Help With Alcohol

Alcohol Free Forever

This powerful guide walks you step-by-step through exactly what you need to do to free yourself from your alcohol addiction without going through AA meetings or expensive sessions. There are three main types of relaxation techniques you can practice when you feel upset and stressed. If you practice regularly, they will become part of your lifestyle and you may find yourself habitually more relaxed as a result. Part 2 will exercise Neuro Linguistic Programming to release thoughts and a technique of progressive muscle relaxation also negative situations. Because of the mind body connection, exercises to relax the body will also flow through the mind. Much of the stress we feel is because of our resistance to certain feelings or emotions. Alcohol Free Forever is a lifesaver ebook. This guide was extremely eye-opening and the daily emails make it extremely easy to quit and to establish a routine that did not involve alcohol. Continue reading...

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Role Of Glutamate In Alcohol Withdrawal Kindling

Alcohol Nmda Receptor

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...

Course of alcohol abuse

The traditional view, which may well apply to some of the most severely affected, is of a relentlessly progressive disorder. Alcohol problems commonly begin when social drinking becomes heavier for psychological reasons, such as living in a hard-drinking environment, or stressful work or family circumstances. This stage of psychological dependence is followed in some cases by development of physical dependence, manifested by loss of control over the amount consumed, and withdrawal symptoms (tremor, sweating, anxiety, and craving) if alcohol is unavailable for a few hours. Intake increases further to combat withdrawal symptoms. Alcohol tolerance increases initially, decreasing again when the condition becomes advanced. Drinking gains priority over other activities, and the various physical, psychiatric, and social problems ensue. Other patterns include repeated relapses and remissions according to current circumstances and or changes in mood. As with other kinds of substance misuse...


Preliminary studies suggested a potential for glutamine to reduce alcohol cravings however, these effects have not yet been studied in controlled trials on humans (PDRHealth 2006a). More recently, in vitro research has suggested that glutamine supplementation may inhibit the deleterious effects of alcohol on the tight junctions of the gut mucosa and in turn reduce the increased risk for gastrointestinal cancers in alcoholics (Basuroy et al 2005, Seth et al 2004).

Alcohol misuse

Moderate alcohol intake is, for many people, an acceptable and enjoyable part of life. However, those who drink to excess, or are particularly vulnerable to the unwanted effects of alcohol, may experience a wide range of medical and psychiatric problems. Alcohol misuse may be defined in terms of quantity of alcohol intake There is no agreed definition of 'alcoholism'. Patients with obvious drink problems often seek to avoid the issue by diversion into discussion about whether they are or are not 'an alcoholic', but these are, by their very nature interminable, as the word means different things to different people. The words are used here as a useful shorthand only.

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. Determine whether the patient ever consumes five or more drinks at a time (binge drinking). Drug abuse.

Health Maintenance And Disease Prevention

As noted previously in this chapter, the occurrence and severity of many kinds of diseases are associated with the habits and lifestyle of the person. Lifestyle is, of course, not the only causative factor in promoting disease, but it is an important one and one about which the individual himself can do something. In young adulthood, the ability of the body to ward off disease and to cope with the effects of accidents and stress is at a maximum, but as one grows older, the body's ability to deal with these problems declines. Unfortunately, the health and energy of young adults may obscure their perception of the negative consequences of a poor diet, smoking, alcohol abuse, and other insults to the body that will have carryover effects on their health in middle-and late life. smoking and consumption of alcoholic beverages. But despite the efforts of schools, the government, and other organizational spokespersons to convince people to get a good night's rest, eat breakfast, stop...

Neurophysiological Factors

Many supporters of a neurological explanation of age-related declines in intelligence view it as the result of small changes in the brain produced by high blood pressure, alcoholism, and other pathological conditions (Rinn, 1988). It is certainly true that intellectual functioning is affected by health status and that people with higher intellectual abilities are healthier and live longer than those with lower abilities. Self-reports of physical and mental health confirm the results of medical diagnoses in this regard (Perlmutter &

Prioritization of Treatment Strategies

Behavioural couple therapy (BCT) is as effective as individual CBT not only with alcohol abuse but also with depression and anxiety disorders (Emmelkamp & Vedel, 2002). Because of Mick's early retirement and the consequences this was going to have on their relationship, and taking into account their overall low marital satisfaction, we decided to offer Dianne and her husband BCT, focusing on the drinking problem as well as their relationship. If still needed, the spouse-aided therapy for alcohol abuse could be supplemented by spouse-aided therapy for depression or anxiety. Because Dianne had already started using Acamprostate, we agreed that she would continue using the anti-craving agent during the course of our treatment.

Analysis of Individual Effects in Clustered Group Level Designs

Let's begin with an unstratified (i.e. no strata) group study which is testing a new group intervention against alcohol abuse (i.e. a Group Level variable XGL 0 for those given Program A, XGL 1 for those given Program B). Four classes using Program A are taught to nk n 15 students each for 60 students total, and 4 classes using Program B are taught to nk n 15 students each for 60 students total. So there are a total of K 8 (4+4) teaching groups. For each person, the outcome Yk is average number of drinks (i.e. wine glass equivalents) of alcohol per week the subject consumes. Since there are no strata (and assuming that no individual level covariates are included in the model), the previously defined model reduces to Yk u + bGL XGL + Ak + ek where bGL indicates the parameter is for a Group Level variable XkGL 0 for classes given Program A, XGL 1 for classes given Program B, u is the mean number of drinks consumed by students from Program A, and bGL is the mean difference between...

Aged Rodents for Biogerontology Research

Human aging is the result of a complex interaction between biological changes and environmental social influences. Healthcare throughout life, diet, and habits such as smoking, alcohol consumption and physical activity can all impact the rate of biological aging and complicate the study of the biology of aging in human populations. The rodent provides a venue for modeling the biological changes with age and investigating the genetic and physiological basis of aging and age-related diseases while controlling intrinsic and extrinsic influences. The genetic background, diet, environment, and health status of the rodent can be strictly controlled. Rodents are similar to humans in much of their physiology, cellular function, and to a lesser degree, even their anatomy. The musculoskeletal system, immune and endocrine systems, and gastrointestinal tract are very similar in both function and architecture between rodents and humans. Cardiac function has been modeled in rodents, as have...

