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Quit Marijuana The Complete Guide Summary

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Emergency Department Recognition of Substance Abuse

The percentage of ED patients who test positive for blood alcohol at the time of the visit ranges from 6 to 34 percent for injured patients and 1 to 19 percent for the noninjured.8 At the time of an urban ED visit, 17 percent of patients were found to meet stringent criteria for alcohol abuse and 19 percent for alcohol dependency, while only 9 percent of the study group were breath alcohol positive, and only 14 percent reported a drinking problem. Among a 1-year sample of more than 7100 patients presenting to another urban ED, 41 percent (n 2931) screened positive for alcohol or drug abuse on a health-needs history.9 Rates of substance abuse as high as 50 percent have been reported among trauma patients,10 and alcohol is a major risk factor for virtually all categories of injury. 11 Although emergency physicians are experts in the stabilization, diagnosis, and treatment of acute alcohol and drug emergencies and their secondary complications, they often fail to detect and refer...

Substance Abuse

Substance abuse is one of the greatest threats to normal pregnancy.22 Illicit substances as well as alcohol and tobacco may affect pregnancy outcome through their effects on both the mother and the fetus. Frequently, multiple substances are involved, since substance abusers rarely use a single substance. ILLICIT SUBSTANCES Use of cocaine, opiates, or amphetamines is associated with multiple complications of pregnancy and congenital abnormalities. Data on other substances, such as hallucinogens and designer drugs, is inconclusive. Effects of abused substances as well as the general health and well-being of the mother are of concern when treating a pregnant substance abuser.22 A multidisciplinary approach is important.

Paul R Stasiewicz and Kellie E Smith

The origin of the term special population can be attributed to several U.S. government agencies involved in health and human services in the mid-1970s. The term is reserved for groups whose need for substance abuse treatment programs has been under-served. The purpose was to identify subgroups in order to help with planning and evaluating the national treatment system for alcohol and drug problems. The goal was to provide funding for specialty programs, or to ensure that mainstream programs were structured to provide appropriate treatment services. Special population groups are most often defined in terms of age, race eth nicity, gender, and health status. This article focuses on the treatment of addictive behavior in racial ethnic minorities and women. These groups present unique treatment issues such as pregnancy and culture-specific beliefs and attitudes regarding substance use. In addition members of minority groups report higher rates of substance abuse problems than do whites,...

The Impact of Critical Medical Anthropology Studies

As Morsy (1996) observes, a review of the CMA literature shows that this genre of medical anthropology spans a range of both substantive and analytical concerns. Critical medical anthropologists have worked on a growing number of health-related issues and health conditions, including mental health, illicit substance abuse, smoking, AIDS, homelessness, reproduction, folk healing, infant care and mortality, diabetes, medical pluralism, immunology, nutrition, health policy, health care disparities, the pharmaceutical industry, rural health services, doctor-patient relationships, the role of the state in primary health care, and medical hegemony. As this (quite partial) list suggests, CMA theory has fostered numerous research and explanatory efforts and proven to be particularly fertile ground for the development of new explanatory concepts and new research questions. Consequently, the CMA perspective has not only strongly influenced the work of many medical anthropologists who define...

Issues in the Use of Self Report Instruments

Behavioral assessors have historically been somewhat skeptical of the inferences made from self-report data. Objections include the role that client biases, memory errors, and other factors might play in degrading the accuracy of self-reports. However, some behavioral problems are difficult to observe directly and the client's self-report may be the only source of information concerning the dimensions of the target behavior. For example, Sobell, Toneatto, and Sobell in 1994 concluded that self-reports are a valuable, cost-efficient, and reasonable source of information when assessing patients with substance abuse problems. However, they issued the caveat that inaccurate self-reports are most likely to occur when (1) individuals may violate social conventions or the law by admitting to engaging in a behavior or (2) individuals are unable to provide accurate self-reports (e.g., a demented patient, a very young child).

