1/45. Managing addiction in advanced cancer patients: why bother?The management of addiction in patients with advanced cancer can be time-consuming, labor-intensive, and difficult. Some clinicians believe that it is not worth the effort, due in part to a failure to appreciate the deleterious impact of addiction on palliative care efforts and a view of addiction as intractable in any case. Indeed, it is possible that some clinicians perceive addiction not only fatalistically but, because of common misconceptions, believe that managing or attempting to decrease the patient's use of alcohol or illicit substances would be tantamount to depriving a dying patient of a source of pleasure. In this paper, we argue that managing addiction is an essential aspect of palliative care for chemically-dependent and alcoholic patients. The goal of such efforts is not complete abstinence, but exerting enough control over illicit drug and alcohol use to allow palliative care interventions to decrease suffering. To illustrate this view, we describe two patients with chemical-dependency. We highlight the impact of unchecked substance abuse on patients' perpetuation of their own suffering, the complication of symptom management, the diagnosis and treatment of mood/anxiety disorders, and the effect on the patients' family and caregivers.- - - - - - - - - - ranking = 1keywords = mood (Clic here for more details about this article) |
2/45. coma and respiratory depression following the ingestion of GHB and its precursors: three cases.Gamma hydroxybutyrate (GHB) is a product of the metabolism of both gamma butyrolactone (GBL) and 1,4-butanediol (1,4-BD). Gamma hydroxybutyrate (GHB) is an illegal agent that causes central nervous system depression. Chemical precursors of GHB, such as GBL and 1,4-BD, have been available for purchase from many health food stores and internet websites for mood-enhancement, sleep-induction, and stimulation of growth hormone release. We report three cases of ingestion of products containing GHB and chemical precursors of GHB. All three patients had severe presentations followed by full recoveries. Some products containing GBL were withdrawn from the market after the FDA issued a warning regarding these products. Products containing 1,4-butanediol remain on the market today.- - - - - - - - - - ranking = 1keywords = mood (Clic here for more details about this article) |
3/45. Divalproex sodium in substance abusers with mood disorder.BACKGROUND: Substance abuse is a common comorbid illness in patients with mood disorders. Little has been written about the pharmacologic treatment of patients with affective lability and co-occurring substance abuse, however. The following report will describe clinical experience using divalproex sodium in substance-abusing patients with mood disorder. METHOD: Twenty patients admitted to an intermediate-care inpatient substance abuse program were diagnosed with comorbid mood disorder (according to DSM-IV criteria) and treated with divalproex sodium in an open-label, naturalistic trial with no blind. All patients were followed clinically and were assessed using the Clinical Global Impressions scale (CGI) and laboratory studies. RESULTS: Seven patients referred while on divalproex treatment continued to exhibit improved mood. Eleven others had at least 1 week of follow-up, and 10 of these also showed improvement. In 13 cases, divalproex was used safely with other psychiatric medications. Two patients complained of slight tremor, 1 of whom was also taking fluoxetine. Fifteen of 17 patients in whom biochemistry and hematology laboratory studies were completed had unremarkable results; 2 other patients had pretreatment abnormalities, which worsened over the course of treatment. Mean plasma valproate level was 58.53 microg/mL. Mean length of follow-up was 38 days. Mean period of abstinence prior to starting medication was 48 days. Some patients reported decreased cravings, and, by self-report, all patients remained abstinent. CONCLUSION: This report suggests that divalproex sodium is efficacious and safe, both alone and in combination with other psychiatric medications, in treating substance-abusing patients with mood disorder.- - - - - - - - - - ranking = 108.79411337374keywords = mood disorder, affective, mood (Clic here for more details about this article) |
4/45. couples therapy for women survivors of child sexual abuse who are in addictions recovery: a comparative case study of treatment process and outcome.Treatment for women who are survivors of child sexual abuse and who have a history of substance abuse has largely involved gender-specific interventions. This study examines the use of conjoint couple therapy with a cohort of women who were survivors of child sexual abuse and who are in addiction recovery and with their partners. A comparative case study analysis incorporated standardized clinical measures with client and therapist interviews. Brief conjoint therapy was found to assist couples in the specific relationship skill areas of communication and mutual problem solving. Further, substantive gains were found in the realm of affective relations. The women reported an increase in support from their male partners, and the men reported a decrease in negative emotional atmosphere in the relationship.- - - - - - - - - - ranking = 2.4064043103748keywords = affective (Clic here for more details about this article) |
5/45. Kangaroo (skin-to-skin) care with a postpartum woman who felt depressed.The mother in this case study had numerous known risk factors for postpartum depression and was in rehabilitation for drug abuse. She was crying at 2 hours postbirth and expressing feelings of sadness as her baby was being unwrapped for her first kangaroo care (KC) experience. Thereafter, during our research protocol, her self-reported depression scores decreased rapidly and had disappeared by 32 hours postbirth. A benefit of KC requiring systematic study is that KC may lessen maternal depression. There is new knowledge that some functions of the maternal HPA axis become dampened during the last trimester of pregnancy as the placenta increases its secretion of corticotrophin-releasing hormone. The sudden loss of the placenta following delivery, accompanied by a suppressed HPA axis, may have an effect on mood during the immediate postpartum period. Perhaps appropriate reactivation of the maternal HPA axis can be triggered following birth by the stimulation inherent in KC, thereby minimizing risk for postpartum depression.- - - - - - - - - - ranking = 1keywords = mood (Clic here for more details about this article) |