Negative Study Bias What Journalists Ignore

Conrad, who has been tracking genetics coverage in 5 major US papers and 3 major newsmagazines followed the reporting of two such stories, a 1987 study about the Old Order Amish and a gene for manic depression and a 1990 study about a link between alcoholism and the dopamine D2 receptor. Both stories received major attention in the print media. But while the New York Times reported later studies discounting the findings of the manic depression gene story, the other papers and the newsmagazines either did not report the new evidence at all or only did so years later as part of another article.

Physical characteristics

The range of head shapes and facial features in this family reflect different feeding behaviors. 1. Choeronycteris mexicana is a nectar-feeding bat with a long snout and bristled tongue 2. Platyrrhinus helleri is a fruit-eating bat with a short snout 3. Chrotopterus auritus is carnivorous, and 4. Lonchorhina aurita is an insect gleaner both have large ears and a nose leaf 5. Diphylla ecaudata is a blood drinker with a short snout and stubby nose leaf. (Illustration by Gillian Harris) The range of head shapes and facial features in this family reflect different feeding behaviors. 1. Choeronycteris mexicana is a nectar-feeding bat with a long snout and bristled tongue 2. Platyrrhinus helleri is a fruit-eating bat with a short snout 3. Chrotopterus auritus is carnivorous, and 4. Lonchorhina aurita is an insect gleaner both have large ears and a nose leaf 5. Diphylla ecaudata is a blood drinker with a short snout and stubby nose leaf. (Illustration by Gillian Harris)

Environmental adversity and reproductive development

The relation between interuterine growth retardation, resulting in diminished birth weight, and an early onset of sexual maturation may seem somewhat counterintuitive. Note, however, that this relation is only apparent under conditions of adequate postnatal nutrition, and indeed is best reflected in those children that reveal postnatal catch-up growth. Interuterine growth retardation is a reliable consequence of materno-fetal function under conditions of environmental adversity. Indeed, increased activity of the maternal and or fetal hypothalamic-pituitary-adrenal (HPA) axis is considered the proximal cause of interuterine growth retardation (Goland et al., 1993, 1995 Matthews and Meaney, 2005 Meaney et al., in press Seckl, 1998). Thus, poverty is associated with a significantly increased risk for inter-uterine growth retardation (IUGR) and the major predictors of low birth weight, maternal protein deprivation, tobacco and alcohol consumption, and maternal stress anxiety are related to

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...

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.

Deficiency Signs And Symptoms

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.

Primary Deficiency

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 & Berkow 2003, Bratman & Kroll 2000, Wardlaw et al 1997).

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...

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...

Causes and symptoms

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...

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

Critical Thinking Questions

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

Category X Drugs Absolute Contraindication In Pregnancy

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.

Peripheral polyneuropathy

Peripheral polyneuropathy is mainly caused by the NRTIs, zalcitabine, didanosine and stavudine. It usually presents with a distal symmetrical distribution and sensorimotor paralysis. Patients complain of paresthesia and pain in their hands and feet, and often, with zalcitabine, about perioral dysesthesia. The symptoms often begin gradually after several months of therapy. HIV infection itself can lead to peripheral polyneuropathy, but the drug-induced form becomes apparent much earlier and may develop within a shorter period of time. Patients must be informed that they should consult their treating physician as soon as possible if the typical complaints develop. Additional risk factors for polyneuropathy, such as vitamin B12 deficiency, alcohol abuse, diabetes mellitus, malnutrition, or treatment with other neurotoxic drugs, e.g. INH, should be addressed in the appropriate manner. The nucleoside analogs, zalcitabine, didanosine and stavudine, should be avoided in these cases.

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). Novel aspects of addictive behavior to alcohol (craving, relapse, and sensitization processes) are uncovered by a new animal model of long-term, free-choice, alcohol self-administration followed by alcohol-deprivation phases. After several months of voluntary alcohol consumption, the drug-taking behavior following a deprivation (withdrawal) phase is characterized by increased alcohol intake and preference. During this so-called alcohol-deprivation effect (relapselike behavior) rats exhibit a high motivation for alcohol (4). This behavior is interpreted as craving, and this model has been used to investigate the potential of new anticraving agents (5). In this model,acamprosate (50-200 mg kg, ip) administered...

Postoperative Haematoma

The potential space under a large bone flap was identified as a significant risk factor in 59 patients who developed postoperative haematoma that required evacuation. Most of these postoperative haematomas were extradural. These 59 patients were from a total number of 850 patients who were admitted with severe head injuries and had intracranial haematoma evacuated. Factors predisposing to a recurrent haematoma included high alcohol intake, brain atrophy,

Angiogenesis Basic Mechanisms and Role in Head and Neck Squamous Cell Carcinoma

The vast majority (95 ) of head and neck tumors are squamous cell carcinomas (HNSCC), the most common type of cancer affecting the lining of the airways and upper digestive organs. HNSCC comprises a wide variety of epithelial malignant lesions affecting the nasal cavity and paranasal sinuses, nasopharynx, oral cavity, lips, alveolar ridge and retromolar trigone, floor of the mouth, tongue, hard and soft palat, tonsil, pharyngeal wall, larynx, hypopharynx, and salivary glands. Cancer in these locations originates from the cuboidal cells along the basement membrane of the mucosa and usually has profound impairing effects on breathing, speaking, and swallowing. The disease is characterized by local tumor aggressiveness, early recurrence, and high frequency of second primary tumors. Neoplasias of the head and neck region are relatively infrequent in comparison with cancer occurring in the breast, lung, prostate, and colon and represent approximately 5.6 of all tumors....

Ineffective Treatment Modalities

The traditional model of treatment in the alcohol problems field is group therapy. It was the principal type of intervention in the residential alcoholism treatment units that dominated the response to alcohol problems in the UK and in other countries from the pioneering work of Dr Max Glatt in the 1950s to the 1980s (Ettore, 1984, 1988). The conduct of group therapy in this tradition was heavily influenced by the teachings of AA and group therapy of this kind is still widely practised today. Unfortunately, there is no evidence that group therapy for alcohol problems is effective. This is shown by the low negative CES for 'group process psychotherapy' in Table 15.1, based on three studies. The involvement of groups of people in the treatment process may be an important principle but there is little justification without further research for continued use of group therapy in the traditional way it has been used in the alcohol field. Alcoholics Anonymous and Twelve-step Facilitation The...

