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1/117. Recognizing factitious hypoglycemia in the family practice setting.

    BACKGROUND: Factitious hypoglycemia is a deliberate attempt to induce a low serum glucose level using either insulin or oral hypoglycemic agents. Sulfonylurea-induced hypoglycemia is more common than incidents of insulin abuse, and hypoglycemia caused by these oral agents is biochemically indistinguishable from insulinoma. methods: We describe a case of factitious hypoglycemia resulting from insulin abuse in an adult diabetic patient, review the essentials of glucose homeostasis, and describe diagnostic tests that allow a differential diagnosis. RESULTS AND CONCLUSION: Factitious hypoglycemia is associated with a higher incidence of suicide, depression, and personality disorders. Insulin-induced hypoglycemia can be detected by an insulin to c-peptide ratio that is greater than 1.0. In the absence of proof to the contrary, insulinoma should be considered the cause of hypoglycemia until another diagnosis is established. The generally poor prognosis for patients with factitious hypoglycemia underscores the importance of early recognition of factitious disorders.
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ranking = 1
keywords = depression
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2/117. role of cannabis in psychiatric disturbance.

    Clinical observation suggests that cannabis is implicated in some types of psychiatric disturbance. A record of admissions to two urban and four rural hospitals in jamaica is examined along with details of individual cases. One-third of male admissions to the psychiatric hospital have used cannabis. Of 74 males admitted to another psychiatric service over a 12-month period, 29 had used cannabis. Ten of these patients were diagnosed as "ganja psychosis," and four others were classified as "marijuana-modified mania." At another psychiatric service, 54 of 223 admissions (24.2%) for functional psychosis presented with cannabis usage as a comtributory factor. These 54 patients included 14 and seven cases of hypomanic and depressive reactions, respectively. At three other rural general hospitals, psychiatric admissions for psychosis showed 11 of 51, seven of 18, and 39 of 75 patients, respectively, in whom cannabis was considered directly responsible. These findings lend support to the idea of causation of illness or modification of existing illness. The negative findings of controlled studies in the same country are not inconsistent. A suggested classification for adverse reactions to cannabis offered by one author is recommended, because it is in accord with common local clinical experience.
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ranking = 81.408132844991
keywords = psychosis, manic
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3/117. Asphyxial death during prone restraint revisited: a report of 21 cases.

    Determining the cause of death when a restrained person suddenly dies is a problem for death investigators. Twenty-one cases of death during prone restraint are reported as examples of the common elements and range of variation in these apparently asphyxial events. A reasonable diagnosis of restraint asphyxia can usually be made after ruling out other causes and collecting supportive participant and witness statements in a timely fashion. Common elements in this syndrome include prone restraint with pressure on the upper torso; handcuffing, leg restraint, or hogtying; acute psychosis and agitation, often stimulant drug induced; physical exertion and struggle; and obesity. Establishing a temporal association between the restraint and the sudden loss of consciousness/death is critical to making a correct determination of cause of death.
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ranking = 26.735829641247
keywords = psychosis
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4/117. 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.
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ranking = 5
keywords = depression
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5/117. 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.
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ranking = 1.1801950165565
keywords = affective
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6/117. 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.
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ranking = 1.1801950165565
keywords = affective
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7/117. benzodiazepines and withdrawal psychosis. Report of three cases.

    Three cases of acute psychotic illness following sudden withdrawal from high daily doses of benzodiazepines were associated with agitation and confusion. Disorientation was prominent in two of the patients. None of the patients had had previous psychotic episodes. The condition of all patients was reversed dramatically with hypnotic drugs. Gradual withdrawal was successfully accomplished without relapse, with a follow-up of as much as one year. To our knowledge, this is the first such series in the literature.
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ranking = 106.94331856499
keywords = psychosis
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8/117. 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.
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ranking = 4
keywords = depression
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9/117. triiodothyronine augmentation for the treatment of depression in substance misusers unresponsive to tricyclic antidepressants.

    We report on two substance misusers with depression resistant to tricyclic antidepressant treatment who responded to triiodothyronine augmentation. The management of resistant depression, augmentation strategies with particular reference to triiodothyronine, and the possible mechanism of action of triiodothyronine are discussed.
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ranking = 6
keywords = depression
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10/117. Prolonged psychosis attributed to phencyclidine: report of three cases.

    After ingesting street drugs sold as "PCP," "THC," and "methadone," three young men developed schizophreniform psychoses, analgesia, anesthesia, and amnesia for the psychotic state. Except for their unusually long duration of 2 to 4 weeks, these reactions resembled phencyclidine psychoses. The authors are aware of other phencyclidine-related hospital admissions but could find no information on phencyclidine in recently published handbooks on drug abuse.
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ranking = 106.94331856499
keywords = psychosis
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