1/9. Self perception affecting adherence to drug regimen following renal transplantation.The patient, a chronic cannabis user, found it increasingly difficult to tolerate the side effects of the medication on her appearance. Rejection in the early post-transplant period meant that immunosuppression could not be further reduced. We were able to avoid a catastrophic self-initiated cut in immunosuppression, and withdrawal of steroids was carried out according to a schedule supervised by the clinic. Cellular rejection resulted and was treated with i.v. methyl prednisolone and conversion from cyclosporin micro-emulsion (Neoral, Novartis) to tacrolimus (Prograf, Fujisawa) and from azathioprine to mycophenolate mofetil (CellCept, Roche).- - - - - - - - - - ranking = 1keywords = affect (Clic here for more details about this article) |
2/9. Traumatic brain injury, depression and cannabis use--assessing their effects on a cognitive performance.Patient RB is presented as a demonstration of the need for a more thorough understanding of the interactions of patient variables. RB had a history of traumatic brain injury along with current mood disorder and cannabis use. It was unclear initially whether or not his cognitive impairment was a permanent result of the brain injury, or a temporary effect of his mood and/or drug use. The literature offers few guidelines or precedents for understanding such complex cases or suggesting at which level it may be most appropriate to intervene. The impact of cannabis use in this individual appeared to have a detrimental effect on his mood. Treating RB's mood disorder resulted in larger cognitive gains than would have been anticipated in the literature. Specific neuropsychological tests are identified as being particularly sensitive to the cognitive changes in mood disorders.- - - - - - - - - - ranking = 265.67116101312keywords = mood (Clic here for more details about this article) |
3/9. hair analysis by GC/MS/MS to verify abuse of drugs.Because of its peculiar characteristics, hair analysis provides a way of obtaining information that cannot be acquired by other commonly used forensic medical analyses, such as blood or urine analysis. In the keratin matrix many xenobiotics are incorporated permanently, in contrast to the situation with blood or urine where they are generally only detectable for a few hours or days. Therefore hair analysis should be the method of choice in the clinical and forensic toxicology field when the assessment of repeated or chronic exposure to a drug is required, e.g. in the case of criminal responsibility, revocation/restoration of a driving licence or in workplace testing. Some factors that can affect the concentrations of drugs in hair, such as passive contamination, age, ethnicity and cosmetic treatment, must be considered. Analytical methodology is also very important: GC/MS/MS has proved to be a highly sensitive and specific technique for the detection of very low concentrations of such drugs in hair. In this study five cases of the application of hair analyses using this technique for the determination of abused drugs (opiates, cocaine, amphetamine, anabolic steroids) are described.- - - - - - - - - - ranking = 0.25keywords = affect (Clic here for more details about this article) |
4/9. cannabis use and mood disorders: patterns of clinical presentations among adolescents in a developing country.Notwithstanding the increase use of cannabis among adolescents in both developing and developed countries, few studies have looked at cannabis use and mood disorders. In a series of case studies, this research project seeks to investigate patterns of clinical presentations seen among cannabis users in psychiatric outpatients in Trinidad. Five clinical patterns of presentations are identified among cannabis users and abusers based on variables of dosing, age of initial use, duration of use, tolerance and reverse tolerance and poly-drug abuse. All patients in these case studies were standardized for method of use and potency of cannabis used. Patients were screened by urine tests to determine co-morbid use of other substances. Other variables such as environmental factors and genetic vulnerability were reviewed as far as possible from historical accounts of family members. The five patterns described are low, controlled use with mild euphoria and heightened awareness, moderate use with mixed depressive symptoms and suicidal behaviour, heavy, short term use with manic symptoms, long term incremental use with psychotic symptoms due to the trumping of depressive symptoms and cannabis mixed with other substances resulting in florid psychosis. mood disorders appear to be a common finding among adolescents using cannabis. Sensitization to symptomatic presentation and early detection of cannabis use in young adolescents are necessary. Further research is needed on the effect of cannabinoids on emotions, behaviour and thinking and its relationship to mental disorders. This study is useful as a guideline for the implementation of public health strategies and legislation concerning the use of cannabis in youths.- - - - - - - - - - ranking = 265.67116101312keywords = mood (Clic here for more details about this article) |
