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1/12. African American female basketball players: an examination of alcohol and drug behaviors.

    The use of drugs and alcohol by National Collegiate Athletic association Division I African American female basketball players and their reasons for using these substances were examined. The investigation is part of a broader study investigating the use of alcohol, weight-loss products, tobacco, amphetamines, and anabolic steroids by female college athletes. Of the 50 athletes in this study, 72% reported having consumed alcoholic beverages, and 46% had engaged in binge drinking. Only 8% reported using either weight-loss or tobacco products, and there were no reports of using amphetamines or anabolic steroids. Usage patterns indicated that the athletes in the study were aware of the short-term negative effects of alcohol and tobacco; those respondents who did use these products greatly reduced their consumption during the competitive season. Factors found to influence use include social and peer influences and coaches' rules.
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2/12. 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.
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3/12. Using the EDAC test to monitor abstinence and relapses during outpatient treatment.

    The main objective of this study is to show the performance of the EDAC test in monitoring alcohol consumption during outpatient treatment. The EDAC is a new approach that uses routine laboratory tests to identify binge drinking as well as chronic drinking. The overall diagnostic performance of the EDAC fluctuates around 80 to 90% for both specificity and sensitivity. Close to two thousand subjects have been tested by the EDAC since the early eighties; 300 of these were patients undergoing treatment at different institutions across the U.S. This article selected five case studies to represent examples of classical drinking behaviors encountered in most outpatient clinics. The first four cases illustrate the use of the EDAC alone and the last case represents the use of the EDAC combined with CDT. These five case studies illustrate the use of the EDAC to detect relapse episodes, to monitor abstinence during outpatient treatment and to recognize a slip early enough to prevent more severe drinking. The use of biomarkers to monitor drinking behavior in alcohol dependent patients is gaining popularity because they provide objective information on a patient's drinking status when used as an adjunct to self-report.
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4/12. adolescent substance abuse and psychiatric comorbidities.

    Substance use disorders have a serious impact on adolescents because these disorders have high prevalence rates and frequent associations with psychiatric disorders. Surveys of adolescent behaviors and substance use show that alcohol is the most common substance abused by adolescents. Despite the high rates of current alcohol use and binge drinking among adolescents, current diagnostic criteria are problematic. Adolescents may have a developing problem with substance dependence but not meet criteria for either substance abuse or dependence. At-risk adolescents, called "diagnostic orphans," may meet only 1 or 2 criteria for alcohol dependence and no abuse criteria and therefore do not receive an alcohol use disorder diagnosis from the diagnostic and statistical manual of mental disorders, Fourth Edition, Text Revision. Adolescents with substance use disorders tend to have higher rates of comorbid psychiatric disorders and are more likely to report a history of trauma and physical and/or sexual abuse than adolescents without a substance use disorder. In addition, psychiatric disorders in adolescents often predate the substance use disorder. Once the substance use disorder develops, the psychiatric disorder may be further exacerbated.
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5/12. cocaine-related vascular headaches.

    The records of 21 patients admitted to hospital from January 1985 to December 1988 for acute headache associated with cocaine intoxication were reviewed. Fifteen patients were identified who experienced headaches with migrainous features in the absence of neurological or systemic complications. None of them had a history of cocaine-unrelated headaches or a family history of migraine, and all had a favourable outcome. Three possible mechanisms of cocaine-related vascular headaches are discussed which depend on the interval between cocaine ingestion and development of the headache. We postulate that acute headaches following cocaine use may relate to the sympathomimetic or vasoconstrictive effects of cocaine, while headaches following cocaine withdrawal or exacerbated during a cocaine "binge" may relate to cocaine-induced alteration of the serotoninergic system.
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6/12. cocaine and rhabdomyolysis: report of a case and review of the literature.

    cocaine abuse is associated with a constellation of serious medical complications. An unrecognized and recently described complication of cocaine use is rhabdomyolysis with acute renal failure. We describe the first patient identified in our institution with this entity, admitted to the medical services with oliguric acute renal failure. Three days prior to admission the patient had a cocaine snorting binge. He presented with bilateral flank pain, gross hematuria, vomiting and chills. No history of crush injury, prolonged immobilization and or seizures was reported. On admission the vital signs were normal, physical exam revealed periorbital edema and marked soft tissue neck swelling. Lab values: Bun 120 mgs%, Creat. 10.7 mgs%, Na 132 meq/lt, Co2 13mq/lt, Cl, 103meq/lt, Co2 13meq/lt, Ca 5.3 mgs%, CPK 30,800 U/L with a MM fraction of 98%, LDH 600 U/L, SGOT 300 U/L. The urine was dark red with a ph of 6.5 and 100 rbc/hpf. The anti-GBM antibody and blood cultures were negative. An abdominal sonogram was normal. He received peritoneal dialysis and was discharged on his 14th hospital day with a CPK of 2,800 U/L and decreasing azotemia. cocaine associated rhabdomyolysis has only been recently described in the literature (AJM April, 88). Acute myoglobinuric renal failure needs to be added to the growing list of medical complications of cocaine use.
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7/12. cocaine psychosis.

    A 28-year-old divorced black male intranasal cocaine abuser presented three times in seven days to the psychiatric emergency service of a general hospital with complaints of psychotic symptoms in the context of a cocaine binge. His repeated visits provided the opportunity to correlate his clinical picture with serum cocaine levels. This article describes that correlation and reviews the current literature on cocaine abuse and the cocaine abstinence syndrome.
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8/12. ipecac abuse: a serious complication in bulimia.

    ipecac abuse among bulimics is being increasingly reported. The case presented is a 19-year-old female with significant eating-related problems, including frequent binges and daily use of ipecac to induce vomiting. Medical evaluation revealed significant muscle weakness, cardiac impairment, and altered levels of serum enzymes. The physical debilitation caused by the ipecac use dissipated following apparent discontinuation of ipecac ingestion. The symptom presentation and management problems in this case are discussed to alert clinicians involved in consultation about ipecac abuse.
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9/12. Prescription diuretic abuse in patients with bulimia nervosa.

    bulimia nervosa, a common eating disorder usually characterized by binge eating and self-induced vomiting, may also involve abuse of prescription diuretics. This article describes four patients who abused prescription diuretics in large quantities (up to 2 g/d of furosemide) for extended periods of time. physical examination and laboratory values provided few clues to the diagnosis of bulimia nervosa. Other eating-related behaviors previously linked to bulimia nervosa--including abuse of diet pills, illicit amphetamines, and laxatives, as well as withholding of insulin in one diabetic patient--were present in these cases. Usually the patients' primary physicians were not aware of these problems. physicians should be aware that patients requesting prescription diuretics may have bulimia nervosa.
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10/12. Methcathinone: a Russian designer amphetamine infiltrates the rural midwest.

    Four cases of methcathinone toxicity in the united states are presented and discussed. This drug is the latest in a series of "designer" amphetamines. Prominent findings of acute toxicity include hallucinations, fever, and tachycardia followed by periods of bradycardia and moderate hypotension as acute symptoms resolve. Chronic binge use may result in development of paranoid psychosis and brief periods of withdrawal tremors. Our current understanding of methcathinone effects and the Russian experience with it are discussed. Our recommendations for treatment of acute toxicity are based on well established guidelines for managing the toxicity of similar amphetamine-like drugs.
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