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I Support groups

Most support groups are facilitated or led by lay persons, often in conjunction with existing organizations such as NAMI, the National Alliance for the Mentally Ill, or AA, Alcoholics Anonymous . Support groups usually have a set meeting time generally weekly or monthly , and an open format. Open format means that the groups are ongoing, and members have the option of attending when it is convenient for them. This is in contrast to other types of structured treatment or psycho-edu ADDICTIONS SUPPORT GROUPS. Traditional addiction support groups include Alcoholics Anonymous AA , Narcotics Anonymous NA , and Gambler's Anonymous GA . Many of these groups follow the traditional 12-step program of working through various aspects of the addiction, and, as such, are more structured than many other types of support groups.

Results 1

Have been created for special purposes over the years by i researchers. These special supplementary scale scores are a often incorporated into the examiner's interpretation of p the test results. Commonly used supplementary scales 5 include the MacAndrews Revised Alcoholism Scale, the Addiction Potential Scale, and the Anxiety Scale. The clinician may also choose to obtain computerized reporting, which yields behavioral hypotheses about the respondent, using scoring and interpretation algorithms applied to a commercial database.

Pancreatic Juice

A painful condition called acute pancreatitis results from a blockage in the release of pancreatic juice. Trypsinogen, activated as pancreatic juice builds up, digests parts of the pancreas. Alcoholism, gallstones, certain infections, traumatic injuries, or the side effects of some drugs can cause pancreatitis.

Info Fxi

Astley, S.J. and Clarren, S.K. 1995 . A fetal alcohol syndrome screening tool. Alcoholism Clinical and Experimental Research, 19, 1565-1571.

I Diazepam

Diazepam is used on a short-term basis to treat patients with mild to moderate anxiety. It is also used to treat some types of seizures epilepsy , muscle spasms, nervous tension, and symptoms relating to alcohol withdrawal. iety or nervous tension. For acute treatment of seizures, a higher dose of diazepam is given intravenously directly into the vein only in a controlled medical setting such as a hospital or emergency room. For alcohol withdrawal, the typical dose is a total of 30-40 mg per day given in three or four doses.

Info Vcn

Ethanol Ethyl Alcohol See Alcoholism and alcohol intoxication, Cardiomyopathy, alcoholic, Disease, alcoholic liver, Syndrome, fetal alcoholic, and Syndrome, Wernicke-Korsakoff. Ethanol Ethyl Alcohol See Alcoholism and alcohol intoxication, Cardiomyopathy, alcoholic, Disease, alcoholic liver, Syndrome, fetal alcoholic, and Syndrome, Wernicke-Korsakoff.

Conclusions Dmf

Nurnberger, J.I. Jr., Foroud, T., Flury, L. et al. 2001 . Evidence for a locus on chromosome 1 that influences vulnerability to alcoholism and affective disorder. American Journal of Psychiatry, 158, 718-24. Prescott, C. A., Aggen, S. H. and Kendler, K. S. 2000 . Sex-specific genetic influences on the comorbidity of alcoholism and major depression in a population-based sample of US twins. Archives of General Psychiatry, 57, 803-11.


Abuse, Drugs or Other Chemicals See Abuse, hallucinogen s , Abuse, marihuana, Dependence, Poisoning, See also Alcoholism and alcohol intoxication. Alcohol intoxication see Alcoholism and alcohol intoxication carbon monoxide poisoning.


Lymphovascular drainage, 365 medulla, 368-9 pathological conditions, 367-8 resection specimens, 369-71 AIDS, 471 Alcohol abuse, 110 Alpha-fetoprotein, 4 Ameloblastoma, 168 Amoebiasis, 71 Ampulla of Vater anatomy, 35-6, 37 neoplasia, 40


Past Medical History Diabetes, alcoholism, sickle cell disease, splenectomy malignancy, immunosuppression, AIDS, intravenous drug use, tuberculosis recent upper respiratory infections.

Health Outcomes Of Stressful Life Events

Patients who were depressed while in the hospital were more likely to die of cardiac causes than those who were not depressed. However, most research in this area fails to include control variables, such as physical illness at baseline, smoking, or alcohol abuse.

Iii Category X Drugs Absolute Contraindication In Pregnancy

M. Alcohol is an organic compound delivered to the fetus through recreational drinking or addictive drinking i.e., alcoholism by pregnant women. Consumption of alcohol during pregnancy can cause fetal alcohol syndrome, which includes mental retardation, microcephaly, holoprosencephaly, limb deformities, craniofacial abnormalities i.e., hypertelorism, long philtrum, and short palpebral fissures , and cardiovascular defects i.e., ventricular septal defects . Fetal alcohol syndrome is the leading cause of mental retardation.

Bacterial Pneumonia

S. pneumoniae is by far the predominant pathogen isolated in hospital-based studies of elderly patients with either CAP up to 58 or NHAP up to 30 Riquelme et al., 1996 Lieberman et al., 1997 Marrie et al., 1997 Riquelme et al., 1997 Lim et al., 2001 Kaplan et al., 2002 Zalacain et al., 2003 . In older subjects treated in the ICU, S. pneumoniae reportedly causes 14 of CAP and 9 of NHAP El-Solh et al., 2001 . The presence of S. pneumoniae is associated with coexisting lung disease, hepatic disorders, or alcohol abuse.

Info Mdp

A. Anterior vermis syndrome involves the leg region of the anterior lobe. It results from atrophy of the rostral vermis, most commonly caused by alcohol abuse. It causes gait, trunk, and leg dystaxia.

Critical Thinking Questions Bxz

13. Cirrhosis of the liver, emphysema, and heart disease are all conditions that can be caused by a faulty gene or by a dangerous lifestyle habit drinking alcohol, smoking, following a poor diet . When gene therapies become available for these conditions, should people with gene-caused disease be given priority in receiving the treatments If not, what other criteria should be used for deciding who should receive a limited medical resource

I Giant Cell Tumor

Bone infarct A bone infarction may lead to popcorn or snakelike serpiginous calcifications in the cancellous bone Fig. 8.12 . It occurs with greater frequency in steroid therapy, alcoholism, and diver's disease decompression sickness . In the large bones it can resemble a cartilaginous tumor.

Flying Phobia

Included Ss with agoraphobia with without panic disorder. Ss with psychosis or drug alcohol abuse excluded

Case Analysis Wps

Alcohol in moderation is generally recognized to be beneficial in adults other than for pregnant women , with apparent protective effects against atherosclerosis. It is only apparent because the scientific evidence for protection is primarily epidemiological and anecdotal. Pathologists have been aware for decades that chronic high dose alcohol abusers tend to have less atherosclerosis than in comparably aged non-alcoholics, but there are also more recent epidemiologic data that suggest benefit other than mental well-being from a few drinks of wine or spirits daily. It has also been recognized for decades that chronic alcoholism is associated with heart damage, and congestive heart failure. The absence of an animal model of alcoholic cardiomyopathy has limited our understanding of the syndrome. However, clinical observations have provided significant clues about pathogenesis. There are 3 potential mechanisms that have been proposed for alcoholic cardiomyopathy Direct effects of alcohol...