5/9. Withdrawal sequelae to cannabis use.A specific withdrawal syndrome resulting from the prolonged use of cannabis is presented. It is believed to be an underreported set of symptoms that are now emerging in the united states as a result of the increasing potency of the drug and greater numbers of long-term users. Two case studies are presented which illustrate the cannabis withdrawal syndrome in an otherwise healthy 25-year-old male and an exacerbation of a preexisting affective disorder in a 38-year-old male who prior to his resumption of cannabis use was asymptomatic for 3 years with antidepressant medications. The cannabis withdrawal sequela is presented with a discussion of differential diagnosis and implications for treatment and future research.- - - - - - - - - - ranking = 0.25keywords = affect (Clic here for more details about this article) |
6/9. Neuropsychological assessment of substance abusers: review and recommendations.Neuropsychological assessment of substance abusers frequently proves useful for the evaluation of those aspects of cognitive functioning that may be relevant for optimal therapeutic management and treatment planning. research has demonstrated the presence of neuropsychological impairment in chronic abusers of CNS depressants, including alcohol, as well as opiates and possibly cocaine, especially when such substances are combined in a polydrug pattern of abuse. Clinical neuropsychological evaluation of individual substance abusers should take into account the various personal, demographic and neuromedical background variables that can affect cognitive functioning. Efforts should be made to distinguish between acute drug effects and more longterm stable deficits that may not become apparent for some time. Neuropsychological referrals should be made, and measures selected to answer particular questions about neurocognitive functioning that are relevant to treatment and eventual overall adjustment. A neuropsychological review of systems is likely to show a pattern of impairment in substance abusers that involves the integration of different cognitive functions for effective problem solving. Strongly focal or lateralized deficit patterns are less likely to be the result of drug abuse alone, and should prompt the appropriate neuromedical follow-up.- - - - - - - - - - ranking = 0.25keywords = affect (Clic here for more details about this article) |
7/9. A therapeutic trial of caerulein to a long-term heavy marihuana user with amotivational syndrome.A male marihuana user with amotivational syndrome who responded poorly to neuroleptic therapy was treated four times with weekly intramuscular injection of caerulein in a dose of 0.6 micrograms/kg. He was maintained on his previous neuroleptic medication during the study period. The BPRS was used to rate the patient's symptoms. There were remarkable improvements in the total scores and the psychosis subscale score, which consists of the following symptoms that do not respond well to neuroleptic therapy in chronic schizophrenia: emotional withdrawal, mannerisms and posturing, uncooperativeness, and blunted affect. These improvements persisted for two weeks after cessation of caerulein administration, after which the patient's condition gradually worsened. Nevertheless, the improvement recurred upon reinjection of caerulein. These findings indicate that the improvement observed seems to be due to caerulein, and suggest that caerulein may be a useful and effective therapeutic drug for marihuana user with amotivational syndrome.- - - - - - - - - - ranking = 0.25keywords = affect (Clic here for more details about this article) |
8/9. Detection of marijuana use in psychiatric patients by determination of urinary delta-9-tetrahydrocannabinol-11-oic acid.Seventy-six male inpatients with diagnoses of schizophrenia, primary affective disorder, post-traumatic stress disorder, borderline personality disorder, other personality disorder, and primary substance abuse disorder were screened for the use of marijuana by determination of urinary delta-9-tetrahydrocannabinol-11-oic acid. Screening was performed to detect marijuana use in asymptomatic patients returning to the ward after passes, and also to elucidate changes in mental state in newly admitted patients and patients who had decompensated during hospitalization. Ward personnel found the screening procedure quite useful and incorporated it into psychotherapeutic and chemotherapeutic interventions. Although susceptible and resistant individuals were found in all diagnostic categories studied, no consistent features were found to distinguish those individuals who exhibited behavioral change in association with marijuana smoking, from those who did not.- - - - - - - - - - ranking = 0.25keywords = affect (Clic here for more details about this article) |
9/9. cannabis psychoses in south sweden.Eleven patients with a psychosis in connection with cannabis abuse admitted to two mental hospitals during 1 year were examined. Patients with a pre-existent psychosis or a mixed abuse were excluded. The patients were divided into three groups: acute, subacute and chronic. The features of the disease were essentially similar in all patients, with a mixture of affective and schizophrenia-like symptoms, confusion and a pronounced aggressiveness. The course as a rule was self-limiting leaving no residual symptoms. There was almost no heredity of severe mental disease. The symptoms were very similar to those seen in cycloid psychosis, and a possible relationship between the two diseases is discussed. As regards the widespread abuse of cannabis we conclude that psychosis is a rare complication but that in unclear psychotic states it is recommended to actively search for a cannabis psychosis.- - - - - - - - - - ranking = 0.25keywords = affect (Clic here for more details about this article) |