Value to Industry and Research

Attention deficit hyperactivity disorder (ADHD) is a condition characterized by inattention and or impulsivity and hyperactivity that begins in children prior to the age of seven. Their inattention leads to daydreaming, distractibility, and difficulties sustaining effort on a single task for a prolonged period of time. Their impulsivity disrupts classrooms and creates problems with peers, as they blurt out answers, interrupt others, or shift from schoolwork to inappropriate activities. Their hyperactivity is frustrating to those around them and poorly tolerated at school. Children with ADHD show academic underachievement and conduct problems. As they grow older, they are at risk for low self-esteem, poor peer relationships, conflict with parents, delinquency, smoking, and substance abuse.

For Behavioral Insomnia Therapies

Insomnia, as a symptom, often heralds underlying psychiatric, medical, or substance abuse disorders that require treatment before the sleep disturbance can be resolved. Nonetheless, effective and enduring insomnia treatment in many cases requires additional strategies designed to reestablish normal functioning of the human biologic sleep system. According to the 1988 theory of Wilse Webb, normal sleep functioning is regulated by homeostatic mechanisms that respond to increasing periods of wakefulness by increasing the propensity to sleep, circadian mechanisms that regulate the timing of sleep onset and offset, and environmental and behavioral factors that may serve to facilitate or inhibit the sleep process. Assuming adequate functioning of the homeostatic and circadian systems as well as sleep-conducive environmental behavioral conditions, normal, subjectively satisfying sleep results. However, disruption of normal homeo-static or circadian functioning and or disruptive environmental...

Primary Clinical Outcomes Abstinence and Relationship Functioning

A series of 14 studies have compared substance abuse and relationship outcomes for substance-abusing patients treated with BCT or individual counseling. Outcomes have been measured at 6-month follow-up in earlier studies and at 12-24 months posttreatment in more recent studies. The studies show a fairly consistent pattern of more abstinence and fewer substance-related problems, happier relationships, and lower risk of couple separation and divorce for substance-abusing patients who receive BCT than for patients who receive only more typical individual-based treatment. These results come from studies with mostly male alcoholic and drug-abusing patients and one study with female drug-abusing patients.

Neurobehavioral Problems

Persons with brain injury and other neurological conditions often experience lasting neurobehavioral problems. Cognitive deficits may include impairments in orientation, initiation, attention, concentration, discrimination, perception, learning, memory, and reasoning. Behavioral problems may include lack of motivation, inhibition, poor self-monitoring, irritability, apathy, aggressiveness, depression, lack of awareness, restlessness, unusual sexual behavior, and substance abuse. Physical difficulties may include fatigue, motor slowness, and diminished coordination.

Who Has the Authority to Decide for Children

CHILDREN'S ASSENT AND CAPACITY Decisions about when to consult or inform children about their healthcare options usually are important for older children and those with serious illnesses in cases in which distinct choices result in different outcomes. Some, but not all, children want to understand the decisions about their healthcare and often have an opinion about their care (Buchanan and Brock Holmes Matthews). Moreover, adolescents do not always need parental consent to obtain services such as treatment for substance abuse, abortion, and contraception (Holder,

Prevalence Of Dual Diagnosis

Mental health professionals have long been aware of the concept of dual diagnosis as it applies to the comorbidity of mental illness and substance abuse. The application of the concept to the existence of psychiatric disorders in persons with developmental disabilities only dates back to the midtwentieth century, and still remains largely unrecognized by the mental health community. Current research suggests that psychiatric disorders are at least three to four times more prevalent among people with MR DD than among the general population. Such a high prevalence statistic is not surprising on consideration of the physical, psychological, and social vulnerabilities of persons with DD. Many individuals with mental handicaps are now facing new tensions as they assimilate to life in the community while the national dein-stitutionalization movement continues to press forward.

Neurologic Complications

AIDS DEMENTIA AIDS dementia complex (also referred to as HIV encephalopathy or subacute encephalitis) is a progressive process commonly heralded by subtle impairment of recent memory and other cognitive deficits caused by direct HIV infection. In the early stages, diagnosis can be confused with depression, anxiety disorders, or substance abuse. Later phases of the illness are characterized by obvious changes in mental status and more severe disturbances, including aphasia and motor abnormalities. When a patient presents to the emergency department with an established diagnosis of AIDS dementia, with progressive signs or symptoms, it is important to rule out other CNS processes. A computed tomography (CT) scan in AIDS dementia typically shows cortical atrophy and ventricular enlargement.