Case Analysis Seg

In this patient, no other specific cause for dysfunction could be identified on either light or electron microscopy. There was no history of diabetes or hypertension, two conditions that could explain a rigid, fibrotic heart. There was evidence of mild atherosclerosis. She was not malnourished and refused treatment with anti-retroviral agents. We are not aware of cocaine or alcohol abuse. The foci of myocardial necrosis were a pre-mortem event due to shock. The ventricular dyskinesis and reduction of ejection fraction were more the result of a restrictive heart disease diastolic dysfunction , rather than dilated cardiomyopathy. Although she had some degree of cardiac dilatation, she had severe biventricular hypertrophy wall thickness LV 2.5 cm and RV 0.7 cm , with extensive fibrosis and collagen deposition, in addition to the microfibrillar changes.


After eating a large meal, drinking alcohol, or being in the supine position 19 . The estimates of GERD in asthma patients are between 34-89 , and many difficult to treat asthmatics may have clinically silent GERD 19 , 20 . Chronic cough is also a common symptom of reflux, with between 4-60 of those with this symptom having acid reflux as the cause


Although neoplasms are not a cause of acute or chronic pharyngitis, tumors arising in the oropharynx often present with signs and symptoms that most commonly indicate an infectious etiology. Patients treated for infectious pharyngitis, who do not improve, warrant further investigation to identify a possible neoplasm. Common presenting symptoms of oropharyngeal cancer include unilateral sore throat, dysphagia, odynophagia, weight loss, and otalgia. On physical exam, an asymmetric pharyngeal mass is the hallmark clinical finding and warrants further investigation Fig. 4 . The mass may be ulcerative, fungating, or mucosal covered and detectable only by palpation. Cervical adenopathy is present with advanced disease that has metastasized to the locoregional lymph nodes. Risk factors for oropharyngeal cancer include tobacco and alcohol abuse. The human papilloma virus has a role in a subset of oropharyngeal tumors.

Causes and symptoms Baw

People with alcoholism since heavy drinkers often eat poorly, and alcoholism interferes with absorption of nutrients from the digestive system. It can also occur in people who are malnourished for other reasons. Thi-amin helps produce energy needed to make neurons function properly. Insufficient thiamin can lead to damage or death of neurons. Wernicke's encephalopathy is diagnosed when patients seek medical attention and have the classic trio of signs mental confusion, eye movement disorders, and ataxia. The diagnosis of Korsakoff syndrome is given when anterograde amnesia is present in an individual with a history of chronic, heavy drinking or malnutrition. When Korsakoff syndrome follows Wernicke's encepha-lopathy, the entire Wernicke-Korsakoff syndrome diagnosis is appropriate. The diagnosis is supported by neu-roimaging or autopsy findings showing degeneration of the thalamus and mammillary bodies and loss of brain volume in the area surrounding the fourth ventricle a fluid-filled...

Info Wjr

NOTE The condition can be caused by many disorders associated with cobalamin or folic acid deficiency e.g., malabsorp-tion-related other causes include adverse drug effects, alcoholism, and rare metabolic disorders. The condition may occur in infancy or during pregnancy. Hemolytic anemia, hypoparathyroidism, adrenal cortical insufficiency Addison's disease , or scurvy may be present.

Introduction Rvp

An epileptic seizure is a behavioral event that is caused by an abnormal neuronal discharge. Epilepsy refers to the condition of recurrent seizure. Certain metabolic or medical conditions, including hypoglycemia, hypona-tremia, and alcohol withdrawal may predispose an individual to a single seizure, but not recurrent seizures epilepsy . In the United States, epilepsy affects approximately 6 of the population. Approximately 4 of individuals living to age 75 may experience a single unprovoked seizure, and if provoked seizures are included, the incidence approaches 10 1 .

Info Aiy

Bilateral symmetric loss of myelinated fibers in central parts of optic nerves. Ganglion cells in macula may be lost. Manifestations of alcoholism, diabetes mellitus, malnutrition, megaloblastic anemia, tobacco dependence, and tuberculosis isoniazid treatment may cause the optic nerve damage .

ToxicMetabolic 1

Alcoholism can indirectly cause dementia through nutritional deficiency. The most widely recognized example is the Wernicke-Korsakoff syndrome, a result of thiamine deficiency. Thiamine is a critical cofactor in cerebral glucose metabolism. Wernicke's encephalopathy is an acute presentation of thi-amine deficiency and is often followed by the chronic amnesia of Korsakoff psychosis. The pathological substrates of Wernicke's encephalopathy and It is unknown whether Marchiafava-Bignami disease results from a direct or indirect effect of chronic alcoholism. The pathologic hallmarks are demyelination of the corpus callosum, especially the genu, and the anterior commissure. Replacement of cortical neurons with gliosis is seen in the third layer of the frontal and temporal lobes. The term primary alcoholic dementia has been used to imply that alcohol acts as a direct toxin and causes a dementia whose pathophysiology is distinct from the aforementioned disorders. However, it is not clear that...

ToxicMetabolic Hxz

Wernicke's encephalopathy should be suspected when an acute confusional state is accompanied by ophthalmoplegia and ataxia or occurs in an individual at risk for thiamine deficiency. MRI reveals increased T2 signal in mamillary bodies, medial thalamus, and periaqueductal gray matter. Diffusion-weighted imaging shows high signal intensity in corresponding regions, which is reversible with treatment Chu, Kang, Kim, Lee, amp Park, 2002 . Despite treatment of Wernicke's encephalopathy, a chronic amnestic syndrome, Korsakoff psychosis, may result. The amnesia can also develop insidiously and without other neurologic findings. Patients are typically apathetic and have little insight into their memory deficit. Confabulation, once felt to be a consistent feature of Korsakoff psychosis, often diminishes over time or is absent entirely Victor, Adams, amp Collins, 1989 . Formal neu-ropsychological testing in Korsakoff psychosis confirms the marked deficit in memory. Additionally, impairments are...


Chief Compliant The patient is a 50 year old white male with alcoholism who complains of abdominal pain for 4 hours.

