Preliminary findings of patterns of substance abuse in eating disorder patients.
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Adult↗
Biomedical subjects
M S Gold
Publications and source records attributed to M S Gold.
The pharmacologic treatment of alcohol and cocaine abuse. Integration of recent findings into clinical practice.
The clinical evidence available to date does not yet support the routine use of pharmacologic interventions in the majority of cases of alcohol or cocaine abuse. The available data suggest, however, that interventions should be considered, especially in patients who relapse or drop out of treatment, in more difficult cases, and in instances in which there are associated psychiatric disorders. Education and prevention should be reconsidered as the important "treatments" they are today.
Adolescent↗
Perioperative fluid management.
The physiologic effects of surgery as well as anesthesia on fluid balance have been discussed. Detailed discussions of some types of surgery and patient populations were included to clarify situations in which fluid management may be unusually difficult. Principles derived from the examination of these situations should make fluid management during the perioperative period easier.
Anesthesia↗
Periaqueductal gray stimulation produces a spinally mediated, opioid antinociception for the inflamed hindpaw of the rat.
The objective of the present study was to characterize stimulation-produced antinociception from the periaqueductal gray matter (PAG) in rats with unilateral hindlimb inflammation induced by an intraplantar injection of Freund's complete adjuvant. Rats were chronically implanted with a bipolar stimulating electrode in the PAG. Nociception was assessed using a paw pressure test. Prior to inflammation, PAG stimulation significantly increased paw pressure threshold in both paws compared to non-stimulated controls. Following inflammation, PAG stimulation inhibited nociception in the inflamed, but not the non-inflamed paw. Systemic administration of naloxone blocked antinociception from ventral, but not dorsal PAG stimulation sites. Intrathecal, but not subcutaneous, administration of quaternary naltrexone completely blocked stimulation-produced antinociception from the PAG. The known increased levels of endogenous opioids occurring in the spinal cord ipsilateral to the site of inflammation suggest a mechanism for the selective antinociceptive effect of ventral PAG stimulation seen for the inflamed paw.
Analysis of Variance↗
Benzodiazepines: a major problem. Introduction.
Benzodiazepine use is prevalent. Moreover, benzodiazepine abuse, addiction, tolerance, and dependence occur commonly with benzodiazepine use. Confusion arises in assessing the nature and magnitude of benzodiazepine use and its consequences. Abuse, addiction, tolerance, and dependence occur in medical and nonmedical populations, but the studies do not clearly differentiate the benzodiazepine use between these two populations. The nonmedical use in medical populations is underestimated and underdiagnosed. The nonmedical use is also misdiagnosed in nonmedical populations as medical use. Clearer definitions and usage of the terms of abuse, addiction, tolerance, and dependence would result in accurate diagnosis and proper treatment of the disorders associated with benzodiazepine use, that is, anxiety and depressive disorders, alcoholism, and other drug addictions.
Anti-Anxiety Agents↗
Suicide risk associated with drug and alcohol dependence.
The association of alcohol and drugs with suicidal thinking and behavior is both causal and conductive. The subjective state of hopelessness is key to the disposition to actual suicides. Alcohol and drugs are influential in providing a feeling of hopelessness by their toxic effects, by possible manipulating of neurotransmitters responsible for the mood and judgement and by disruption of interpersonal relationships and social supports. The identification of alcohol and drug use and dependence is critical to the proper assessment of suicide. According to studies, over fifty percent of all suicides are associated with alcohol and drug dependence and at least 25% of alcoholics and drug addicts commit suicide. Over 70% of adolescent suicides may be complicated by drug and alcohol use and dependence. Because alcoholism and drug addiction are leading risk factors for suicidal behavior and suicide, any alcoholic or drug addict should be assessed for suicide, especially if actively using alcohol or drugs.
Alcoholism↗
Abuse, addiction, tolerance, and dependence to benzodiazepines in medical and nonmedical populations.
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Anti-Anxiety Agents↗
Violent behaviors associated with cocaine use: possible pharmacological mechanisms.