Obstetric Complications

The significance of obstetric complications in the development of schizophrenia has led to some disagreement among researchers. In their 1978 review, McNeil and Kaij concluded that obstetric complications are not increased in the births of high-risk offspring 77 . A later meta-analysis arrived at a different conclusion Sacker et al. found small but significant effect sizes indicating that ''the risk of obstetric complications is increased in the births to parents with schizophrenia'' 78 . Specifically, birth weights were lower, there were more birth complications and the baby's condition was poorer 78,79 . Schizophrenic women are thought to be at greater risk for complications because of the association between schizophrenia in young women and smoking, substance abuse and low socioeconomic status 78,79 . In addition to noting a higher incidence of obstetric complications in the births of schizophrenic mothers, complications have been explored as having a causal role in later...

Chapter References

Ramsey J, Anderson HR, Bloor K, et al An introduction to the practice, prevalence and chemical toxicology of volatile substance abuse. Hum Toxicol 8 261, 1989. 5. Esmail A, Meyer L, Pottier A, et al Deaths from volatile substance abuse in those under 18 years Results from a national epidemiological study. Arch Disease Child 69 356, 1993. 14. Shepherd RT Mechanism of death associated with volatile substance abuse. Hum Toxicol 8 289, 1989.

Dbt Model Of Eating Disorders

The dialectical philosophy that informs treatment views the aim of DBT as replacing extreme and rigid response patterns with more synthesized and balanced ways of thinking and doing, using dialectical strategies (e.g., metaphor, paradox, cognitive restructuring). One exemplar of this application of dialectical philosophy, borrowed from DBT for substance abuse, is in the concept of dialectical abstinence, which synthesizes the goal or thesis of treatment as binge abstinence with the antithesis acceptance and preparation for the possibility of lapses. Other areas where

Culture Context and Individual Differences

Rates of depression and substance abuse disorders are low among Mexican Americans born in Mexico (Vega et al., 1998), and immigrant Mexican American women have a lifetime rate of depression of 8 , similar to the rates of nonimmigrant Mexicans (Vega et al., 1998). However, after 13 years in the United States, rates of depression for those women who immigrated to the U.S. rise precipitously. U.S.-born women of Mexican heritage experience lifetime rates of depression similar to those of the White population in the United States, nearly twice the rate of immigrants. These findings are mirrored in other indicators of health Despite high rates of poverty, Mexican American immigrant women have low rates of physical and mental health problems (Vega et al., 1998), Chinese American immigrant women have a lifetime rate of major depression near 7 , approximately half that of White women (Takeuchi et al., 1998). These results suggest that some aspects of culture may protect against culture pp....

Errors in Demand Based on Perceived Need

In defense of health economists, perceived need is often different than actual need, or a perceived need may be correct but public policy creates incentives in the wrong direction. In behavioral care this became apparent shortly after the Congress enacted DRGs in medicine and surgery, leaving psychiatry without these restrictions. Almost overnight medical and surgical beds were emptied all over America. A number of hospitals, used to cost-plus reimbursement with no restrictions, went bankrupt before some astute hospital administrators saw an opportunity in the absence of DRGs in psychiatry. Empty hospital beds, as many as 50 in some general hospitals, were quickly converted to psychiatry and substance abuse treatment. These were huckstered on television, educating the public that the hospital was the appropriate place for a wide range of life's problems, and especially the usual difficulties of adolescence. Mental health chemical dependency (MH CD) hospital-ization costs soared....

Mutually Misperceived Demand The Importance of Medical Cost Offset

For this and other reasons, the policy makers at NIMH and the Substance Abuse and Mental Health Services Administration (SAMHSA) are actively encouraging through research and demonstration projects the integration of behavioral health within primary care, and the inclusion of medical cost offset as an economic tool.

