Cases reported "Morphine Dependence"

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1/9. naltrexone treatment of combined alcohol and opioid dependence: deterioration of co-morbid major depression.

    naltrexone is frequently used for the treatment of opioid or alcohol dependence. However, the reports on its potential to worsen affective disorders are contradicting. Here we report on a patient with combined alcohol and opioid dependence whose co-morbid major depression deteriorated reversibly and repeatedly under naltrexone. By exchanging buprenorphine for naltrexone, his depression and craving for alcohol and opioids disappeared. This underlines the close interaction between depression, substance dependence and the opioid system. ( info)

2/9. A single case report of recurrent surgery for chronic back pain and its implications concerning a diagnosis of munchausen syndrome.

    While undergoing treatment in the psychiatric department, A.C., a 40-year-old white male, who had arrived in the casualty department complaining of an uncontrollable anxiety attack and in a state of fluctuating consciousness, was found to be suffering from a psychopathological condition characterized by pathological lying, gambling, compulsive restlessness, a long clinical history of chronic back pain, with multiple invasive diagnostic investigations and repeated surgery for disc hernia with relative complications, culminating in the fitment of a fixed neurostimulator, a slow-discharge morphine pump and the patient being granted a full disability pension. The continual increases in the doses of morphine suggested a tendency towards drug addiction. After providing a brief overview of the historical background and current concepts relating to the relationship between factitious disorders, malingering and hysteria, the authors discuss the differential diagnosis of the case, suggesting a diagnosis of munchausen syndrome (the hypothesis best supported by the clinical evidence). This diagnosis, although the subject of much academic debate, is, unfortunately, still not frequently encountered in the medical literature, with the result that even today it has a strong clinical, relational and social impact. ( info)

3/9. buprenorphine for pain relief in a patient with drug abuse.

    buprenorphine is a mixed opioid agonist/antagonist which appears to produce less physical dependence and respiratory depression than typical mu-agonist opioids. These effects suggest its use for analgesia for drug abusers. However, buprenorphine may precipitate withdrawal from other opioids. The present case illustrates the utility of buprenorphine and describes a method to transfer a patient from a mu-agonist to buprenorphine without precipitating withdrawal or interrupting analgesia. ( info)

4/9. gallbladder sludge and lithiasis in an infant born to a morphine user mother.

    We report a 3-month-old boy with gallbladder sludge formation and lithiasis. The known associated factors causing cholelithiasis in infancy were not present. We postulate that maternal chronic use of morphine during pregnancy may result in biliary sludge formation in utero in the fetus with progression and manifestation of cholelithiasis at 3-months of age. ( info)

5/9. Opioid pseudoaddiction--an iatrogenic syndrome.

    A case is presented of a 17-year-old with leukemia, pneumonia and chest-wall pain. Inadequate treatment of the patient's pain led to behavioral changes similar to those seen with idiopathic opioid psychologic dependence (addiction). The term pseudoaddiction is introduced to describe the iatrogenic syndrome of abnormal behavior developing as a direct consequence of inadequate pain management. The natural history of pseudoaddiction includes progression through 3 characteristic phases including: (1) inadequate prescription of analgesics to meet the primary pain stimulus, (2) escalation of analgesic demands by the patient associated with behavioral changes to convince others of the pain's severity, and (3) a crisis of mistrust between the patient and the health care team. Treatment strategies include establishing trust between the patient and the health care team and providing appropriate and timely analgesics to control the patient's level of pain. ( info)

6/9. Oligozoospermia, asthenozoospermia, and sperm abnormalities in ex-addict to heroin, morphine, and hashish.

    A 40-year-old male had been addicted to heroin, morphine, hashish, and other narcotics for 12 years. At examination, 2 years after abstinence from drugs, his semen analysis revealed oligozoospermia, asthenozoospermia, and morphologically abnormal spermatozoa such as "round-headed" and "kinked"--sperm with neck abnormalities and immature forms. There was no evidence of other morphological abnormalities or of the presence of morphologically normal sperm. A possible correlation is discussed between the long-lasting drug addiction and morphological sperm abnormality, endocrinological function, karyotype, and immunological status. ( info)

7/9. diagnosis of pulmonary talcosis by electron-probe x-ray analysis.

    A miner with a long history of drug abuse developed pulmonary fibrosis. It was not clear whether his disease was due to drug abuse or exposure to mine dust. Electron-probe x-ray analysis of mineral deposits in the lung showed that his disease was due to drug abuse and not occupational exposure to mine dust. ( info)

8/9. Propoxyphene in children with iatrogenic morphine dependence.

    In four children with iatrogenic morphine sulfate tolerance and dependence, narcotic withdrawal was successfully accomplished using propoxyphene napsylate. The patients showed signs and symptoms typical of narcotic withdrawal, which resolved with morphine administration and increased during attempts to lower the daily morphine dose. Propoxyphene napsylate at total daily doses of 25 to 65 mg/kg, administered at four-hour intervals, allowed rapid reduction of the morphine dosage, with few withdrawal signs and symptoms, and lessened respiratory depression. This treatment enabled patients to be rapidly weaned from the respirator. One child experienced increasing lethargy and respiratory depression and responded to naloxone hydrochloride and a decrease in the dose of propoxyphene; another had transient agitation, which may have been related to high levels of propoxyphene. Our treatment used alternating doses of propoxyphene and morphine, which allowed the child to be morphine free after four days and narcotic free after nine days. ( info)

9/9. Renal and cardiac complications of drug abuse.

    The case is presented of a young man who, after prolonged intravenous narcotic administration, developed subacute bacterial endocarditis involving the aortic valve, and rapidly progressive glomerulonephritis. After treatment of and recovery from renal failure, persistent proteinuria was shown to be caused by focal glomerulosclerosis. The association of these lesions with "mainlining" is reviewed. ( info)

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