Violent behaviors are increasingly noted in clinical practice to be associated with cocaine use; however, few studies actually characterize these behaviors. Cocaine addicts who made self-inquiries for themselves to obtain information about the effects, diagnosis, and treatment of cocaine dependence were interviewed. The study examined in a structured telephone interview their violent behaviors associated with cocaine use. The types of violent behavior reported by these cocaine addicts ranged from minor psychological aggressions to major physical acts that included murder and rape. The pharmacological mechanisms underlying the induction of cocaine-associated violence may involve known neurotransmitter systems affected by cocaine. A possible explanation may be that cocaine acts in those areas of the brain, particularly the limbic system, that subserve aggressive and violent behaviors.
Adult↗
Dual diagnoses: psychiatric syndromes in alcoholism and drug addiction.
Concomitant psychiatric illness and alcohol or drug addiction are difficult to diagnose and treat. Alcohol and drug problems are significantly underdiagnosed in medical and psychiatric populations, while psychiatric disorders may be underdiagnosed in alcohol- and drug-addicted patients. An understanding of addiction and psychiatric disorders is essential for successful treatment of the comorbidity of these disorders. Alcohol or drug addiction frequently produces significant psychiatric syndromes, which may resolve during periods of sobriety. The combination of addiction and established psychiatric disorders is less common.
Alcoholism↗
Organic solvent and aerosol abuse.
Volatile organic solvents and aerosols are available in a wide variety of household and commercial products. Inhalation of these substances produces euphoria, excitement, sedation, delusions, and visual and auditory hallucinations. With acute and chronic use, organic solvents and aerosols cause slurred speech, ataxia, frank intoxication, and poor insight and judgment. Both acute and chronic toxic effects can occur, and addiction can develop with chronic use.
Aerosols↗
Primary peptic ulcer disease in childhood.
In a retrospective survey, the clinical details of all children with primary peptic ulcer seen at Red Cross War Memorial Children's Hospital over a 12-year period were analysed. The diagnosis was confirmed in 31 cases, 22 of whom had a duodenal ulcer. Gastro-intestinal bleeding was the presenting symptom in 19 patients. In 7 of these there were no preceding symptoms, rendering earlier diagnosis impossible. Those presenting with abdominal pain had a mean interval of 2.8 years between onset of symptoms and diagnosis. Useful clinical clues in these children were epigastric tenderness and anaemia. To avoid diagnostic delays, peptic ulcer disease should be considered more often in children with abdominal pain. When available, gastro-intestinal tract endoscopy should be the diagnostic investigation of choice.
Adolescent↗
Pancreaticoduodenectomy for bleeding periampullary tumors.
Periampullary neoplasms with necrosis or ulceration may have potentially troublesome and occasionally life-threatening bleeding. Four patients required pancreaticoduodenectomy for control of bleeding; three had adenocarcinoma of the duodenum and head of the pancreas, and one had an ulcerated carcinoid tumor of the duodenum. In two of these patients, incomplete resection was performed, and in one there was evidence of metastatic disease to the liver. Surgical results were excellent, postoperative courses were benign, and satisfactory palliation was provided. Improving morbidity and mortality with radical resection and aggressive radiotherapy and chemotherapy after surgery with the potential for bleeding from tumor necrosis make resection a reasonable alternative for palliation when localized but advanced disease exists.
Adenocarcinoma↗
Drug testing: medical, legal, and ethical issues.
Laboratory testing for drugs is a controversial issue in America. The authors present arguments for mandatory use under specific circumstances. Physical limitations of each test are discussed in terms of applicability as well as protection of the person being tested.
Ethics, Medical↗
Cannabis diagnosis of patients receiving treatment for cocaine dependence.
In three separate samples using DSM-III-R criteria for substance dependence in 232 inpatients and 51 outpatients, we confirm the clinical suspicion that many cocaine dependents qualify for the diagnosis of cannabis dependence. As many as 53% of cocaine dependents diagnosed by DSM-III-R criteria have the concurrent diagnosis of cannabis dependence. The reports regarding cannabis dependence among cocaine dependents are few and inconclusive. The diagnosis of cannabis dependence in cocaine dependents has important consequences on etiology, prognosis, and treatment.