The Industrialization of Behavioral Care

Of particular significance to psychotherapists is the industrialization of behavioral care, which occurred separately, but in parallel to the industrialization of medicine and surgery. This resulted in the carve-out, discussed earlier, and the reason for that separate entity. DRGs had tethered medical and surgical costs so drastically that hospitals experienced as much as 50 bed vacancies. They converted these to adult and adolescent psychiatric hospitalization and the seemingly ubiquitous 28-day substance abuse hospitalization. Behavioral care costs soared, and at a time DRGs reduced medicine and surgery to an 8 annual inflation rate, behavioral care was driving the entire health spiral upward with its own annual inflationary rate of 16 . With the absence of DRGs in MH CD, third-party payors felt helpless in the face of this inflationary spiral and began dropping the MH CD benefit. In time the MH CD benefit might well have disappeared were it not for the emergence of carve-out...

History And Neuropsychological Findings

Although these groundbreaking human neurocog-nitive and animal studies alerted the medical community to the possibility of identifiable microscopic lesions and significant neurocognitive morbidity in some of the mild head injury population, the experimental designs utilized did not account for confounding factors. They also did not address issues related to differences in primate and human anatomy and physiology. In the mid-1980s and early 1990s, studies in Texas, New York, California, and Washington attempted to control some of these confounding factors, such as previous head injury, substance abuse, and litigation, by selecting participants with no history of these aforementioned risk factors. This sample of patients with uncomplicated mild head injury demonstrated neurocognitive deficits 1 month postinjury in comparison to controls, with good recovery for almost all this population after 3 months.

Recovery Curves And Treatment

The first and most obvious risk factor for poor recovery is greater severity of injury and related neurological physiological dysfunction. A complicated mild head injury defined by positive neuroima-ging findings or a high probability of axonal shear strain injury (based on documented loss of consciousness, posttraumatic amnesia, and or retrograde amnesia) places a patient in a high-risk category for slow and poor recovery. Other factors, such as pain (e.g., headache and back and neck trauma), depression, stress, sleep disturbance, poor premorbid health, and cognitive abilities, previous head injuries, psychiatric disorders, substance abuse, advanced age, poor social support systems, inadequate information about mild head injury recovery, and pending litigation, can all contribute to a patient's individual vulnerability to and risk for poor outcome. Given the complexity of these factors, and the previously mentioned neurocognitive deficits that may accompany these injuries, a...

Oppositional Defiant Disorder Odd And Conduct Disorder Cd

It is extremely rare that ODD does not appear at home, but it does definitely happen that its expression in other frameworks is minor. Generally the start of the clinical expression is at home, and at a later stage it spreads to educational and social frameworks outside the home. In this case, the child is likely to suffer from relatively lower academic achievement than his her ability warrants and social isolation. Then, damage to self-esteem, mood disorders and substance abuse are liable to appear.

Empirical Support For Cbt With Children

Evidence-based practice has become a common catchphrase within the educational and mental health professions. However, most of the literature on the use of CBT with children and adolescents has involved clinical populations rather than addressing the use of CBT in schools. The literature has shown CBT to be effective in the treatment of a number of childhood difficulties including depression, anxiety, and disruptive behaviors (see reviews in Kazdin & Weisz, 1998 Weisz & Jensen, 1999). There continues, however, to be a need for further investigation into a number of childhood difficulties including eating disorders, posttrau-matic stress disorder, bipolar disorder, substance abuse, school-related problems, and other health conditions (e.g., pain management, obesity). Additionally, further investigation is necessary regarding the provision of CBT in alternative settings such as a school system.

Psychiatric Emergencies

A psychiatric emergency is defined as a disturbance in thoughts, feelings or actions for which immediate therapeutic intervention is needed. For a variety of reasons, from substance abuse to violent behavior, the number of psychiatric patients in the Emergency Department is on the rise. Patients with psychiatric disorders account for as many as 15 of all emergency department visits thus creating a need for an increase in psychiatric awareness in medical personnel.