The face as a mirror of disease

A fascinating aspect of the art of clinical medicine is the clinical interpretation of the patient's facies. Not only are specific skin lesions common on the face but the face may also mirror endocrine disorders and organ failure such as respiratory, cardiac, renal and liver failure. Jaundice may be masked by the natural colour of the cheeks but the yellow conjunctivae will be distinctive. A marked plethoric complexion may be seen in chronic alcoholics (alcohol may produce a pseudo-Cushing's syndrome), in Cushing's disease or in polycythaemia. Thickening of the subcutaneous tissues may be seen in chronic alcoholism, acromegaly and myxoedema, and the puffiness of the eyelids in the latter condition may simulate the true subcutaneous oedema of renal disease.

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...

And L Judson Chandler PhD

Perirhinal Cortex

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,...

Intensity Setting And Costeffectiveness Of Treatment

With the advent of brief interventions, treatment for alcohol problems has become more variable in length (duration) and intensity (amount of therapist contact). There is little doubt that, for heavy drinkers not seeking treatment and identified by screening in generalist settings, brief interventions of one or two sessions are all that is necessary in most cases for those in the treatment-seeking population with more serious problems the optimal intensity of treatment is unknown. Project MATCH (1997a) found that four sessions of MET were generally as effective as eight sessions of CBT or TSF although, as we have seen, certain types of client benefited more from the more intensive treatments. Nevertheless, the Project MATCH findings suggest that, on the whole, less intensive treatment by MET is more cost-effective than more intensive alternatives (Cisler et al., 1998). Against this, in a reanalysis of the MATCH economic data, Holder et al. (2000) reported that, for certain types of...

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...

Social History And Habits

Social history and habits can also play an important role in pain management therapy. Smoking and alcohol use can complicate acute pain management. Patients who use alcohol on a regular basis can experience various degrees of withdrawal symptoms if it is discontinued abruptly. This is especially important in postsurgical patients. Alcohol withdrawal symptoms can occur 24 to 48 hours after abrupt discontinuation. Alcohol withdrawal can cause anxiety and agitation, which can make the patient far less able to cope with pain. Patients who take several alcoholic drinks daily should be evaluated on hospital admission to receive benzodiaz-epine for withdrawal prevention.

Clinical Manifestations

The most common sites affected are the abdomen, femoral shaft, knee, and lower back. The etiology remains unclear. There appears to be an inciting factor in many cases. Inciting factors may include emotional stress, physical exertion, and alcohol consumption. Pain probably results from microinfarction of the end organ, for example, medullary infarction resulting in bone pain. About 1 of sickle cell patients have more than six episodes per year (12).

Medicolegal Forms With Legal Analysis P-47

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).

Health Outcomes Of Stressful Life Events

Life Events Theory Health Psychology

Most individuals who experience stress do not develop illness. Stressful life changes are usually temporary, whereas other risk factors for disease can be longer lasting, for example, smoking, alcohol consumption, a high-fat, low- ber diet, and risky lifestyle in general. When comparing a single life event with those long-term behaviors, the latter seem to be more in uential in developing illness. Moreover, the experience of a critical life event is related to coping and social support, whereby these two factors may moderate the stress-illness connection. How can we understand the mechanisms of the stress-illness association There are three major pathways that link stressful life events to ill health (Figure 2.2). 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.

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).

Studies Of Psychological Treatments In Bipolar Disorders

A study by Scott, Garland & Moorhead (2001) examined the effect of 20 sessions of CT in 42 clients with BP. Participants could enter the study during any phase of BP. Clients were initially randomly allocated to the intervention group or to a 'waiting-list' control group who then received CT after a six-month delay. The randomized phase (six months) allowed assessment of the effects of CT plus usual treatment as compared with usual treatment alone. Individuals from both groups who received CT were then monitored for a further 12 months post-CT. At initial assessment, 30 of participants met criteria for an affective episode 11 participants met diagnostic criteria for depressive disorder, three for rapid cycling disorder, two for hypomania, and one for a mixed state. As is typical of this client population, 12 participants also met criteria for drug and or alcohol problems or dependence, two met criteria for other Axis I disorders and about 60 of the sample met criteria for personality...

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 & 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 & 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 & Barlow, 1996a). Socially anxious children and adolescents may also suffer from elevated rates of general anxiety, depression, and secondary alcohol abuse...

Differential diagnosis of paranoid states

Paranoid symptoms are found in many of the common psychiatric conditions described elsewhere in this book, including schizophrenia, affective disorders (depressive illness and mania), drug and alcohol misuse, and the dementias. The following list describes some other syndromes in which paranoid symptoms are a main feature Morbid jealousy (pathological jealousy, Othello syndrome) patients, usually men, are deluded that their sexual partners are unfaithful. Morbid jealousy is often part of another syndrome paranoid schizophrenia, depressive illness, organic brain syndrome, or alcoholism. Many patients have sexual dysfunction and or poor personality adjustment. A small percentage may show homicidal behaviour, and lesser degrees of violence are even more common, so morbid jealousy is an important condition despite being rare. A formal risk assessment must be made in such cases, and an appropriate care plan put in place. Referral to forensic psychiatric services may have to be considered....

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...

Frontotemporal Dementia

Consensus criteria have made them more general, but they are similar to previous criteria (McKhann et al., 2001). These criteria, shown in Table 4.2, are supplemented by core features of the three common presentations of FTD outlined by Neary et al. All presentations of FTD have an insidious onset and gradual progression. Onset is frequently before age 65, and a family history of FTD is common. Features of motor neuron disease or parkinsonism can been seen during the course of FTD, but hyperkinetic movement disorders (e.g., myoclonus, chorea) are not seen. Clinical features that would suggest an alternative cause of dementia are used to exclude FTD, including evidence of vascular dementia, HIV-associated dementia, multiple sclerosis, chronic alcoholism, herpes simplex encephalitis, or dementia due to closed head injury.

Minority Groups And The Urban Environment

Although health risk behaviors such as smoking, alcohol consumption, and diet have been viewed simply as individual characteristics, accepting this view ignores the forces and inequalities in our society that not only promote the initiation of these behaviors but also help maintain these practices. For example, alcohol and smoking have been positively associated with poverty and are frequently used to obtain relief from harsh living, working conditions and stressful environment induced by the social structures and unequal distribution of resources. In addition, there is also a strong association between availability of these products, specifically alcohol consumption (Rabow and Watts, 1983 1984). Blacks and latinos are more likely to hold stressful jobs and live in impoverished communities. To complement that, it is well known that blacks and latinos have been targeted by these industries, and in fact, over 80 of billboards in the U.S. contain advertisements targeted to blacks and...

