Cases reported "Opioid-Related Disorders"

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1/6. Narcotic withdrawal syndrome following gastric bypass--a difficult diagnosis.

    BACKGROUND: It is common for bariatric patients to experience postoperative nausea, depression and remorse for several months following surgery. Difficulty exists for the surgeon in delineating the physical from the psychological in treating these patients. Preoperative education, evaluation and preparation, although essential, will not identify nor eliminate all potential problems. methods: We report the case history of a patient who ultimately underwent reversal of her gastric bypass. Her symptoms required multiple procedures and hospital admissions for what appeared to be anatomical problems. All procedures were done laparoscopically. RESULTS: The patient's main complaints of persistent nausea and abdominal pain combined with radiographic evidence of sub-optimal anatomic construct led to multiple operative procedures. Psychological intervention relative to the persistent nausea and abdominal pain was ineffectual, although the supportive and consistent nature of the psychotherapy relationship was useful in overall patient stability and emotional well being. Complete reversal of the bypass did not effect improvement. Ultimately, the diagnosis of narcotic withdrawal prompted the institution of methadone treatment with complete cessation of the symptoms of nausea and pain. CONCLUSIONS: The diagnosis of narcotic withdrawal syndrome can be difficult in the postoperative bariatric patient. Psychological evaluation and support are essential elements of the program throughout the entire course of a patient's treatment experience. Laparoscopic techniques simplified the surgical care of this patient.
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ranking = 1
keywords = depression
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2/6. Treatment of dual diagnosis patients: a relapse prevention group approach.

    The authors describe the successful use of an adjunctive group psychotherapy for substance-abusing patients with major psychiatric disorders (bipolar, schizophrenia, schizoaffective, psychotic depression, and atypical psychosis). The group utilizes a psychoeducational approach that focuses on substance abuse causes and consequences, principles of recovery, and relapse prevention strategies. Eight patients with prolonged histories of abuse of cocaine, alcohol, marijuana, or other drugs were enrolled in this weekly group treatment at a community mental health center drug treatment program, while continuing in treatment with their current case manager or primary therapist. Six of the eight patients achieved periods of stable abstinence, documented by self-report, urine toxicology screens, continued group attendance, and improved social functioning. Case examples are utilized to illustrate the group process.
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ranking = 11.353510111528
keywords = psychosis, depression
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3/6. Unrecognized drug dependence and withdrawal in the elderly.

    The clinical diagnosis of drug abuse is frequently omitted from the differential diagnosis of transient fevers, arrhythmias and changes in mental status in the elderly despite the high risk of iatrogenic dependence in this age group. In pursuit of symptomatic relief from unrecognized depressions and from the chronic ailments of advancing age, the elderly receive many medications from numerous physicians. Therapeutic interventions are often duplicated or contradictory and result in the co-administration of tranquilizers, sedatives and analgesics. The result may be dependence which the patient and physician fail to recognize or to diagnose in the presence of withdrawal symptoms. In this report we present two such cases.
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ranking = 1
keywords = depression
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4/6. The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence.

    Recent clinical observations and psychiatric diagnostic findings of drug-dependent individuals suggest that they are predisposed to addiction because they suffer with painful affect states and related psychiatric disorders. The drugs that addicts select are not chosen randomly. Their drug of choice is the result of an interaction between the psychopharmacologic action of the drug and the dominant painful feelings with which they struggle. Narcotic addicts prefer opiates because of their powerful muting action on the disorganizing and threatening affects of rage and aggression. cocaine has its appeal because of its ability to relieve distress associated with depression, hypomania, and hyperactivity.
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ranking = 1
keywords = depression
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5/6. The psychodynamics of opiate addiction.

    Opiate addicts and polydrug, but nonopiate, substance abusers were assessed for depression on the Raskin rating scale for a clinical interview and several self-report measures of depression including the Hamilton, SCL-90, and the recently developed Depressive Experiences Questionnaire (DEQ), which differentially assesses depression focused around neediness from a depression focused around self-criticism (guilt and shame). Opiate addicts were consistently more depressed than polydrug drug abusers on all the measures. On the DEQ, opiate addicts were significantly (p less than .001) more depressed than normals and even somewhat more depressed than psychiatric patients. This depression, however, was focused primarily around issues of self-criticism, guilt, and shame rather than issues of dependency, abandonment, rejection, and neglect. Even further, depression focused around self-criticism, as measured on the DEQ, was significantly correlated (p less than .001) with the extent to which the polydrug, non-opiate-addicted substance abusers had begun to experiment with opiates. These data suggest that intense depression, particularly depression focused around issues of self-criticism, has an important role in opiate addiction.
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ranking = 8
keywords = depression
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6/6. methadone withdrawal psychosis.

    BACKGROUND: methadone is a typical mu-opioid receptor agonist that is widely used for maintenance and detoxification treatment of opiate-dependent patients. Although methadone withdrawal syndrome is well described, it generally does not include psychosis. METHOD: Having observed new onset psychosis in a patient on methadone taper, the authors identified three other such patients by chart review. All met DSM-III-R criteria for opioid dependence. Distinctive features of their clinical presentation, pharmacotherapy received, and follow-up were recorded. RESULTS: Two patients had no history of psychosis, one patient had a psychotic episode 21 years prior to admission, and one patient was diagnosed with schizophrenia but remained asymptomatic for at least 1 year while treated with only methadone. Psychosis resolved spontaneously in one case, whereas the other cases required neuroleptic treatment. In one case, methadone resumption was required. None of the patients developed typical methadone withdrawal syndrome. CONCLUSION: The above results suggest that opioid taper may be a period of high risk for development of psychosis. This risk is probably higher in patients with preexisting CNS illness. Clinicians caring for patients in opioid withdrawal should be aware of this risk. Further research is required to evaluate whether methadone withdrawal psychosis represents a clinical manifestation of opioid agonist modulation of dopaminergic neurotransmission in the human brain.
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ranking = 93.181591003748
keywords = psychosis
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