The Cognitive Revolution

The Cognitive Revolution

The principle task in cognitive therapy (CT) is to help clients systematically determine ways of challenging these thoughts, usually by evidence gathering and self-monitoring. Since the time that Beck and his colleagues described this method for treating depression, it has been extended to anxiety disorders, substance abuse, personality disorders, obsessive-compulsive disorder, eating disorders, and delusions. Beck's approach has shown a great deal of promise in alleviating emotional distress, as well as shedding light on the interaction between therapy and medication. Specifically, it has been shown in numerous trials that cognitive therapy alone is at least as effective as antidepressant medication for depression, while also showing greater maintenance of gains following medication discontinuation. This has since become an important experimental design for use in determining the relative contribution of CBT and medication for a number of other psychological conditions such as...

The Therapists Approach to Psychotherapy and How It Works

Like psychoanalysis, cognitive therapy has provided a lexicon for case formulation, and sets of standardized formulations of psychopathology, particularly for depression, anxiety, substance abuse, and personality disorders. These formulations emphasize cognitive patterns, schemas, faulty reasoning processes, and core beliefs, each specific to particular disorders.

Selective Serotonin Reuptake Inhibitors Ssris

Since the introduction of fluoxetine (Prozac) in 1988, the SSRIs have become the most commonly prescribed antidepressants in the United States. Other SSRIs currently available include sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), and citalopram (Celexa). SSRIs are primarily indicated for treatment of major depressive episodes but also have utility in dysthymia and anxiety disorders including generalized anxiety disorder, panic disorder, and obsessive compulsive disorder. Because of their favorable side effect profile and relative safety in overdose, some have argued that institution of an SSRI by an emergency department physician may occasionally be appropriate if (1) the patient can be assessed to rule out general medical causes for the depression, (2) ongoing substance abuse can be ruled out, and (3) the patient can be followed in the emergency setting until picked up by another health care provider. However, this rationale has rightly been questioned because of the...

Effectiveness of Brief Intervention

That ED intervention represented a paradigm shift from the legacy of prohibition, the Harrison narcotics laws, and their underlying perspective of substance abuse as a moral weakness requiring criminal sanctions for individuals with substance abuse problems and penalties for physicians who tried to intervene. Shortly before the Chafetz study was published, the American Medical Association recognized alcoholism as a disease for the first time and encouraged physicians to care for patients with this problem as they would other sick individuals.

Behavioral Strategies and Relapse Prevention

Alcohol and drug consumption For many gamblers, alcohol or drug consumption contributes to losing control and leads to excessive gambling. If this appears to be an issue, it should be evaluated immediately. Even if there is no substance dependency, but some substance abuse is occurring, the client will have to address this issue because it can contribute to the maintenance of excessive gambling.

Consequences Of Failure To Diagnose Domestic Violence

Other consequences of failure to diagnose include an increase in the patient's feelings of hopelessness, despair, isolation, and entrapment. Battered women may resort to substance abuse or develop depression with and without suicide attempts. Continuing or escalating domestic violence can lead to permanent disability or death. Domestic violence has adverse consequences for the children of victims as well. Perpetrators of domestic violence abuse the children in the home in approximately 30 percent of cases.24 Even if the children are not physically or sexually assaulted, experiencing or witnessing violence in the home as children has both short-term and long-term health consequences, including an increased incidence of adverse health-risk behaviors as adults. 1925 Finally, failure to interrupt the cycle of violence can lead to repetition of violence in the next generation. 26

Your Mental Health Rights Right to Know

This information should include details on procedures to obtain access to services, on utilization management procedures, and on appeal rights. The information should be presented clearly in writing with language that the individual can understand.

TABLE 2846 Benodiazepines

Benzodiazepines may also be administered acutely for a patient who is having a panic attack, regardless of the etiology of the panic. They should be used with caution in patients with a respiratory disorder or in those who have a history of substance abuse or dependence.