Ethical Issues in the Quality of Care

Because of the role that behavior plays in the occurrence of many of today's health problems, it has been suggested that many of these so-called health problems be demedicalized (B. Jennings, 1986). For example, illicit drug use, alcoholism, domestic violence, motor-vehicle accidents, and homicide are ills arising from and impacting upon the whole of society and not just the health care system. Demedicalization is intended to foster a multifaceted and integrated strategy for solving the given problem by utilizing and incorporating other rel

Neuropsychiatric complications

Delirium tremens (DTs), an indication of physical dependence, can be precipitated by abrupt withdrawal of alcohol in a heavy drinker, caused, for example, by the end of a drinking bout, efforts to give up drinking without professional advice, intercurrent illness, hospital admission, or arrest imprisonment. Confusion, fever, visual or tactile hallucinations, and fits may occur. Delirium tremens is a medical emergency with an appreciable mortality, and should be treated by physicians. Treatment includes correction of any fluid or electrolyte imbalance, or hypoglycaemia, and a 5-day reducing course of a benzodiazepine, such as chlordiazepoxide, to counteract withdrawal symptoms by sedation and prevention of fits. These drugs have potential for dependence and abuse, and should not be continued after detoxification. Parenteral vitamins, thiamine being most important, are also given to prevent other neurological complications. Epilepsy may be caused by direct toxicity of alcohol,...

Phenotypic variation in human female reproductive development

The most reliable measure of environmental quality in human research is that of socioeconomic status (SES), which predicts multiple health outcomes. Studies, including those using prospective analyses, reveal significant effects of SES during childhood that are statistically independent of those associated with adult SES, on adult mortality (Davey-Smith et al., 1998 Kaplan and Salonen, 1990 Marmot et al., 2001), metabolic (e.g., body mass index, hip waist ratio) and cardiovascular (Barker, 1992 Blane et al., 1996 Bosma et al., 1999 Brunner, 1996 Kaplan and Salonen, 1990 Poulton et al., 2002 Power et al., 2005 Rahkonen et al., 1997). Likewise, there are effects of SES in early life on psychological function and mental health. Childhood SES affects alcohol dependence in adulthood and the effects are not reversed with subsequent upward mobility (Poulton et al., 2002). An extensive, prospective study by Gilman et al. (2003) found a clear effect of childhood SES on depression (Kessler et...

Differential Diagnosis of Atrial Fibrillation

Lone Atrial Fibrillation No underlying disease state. Cardiac Causes Hypertensive heart disease with left ventricular hypertrophy, heart failure, mitral valve stenosis or regurgitation, pericarditis, hypertrophic cardiomyopathy, coronary artery disease, myocardial infarction, aortic stenosis, amyloidosis. Noncardiac Causes Hypoglycemia, theophylline intoxication, pneumonia, asthma, chronic obstructive pulmonary disease, pulmonary embolism, heavy alcohol intake or alcohol withdrawal, hyperthyroidism, systemic illness, electrolyte abnormalities. Stimulant abuse, excessive caffeine, over-the-counter cold remedies, illicit drugs.

Nondietary Prostate Cancer Risk Factors

Other factors have been suggested to increase prostate cancer risk but with highly inconsistent results. Alcohol consumption, which is of interest primarily because of its impact on circulatory steroid hormone levels, was recently the subject of a meta-analysis involving 33 epidemiological studies that had assessed alcohol consumption and prostate cancer risk.33 Alcohol consumers overall had a risk of prostate cancer of 1.05 compared to non-drinkers, but risk increased to 1.21 among men consuming at least four drinks per day.

The Role Of Social Structures In The Treatment Of Patients With Personality Disorders

The social factors affecting personality disorders are structurally rooted in modern society and cannot be changed by clinicians. Thus, patients with personality disorders have difficulty in finding social roles and are more likely to recover if they establish such roles. But there is no way to provide a full range of opportunities for patients. Nor can we offer them the structures provided by traditional families and communities. Nonetheless, personality-disordered patients usually benefit from establishing better social networks and supports. Therefore, clinicians can encourage their patients to establish more connections with community organizations. Support groups, often based on the model of Alcoholics Anonymous, target individuals suffering from social isolation.

Drug Dependency Assessment

Embarrassed to tell the clinician the truth. Too often, the clinician finds out about the patient's alcohol usage only after the patient starts to experience withdrawal. By then, more aggressive therapeutic and medical interventions may be required, which could easily have been prevented with appropriate medications. At the earlier stages of withdrawal, the patient may only complain of spasms or unrelieved pain in addition to agitation and restlessness. Frequently, the clinicians attribute these symptoms to pain and give more opioids without success. However, appropriate assessment of and judicious use of benzodiazepines by patients with alcohol withdrawal can quickly bring the patient's pain and anxiety under control. The correct assessment will require clinician persistence in pursuing the clinical clues and the assistance of the patient's family members.

Nonpsychotic Disorders

The highest frequency of occurrence among nonpsychotic mental disorders is found in substance abuse and alcoholism, which affect over 16 of the general U.S. population (Regier & Burke, 1989). Although alcoholism is at its peak in middle age, many older adults turn to alcohol as a means of coping with grief, loneliness, and pain. Alcoholism in early and middle adulthood occurs more often in men than in women, but, because of loneliness and depression, many women also start drinking in later life (LaRue et al., 1985). Older alcoholics are more likely to manifest impairments in memory and thinking. Because alcohol is rich in carbohydrates but low in proteins and vitamins, long-term users can develop cirrhosis of the liver due to protein deficiency or Korsakoff's syndrome due to vitamin B deficiency. The symptoms of Korsakoff's syndrome, a chronic brain disorder occurring most often in chronic alcoholics in their fifties and sixties, include disorientation, impulsiveness, memory loss,...

Tuberculosis in the homeless

The reasons for the high incidence of tuberculosis in the homeless and their epidemiological effect in causing new cases are multiple. In spite of a high rate of completion of chemotherapy overall in San Francisco, the highest rates of loss were among the homeless. At least some of these cases continue to be infectious. Many of the persons in this environment are vulnerable to tuberculous infection because of HIV infection or other factors that are more difficult to quantify, such as drug abuse, alcoholism, poor nutrition or generally poor health (Zolopa et al 1994).

