1/579. Ecstasy (MDMA) dependence.Methylenedioxymethamphetamine (MDMA) is generally described as non-addictive. However, this report describes three cases in which criteria for dependence were met. A wider understanding that MDMA can be addictive in rare cases is important as very heavy use may cause lasting neuronal changes. This risk could be reduced with effective identification and treatment of dependent persons. In one case dependence was linked with self-medication of post-traumatic stress disorder (PTSD).- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
2/579. The triple diagnosed.The triple diagnosed are AIDS patients who are also substance abusers and mentally ill. Such a combination raises roadblocks to care that any of the conditions alone would not cause. A team approach throughout the home care community, however, seems to overcome the obstacles.- - - - - - - - - - ranking = 0.0075576202820375keywords = ill (Clic here for more details about this article) |
3/579. 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 = 0.0075576202820375keywords = ill (Clic here for more details about this article) |
4/579. Drug-induced lung disease.Since there are no diagnostic studies to confirm the presence of a drug-induced lung reaction the physician will make a correct diagnosis only if he is aware of the drugs which have been identified to cause pulmonary reactions and their specific manifestations. Failure to recognize a drug-induced lung disease can lead to significant morbidity and in some cases mortality. The major drug-induced lung diseases are reviewed, the drugs being presented in the context of their clinical use and the reactions on the basis of common pathogenetic mechanisms.- - - - - - - - - - ranking = 0.0075576202820375keywords = ill (Clic here for more details about this article) |
5/579. Toxic ingestion of gamma-hydroxybutyric acid.Gamma-hydroxybutyric acid (GHB) has become a popular new drug of abuse. Its effects include euphoria and disinhibition. Recently, several cases have been reported in the literature of life-threatening or lethal ingestions. We report the case of a 17-year-old male who became unresponsive after taking GHB. Gamma-hydroxybutyric acid is used outside the united states to treat narcolepsy. In the past, it was touted as a muscle-bulking aid and was taken by body-builders. It has also been implicated as a drug involved in "date-rapes." patients who ingest excessive GHB have a markedly altered level of consciousness, as did the patient in this illustrative case. neostigmine and physostigmine show promise as potential reversal agents. Gamma-hydroxybutyric acid overdose should be considered in any patient with altered mental status and a history of recreational drug abuse.- - - - - - - - - - ranking = 0.0075576202820375keywords = ill (Clic here for more details about this article) |
6/579. Recognizing factitious hypoglycemia in the family practice setting.BACKGROUND: Factitious hypoglycemia is a deliberate attempt to induce a low serum glucose level using either insulin or oral hypoglycemic agents. Sulfonylurea-induced hypoglycemia is more common than incidents of insulin abuse, and hypoglycemia caused by these oral agents is biochemically indistinguishable from insulinoma. methods: We describe a case of factitious hypoglycemia resulting from insulin abuse in an adult diabetic patient, review the essentials of glucose homeostasis, and describe diagnostic tests that allow a differential diagnosis. RESULTS AND CONCLUSION: Factitious hypoglycemia is associated with a higher incidence of suicide, depression, and personality disorders. Insulin-induced hypoglycemia can be detected by an insulin to c-peptide ratio that is greater than 1.0. In the absence of proof to the contrary, insulinoma should be considered the cause of hypoglycemia until another diagnosis is established. The generally poor prognosis for patients with factitious hypoglycemia underscores the importance of early recognition of factitious disorders.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
7/579. Endogenous endophthalmitis associated with bacillus cereus bacteremia in a cocaine addict.A 22-year-old black female intravenous cocaine addict presented with an endophthalmitis of the right eye. Diagnostic evaluation included an immediate anterior chamber paracentesis and a delayed vitreous aspiration. Although cultures from the involved eye were negative, all 7 blood cultures grew Bacillus cereus suggesting that this organism was the responsible agent of an endogenous endophthalmitis. The patient was treated with appropriate systemic and local antibiotics with resolution of the acute inflammatory signs. However, a phthisical eye has been noted on follow-up examinations.- - - - - - - - - - ranking = 0.037788101410187keywords = ill (Clic here for more details about this article) |
8/579. Case studies in the family treatment of drug abuse.This article, with case illustrations, attempts to demonstrate that drug-abuse behavior can be understood more clearly in the light of family loyalties and unresolved family crises than from the perspective that drug abusers are social deviates.1 Drug abuse is viewed as symptomatic, as a signal that both drug abuser and his or her family are having difficulty in getting past a particular stage in the natural unfolding life cycle of a family. Treatment of drug abuse is seen primarily as helping the family to become "unstuck," thereby freeing the individual's and family's energy for the task of self-development and growth rather than expending it to maintain rigid patterns of interaction in an attempt to prevent change.- - - - - - - - - - ranking = 0.0075576202820375keywords = ill (Clic here for more details about this article) |
9/579. The chemically dependent PA: role models for recovery.The problem of substance abuse and chemical dependency among physician assistants first became evident in the late 1970s. Since then, the profession has taken significant steps to implement impaired provider programs, at both the constituent chapter level and the national level. Increased awareness of these programs--along with a concerted effort to debunk the myths and stereotypes associated with those who abuse chemicals or become dependent--should encourage more PAs who need assistance to seek treatment. Six recovering PAs share their personal experiences in the hope that they can inspire others in the profession who may need help with an addiction problem.- - - - - - - - - - ranking = 1keywords = person (Clic here for more details about this article) |
10/579. Dissociative identity disorder and substance abuse: the forgotten relationship.The treatment and research of dissociative disorders, particularly dissociative identity disorder (DID), are hampered by professional skepticism and diagnostic uncertainties. Almost always associated with severe and sustained childhood trauma, its chief manifestations are at least two distinct and separate identities which have an independent manner of existing in the world. It is also associated with a high degree of psychiatric comorbidity. Among the most frequent diagnoses found in patients with DID are substance use and dependence. For a variety of reasons there has been little dialogue among the disciplines that study patients with trauma and those that study and treat substance abuse. Clinicians dealing with a primarily substance-abusing population are likely to encounter but not recognize these patients. The authors present several representative cases illustrative of features of patients with DID. The epidemiology, phenomenology and presentation of DID, as well as its relation to posttraumatic stress disorder are discussed. Little systematic investigation exists on the treatment of DID in general, and substance abuse in DID in particular. The authors draw upon the existing literature, and their experience to discuss treatment strategies aimed at treating patients with both diagnoses. Ignoring either diagnosis is likely to be detrimental to patients; both disorders and their coexistence need to be addressed.- - - - - - - - - - ranking = 0.0075576202820375keywords = ill (Clic here for more details about this article) |
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