Terence M Keane and Meredith Charney

Keane and Kaloupek (1982) treated a Vietnam theater veteran who presented with war-related PTSD, depression, and substance abuse problems. They offered a theoretical model that focused on two-factor learning theory to explain the development and maintenance of PTSD symptoms. Viewing PTSD as consisting of classical conditioning and instrumental avoidance, this model resulted in the use of treatments previously demonstrated as successful in other forms of anxiety disorders such as agoraphobia, panic, and obsessive-compulsive disorder. Implicit in the treatment developed was consideration of the traumatic memories and nightmares as the motivating factors in many of the symptoms of PTSD. Exposure therapy using imagery of the content of nightmares, flashbacks, images, and memories was effective in reducing symptoms of PTSD in a wide range of patient populations (Foa, Keane, & Friedman, 2000).

Esther Deblinger and Melissa K Runyon

While children who have suffered CSA are less likely to engage in physically aggressive behaviors, inappropriate sexualized behavior has been reported in the literature for child victims of all ages (Beitchman et al., 1992) and may be directed toward other children and adults alike. It is notable that a majority of child victims do not develop a longstanding pattern of offending behaviors that persist into adulthood. However, research has provided evidence suggesting that CSA increases one's risk for suffering sexual dysfunctions, substance abuse difficulties, suicidal behaviors as well as revictimization experiences in adulthood (Arata, 2000 Dube et al., 2001). These studies suggest that child abuse not

Nurturant Supportive Affectionate Loving and Warm Parenting

Mental Health, Psychological Adjustment, and Emotional Well-Being Outcomes. Evidence of mental health, psychological adjustment, behavioral, and substance abuse outcomes of maternal warmth or lack thereof have now been documented for over 50 years. For example, when Australian, Chinese, Egyptian, German, Hungarian, Italian, Swedish, and Turkish mothers exhibit little warmth, offspring tend to exhibit significant symptoms of both clinical and non-clinical depression. Moreover, lack of maternal warmth has been related to depression among every major ethnic group in the United States, including Asian Americans, African Americans, Mexican Americans, and European Americans (Rohner & Britner, 2002). Substance Abuse Outcomes. Rohner and Britner (2002) also show that lack of maternal warmth has been linked to substance abuse problems in Australia, Canada, England, The Netherlands, Sweden, Australia, Brazil, China, Curacao, Japan, Singapore, and Venezuela, as well as in most American ethnic...

The Physiological Differences of Addiction

The intense attachment of the addict to his or her drug habit also removes the addict from the narrative of progress and growth that is taken to describe the normal life cycle in standard psychological accounts of human development. Although the term life cycle is conventional in this literature, the process of development described (and prescribed) is in fact a trajectory in which the individual passes through set chronological stages, based on the resolution of particular socio-emotional tasks (Wallen 1993 2). According to Jacqueline Wallen, author of a textbook on developmental psychology for substance abuse professionals, the failure to resolve developmental issues is both a cause and a result of drug problems. She presents a typical case of a couple in their thirties whose history of drug and alcohol use has left them still struggling with the developmental tasks of late adolescence. They have two children but are not providing adequate parenting or a stable home there is...

Medical Clearance For Detoxification

Inquire about past history of hospitalization for delirium tremens, alcohol-related seizures, hepatitis, and pancreatitis screen for severity of alcohol withdrawal signs and symptoms review past medical illness and medications and rule out underlying medical conditions related to substance abuse.

Bringing Power Relations into the Study of Medical Pluralism

Research on this phenomenon has to recognize that, as Stoner (1986, p. 47) asserts, p luralism can now be examined as a multiplicity of healing techniques, rather than of medical systems. Indeed, in its response to the growing popularity of the holistic health movement, biomedical physicians in the United States have increasingly been incorporating various therapeutic techniques, from homeopathy, herbalism, acupuncture, and bodywork, into their regimen of treatment in an effort to create an integrative medicine. Brodwin (1996) asserts that the study of medical pluralism had reached a theoretical impasse because efforts to categorize plural medical systems often produced rigid functionalist typologies or broke down in a welter of incomparable terms. Medical anthropologists turned to concerns such as the political economy of health, biomedical hegemony, alternative medical systems in Western societies, reproduction, the mindful body, the social dynamics of clinical encounters,...