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...

Anxiety Disorders and Other Mental Disorders

The rates of alcohol abuse and dependency are reportedly higher in older minorities than non-Hispanic whites, particularly among older males. Data from the ECA (Helzer, Burnam, & McEvay, 1991), for example, indicate lifetime rates of 17.8 among older African American males, in comparison to 10.8 among older Hispanics and 10.4 among non-Hispanic whites. Both older African American and Hispanic males, however, are reported to have higher current rates of alcoholism (2.9 and 6.6 , respectively) than non-Hispanic white males (2.8 ). The rates are highest, however, among older Native Americans, particularly older males. The rates of alcohol abuse and dependency, as well as alcoholism are generally much lower in all groups of older females. The rates of drug abuse and dependency are very low among virtually all older adults, although they constitute a serious problem (Gaw, 1993). Both alcohol and drug abuse, however, may be underecognized in older adults, due to symptoms that may be...

General Multicultural Issues

Culturally diverse clients with HIV AIDS. For example, Marin and Marin (1990) found that less acculturated Hispanics tended to have less correct knowledge about HIV transmission than highly acculturated Hispanics. In the case of American Indians, Schinke (1996) suggested that the high prevalence of alcohol abuse among members of this racial group could be explained in terms of the effect of acculturation. (It should be noted that alcohol abuse is considered a risk factor for the transmission of HIV disease because alcohol is often associated with unprotected sexual activities, which is another risk for HIV transmission Hoffman, 1996.) Schinke pointed out that many American Indians living in cities outside their reservations may feel multiple pressures related to conflicts between their own culture and the dominant society. Such pressures demand a coping response and American Indians may adopt alcohol use as a coping mechanism against acculturation stress (p. 371). This is another...

The aftermath of suicide effects on those involved

Sometimes, suicide can even seem to be an act with a violent aspect, perhaps directed toward those left behind, leaving the family almost as 'victims' of suicide. Others, however, might ultimately find their lives made easier if the dead person had been affected for many years by a severe and intractable personality disorder, mental illness, or drug alcohol misuse.

Psychological and social approaches

Systematic reviews indicate that most of the brief approaches that have been trialled are effective in reducing consumption, but that longer-term psychological treatments (including dynamic, behavioural, or supportive psychotherapy, individual or group, on an inpatient or outpatient basis) have little or no additional benefit. The trend is firmly toward inexpensive community treatments with input from health, social, and probation services. However, inpatient alcoholic units still exist, offering intensive group psychotherapy over several weeks or months. Long-term residence in a 'dry' hostel offers support for some severely damaged ex-drinkers. Alcoholics Anonymous (AA) is a voluntary organization offering self-help group therapy at evening meetings, and it also runs groups for partners and children. The goal of lifetime total abstinence is central to AA's approach. Some people derive great benefit from AA, and continue frequent attendance at meetings for many years to make sure they...

Psychiatric conditions

Substance misuse commonly coexists with mood disorders. Depression of mood can be secondary to alcoholism, due to the depressing effects of alcohol on the brain. Equally, patients with depression not infrequently attempt to self-medicate with alcohol this is counterproductive, however, because the euphoriant effects of alcohol only last an hour or two, and are followed by a superadded lowering of the mood. Manic patients commonly abuse substances. Hence, all psychiatric assessments must include a record of the patient's pattern of substance use.

Physical complications

The mortality rate in alcoholics is about three times the general population rate. Liver damage includes acute hepatitis, fatty infiltration, and cirrhosis. In men, cirrhosis seldom develops until heavy drinking has continued for at least 5 years, but women are more vulnerable. Cirrhosis has a high mortality rate even in those who become totally abstinent. In pregnancy, heavy drinking may cause abortion, stillbirth, or the 'foetal alcohol syndrome', comprising microcephaly and other deformities, and learning disability. Accidents, including road accidents, and accidental deaths are common. Suicide is the cause of death in about 15 per cent of alcoholics, and 50 per cent of nonfatal self-poisonings are combined with alcohol.

Classification systems

Classification systems include categorical, dimensional, and multiaxial types. In the categorical type of classification, each case is allocated to one of several mutually exclusive groups. This simple method is the most suitable one for clinical settings. Categorical systems are usually used in a hierarchical way, so that each case receives only one main diagnosis. Organic psychoses take precedence over functional psychoses, and functional psychoses over neuroses. This can lead to oversimplification of complex cases, and does not take account of 'comorbidity', in which two psychiatric diagnoses (for example, anxiety state and alcohol misuse) or a physical and a psychiatric diagnosis (for example, diabetes and depression) coexist.

General Methodological Considerations Of Observational Studies

With the exception of experimental studies, epidemiologic research is based on observational studies, and as such, in theory prone to bias by ''confounding.'' Confounders are ''extraneous factors'' that may lead to an apparent (or conceal a true) association between putative risk factors (or protective factors) and disease, due to their own association with both the former and the latter. For example, various lifestyle factors, such as dietary habits, physical activity, smoking and alcohol consumption, which are clearly related to a variety of health outcomes at old age, are often also interrelated. Therefore, when the impact of one of these factors on some health outcome is assessed, it is crucial that the other factors, as well as additional relevant factors, such as age or gender, are carefully measured and controlled for in the analysis. Control for confounding is typically done by means of multivariable analysis, such as multiple logistic regression or the Cox proportional...

Cardiovascular Disease

Regarding etiology and risk factors, three major types of stroke have to be distinguished ischemic stroke (IS), intracerebral hemorrhage (ICH), and sub-arachnoid hemorrhage (SAH), accounting for about 88 , 9 , and 3 of all strokes, respectively (American Heart Association, 2005). Major modifiable risk factors for IS identified in large-scale epidemiologic case-control and cohort studies include hypertension, diabetes, lack of physical activity, smoking and coronary artery disease (Boden-Albala and Sacco, 2004). Hypertension is clearly the most important modifiable risk factor for IS, but other factors, including heavy alcohol consumption, anticoagulant therapy and potentially low cholesterol levels may also play a role. For SAH, smoking appears to be a particularly strong risk factor (Longstreth et al., 1992).

Partnership and Adult Lifestyle

If the delinquent behaviour persists into adulthood, this may indicate an antisocial personality disorder or the more narrowly defined psychopathy (Hare, 1995, 2001). In these cases, deviant behaviour is very hard to modify (Losel, 1998). Such chronic delinquents often have difficulties in forming stable intimate relations or they chose partners that have similar problems (Quinton et al., 1993). Although most criminal careers fade out after the age of 40, other difficulties such as alcoholism, chronic unemployment, psychiatric problems and violence in the family often continue (Farrington, 1989). Such lifestyles, and the inheritance of genetic information create, in turn, developmental risks for the next generation. But, again, this is not necessarily a closed cycle and depends on interactions with protective factors and mechanisms.

Management of Depressed Mood

Inactivity being one of Dianne's most salient high-risk situations, we introduced activity training as an intervention to tackle negative mood as well as her drinking problem. Activation training is a fairly common behavioural technique in treating depression, derived from Lewinson's theory of depression. We encouraged Mick to help his wife in organizing her week combining basic daily activities (like getting dressed in the morning), taking care of neglected activities (such as cleaning up the bedroom) and increasing the amount of pleasant activities (listening to music, going out for a cup of coffee with a friend). Given Dianne's social anxiety, a gradual approach was used in having her engage in social situations.

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 & 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...

Forensic and Chemical Warfare Toxicology

NMR is not widely used in forensic toxicology, probably due to the perceived poor sensitivity and the lack of routine access to high-field ( 500 MHz) NMR instrumentation. Some interesting historical examples using low-field magnets demonstrate the versatility of NMR for identifying biomarkers of poisoning. Cartigny and colleagues 36 reported on a 4-month-old girl who presented with agitation, fever, dehydration, and metabolic acidosis. Metabolites including o-hydroxyhippuric acid, 2,5-dihy-droxyhippuric acid, and 2-hydroxybenzoic acid (salicylic acid) were observed in XH NMR spectra of freeze-dried urine, which indicated that she had been poisoned with aspirin. The pattern of unusual metabolites can provide a biomarker of aspirin poisoning. This result was remarkable in that an 80-MHz system was employed. NMR has also been used to monitor progressive liver failure following paracetamol-related overdose (10 g) 37 . In addition, the second-ever known instance of acute intentional...

Mood and Behavioral Disturbances

In contrast to apathy and withdrawal, some individuals exhibit agitation, aggression, or sexually inappropriate behavior (Hermann & Black, 2000). Psychotic symptoms may include a wide variety of delusions, hallucinations (usually visual), and nocturnal agitation (Eker & Ertan, 2000). Studies report contradictory findings on the comparative rates of behavioral disturbances across dementia groups. For example, the frequency and severity of behavioral disturbances did not differ across patients with MD, VaD, and AD (Swearer, Drachman, O'Donnell, & Mitchell, 1988). Yet, others have reported that behavioral disturbances were more common in MD than AD or MID patients, which the authors interpret as the synergis-tic effect of two brain diseases on behavior (D. Cohen et al., 1993). Another study compared the differences in cognitive and behavioral problems exhibited by AD, VaD, dementia due to alcohol, and MD (Kunik et al., 2000). On the Cohen-Mansfield Agitation Inventory, the MD individuals...

Physical Examination

Differential Diagnosis Inadequate caloric intake, peptic ulcer, depression, anorexia nervosa, dementia, hy-per hypothyroidism, cardiopulmonary disease, narcotics, diminished taste, diminished olfaction, poor dental hygiene (loose dentures), cholelithiasis, malignancy (gastric carcinoma), gastritis, hepatic or renal failure, infection, alcohol abuse, AIDS.

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.

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

Do Vitamin C and Other Antioxidants Benefit Health

Joints, and gums and unusual fatigue. Scurvy was especially prevalent among sailors on long sea voyages. Although vitamin C deficiency as the specific cause of scurvy was not discovered until 1911, the British navy learned in the late 1700s that it could easily be prevented by eating fresh fruits and vegetables. Scurvy is uncommon in developed countries today except among alcoholics and indiv iduals who are mentally ill or socially isolated.

Secondary Deficiency

Besides impaired absorption, inadequate use can occur with concurrent vitamin B12 or C deficiency or chronic alcoholism. A genetic variation in folate requirement has also been identified, as a congenital enzyme deficiency exists in approximately 13 of the Western population (Ma et al 1994). In these cases, total or partial absence of the enzyme responsible for the final step in converting folate to its major active metabolite (methylene tetrahydrofolate reductase) results in decreased plasma levels (Kumar & Clarke 2002). Therefore, these individuals have a higher folate requirement than others without this congenital enzyme deficiency and display increased susceptibility to folate deficiency. Folate 469

History And Clinical Examination The History

Start with general information about the man's life and work. Employment related stress and relationship difficulties are often involved in the etiology. Ask about the problem, its duration, frequency, and specifics such as whether the erection can be elicited but not maintained (suggestive of a veno-occlusive disorder). Ask about his past medical history and current treatments. As we have already seen, an elderly diabetic is in the highest risk group for ED. What is the patient's motivation for seeking help, and why now There is sometimes a mismatch of expectation between the patient and his sexual partner. ED is often situational, occurring only in the presence of a partner, but the man may enjoy satisfactory masturbation and have spontaneous nocturnal erections. Note that loss of nocturnal erections is a strong indicator of a physical problem, but can also be as a result of a major depressive disorder. Ask specific questions about other cardiovascular, neurological, and...

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.

Organ Systems Affected By Low T Levels

Men undergo a gradual loss in bone mass beginning in their 30s. It is estimated that two million men in the United States have osteoporosis and that one in eight men over age 50 will have an osteoporosis-related fracture (NIAMS, 2003). Risk factors for osteoporosis include family history of osteoporosis, smoking, excessive alcohol intake, physical inactivity, poor nutrition, vitamin D deficiency,

Clinical evaluation of premenstrual syndrome

The differential diagnosis includes hypothyroidism, anemia, perimenopause, drug and alcohol abuse, and affective disorders. Common alternative diagnoses in patients complaining of PMS include affective or personality disorder, menopausal symptoms, eating disorder, and alcohol or other substance abuse. A medical condition such as diabetes or hypothyroidism, is the cause of the symptoms in 8.4 , and 10.6 have symptoms related to oral contraceptive (OC) use.

