual physical sequel of psychogenic vomiting. CLINICAL PICTURE: A 22-year-old man with a picture of psychogenic vomiting and marijuana use developed the complications of a pneumomediastinum and subcutaneous emphysema. TREATMENT: Therapy included gradual exposure to anxiety provoking stimuli, psychotropics to reduce vomiting and psychotherapeutic exploration of family relationships. OUTCOME: The patient's vomiting and physical state resolved without complication. Follow-up at 12 months revealed continued improvement with occasional less severe vomiting. CONCLUSIONS: Psychogenic vomiting as a manifestation of anxiety can result in serious physical and psychological sequelae. This patient's desperate attempts to control such vomiting complicated the picture. Successful short term intervention included the use of several treatment modalities.- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |