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1/34. Substance abuse and emergency psychiatry.

    Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care. ( info)

2/34. Amphetamine abuse and intracranial haemorrhage.

    amphetamines taken by any route can cause cerebral vasculitis and intracranial haemorrhage. 8 cases were seen in a neurosurgical unit over 3.5 years. The published work indicates that those who experience these complications, mainly young adults, have poor outcomes. ( info)

3/34. Acute myocardial infarction associated with amphetamine use.

    Myocardial infarction is a rarely reported complication of amphetamine use. We report the case of a healthy 31-year-old man who presented to our emergency department with no clinical evidence of an acute coronary event after intravenous injection of amphetamines. However, he subsequently experienced a non-Q-wave anterior wall myocardial infarction associated with the use of amphetamines. ( info)

4/34. acceleration of hiv dementia with methamphetamine and cocaine.

    We report a patient with rapidly accelerating hiv dementia accompanied by seizures and an unusual movement disorder despite highly potent antiretroviral therapy. This clinical constellation was associated with the non-parenteral use of methamphetamine and cocaine. Fractional enhancement time on post contrast magnetic resonance imaging studies revealed a progressive breakdown of the blood brain barrier particularly in the basal ganglia. The movement disorder but not the dementia responded to a combination of dopamine replacement and anticholinergic therapy. While the movement disorder may have been unmasked by concomitant anticonvulsant therapy, we suggest in this instance, that prior drug abuse synergized with hiv to cause a domino effect on cerebral function. Careful attention and analysis to histories of remote non-injecting drug abuse may help substantiate our hypothesis. ( info)

5/34. Use ecology and drug use motivations of methamphetamine users admitted to substance abuse treatment facilities in los angeles: an emerging profile.

    Who are methamphetamine (MA) users and what are the circumstances that surround their drug use? This article provides a foundation for future ethnographic studies and collaborative clinician-researcher assessments of MA use by describing use ecology and drug use motivation for 260 MA users admitted to treatment at public los angeles County facilities in 1996. Use ecology data include MA varieties and street names, first introductions to use, drug use histories, access, selling and manufacturing, routes of administration, unwanted results of use, and participants' use behavior in the year before the 1996 treatment. Use motivation data describe clients using MA as a substitute for other stimulants; to cope with mental distress; to stay awake; to enhance sexual experience; and to lose weight. Qualitative case studies illustrate the findings and demonstrate the complex inter-relations of society, culture, psyche and soma shaping MA use over time. ( info)

6/34. Patient characteristics, hiv serostatus, and risk behaviors among gay and bisexual males seeking treatment for methamphetamine abuse and dependence in Los Angeles.

    methamphetamine, a drug used at alarming rates among gay/bisexual males in the West, is often combined with sexual activities, thereby increasing hiv-related risks in an already high-risk group. Findings from 68 gay/bisexual men seeking treatment for methamphetamine dependence in Hollywood, california were analyzed to predict hiv serostatus based on demographic, drug use, or sexual behavior variables. Results showed that more hiv-infected participants than non-infected men reported medical problems (97.6% versus 46.2%; X2 = 24.7, df = 1, p < .0001), histories of genital gonorrhea (59.5% versus 26.9%; X2 = 6.9, df = 1, p < .01), use of injection methods (45.2% versus 19.2%; X2 = 4.8, df = 1, p < .03), and more sexual partners with unprotected receptive anal intercourse in the 30 days prior to intake (5.9 versus 0.7; separate t = 3.5, df = 43.7, p < .001). More non-infected participants (19.2%) reported suicidal thoughts than hiv-infected men (0%; X2 = 4.8, df = 1, p < .03). Discriminant function analysis correctly classified 74.6% of cases into serostatus groupings based on presence of suicidal thoughts, history of gonorrhea, number of sexual partners with unprotected receptive anal intercourse and prior methamphetamine treatment. Findings provide information that may prove helpful in tailoring culturally relevant treatment and prevention messages. ( info)

7/34. Altered response to intravenous thiopental and succinylcholine in acute amphetamine abuse.

    Substance abuse has become increasingly prevalent: illegal drugs have profound and varied physiologic effects which create a large potential for anesthetic problems and complications (1). Amphetamine is a strong sympathomimetic and may therefore influence the course of anesthesia. We report the case of a patient with acute amphetamine abuse presenting difficulties during anesthesia. ( info)

8/34. Upper airway obstruction and acute lung injury associated with cocaine abuse.

    We describe the case of a 14-year-old boy who developed airway obstruction due to acute upper respiratory tract infection. Following emergency tracheostomy, he developed pulmonary oedema and required ventilation. The postoperative course was complicated by the development of adult respiratory distress syndrome, characterised by marked respiratory distress, diffuse pulmonary infiltrates on chest radiography, reduced pulmonary compliance and marked increase in alveolar-arterial oxygen difference. He also developed persistent high-grade pyrexia, renal failure and cardiac instability. A social history of substance abuse (crack cocaine, amphetamines, alcohol and cigarettes) was obtained three weeks post-admission and is thought to have made a significant contribution to the severity of his disease. ( info)

9/34. The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence.

    Patients with a severe mental illness such as schizophrenia have significant rates of concurrent amphetamine use. Such dual diagnosis patients have been shown to have poorer treatment outcomes. Often, they do not comply with treatment plans and have frequent episodes of hospitalization. There is growing evidence for the role of prescribed dexamphetamine in the treatment of amphetamine dependence. The prescription of dexamphetamine to patients with schizophrenia and amphetamine dependence has not been previously reported. Eight schizophrenic patients are described to whom dexamphetamine has been prescribed, with information being extracted retrospectively from case notes. In four out of eight cases, the prescription of dexamphetamine led to apparently good progress both in terms of substance misuse and psychiatric health. In two cases, progress was more equivocal, but appeared to produce some benefit. Two cases could be judged as treatment failures, but the condition and situation of the patients were not worse at the end of treatment than at the beginning. compliance with neuroleptics increased in most cases. No patients exhibited exacerbation of psychosis as a result of treatment. The rate of outcome success is satisfactory when consideration is given to the difficult nature of this patient group, and their previous failure to respond to intensive treatment. It is argued that benefits may be gained from increased compliance with psychiatric treatment in patients prescribed amphetamine, and that this may outweigh possible risks. However, any conclusions are tentative in view of the nature of this study. A small open-label prospective study is recommended. ( info)

10/34. hearing loss in amphetamine users.

    Sensory perceptions are modified by amphetamines. Prolonged and heavy use can lead to neuronal damage, neurotransmitter depletion and receptor supersensitivity. Sensorineural deafness had been reported in chronic users of volatile inhalants, alcohol and heroin. There are no reports of hearing problems with amphetamines. hearing loss was identified in seven amphetamine-dependent inpatients in the detox unit at Al Amal Hospital, Jeddah. Subjects were men aged 18 and over who met DSM IV criteria for substance dependence. The hearing loss was suspected on clinical grounds during the admission interview, and was quite noticeable. Both ears were similarly affected. The symptom mostly appeared three to eight hours after ingestion of the tablets, and did not develop every time the drug was used. Hearing was apparently recovered in every case within four to ten days of cessation of amphetamine use. During the hearing loss, sounds were perceived as less loud and less sharp compared to normal. These cases suggest that chronic amphetamine use may result in reversible hearing loss. The various mechanisms by which this might occur are discussed. The author concludes that these observations should be replicated with a large group of subjects and recommends further investigations to elucidate the nature and site of the damage. ( info)
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