Kelly L Gilrain and Jacqueline D Kloss

On the nature and course of each particular condition, sleep disorders pose a serious personal and public health concern. Individuals with sleep problems may encounter a myriad of adverse nighttime and daytime sequelae ranging from frustration due to difficulty in falling or staying asleep at night, to excessive daytime sleepiness. Impaired concentration, fatigue, irritability, anxiety, depression, substance abuse (caffeine or alcohol), general physical malaise, compromised occupational performance, and interpersonal or marital distress are also among the most commonly reported symptoms. With some conditions, such as untreated narcolepsy or apnea, symptoms may even evolve into safety concerns, such as impaired driving due to the effects of sleep deprivation.

Impact Of Catecholamines On Behavior

Much of the information that is available concerning the functions of catecholamines in regulating human behavior directly results from the use of a group of medications often called psychotropic drugs and antidepressant medications called thymoleptics. Other medications that impact on catecholamines include psychostimulants, such as dextroamphetamine and methylphenidate (commonly known by its trade name, Ritalin) and l-dopa (which has been used to treat Parkinsonism), as well as a medication that was initially used to treat hypertension. Most of these drugs affect more than one system (e.g., dopaminergic, noradrenergic, or serotonergic systems). Catechola-mines have been proposed as mediators of many psychiatric illnesses, including schizophrenia, Tour-ette's syndrome, depression, autism, attention deficit-hyperactivity disorder, stereotypic movements, tremors, and substance abuse. More generically, cate-cholamines also play a critical role in the stress response. Unfortunately,...

Criticisms Of Cbt For Schizophrenia And Directions For Future Research

Results for acute inpatients have been less impressive than for stabilized (chronic) outpatients with residual symptoms (Bach & Hayes, 2002 Lewis et al., 2002). Most trials have not recruited patients randomly. Rather, subjects have generally been selected so as to be appropriate for a verbal psychotherapy. Patients with significant cognitive impairment or with substance abuse problems have not been well-represented in these trials. It is questionable if the more abstract, cognitively demanding CBT techniques can work with highly impaired patients, or with dually diagnosed patients for whom attendance at treatment sessions is often more of a problem. As most trials have been conducted in the United Kingdom, CBT has been superimposed on a backdrop of the socialized care provided to SMI patients in the United Kingdom, rather than the more disjointed approach characteristic of mental health care in the United States. The only U.S. study to date compared a brief (four-session) trial of...

The Nullification of the Supply and Demand Relationship

Of all of the health professionals, behavioral care specialists (including psychiatrists, psychologists, social workers, marriage and family counselors, master's level psychologists, and substance abuse counselors) are in the greatest over-supply. It would be expected, therefore, that demand creation would be a prevalent practice among psychotherapists and others who treat behavioral disorders. Examples abound, but some of the most widely recognized include the following, although most of these have been curtailed in the new health care environment (see Section IV).

Young Adults with Stroke

Particular care should be exercised when evaluating the young adult (ages 15 to 50) with acute stroke. In this group, arterial dissection accounts for 20 percent of all ischemic strokes and may often be preceded by only minor trauma. The young adult with a cardioembolic event may have mitral valve prolapse, rheumatic heart disease, or paradoxical embolism as the originating cause. Migrainous stroke in this age group is a potential, with a female predominance. Air embolism should be considered in patients with a history of recent scuba diving or an invasive medical procedure. Such patients should be placed in a left lateral decubitus position and also placed on 100 oxygen. Emergent recompression in a hyperbaric chamber should be arranged. Finally, this population is at risk for ischemic stroke from substance abuse, with heroin, cocaine, and amphetamines often implicated. Any drug with sympathomimetic effects increases the risk of hemorrhagic stroke.