Oligopolygenic complex genetic hyperlipidemias

Polymorphism of the apoE gene has been detected in all populations. The most common allele in Europe is apoE3 frequency 0.75 followed by apoE4 0.13 and apoE2 0.1 Motulsky et al., 2002 . ApoE3 binds with high affinity to the LDLR, whereas apoE2 has much reduced binding. About 1 of the population are homozygous for apoE2 but only 1 of these individuals will have the additional genetic or acquired factors obesity, diabetes, hypothyroidism, FCHL, alcohol abuse that lead to type III hyperlipidaemia. This rare disorder, which results from the presence in the circulation of large amounts of CM remnants and VLDL remnants collectively termed b VLDL is characterized by markedly raised serum cholesterol


Endoscopy should always be performed in the presence of alarm symptoms, such as dysphagia 57 . If a patient has a long history of nicotine and or alcohol abuse, or regular use of NSAIDs, they should be referred for EGD or barium study to exclude structural disease 29 , 57 . Even in elderly patients who are currently asymptomatic, but who have a strong history of reflux symptoms, endoscopy is indicated to rule out Barrett's esophagus BE 10 . There is disagreement among physicians concerning the age cut-off for endoscopy in a patient presenting with new-onset reflux symptoms. Recommendations range from 45-65 years old 3 , 31 , 56 , 57 . However, what is agreed upon is that due to the occult severity of disease in the elderly, endoscopy should be done very early in the evaluation 23 .

Autopsy Diagnoses

Autopsy diagnoses can be reported and listed 1 in a standard sequence for example, cardiovascular system, respiratory system, digestive system, and so forth to facilitate anatomic orientation, statistical analysis, and coding 2 in order of causal relationships and relative importance for example, chronic alcoholism, alcoholic cirrhosis, ruptured esophageal varices, and gastrointestinal hemorrhage or 3 in a problem-oriented fashion. The first method is preferred by statisticians and those charged with coding, whereas the latter two methods appeal most to the clinician because more interpretative information is provided. Problem-oriented autopsy diagnoses and protocols see below are essential wherever problem-oriented medical records are used 1,2 .

Treatments 1

If an extrinsic mechanism is discovered as the cause of the orgasmic disorder, steps should be taken to eliminate or ameliorate the problem. An example would be substance or alcohol abuse or the use of certain provocative medications. In the case of antihypertensives, for example, a number of equally effective agents are available if the one in current use is suspect. Therapy should be directed toward improvement of concurrent conditions such as diabetes that may be having an adverse


Toxins and metabolic abnormalities should be considered in all cases of dementia, but especially in the elderly, who have a higher prevalence of systemic illness and medication use. The list of toxic metabolic causes of dementia is extensive see Table 8.2 . Many of these conditions produce an acute confusional state more often than a dementia. Nonetheless, they are not infrequently identified in epidemiological studies of dementia. In 200 elderly patients with symptoms for three or more months, medications 9.5 and hypothyroidism 3 were the leading toxic metabolic causes of dementia Larson, Reifler, Suni, Canfield, amp Chinn, 1986 . Features that favored a toxic metabolic cause were a higher number of prescription medications and a shorter duration and lesser severity of dementia. This chapter reviews the toxic metabolic dementias associated with alcoholism, thyroid disease, and Neuropsychological impairment may be detected in nearly half of individuals who drink excessive alcohol...

Neuropsychiatric complications

Epilepsy may be caused by direct toxicity of alcohol, especially if there is preexisting brain damage, alcohol withdrawal, over-hydration, or hypoglycaemia.

Ginseng And Alcohol

Treatment the hepatocytes were not so damaged Joo, 1992 . The acetaldehyde level in the liver and the serum of rats treated with ethanol was much higher than for non-treated animals but only slightly higher for the ethanol and ginseng group. Careful analysis of individual lipids e.g. phospholipids, cholesterol, fatty acid and triglycerides revealed a decrease in phospholipid biosynthesis and an increase in fatty acid and triglycerides as a result of ethanol feeding these effects were significantly countered by co-feeding ginseng saponins. The saponins apparently stimulate the microsomal ethanol-oxidising system and the aldehyde dehydrogenase enzyme action and therefore there is faster removal of acetaldehyde with rapid shunting of excess hydrogen into lipid biosynthesis Kwak and Joo, 1988 . In rats it has been shewn that plasma levels are about 20 per cent lower when ethanol is administered orally with aqueous red ginseng extract than when ethanol is given alone. However orally...

Conditions That Mimic or Provoke Heart Failure

A. Increase Demand Anemia, fever, infection, excess dietary salt, renal failure, liver failure, thyrotoxicosis, arteriovenous fistula. Arrhythmias, cardiac ischemia infarction, pulmonary emboli, alcohol abuse, hypertension.

I Clonidine

Clonidine is beneficial in opiate withdrawal because it treats symptoms that are commonly associated with that condition watery eyes and nose, diarrhea, irritability . For this condition, clonidine is often used alone. For the treatment of alcohol withdrawal, clonidine is usually combined with benzodiazepine tranquilizers such as Librium, Valium, Xanax, or Ativan.

Beta blockersb

Beta blockers are proven effective in the treatment of performance anxiety, lithium-induced tremor, and neu-roleptic-induced akathisia a physical condition caused by certain antipsychotic drugs . Beta blockers have sometimes been used with benzodiazepines in treating alcohol withdrawal.

I Social phobia

Social phobia, which is also known as social anxiety disorder, is a serious mental health problem in the United States. In any given year, social phobia affects 3.7 of the American population between the ages of 18 and 54, or about 5.3 million people. It is the third most common psychiatric condition after depression and alcoholism. Patients diagnosed with social phobia have the highest risk of alcohol abuse of all patients with anxiety disorders in addition, they suffer from worse impairment than patients with major medical illnesses, including congestive heart failure and diabetes.

Demographics Qsl

FLD, Pick's disease, Huntington's disease, Parkinson's disease, HIV infection, alcoholism, head trauma, etc. account for about 10 of all cases of dementia. In FLD and Pick's dementia, women appear to be affected slightly more often than men.

Causes and symptoms Phi

Because obesity reflects an imbalance between the amount of energy taken into the body in the form of food and the amount of energy expended in metabolism and physical activity, and because eating is an activity that involves choice and volition, obesity is classified by the Health Care Financing Administration HCFA as a behavior rather than as a disease. In recent years, following a pattern established in other behavioral problems such as alcoholism, researchers have attempted to establish a biologic basis for the development of obesity. They have succeeded in identifying many markers of the biochemical mechanisms that appear to be involved in feedback loops that control energy balance. However, much of the information is extrapolated from experimental work in rodents. Leptin, a hormone produced in fat cells is an example of such a marker. Leptin excited a great deal of hope as a potential treatment of obesity, but, as with many other laboratory discoveries, the hormone has proved...


Diseases, such as mental disorders, heart diseases, or alcoholism however, contrary to general opinion, the mortality in conservatively treated GERD patients may not have decreased, possibly due to the overall trend to an increase number of elderly subjects. This is mirrored by an increase in death rate from non-malignant disease of the esophagus ICD-9 530 which has been observed in Europe as an example, in England and Wales between 1974 and 1988 the number of deaths due to this code trebled in women from 118 to 340 0.5 to 0.13 per 100,000 and doubled in men, from 131 to 251 0.55 to 1.0 per 100,000 53 . The calculation of age specific death rate shows the increase to result from a rise in mortality in those over 75 years and age standardized mortality confirms a rise in overall frequency from 0.29 to 0.70 per 100,000 in men and from 0.52 to 1.31 per 100,000 in women 53 .