Adult↗
Comparison of hetastarch to albumin for perioperative bleeding in patients undergoing abdominal aortic aneurysm surgery. A prospective, randomized study.
The effects of hetastarch and human albumin solutions on perioperative bleeding and coagulation parameters during abdominal aortic aneurysm repair were compared. In two randomized groups of 20 patients, albumin 5% (group 1) or hetastarch 6% (group 2) 1 g/kg was given during surgery. The remaining perioperative fluids consisted of lactated ringers and packed red blood cells. Perioperative coagulation measurements included partial thromboplastin time, prothrombin time, activated clotting time, platelet count, and bleeding time. Estimated blood loss and the total amount of crystalloid and blood infused were also measured. The surgeon, blind to the colloid used, subjectively rated bleeding on a scale of 1 to 10. There was no significant difference between groups for any measured parameter at any time. Measurements of coagulation function were within normal limits for both groups. Hetastarch does not cause clotting disorders in patients undergoing abdominal aortic aneurysm repair, at least if the quantities used in this study are not exceeded.
Aged↗
The diagnosis of alcohol and cannabis dependence in cocaine dependence.
In two separate studies using DSM-III-R criteria for substance dependence in two hundred sixty-three (263) inpatients we confirm the clinical experience that cocaine addicts use other drugs including alcohol. As many as 89% of cocaine addicts diagnosed by DSM-III-R criteria for cocaine dependence qualify for other substance dependence diagnoses. Previous reports regarding alcohol and other drug use among cocaine addicts are few and inconclusive. The diagnoses of other substance use and dependence in cocaine dependence has important impact on etiology, prognosis and treatment. Our study finds a high prevalence of alcohol dependence and cannabis dependence in patients with cocaine dependence.
Adult↗
Benzodiazepines: reconsidered.
The benzodiazepines were first introduced in 1960. Chlordiazepoxide (Librium) was the first of the class of drugs called benzodiazepines, in a deliberate attempt to synthesize a tranquilizer without the sedative properties and abuse, addiction, tolerance, and dependence potential of the barbiturates, and other sedative/hypnotic drugs. The popularity of the benzodiazepines rose steadily to a peak period in the mid 1970s when diazepam (Valium) was the most commonly prescribed drug of any kind, including antihypertensive, analgesic and other psychotropic medications. The current evaluations of benzodiazepines use and abuse demonstrate clearly that they produce tolerance and dependence in short and long-term administration. The development of abuse and addiction is also strongly substantiated although they are not as easily appreciated and identified because of confusion in diagnosis and treatment of abuse and addiction. Significant problems in definitions, diagnosis, interpretations and conclusions exist in general practice regarding abuse and addiction, and their relationship to use of and symptoms produced by benzodiazepines. The lack of clarity in defining abuse and addiction and tolerance and dependence in clinical practice leads to institution and perpetuation of the toxicity and untoward effects of the benzodiazepines.
Anti-Anxiety Agents↗
Addictiveness of central stimulants.
Central stimulants have been abused since their inception and we are currently in the midst of a cocaine epidemic that challenges our resources and capabilities. Through their actions on powerful endogenous reward centers, central stimulants produce intense euphoria that reinforces subsequent usage and eventual dependence. Considerable evidence indicates that the activation of dopamine circuits mediates stimulant reward. With regard to cocaine, it has been hypothesized that depletion of central dopamine leads to craving. Euphoria and craving, the key dynamics of stimulant addiction, may therefore result largely from neurochemical alterations of dopamine systems in the brain's reward center. Progressive deterioration of the stimulant addict involving medical, psychiatric, and psychosocial impairment occurs rapidly, underscoring the addiction potential of these agents. Tolerance, sensitization and withdrawal phenomena are discussed from clinical and neurochemical perspectives.
Amphetamines↗