6/45. Under the influence of unconscious process: countertransference in the treatment of PTSD and substance abuse in women.PTSD and addiction are a marriage made in the avoidance of unbearable affect; an avoidance that is costly in the resulting traumatic reenactments experienced by patients whose attempts to escape the past keep them evermore tightly bound to it. Rather than "difficult patients" a more dynamic and intersubjective conceptualization emphasizes the notion of a "difficult treatment dyad." Vicarious traumatization, unconscious affects about addiction, and pressures within the treatment surround conspire to pull the therapist out of connection with the patient at critical points, and toward sadistic abandonment or collusive indulgence. The concomitant desires to rescue and desert patients create forces for action in the therapist, precisely when what is needed most is the ability to tolerate and contain one's own and the patient's affective experience. The pull for action is also felt by treatment systems, eager for "action" that can be measured in "behavioral observables." Support for the therapist in the form of process supervision can assist the therapist to contain, identify, and acknowledge his/her affective responses evoked in treatment. The therapist is called upon to "grow one's own heart" through a confrontation with the undeveloped parts of self that are vulnerable to the dynamics of the treatment.- - - - - - - - - - ranking = 4.8128086207496keywords = affective (Clic here for more details about this article) |
7/45. bariatric surgery in a patient with possible psychiatric contraindications.Grade III obesity (BMI > 39.9 kg/m2) is considered a chronic disease where clinical and diet therapy show poor results, with high rates of relapse. The most consistent results are those obtained through surgical procedures. Several authors discuss the contraindications for the performance of anti-obesity operations. Psychiatric disorders are often considered contraindications to these operations, especially affective disorders, psychotic disorders and personality disorders. The authors report the case of a 37-year-old patient, with obesity history since the age of 12, and anorexiant abuse (amphetamine-derived substances) during 20 years, binge-eating episodes, purgative compensatory behaviors and recurrent depressive symptoms. She was submitted to anti-obesity surgery in August 2000 (BMI 40.2). The outcome is reported and a discussion of the possible psychiatric contraindications for the anti-obesity surgeries is proposed.- - - - - - - - - - ranking = 20.542679582515keywords = affective disorder, affective (Clic here for more details about this article) |
8/45. An evaluation of anabolic-androgenic steroid abusers over a period of 1 year: seven case studies.The purpose of the study was to evaluate anabolic-androgenic steroid (AAS) abusing adults every 2 weeks with a comprehensive behavioral and clinical assessment battery. The study was conducted at the University of pennsylvania Treatment research Center; 10 subjects were enrolled and 7 completed the protocol. AASs and other drugs were obtained and self-administered by subjects through their usual mechanisms. On-study evaluations included medical, behavioral, and drug-use assessments. While a high incidence of mood disorders and substance abuse was found, few clinically relevant changes in physiological parameters or laboratory measures were noted throughout the study. Changes as measured by various behavioral rating scales were observed across time; however, these changes were not clearly related to periods of reported AAS use. Additional factors such as life events, subjects' other drug use, and the extended duration of activity of some of the AAS preparations probably influenced the results. Differences in subject-reported adverse effects were seen with respect to periods of AAS use and nonuse. Cycles of AAS nonuse were associated with a greater percentage of subject-reported increased testicular size, appetite, frequency of sexual activity, and libido. The results provide the first long-term, prospective evaluation of the effects of AASs, when these drugs are administered in a naturalistic pattern of abuse.- - - - - - - - - - ranking = 13.173463632921keywords = mood disorder, mood (Clic here for more details about this article) |
9/45. An investigation of solvent-induced neuro-psychiatric disorders in spray painters.An index case of chronic toxic encephalopathy is described in a 28 year old male spray painter with eleven years of exposure to solvents at work. The patient had progressive affective symptoms following repeated past episodes suggestive of acute solvent intoxication. He also showed impaired performance on tests of auditory memory, perceptual speed, visual scanning, and manual dexterity, as well as electromyographic evidence of prolongation of distal terminal latency and slowing of conduction velocities. The case investigation was followed up with an epidemiological study of the factory where he worked, to determine if other spray painters might have similar excessive complaints of neuropsychiatric symptoms and/or objective neurobehavioural deficits. This involved 15 other male spray painters employed for at least five years, and a sex- and age-matched group of 15 control workers not exposed to solvents. The spray painters reported significantly more numbers of neurobehavioural symptoms than the controls. There were little differences in neurobehavioural test results, except for aiming test (psychomotor co-ordination) and Benton visual retention test (visual memory). Spray painters with four or more neurobehavioural symptoms also performed more poorly on Digit Symbol (perceptual speed) compared with those with less number of symptoms. The epidemiological results provide strong circumstantial basis for the diagnosis of chronic toxic encephalopathy in the patient, and also indicates a need for vigilance of the hazards of central nervous system disorders in workers with chronic exposure to solvents in singapore.- - - - - - - - - - ranking = 2.4064043103748keywords = affective (Clic here for more details about this article) |
10/45. cocaine addiction: relationship to seasonal affective disorder.We report a 25 year-old patient with seasonal affective disorder (SAD) and cocaine abuse who experienced cyclical fluctuations in cocaine craving which were concomitant with seasonal alterations in mood. The temporal association of both disorders in this patient suggests that they may share a common underlying pathophysiology. Since disturbances in circadian rhythms and pineal melatonin functions may in part underlie the pathophysiology of SAD and the psychomimetic effects of cocaine are mediated in part through the pineal gland, we propose that dysfunction of circadian rhythms and pineal melatonin functions may partly mediate the association of SAD with cocaine abuse. This hypothesis may have potential clinical and therapeutic implications for a subgroup of cocaine abusers with SAD since light therapy, which is efficacious in the therapy of SAD, may also prove to be beneficial in reducing cocaine addiction. Furthermore, the report illustrates the need for investigations of environmental cues for cocaine abuse with specific attention given to the effects of light on circadian mood changes.- - - - - - - - - - ranking = 104.71339791258keywords = affective disorder, affective, mood (Clic here for more details about this article) |
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