Future Developments

Finlayson, R. E., Hurt, R. D., Davis, L. J., amp Morse, R. M. 1988 . Alcoholism in elderly persons A study of the psychiatric and psychosocial features of 216 inpatients. Mayo Clinic Proceedings, 63, 761-768. Ron, M. A., Acker, W., Shaw, G. H., amp Lishman, W. A. 1982 . Computerized tomography of the brain in chronic alcoholism A survey and follow-up study. Brain, 105, 497-514. Torvik, A., Lindboe, C. F., amp Rodge, S. 1982 . Brain lesions in alcoholics A neuropathological study and clinical correlations. Journal of the Neurological Sciences, 56, 233-248. Walker, D. W., Hunter, B. E., amp Abraham, W. C. 1981 . Neuroanatomical and functional deficits subsequent to chronic ethanol administration in animals. Alcoholism Clinical and Experimental Research, 5, 267-282.

Cognitive Ability

To further illustrate the complexity of diseases influenced by many genes, it is believed that alcoholism, schizophrenia, and manic-depressive disorder are also at least partially controlled by genes. However, in spite of various claims, we still do not know how many genes are involved or where these genes are located in the human genome.

Vii Pancreas

2. Acute pancreatitis is inflammation of the pancreas that usually is associated with biliary tract disease or alcoholism. Clinical findings include pain in the epigastric region that radiates to the back, nausea, vomiting, elevated amylase or lipase levels, and retroperitoneal hemorrhage that may lead to flank ecchymosis Turner sign or periumbilical ecchymosis Cullen sign .

I Acupuncture

Acupuncture's record of success has been sufficiently impressive to stimulate a number of research projects investigating its mechanisms as well as its efficacy. Research has been funded not only by the National Center for Complementary and Alternative Medicine NCCAM , but also by the National Institute on Alcohol Abuse and Alcoholism NIAAA , the National Institute of Dental Research, the National Institute of Neurological Disorders and Stroke NINDS , and the National Institute on Drug Abuse. In 1997 a consensus


Synonyms and Related Terms Thiamine deficiency Wernicke encephalopathy cerebral beriberi . Possible Associated Conditions Chronic alcoholism chronic peritoneal dialysis hemodialysis Wernicke disease Wernicke-Korsakoff syndrome. 1. Windebank AJ. Polyneuropathy due to nutritional deficiency and alcoholism. In Peripheral Neuropathy, vol. 2. Dyck PJ, Thomas PK, eds., W.B. Saunders, Philadelphia, PA, 1993, pp. 1310-1321.

Classification And Nomenclature Of Sult Genes Identified From Vertebrates

Dendrogram Sult

The number of SULT cDNAs has been isolated not only from animals but also from plants and bacteria in past years, and their primary structures have been identified Marsolais and Varin, 1998 Nagata and Yamazoe, 2000 . In vertebrates, more than 50 sulfotransferases have been isolated and classified into seven gene families from their deduced amino acid homologies in animals so far. These families share less than 40 homology with each other. The SULT1 and SULT2 families, which show catalytic activities to phenols and alcoholics, are further divided into five and three subfamilies, respectively, in this review. Each subfamily retains 60 or higher homology in the members. Other families such as SULT3, SULT4, SULT5, SULT6, and SULT7 include only one subfamily at present. It is very interesting how many forms of cytosolic sulfotransferase exist in animals. A dendrogram of vertebrate

Primary Deficiency Xri

This may result from malabsorption syndromes, cancer, liver cirrhosis and alcoholism, hyperthyroidism, congestive heart failure or medicine use, such as OCP, isoniazid, hydralazine, penicillamine, theophylline or MAO inhibitors Beers amp Berkow 2003, Bratman amp Kroll 2000, Wardlaw et al 1997 .

Info Tzh

Proportion Newborn Body

Stages of pregnancy are not yet well understood and because each woman metabolizes alcohol slightly differently, it is best to avoid drinking alcohol entirely when pregnant or when trying to become pregnant.

Introduction To Mood Disorders And Limitations Of Current Treatments

Bipolar disorder and unipolar depression are classified as mood disorders. They are common, severe, and chronic illnesses. Depression is typified by a depressed mood, anhedonia inability to experience pleasure , feelings of worthlessness or excessive guilt, impaired sleep either insomnia or hyper-somnia , cognitive and concentration deficits, psychomotor changes, recurrent thoughts of death or suicide, and a variety of neurovegetative symptoms. In bipolar disorder, patients typically alternate albeit not in a one-to-one manner between episodes of depression mostly indistinguishable from unipolar depression and episodes of mania, which is characterized by a heightened mood, hyperaroused state, racing thoughts, increased speed and volume of speech, quicker thought, brisker physical and mental activity levels, inflated self-esteem, grandiosity, increased energy with a corresponding decreased need for sleep , irritability, impaired judgment, heightened sexuality, and sometimes frank...

Info Xza

With certain limitations, one can base calculations of this kind on the assumption that the blood alcohol level decreases from its peak at a fairly constant rate of 0.015-0.018 h until death 10 . If blood is not available, conversion factors see above must be used. Alcoholics have been reported to metabolize at a rate of up to 0.043 h 6 .

I Chlordiazepoxide

Chlordiazepoxide is used for the short-term relief of symptoms of anxiety and management of anxiety disorders. It is also used for treating symptoms of withdrawal from acute alcoholism and alcoholic intoxication.

Normal results

Researchers have found that meditation is effective in the treatment of chemical dependency. Gelderloos and others reviewed 24 studies and concluded that TM is helpful in programs that target smoking behavior and drug and alcohol abuse.


People who need to remain mentally alert such as those who are driving or operating dangerous machinery, need to take quazepam with caution as it may cause drowsiness. This effect is intensified when quazepam is taken with alcohol. It is best not to drink alcoholic beverages while taking quazepam. Patients with compromised respiratory function breathing problems , as well as patients with a history of drug or alcohol abuse, should closely be monitored during the short-term treatment with quazepam.

Frontotemporal lobe dementia FTD

Fronto-temporal dementia is a pleomorphic neuro-degenerative illness which typically begins before the age of 65 years. In a minority of cases, the disease is inherited as an autosomal-dominant trait Lynch et al., 1994 Wszolek et al., 1992 . The disease often begins with personality and behavioral changes including disinhibition manifest by alcoholism, hyper-religiosity, hypersexuality, hyperphagia elements of the Kluver-Bucy syndrome and stealing. As the disease progressed in these families, further abnormalities in judgment, language and praxia developed. In addition to these cognitive changes, some patients also developed Parkinsonism and amyotrophy. However, presentations with primary progressive aphasia, Parkinsonism, dystonia and or oculomotor disturbances are not infrequent. Neuropathologically, the illness is typified by fronto-temporal atrophy with severe neuronal loss, spongiform change in the superficial layers

Nonneoplastic Conditions Utc

Avascular necrosis seen in some fractures neck of femur, scaphoid, talus , chronic steroid therapy, alcohol abuse, sickle cell anaemia, Caisson disease dysbarism .

Purpose Aum

The Halstead-Reitan is typically used to evaluate individuals with suspected brain damage. The battery also provides useful information regarding the cause of damage for example, closed head injury, alcohol abuse, Alzheimer's disorder, stroke , which part of the brain was damaged, whether the damage occurred during childhood development, and whether the damage is getting worse, staying the same, or getting better. Information regarding the severity of impairment and areas of personal strengths can be used to develop plans for rehabilitation or care.

Congestive Heart Failure

Past Medical History Past episodes of heart failure hypertension, excess salt or fluid intake noncompliance with diuretics, digoxin, antihypertensives alcoholism, drug use, diabetes, coronary artery disease, myocardial infarction, heart murmur, arrhythmias. Thyroid disease, anemia, pulmonary disease.

Notes Abs

8. Veterans associations Young 1995 and Alcoholics Anonymous Powell 1987 provide examples of such sociality forged earlier in the twentieth century.

Selected Definitions

Pancreatitis Pancreatitis refers to the inflammation of the pancreas. It can be caused by alcoholism,

Summary And Conclusions

Receptors in hippocampal neurons 91 . In drug-discrimination studies, in which animals are trained to produce an operant behavior in response to ethanol administration, NMDA antagonists can substitute for ethanol in rats and pigeons 92-96 , suggesting that the animals perceive the subjective effects of ethanol and NMDA antagonists to be similar. Furthermore, microinjection of NMDA receptor antagonists into the nucleus accumbens or hippocampus was able to substitute for ethanol administered sys-temically in rats 97 . Observations that NMDA receptor antagonists reduce self-administration of ethanol in rats are also consistent with similar subjective effects of NMDA receptor antagonists and alcohol 98,99 . Finally, human alcoholics perceive the subjective effects of ethanol to be similar to those of an NMDA antagonist 100 Chapter 26 . Thus, NMDA receptors appear to play an important role in mediating the intoxicating actions of alcohols AMPA kainate receptors may be involved in the...

The masquerades

A century ago it was important to consider diseases such as syphilis and tuberculosis as the great common masquerades, but these infections have been replaced by iatrogenesis, malignant disease, alcoholism, endocrine disorders and the various manifestations of atherosclerosis, particularly coronary insufficiency and cerebrovascular insufficiency.

Info Skl

P.L. 91-616, the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act, established the National Institute of Alcohol Abuse and Alcoholism. The law provided a separate statutory base for programs and activities related to alcohol abuse and alcoholism. The legislation also provided a comprehensive program of aid to states and localities in their efforts addressed to combating alcohol abuse and alcoholism.

Other Actions Pux

Alcohol metabolism Many reports have now confirmed the teratogenic potential of alcohol in humans and in laboratory animals. A characteristic pattern of congenital anomalies is present in infants born to mothers with chronic alcoholism. Chronic consumption of ethanol causes a depletion of EFAs, partly by blocking GLA formation and partly by depleting DGLA. Treatment of pregnant rats with ethanol and EPO Efamol , a rich source of GLA, led to a significant reduction in the embryopathic activity of ethanol Varma amp Persaud 1982 .

I Dual diagnosis

The term dual diagnosis is considered to be misleading by some professionals because most people with this diagnosis actually have many problems rather than just two discrete illnesses. Occasionally, the term is used to describe a person with developmental disabilities and or a mental health disorder or substance abuse disorder. More commonly, dual diagnosis refers to those with severe mental illness and a drug or alcohol abuse disorder, and who receive therapy in the public treatment systems. The prevalence of people with dual diagnoses became fully apparent to clinicians in the early 1980s. Initially, dual diagnoses were thought to be most likely in young adults with schizophrenia or bipolar disorder who also had extensive histories of drug or alcohol abuse. There was a widespread belief, often shared by family members of affected patients, that a young person's initiation into illegal drug use actually caused a subsequent mental illness. It is now more commonly thought that...

Case Study II Neurological Perspectives

To further evaluate this patient, it would be important to determine from history if there have been clinical strokes, alcohol abuse, closed head injuries, visual hallucinations, or frequent cognitive fluctuations. The


Allostatic load effect of, 218 health effects of, 8 Stressors, in the urban environment adaptation to, 244, 245 anthropological research on, 244, 245-248 culture as, 247-248 neighborhood-related, 460 noise as, 248 nutritional, 247 pollution as, 248 social stress as, 246-247 Strip malls, 507 Stroke, 54-55, 56 as dementia cause, 183 in older adults, 182, 183 as mortality cause, 181 Strongyloidiasis, in immigrants, 106 Substance abuse. See also Alcohol abuse Drug use in children and adolescents, 166 as homelessness risk factor, 30 in homeless people, 20, 21, 22, 30 in immigrants, 114-115 in sexual minority group members, 92-93 Substance abuse treatment, for homeless people, 30

Alcohol Withdrawal

Chief Compliant The patient is a 50 year old white male with alcoholism who presents with tremor and agitation after discontinuing alcohol 12 hours prior to admission. History of the Present Illness Determine the amount and frequency of alcohol use and other drug use in the past month, week, and day. Time of last alcohol consumption tremors, anxiety, nausea, vomiting diaphoresis, agitation, fever, abdominal pain, headaches hematemesis, melena, past withdrawal reactions history of delirium tremens, hallucinations, chest pain. Age of onset of heavy drinking.


Interventions, 58 perspective, 45-47 transactions, 45 Ecological Systems Theory, 45 elderly, minority acculturation, 328-329 demographics of, 326-328 mental health of, 326-328 rates of alcoholism, 335 rates of disability, 328 rates of mental disorders, 327-329 emic-etic, 113-114, 458-461, 475

Info Pke

P.L. 96-79, the Health Planning and Resources Development Amendments, amended the National Health Planning and Resources Development Act see the 1974 P.L. 93-641 to add provisions intended to foster competition within the health sector, to address the need to integrate mental health and alcoholism and drug abuse resources into health system plans, and to make several revisions in the CON requirements. In other provisions, OBRA '81 combined 20 existing categorical public health programs into four block grants. The block grants were 1 Preventive Health and Health Services, which combined such previously categorical programs as rodent control, fluoridation, hypertension control, and rape crisis centers among others into one block grant to be distributed among the states by a formula based on population and other factors 2 Alcohol Abuse, Drug Abuse, and Mental Health Block Grant, which combined existing programs created under the Community Mental Health Centers Act, the Mental Health...

Epidemiology 1

There is growing evidence that chronic anxiety is associated with increased risk for medical illness Greenberg et al., 1999 . Indeed, it may be a fundamental vulnerability factor in the aetiology of a range of psychiatric disorders but particularly depression and alcohol abuse Fava et al., 2000 Judd et al., 1998 . It is estimated to cause psychosocial disability of a similar magnitude to that of chronic somatic disease Ormel et al., 1994 and depression Wittchen et al., 2000 . There is also evidence that comorbidity between GAD and other conditions increases the rate of attempted suicide Lecrubier, 1998 . In short, the overall evidence supports the view that GAD is a significant public health problem.

Clinical Use Jti

Traditionally, zinc supplementation has been used to treat deficiency or prevent deficiency in conditions such as acrodermatitis enteropathica, anorexia nervosa, malabsorption syndromes, conditions associated with chronic diarrhoea, alcoholism, diabetes, HIV and AIDS, recurrent infections, severe burns, Wilson's disease and sickle cell anaemia. Zinc supplements are also popular among athletes in order to counteract the zinc loss that occurs through perspiration.

Deficiency Signs And Symptoms Fsy

Severe deficiency is rarely seen in industrialised countries, but marginal deficiency and inadequate intakes are not uncommon. According to a large national survey of over 29,000 people conducted in the USA, only 55.6 had adequate zinc intakes based on total intakes of gt 77 of the 1989 US RDI levels . Young children aged 1-3 years, female adolescents and older people aged gt 71 years had the lowest percentage of 'adequate' zinc intake, and were identified at greatest risk of deficiency Briefel et al 2000 . Others at risk are alcoholics especially those with liver disease , pregnant and lactating women, teenagers experiencing rapid growth, malnourished individuals


It is known that many individuals with fetishistic cross-dressing have comorbid psychiatric disorders. A sample of transvestites who sought psychiatric evaluation in a sexual behaviors clinic were found to have high rates of mood or substance abuse disorders 28 . This was consistent with a previous study wherein 80 of gender dysphoric transvestites qualified for a concurrent Axis I diagnosis, generally an affective disorder 29 . A recent study of comorbidity between alcoholism and specific paraphilias found that gt 50 of sexual sadists were alcohol dependent, with the lowest association between transvestism and alcoholism 30 .

Isoniazid INH

Side effects toxic hepatitis, more frequent in older patients, with chronic liver disease and alcohol abuse. Peripheral neuropathy. Discontinue isoniazid in severe cases and treat for several weeks with pyridoxine and vitamin B12. Psychosis, CNS symptoms. Fever, rash, nausea, vomiting, anemia, leukopenia, thrombocytopenia.

Adriaan S Potgieter MD

Eighteen double-blind, placebo-controlled clinical studies have been completed since 1982. Of these, 17 were performed in Europe see Table 1 and 1 in the United States. The results of the latter project have not been released by the sponsoring company. Sixteen of the 18 studies employed DSM criteria for diagnosis of alcohol dependence. Patients were between the ages of 18 and 65 and treatment periods varied from 3 to 12 mo. Other drug dependencies were always excluded.

Low Back Pain and Sciatica

Social History Drug or alcohol abuse functional impact of the pain on the patient's work and activities.

Gaps In The Evidence Base

Of major concern is the limited number of therapists who can recognize and effectively treat social anxiety disorder. Clinicians are most likely to recognize and diagnose a psychological problem in socially anxious persons who present with a comorbid condition -typically major depressive disorder or alcoholism - and are most likely to treat the comorbid condition before the social anxiety Ballenger et al., 1998 . In addition, studies have reported that, among the anxiety disorders, the most highly utilized psychosocial treatments are dynamic psychotherapy Goisman, Warshaw amp Keller, 1999 and supportive therapy Rowa et al., 2000 . There appears to be an underutilization of efficacious treatments in favour of those that have been less well studied. One promising study demonstrated that general practitioners may be trained successfully to provide brief exposure therapy eight sessions of 15 to 20 minutes' duration within a primary-care setting Blomhoff et al., 2001 Haug et al., 2000 Haug...

Social Anxiety In Children And Adolescents

Social anxiety is often evident early in life and may be diagnosed in children as young as eight years old Beidel amp Turner, 1998 . Furthermore, when the social fears of children continue to be expressed through late adolescence they are more likely to be associated with a poor prognosis for recovery Davidson et al., 1993 Mannuzza et al., 1995 . The clinical presentation of social anxiety in children is similar to that of adults, with comparable somatic symptoms and feared situations. However, because of the limited cognitive development of younger children, they may not report specific negative cognitions Beidel amp Turner, 1998 . Social anxiety in children is also associated with significant distress and impairment, including poor school achievement, greater loneliness, and difficulties with social relationships Albano, Chorpita amp Barlow, 1996a . Socially anxious children and adolescents may also suffer from elevated rates of general anxiety, depression, and secondary alcohol...

W Zieglgansberger G Rammes R Spanagel W Danysz and Ch Parsons

The taurine analog acamprosate calcium acetylhomotaurinate has received considerable attention in Europe for its ability to prevent relapse in abstained alcoholics 1 Chapter 28 and has been suggested to act by reducing craving associated with conditioned withdrawal 2,3 . The mechanism of action of acamprosate in the central nervous system CNS is still unclear. A better understanding of this is important to increase our knowledge of the fundamental processes governing alcohol abuse that would, in turn, allow the development of better drugs to prevent relapse in weaned alcoholics. Although early studies indirectly suggested an action at GABA receptors 10-13 , more recent data suggest that acamprosate rather or also interacts with the N-methyl-d-aspartate NMDA subclass of ionotropic glutamate receptor. These Ca2 -permeable channels have, in turn, been implicated in the induction of alcohol dependence. Ethanol can be seen as an NMDA receptor antagonist 43-45 at concentrations reached in...

Primary Deficiency Lbx

People at risk are those living in India, Central and South America, and selected areas in Africa Stabler amp Allen 2004 , strict vegetarians and vegans, breastfed infants of vegetarian mothers with low B12 stores, elderly patients with 'tea and toast diets' and chronic alcoholics. As vitamin B12 is stored to a considerable extent, even after complete depletion of food-ingested cobalamin, clinically relevant deficiencies will usually only develop after 5-10 years Schenk et al 1999 . This time frame increases to an average of approximately 18 years in strict vegetarians when intrinsic factor secretion is intact Babior 1996 . In this case, some enterohepatic recycling of cobalamin should occur in the distal ileum Howden 2000 .

Summary And Treatment Implications

There is now growing evidence in humans that 1 glutamate receptors are an important target for ethanol in the brain, 2 ethanol actions at NMDA receptors contribute to its behavioral effects, 3 ethanol dependence may be associated with upregulation of NMDA receptors, 4 acute ethanol withdrawal may be associated with increased glutamate release and protracted withdrawal may be associated with reduced brain glutamate turnover, and 5 the familial risk for developing alcoholism may be associated with alterations in NMDA receptor function. Genetic variation that might link glutamatergic systems to the vulnerability to alcoholism and its treatment have yet to be explicated. Acamprosate is the first agent developed for the treatment of alcoholism with a mechanism of action that may be related to glutamate function. Future pharmacotherapy research glutamatergic pharmacotherapy research may explore medications designed to suppress withdrawal, reduce ethanol consumption, attenuate...

Physical Psychological And Socioeconomic Sequelae

Apart from the physical injuries sustained by child soldiers, another area of concern for aid agencies and healthcare workers is the psychological health of these children. A recent Belgian study revealed the extent of this problem in a voluntary survey of former child soldiers of Uganda's notorious Lord's Resistance Army. Of the 301 children interviewed, 77 had witnessed at least one killing, 39 had been forced to kill, 39 had abducted other children, 63 had looted and burned civilian homes, and 52 had been seriously beaten. A secondary survey was conducted on a randomly selected subgroup of 75 children, of whom 71 agreed to participate. They completed a questionnaire designed to evaluate the extent of posttraumatic stress disorder PTSD . A score of greater than 24 on the impact of event scale-revised IES-R , which is a self-report scale akin to the DSM-IV criteria for PTSD, indicates clinically significant symptoms. The mean IES-R score was 53.5, with 97 of participants falling into...

Glutamatergic Dysregulation In Ethanoldependent Patients

Clinical research studies have begun to document the enhancement in glutamatergic function during withdrawal. Postmortem studies of ethanol-dependent individuals suggest that the Bmax or KD of NMDA receptors are increased in cortical structures alcoholics 43,44 . In vivo, ethanol withdrawal increases cerebrospinal fluid glutamate levels 45 , consistent with preclinical evidence of enhanced glutamate release 46,47 . Repeated episodes of withdrawal may promote the initiation of forms of neural sensitization that may contribute to increased startle magnitude 48 and enhanced seizure risk 49,50 . It is possible that withdrawal-related neuroplasticity contributes to associative learning, as might be reflected in drug-craving 51 . resembling the changes seen in ethanol-dependent patients 71 . Thus, inherited differences related to NMDA receptor function may contribute to alterations in the set point for sensitivity to ethanol effects that promote the development of the abuse of ethanol....

Graeme Mason PhD and Louis Trevisan MD

Ethanol has multiple specific targets in the brain that combine to yield a complexly nuanced psychoactive agent 1 . However, the study of glutamatergic targets of ethanol have been a recent development 2 . The recency of these clinical studies may be surprising. Glutamate is the most prevalent excitatory neurotransmitter in the cerebral cortex and it mediates most output of the cortex and limbic system 3 . Also, the V-methyl-d-aspartate NMDA subtype of glutamate receptor is among the highest-affinity targets of ethanol inthe brain 4 . This chapter will provide an introduction to studies indicating that NMDA receptor blockade contributes to the behavioral effects of ethanol in humans. In doing so, it will provide clinical insights into the neurobiology of the rewarding and dysphoric effects associated with the blockade of NMDA receptors by ethanol. This chapter will then describe evidence of glutamatergic dysregulation in ethanol-dependent patients. In doing so, it will emphasize the...

Natural Disasters

Eberly and Engdahl 1991 analyzed medical and psychiatric data for American former prisoners of war World War II and Korean War . In comparison with the general population, PTSD prevalence rates were greatly elevated, whereas lifetime prevalence rates of depressive disorders were only moderately increased. However, the authors did not nd evidence for generally higher rates of hypertension, diabetes, myocardial infarction, alcoholism, and other psychiatric disorders. Within the study group, those former prisoners who had suffered massive weight loss demonstrated a greater number of psychiatric disorders than their comrades. Some of the causes of death among widowers are alcohol-related diseases, accidents, suicide, and chronic ischemic heart disease. Miller and Wortman discuss various possible explanations for their ndings. The rst reason for experiencing widowhood differently may be the different marital roles. Men tend to rely solely on their spouses in many ways. Wives are often the...

Role Of Glutamate In Alcohol Withdrawal Kindling

Mechanisms underlying alcohol withdrawal sensitization or kindling are not well understood. In fact, the terms sensitization and kindling are used interchangeably here to describe observed exacerbation of withdrawal signs noted in both clinical and preclinical studies rather than infer a particular mechanism, per se. Both neuroadaptive changes in response to alcohol exposure as well as changes unique to withdrawal from alcohol most likely play a joint role in the final expression of the phenomenon 15,46 . Furthermore, mechanisms underlying the development of withdrawal kindling or sensitization may be distinct from those critical for expression of the phenomenon. Experimental work in recent years is beginning to elucidate neural substrates involved in the complex and dynamic changes in brain function associated with multiple-withdrawal experience. It is well documented that excessive alcohol consumption results in neuroadaptive changes in many neurochemical systems. These compensatory...

Howard C Becker PhD and Nicole Redmond PhD

It is well known that continued excessive alcohol consumption can lead to the development of physiological dependence. When drinking is abruptly terminated or substantially reduced in the dependent individual, a characteristic withdrawal syndrome ensues. As with other central nervous system CNS depressants, withdrawal symptoms associated with cessation of chronic alcohol use are opposite in nature to the effects of intoxication. Thus, clinical features of alcohol withdrawal include signs of heightened autonomic nervous system activation e.g., tachycardia, elevated blood pressure, diaphoresis, tremor , CNS hyperexcitability that may culminate in motor seizures, and, in its most severe form, hallucinosis and delerium tremens 1-3 . In addition to physical signs of withdrawal, a constellation of symptoms contributing to psychological discomfort e.g., irritability, agitation, anxiety, dysphoria constitute a significant component of the withdrawal syndrome 4-7 . The overall intensity of the...

Deficiency Signs And Symptoms Tzs

Secondary deficiencies can develop in chronic diarrhoea, liver disease, chronic alcoholism, adrenal or thyroid hormone insufficiency and postoperative situations in which TPN solutions lack riboflavin. In most cases, riboflavin deficiency is accompanied by other vitamin deficiencies such as vitamin B6, niacin and folic acid. Drugs that impair riboflavin absorption or utilisation by inhibiting the conversion of the vitamin to the active coenzymes include tricyclic, antidepressants, chemotherapy drugs and psychotropic agents. There is also evidence suggesting an apparent increase in riboflavin requirements with increased physical exercise.

Clinical Use Ayk

Hyperemesis Although thiamine supplementation will not reduce the symptoms of hyperemesis, it may be necessary in cases of hyperemesis gravidarum and hyperemesis due to gastroplasty in order to avoid deficiency states and the development of Wernicke's encephalopathy, which has been reported in these situations, although noted to be a rare consequence. It may be precipitated in part by intravenous fluids containing dextrose, and is more commonly seen when the patient's liver transaminases are elevated, which may contribute to the encephalopathy Gardian et al 1999, Seehra et al 1996, Spruill amp Kuller 2002, Tan amp Ho 2001, Togay-lsikay et al 2001, Toth amp Voll 2001, Welsh 2005 . Alcoholism In alcoholism, a state of decreased intake, absorption, utilisation and increased requirement for thiamine occurs, suggesting a need to increase intakes to avoid deficiency states D'Amour et al 1991 . In cases of Wernicke's encephalopathy, monitoring of thiamine status and prophylactic intravenous...