Male Reproductive Effects

Mammalian male reproductive function can be affected through a direct effect on the testis, resulting in decreased or altered sperm production, through impairment of the accessory sex gland secretions, and or indirectly through the neuroendocrine system, causing hormonal imbalance. Adverse effects on male fertility include altered genetic material of sperm, contributing to altered spermatogenesis, pregnancy loss, or genetic disease in offspring. Common endpoints for assessment of male reproductive function include size of testis, semen quality, secretory function of the prostate and seminal vesicles, reproductive endocrine function, impotence or reduced libido, and fertility. When evaluating reproductive effects of a certain metal on human males, one must take into account possible influences of concomitant exposures to other toxic and essential metals these may act addi-tively, synergistically, or antagonistically. Moreover, the influence of age and lifestyle factors particularly...

Differential Diagnosis

Given the variety of non-specific symptoms associated with TTP, accurate diagnosis may be difficult. As mentioned, the classic pentad is present in only 40 of patients. Patients seen initially are often given a variety of diagnoses ranging from alcohol withdrawal to septic shock syndrome. Since TTP may be seen in patients with lupus, confusion exists between the two diagnoses. One report indicates that 24 of patients dying with lupus cerebritis had pathologic evidence of TTP. TTP should always be thought of, especially in young patients who develop a dramatic multisystem illness unexpectedly. TTP is a treatable disorder. It is essential to review the smear in any sick patient with even mild thrombocytopenia to assess for the presence of schistocytes. Despite recent elucidation of reduced activity of ADAMTS13, this is not a consistent finding and it is unclear whether this will ever be a clinical useful assay.

Influence of Drugs Alcohol and Tobacco on Metal Metabolism and Toxicity

Alcohol influences the metabolism of mercury after exposure to mercury vapor. This is thought to be due to the interference of alcohol with some of the enzymes taking part in the conversion of mercury vapor to mercury (II) (Nielsen-Kudsk, 1965 Chapter 33). Simultaneous exposure to cobalt and alcohol has caused so-called beer drinker cardiomyopathy, where the effect was greater than would be expected from the single action of the compounds (see Chapter 25).

Substancerelated Disorders A Alcohol Related

Among all substance-related disorders, alcohol-related disorders (e.g., Alcohol Intoxication and Alcohol Withdrawal) have received most attention in the cross-cultural literature (Westermeyer, 1995). Alcohol use patterns could be the result of cultural traditions in which the consumption of alcohol is expected in family, religious, and social settings. For example, many Hispanics consider heavy drinking an acceptable behavior among Hispanic males (Canino, Burn-man, & Caetano, 1992). This is particularly true in the case of Hispanics who believe in machismo, which, among other characteristics, refers to Hispanic males' ability to consume an excessive amount of alcohol without getting drunk (Paniagua, 1998). Castillo (1997) reviewed the literature on this topic and found a similar situation in Ireland, Korea, and Japan and concluded that in these societies, heavy alcohol use is expected and required by cultural customs for normal social interaction among males (p. 162). As noted by...

Selected Photomicrographs

Figure 17-3. (A) Light micrograph of normal exocrine pancreas. Acinar cells containing numerous granules (gr) arc arranged in clusters. A small capillary (cap) and duct (arrow) can be observed. (B) Light micrograph of pancreatitis. A large area of exocrine pancreas (ex) is shown surrounded by thick fibrous bands (fib) that are highly infiltrated with lymphocytes (inflammatory response). Acinar cells undergoing autolysis are shown (arrows). Acute pancreatitis is associated in 80 of patients with biliary tract disease or obstruction and alcoholism. The pathologic destruction of the pancreas results from the release of digestive enzymes from acinar cells. (B Reprinted with permission from East Carolina University, School of Medicine, Department of Pathology slide collection.) Figure 17-3. (A) Light micrograph of normal exocrine pancreas. Acinar cells containing numerous granules (gr) arc arranged in clusters. A small capillary (cap) and duct (arrow) can be observed. (B) Light micrograph...

Ecological Interventions In Mental Health

Psychology as a profession, according to Shore (1998), is still establishing its identity and more recently has been developing interests and greater involvement in issues of prevention of psychological disorders and the promotion of mental health. These more recent areas of focus of the profession of psychology address such concerns as social issues, ethnic minorities, and ultimately the elaboration of what is needed in a society so that all its members have the opportunity to grow mentally healthy, with appropriate services available if and when problems arise (Shore, 1998). The application of psychological science and methodology to community defines the growing field of Community Psychology. Among the legitimate professional activities of Community Psychology is advocacy, the integration of theory, research, and practice to bring about change to issues of concern for a given community. Theory plays a role in organizing and structuring knowledge. Research plays a role in offering...

Recommended dosage

Doses of clorazepate for the management of seizures differ in adult and pediatric populations. Patients who are nine to 12 years of age should be started on 3.75-7.5 mg twice daily. This dose should be increased by no more than 3.75 mg weekly. The maximum dose per day is 60 mg administered in two to three divided doses. Children older than 12 and adults should receive 7.5 mg two to three times daily. This can be increased to a higher dose by adding 7.5 mg at weekly intervals. The total daily dose should not exceed 90 mg daily administered in two to three doses. In patients undergoing alcohol withdrawal, the first dose is 30 mg. Treatment is continued with 15 mg two to four times daily for the maximum dose of 90 mg in one day. Once maximum dose is achieved, the dose is gradually decreased over subsequent days.

Chronic liver disease

Chronic liver disease may present with features of impaired synthetic function, such as oedema, bruising, jaundice or pruritus, with features of portal hypertension, such as asci-tes, abdominal pain or variceal haemorrhage, or with general malaise, fatigue and anorexia. Alternatively the underlying aetiology, such as excess alcohol consumption, may bring the problem to light or it may be discovered incidentally during routine blood testing.

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...

Balancing The Ideal And The Practical Normative Goals For Mental Health And Aging

These issues, however, do not exhaust the ethical problems at the intersection of mental health and aging. Both prevention and intervention require thinking about underlying or foundational moral demands that we should make on any mental health policies or services. They also raise questions about ''worthiness.'' Can people be held blameless if their illness has its roots in chronic alcoholism or other socially disvalued activities Who should decide what services are offered to whom

Diseases Laws And Social Constructs

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...

