1/43. A multiple group psychotherapy approach to adolescents with psychiatric and substance abuse comorbidity.Multiple group psychotherapy was employed as the primary treatment modality in a day-treatment program as an innovative multifaceted approach to treating adolescents comorbid for psychiatric and substance abuse diagnoses. The concurrent educational program included a high school on site. The groups included Substance Abuse Group, which promoted the 12-step model; health Group; psychotherapy Group; Leisure time Group; Self-awareness Group; and Multiple family Group. The effect of the multiple groups was to provide a variety of experiences focusing on varied aspects of normal and dysfunctional adolescent development. Together the combination of groups served to strengthen the participants' cohesiveness, communicating skills, and hopefulness.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
2/43. trust violated: analgesics for addicts.Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. Addiction among cancer patients on strong analgesics is a rare but difficult management challenge. The case is presented of a 28-year-old woman with breast cancer and painful bone metastases, suffering with dysfunctional social chaos and addicted to Percocet (oxycodone and acetaminophen). Having broken the trust of her health care team, trust was rebuilt by incorporating the substance abuse clinic and enforcing a contractual agreement. With open and honest support, the team was able to both care for and empower the patient. Issues of trust, liability, opioid tolerance, and barriers to optimal analgesia for cancer pain are discussed.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
3/43. Unusual facial markings and lethal mechanisms in a series of gasoline inhalation deaths.A review of deaths associated with hydrocarbon toxicity from gasoline sniffing in south australia throughout a 10 year period from July 1987 to June 2002 revealed 4 cases. The victims were all Aboriginal people from remote inland communities. Each death had occurred while the victim was lying in bed sniffing gasoline from a can held to the face. Once unconsciousness had occurred, the mouth and nose had been pressed firmly against the can by the weight of the head. In each case, the effects of gasoline toxicity had been exacerbated by hypoxia and hypercapnia from rebreathing into the container once a tight seal had been established between the face and the can. The circular impressions left by the can edges on the faces of each of the victims provided an autopsy marker that assisted in clarifying the details of the fatal episodes. Discouraging solitary gasoline sniffing in bed may reduce the death rate in communities where this behavior is practiced.- - - - - - - - - - ranking = 3keywords = face (Clic here for more details about this article) |
4/43. Tailoring adult psychiatric practices to the field of geriatrics.The united states' population is aging. Epidemiological surveys suggest significant rates of mental illness amongst the rapidly growing over-65 cohort. A burgeoning experience and data base related to the developing sub-discipline of geriatric psychiatry is now available. This article synthesizes key issues and concepts as an introduction to geropsychiatric practice-in particular, a) the interface between medical illness and psychiatric expression in the elderly, b) delirium, c) dementia, and d) depression-and considers their interactions. Finally, there is a brief overview of geriatric psychopharmacology, followed by clinically-oriented discussions of each of the major classes of psychotropics as applied to a geriatric population.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
5/43. brain perfusion abnormalities in a thinner and amphetamine abuser detected by I-123 IMP scintigraphy.MR images and three dimensional surface images (3-D images) using N-isopropyl-p-[I-123] iodoamphetamine (I-123 IMP) were obtained in a patient who acknowledged using thinner and amphetamine. While MR images could not find any definite abnormality, 3-D images with I-123 IMP demonstrated multifocal defects. 3-D images with I-123 IMP might be able to detect an early abnormality in brain perfusion in a drug abuser.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
6/43. Toxic keratopathy associated with abuse of low-dose anesthetic: a case report.OBJECTIVE: To describe the clinical course and treatment of toxic keratopathy associated with abuse of topical anesthetic at a very low concentration, 0.05%. METHOD: Case report. RESULT: A 47-year-old female systemic lupus erythematosus (SLE) patient with blurred vision and irritated right eye was referred to the ophthalmology department of our hospital. Under slit-lamp microscope, a 5.5 x 4.5 mm central corneal epithelial defect with underlying infiltrative and opaque stroma was noted in her right eye. Two weeks before, a corneal ulcer was diagnosed, and oxybuprocaine 0.05% (Lacrimin, Santen, Osaka, japan) eye drops were prescribed 4 times daily but used every 5 to 10 minutes because the right eye was severely irritated. She was admitted immediately under the impression of toxic corneal ulcer. Preservative-free lubricants and prophylactic topical antibiotics 4 times daily were applied. Therapeutic soft contact lens was started after no infective agents were detected. Two weeks later, the stromal infiltration subsided, and the corneal epithelium was slowly healing, but superficial punctate epithelial defects at the lesion site persisted for another 6 months. The vision of her right eye improved from finger-counting at a 30-cm distance to 20/1200 with correction. CONCLUSION: Toxic keratopathy may result from abuse of topically administered anesthetics even at a very low concentration, 0.05%. Because this SLE patient has tear problems, we suggest that topical anesthetics must be used very cautiously and never prescribed to patients with dry eyes where the integrity of ocular surface is altered.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
7/43. palliative care of the terminally ill drug addict.palliative care with terminally ill drug addicts is a major challenge for medical professionals to face. With growing problems of prescription drug abuse in this country, the problem is only going to continue to grow and be faced more often. To date, very little has been done focusing on this special population of end-of-life care patients. This review article attempts to explore the terminology and definitions for identifying addiction in the terminally ill as well as exploring management options for healthcare professionals. As with other opioid treated pain patients, relying on terms such as "physiological dependence" and "tolerance" is inappropriate for use in this population, who are likely to have been on opioids for extended periods of time requiring dose escalation for progressive disease. Thus, these terms have little utility for identifying problem patients. Rather, understanding the context of the drug abuse as it reflects on the concepts of use despite harm and the damage inflicted to the physical, psychological, or social make-up of the patient is necessary. Recommendations include careful monitoring and assessment of patients, utilizing multidisciplinary team approaches, encouraging participation in recovery programs, and utilization of pill counts and urine toxicology screenings as necessary. Implications for the field are discussed.- - - - - - - - - - ranking = 2keywords = face (Clic here for more details about this article) |
8/43. Intervention: a strategy to help chemically dependent students.Chemical dependence in nursing students is not a pleasant reality to face. However, facing rather than denying this disease in our students may help to save a valuable professional resource. The author describes how one nurse educator used the chemical dependence tool of intervention as a strategy to help a student eventually enter the nursing profession.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
9/43. The many faces of cocaine: the importance of psychosocial assessment in diagnosing and treating cocaine abuse.cocaine abuse is a major social health problem in the united states. However, much too frequently, cocaine abuse is overlooked by social workers, physicians, and other health team members who are busy directing their interventions at solving and treating the biological and psychosocial effects of taking cocaine, but fail to see the connection between these symptoms and cocaine use. In order to help social workers in health care settings recognize and deal effectively with cocaine-abusing patients, the author presents a three stage practice model. The first two stages focus on strengthening assessment skills via symptom identification and diagnosis confirmation, with attention to patterns and severity of illness. The third stage highlights the referring process leading to appropriate treatment resources.- - - - - - - - - - ranking = 4keywords = face (Clic here for more details about this article) |
10/43. cat-scratch disease: an unusual cause of combative behavior.Acute encephalitis is an unusual manifestation of cat-scratch disease. The authors present the case of a 27-year-old man who exhibited the acute onset of encephalitis manifested by violent behavior and confusion. The diagnosis of drug abuse was presumed initially, but a careful examination revealed the true cause to be cat-scratch disease. Emergency physicians are frequently faced with the challenging task of evaluating confused and combative patients. This case demonstrates the importance of a complete physical examination and a thorough laboratory evaluation.- - - - - - - - - - ranking = 1keywords = face (Clic here for more details about this article) |
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