Deficiency Signs And Symptoms Hpz

There are three forms of beriberi dry, wet and cerebral, also known as Wernicke-Korsakoff syndrome. Dry beriberi is associated with peripheral neurological changes whereas cerebral beriberi involves alterations to ocular function, cognitive function and produces ataxia, which can also be fatal. In addition to neurological changes, wet beriberi is associated with cardiovascular changes characterised by peripheral vasodilation, sodium and water retention, increased cardiac output and myocardial failure, which can advance to become fatal in severe cases. Although alcoholism is the major cause of Wernicke-Korsakoff syndrome, it has also been reported in several other conditions such as hyperemesis gravidarum and hyperemesis due to gastroplasty Gardian et al 1999, Ogershok et al 2002, Seehra et al 1996, Spruill amp Kuller 2002, Tan amp Ho 2001, Togay-lsikay et al 2001, Toth amp Voll 2001 . primary deficiency Secondary deficiency is caused by an increased requirement, as in hyperthyroidism,...

Summary And Conclusions 1

Human and animal studies have clearly established that chronic alcohol intake causes a loss of brain mass as a result of ethanol-induced brain damage. Although human studies show loss of brain tissue and the loss of specific brain nuclei after years of alcohol consumption, recent animal studies have indicated that neuronal loss can occur after only a few days of binge drinking. The neuropathol-ogy in humans involves both gray and white matter, whereas the animal studies have focused on neuronal loss e.g., gray matter . It is possible that long-term animal studies could confirm the human findings. Alcohol-induced neuropathology is associated with the loss of some cognitive functions, including the executive functions associated with the frontal cortex. Neuropathology and the loss of executive functions, including impulse inhibition and goal setting, could contribute to the development of alcohol dependence. Ethanol-induced brain damage appears to be secondary to changes in glutamate...

Drugs And The Law

These issues have been discussed in detail in Davies 1998 but to cut a lengthy philosophical discussion short, we tend to regard people who for example drink normally as being able to make choices about whether to drink or not, when to stop, when to carry on. In other words, to behave like thinking beings capable of exercising acts of will in controlling their consumption that is, doing 'what they want to do'. On the other hand, we tend to think of 'alcoholics' an unpopular word these days as using alcohol because they have to due to an underlying compulsive mechanism. In a similar way, drug 'addicts' are felt to use drugs compulsively even though they may be 'trying to stop' that is, against their 'will'.

Diseases Laws And Social Constructs

It. While the 'presence of an invading organism' is a key feature of many things we term 'diseases', it is by no means the case that all 'diseases' have this 'scientific' feature. 'Addiction' and 'alcoholism' for example are both regularly conceptualised as diseases signalling that 'treatment' is appropriate although there is no invading organism and the main 'disease' symptoms consist of an organised, planned and generally well integrated sequence of behaviours directed towards the goal of acquiring the next fix. These arguments have been discussed elsewhere Davies, 1997a . 'Gambling addiction' is perhaps the most striking example of this type of functional labelling, possessing neither an invading organism nor an external pharmacology see Davies, 1997a, pp. 71-73, for a critique of the argument that there is an internal pharmacology and thereby opening the door to the labelling of any other type of doggedly determined behaviour as an 'addiction' e.g. shopaholism, computer-game...

The Pathological Context and Diagnosis

Because the patient was referred for testing and evaluation as a result of presenting complaints and the confusion surrounding them, it is logical to address the context of the presenting complaint when developing and formalizing the diagnostic summary. Simply restating the problem in diagnostic terms is not sufficient because it fails to enhance the explanatory power of the assessment and does not summarize the test findings. For example, simply reporting alcohol abuse does not clarify any processes involved. Consequently, a diagnosis of the pathological context in which the presenting problem is embedded is a crucial part of the diagnostic effort. Thus, relating the presenting complaint to its pathological context is the logical conclusion to the entire report. This means that the essential diagnostic effort and conclusion by Alcoholism can serve as an example to indicate that a presenting problem needs to be embedded in a careful diagnostic formulation because it illustrates the...

And L Judson Chandler PhD

Alcohol is a major drug of use and abuse in the United States. An estimated 15 million Americans 1988 NHIS study are alcohol abusers or alcohol dependent. Lifetime prevalence of alcohol dependence is estimated at 13 and 4 for American men and women over 18 yr of age, respectively 1 . It is well established that chronic excessive ethanol consumption produces marked deficits in cognitive and motor abilities 2,3 . Alcohol is a leading cause of adult dementia in the United States, accounting for approx 10 of cases Alzheimer's disease is the leading cause, accounting for 40-60 of cases . Although there is evidence of reversibility of deficits with sobriety 4 , a variety of studies report that 50-75 of sober, detoxified, long term alcohol-dependent individuals suffer from some degree of cognitive impairment, and approx 10 of these are seriously demented 5 . The damaging effects of alcohol appear to lie on a continuum, with moderate deficits in the majority of long-term alcoholics,...

Integrating Diagnostic Levels

Any outstanding features that distinguish the diagnostic status of the patient can be added to the diagnostic statement. This addition enables the diagnostic summary to reflect more accurately the major factors of personality functioning for example, the addition of an indication of depressive features to any diagnostic formulation where this is appropriate. Information concerning a subject's alcohol abuse or drug addiction might also be appended in cases in which these involvements are known and have influenced the test results sufficiently to warrant reporting of associated findings.

Cognitive and Psychiatric Disturbances

Earlier literature described euphoria as a feature of MS 120 . However, depression is now recognized much more commonly, with 50 or more of patients experiencing this affective disturbance in some form during the course of the illness 121-123 . Although this is usually relatively mild, major depression can occur 123 . Suicide may be a major cause of mortality, accounting for 15 of adult deaths in one series 124 . Recently, Feinstein 125 identified warning signs that include living alone, having a family history of mental illness, and reporting social isolation. Patients with a prior history of major depression, anxiety disorder, or alcohol abuse are also particularly vulnerable. The so-called euphoria is actually the inability to inhibit emotional expression, resulting in inappropriate laughing and crying. This occurs with subcortical forebrain lesions 126 . Other instances of apparent euphoria seem to be associated with evidence of significant cognitive decline. Euphoria is rarely,...

Reward Deficiency Syndrome

Individuals tend to be at risk of multiple addictive, impulsive and compulsive behavioural problems, such as severe alcoholism, cocaine, heroin, marijuana and nicotine addiction, pathological gambling, sex addiction, chronic violence, posttraumatic stress disorder, risk taking behaviours and antisocial behaviour. As such, the use of tyrosine as a precursor to dopamine has a theoretical basis for use in this condition Blum etal 2000 .