Effective Treatment Modalities

In this section, we shall consider some of the modalities that can be considered effective, as shown by high CESs in the Mesa Grande. Again, the idea is not to describe every single effective treatment for alcohol problems but merely to focus on a few general approaches that are supported by research evidence and can easily be implemented in practice. The highest CES in Table 15.1 is for brief interventions however, there are a number of important considerations to bear in mind here. First, the category of brief interventions contains two different kinds of activity very brief interventions given by generalist workers (for example, general medical practitioners) in community settings to excessive drinkers not complaining of an alcohol-related problem and longer brief interventions, better called 'brief treatment', given by alcohol or addiction workers in specialist treatment centres to those who do complain, or have been persuaded to complain, of an alcohol-related problem (Heather,...

Folic acid deficiency

The main cause is poor intake associated with old age, poverty and malnutrition, usually associated with alcoholism. It may be seen in malabsorption and regular medication with antiepileptic drugs such as phenytoin. 3 It is rarely, but very importantly, associated with pregnancy, when the demands of the developing foetus together with the needs of the mother outstrip the dietary intake the so-called 'pernicious anaemia of pregnancy' which, if not recognised and treated immediately, can still be a fatal condition. Unlike Vitamin B12, folic acid is not stored in the body to any significant degree and

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

O Troubleshooting

Together to try to identify which inclusion was present. The student preliminarily identified the inclusions as Howell-Jolly bodies, which are single inclusion, DNA in origin, and usually located in the periphery of the red cell. Basophilic stippling was another possibility, but stippling is RNA in origin and seen throughout the red cells the new employee noted that the inclusion was located toward the periphery of the cell. The next possibility was Pappenheimer bodies, small inclusions that look like grape clusters. Pappenheimer bodies are usually iron deposits either in the form of ferritin or hemosiderin. If they are suspected, an iron stain (Prussian blue) will confirm the presence of iron. A Prussian blue stain was performed, and the inclusions were confirmed to be siderocytes, iron-containing inclusions. These inclusions can be found in hemochromatosis, alcoholism, hemolytic anemia, and post splenectomy.

Governmental Public Health

In 1850, Lemuel Shattuck issued a report that linked infant and maternal mortality to communicable disease. He recommended a decennial (every 10 years) census, standardization of disease and death terminology, and collection of health data by demographics. He also applied his recommendations to program activities, such as immunization, school health, and smoking and alcohol abuse (Thacker, 2000).

Management of essential tremor

Necessary, use propranolol (first choice) or primidone 4 . A typical starting dose of propranolol is 40 mg bd many require 120-240 mg day. 4 If the tremor is only intrusive at times of increased emotional stress, intermittent use of benzodiazepines, e.g. lorazepam, 30 minutes before exposure to the stress may be all that is required. Modest alcohol intake, e.g. a glass of scotch, is very effective.

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...

Nutrition and the brain

Several nutritional factors can influence mental health, including overall energy intake, intake of the energy-containing nutrients (proteins, carbohydrates, and fats), alcohol intake, and intake of vitamins and minerals. Often In the United States and other developed countries, alcoholism is often responsible for nutritional deficiencies that affect mental functioning. Diseases can also cause nutritional deficiencies by affecting absorption of nutrients into the body or increasing nutritional requirements. Poverty, ignorance, and fad diets also contribute to nutritional deficiencies.

Nutritional Disorders

Nutritional megaloblastic anemias have been described for over 100 years. The hallmark megaloblast results from impaired DNA synthesis as a result of vitamin B12 (cobalamin) or folate deficiency. Animal products (meat and dairy) are the sole dietary source of cobalamin in humans. It takes years to develop deficiency of cobalamin (Green and Kinsella 1995). Antibodies to intrinsic factor (pernicious anemia) are a common cause in the elderly, and other causes of intestinal malabsorption (e.g., sprue, bacterial overgrowth, etc.) account for remaining cases. Folate is found in animal products and leafy green vegetables. Because folate deficiency may develop within months, decreased dietary consumption accompanied with alcohol abuse is a common etiology.

Alcohol and related disorders

Alcoholism is defined as alcohol seeking and consumption behavior that is harmful. Long-term and uncontrollable harmful consumption can cause alcohol-related disorders that include antisocial personality disorder, mood disorders (bipolar and major depression) and anxiety disorders. Alcoholism is the popular term for the disorder recognized by the American Psychiatric Association (APA) as alcohol dependence. The hallmarks of this disorder are addiction to alcohol, inability to stop drinking, and repeated interpersonal, school- or work-related problems Delirium tremens Serious alcohol withdrawal symptoms that must be treated in a hospital and that may include shaking, delirium, and hallucinations. Detoxification A process in which the body is allowed to free itself of a drug while the symptoms of withdrawal are treated. It is the primary step in any treatment program for drug or alcohol abuse. Thiamin A B-vitamin that is essential to normal metabolism and nerve function, and whose...

Key Health Issues For Homeless People

The burden of illness and disease is extremely high among homeless people (Levy and O'Connell, 2004). However, any consideration of the common health problems of homeless people must first recognize the large degree of heterogeneity among people who are homeless. Among street youth, single men, single women, and mothers with children, the patterns of illness differ notably. Adolescents suffer from high rates of suicide attempts, sexually transmitted diseases, and pregnancy (Greene and Ringwalt, 1996 Greene and Ringwalt, 1998 Greene, et al., 1999 Feldmann and Middleman, 2003). Female heads of homeless families tend to have far fewer health problems than single homeless women, although their health is poorer than their counterparts in the housed general population (Robertson and Winkleby, 1996). Homeless single men have a higher prevalence of alcohol abuse and drug abuse, whereas single women have a higher prevalence of serious mental illness (Fischer and Breakey, 1991). Cross-national...

Alcohol and mental health

A high alcohol intake can interfere with normal sleep patterns, and thus can affect mood. Alcoholism is one of the most common causes of nutritional deficiencies in developed countries. Alcoholic beverages provide energy but virtually no vitamins or minerals. A person who consumes large amounts of alcohol will meet their energy needs but not their vitamin and mineral needs. In addition, extra amounts of certain vitamins are needed to break down alcohol in the body, further contributing to nutrient deficiencies.

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Beat The Battle With The Bottle

Alcoholism is something that can't be formed in easy terms. Alcoholism as a whole refers to the circumstance whereby there's an obsession in man to keep ingesting beverages with alcohol content which is injurious to health. The circumstance of alcoholism doesn't let the person addicted have any command over ingestion despite being cognizant of the damaging consequences ensuing from it.

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