Ecogenetics Individual Variation in Susceptibility to Environmental and Chemical Agents

Ecogenetics examines how genes and environmental factors interact with each other to affect human health and disease. Genes are sequences of DNA in humans' twenty-three pairs of chromosomes in each nucleated cell. Genes specify the sequence of proteins, which are the main effector molecules of cells, serving as enzymes (catalysts), structural molecules (like collagen), antibodies to fight off infections, and binders of oxygen or xenobiotics (including pharmaceuticals or chemicals in the environment). Environmental factors include social and familial environment, intrauterine environment, cigarette smoking, alcohol, other substance abuse, stress, and exposures to chemical, physical, and biological agents. Some environmental exposures such as ultraviolet light, X rays, and certain industrial chemicals cause damage to DNA (genetic mutations), which alter gene function as well as the structure and function of the protein specified by that gene. Although many such mutations appear to be of...

Very Low Calorie Diets and Meal Planning

His identity was highly connected to being obese. For example, he delivered pizzas and took great pride in consuming multiple pizzas if they could not be delivered. His friends were amazed at his appetite and ability to consume very large quantities of food. He was enrolled in college, but was on the verge of flunking out of school at the time of the referral. He reported eating binges, but they were atypical in that they were not secretive and he did not experience guilt or negative feelings following the binges. He had never seriously attempted dieting to lose weight and he was very sedentary, but in generally good health other than his rather significant obesity. His family was intact, with a mother, father, and older brother, who had experienced problems related to substance abuse.

Total Cerebral Volume

Autism, attention deficit hyperactivity disorder (ADHD), childhood-onset schizophrenia, dyslexia, eating disorders, fetal alcohol syndrome, obsessive-compulsive disorder, Sydenham's chorea, and Tourette's syndrome. It is evident that a normative sample must be carefully screened to rule out these conditions. Likewise, affective disorders and substance abuse have been associated with structural anomalies in adults and should be considered as potential confounds in pediatric samples as well.

Description Of Treatment Processes

Tendencies regarding weight and energy expenditure, obsessionality, perfectionism, and or proneness to anxiety, depression, low self-esteem, and uncertain sense of self. In some patients the co-incident occurrence of substance abuse problems may contribute to the initial appearance of eating disorders. Clinicians have increasingly appreciated the importance of the patient's motivational state for engagement in treatment and recovery. These views in turn have led to the development of psychotherapeutic strategies for eating disorders based on the transtheoretical models and motivational enhancement strategies based on the work of James Prochaska and Carlo DiClemente and, more recently, of William Miller, approaches that have been primarily used with patients suffering from alcoholism and substance abuse. These strategies try to move patients from what often appears to be a precon-templative state (denial, avoidance, minimization) to contemplative states, in which they may at least...

Christine Maguth Nezu and Michelle A Peacock

In 2000 (Rush & Frances, 2000), practical clinical guidelines based on expert consensus and relevant research for treating persons with mental retardation suffering from major mental disorders were developed to assist clinicians in treatment decision making. Applied behavior analysis, managing the environment, and client and family education were the most highly recommended psychosocial treatments for many disorders including autism, attention-deficit hyperactivity disorder, conduct disorder, substance abuse and substance dependence, as well as target symptoms such as self-injurious behavior, aggression, and pica. CBT (e.g., anger management, assertiveness training, conflict resolution) was recommended as a first-line option for major depressive disorder, posttraumatic stress disorder, obsessive-compulsive disorder, and symptoms of anxiety. CBT was also recommended as a second-line option for bipolar disorder (manic phase), schizophrenia and other psychotic disorders, generalized...

Biological Theories Of Depression

Depression can be caused by specific biological conditions, including strokes, nutritional deficiencies, and infections. In these cases, the diagnosis mood disorder due to a general medical condition is given. Depression can also be the result of alcohol or substance abuse, often associated with the symptoms of withdrawal and intoxication. In these cases, the diagnosis substance-induced mood disorder is appropriate. Apart from these two categories, however, the role of biological causes in the development of depression is less definitive. Researchers view the role of biology as contributing one important element to the development of depression.

Recognizing The Violent Patient

The only agreed upon predictors of violence are gender and alcohol abuse. Most perpetrators of violence are males with a history of substance abuse. The amount of education, ethnic background, marital status, or diagnosis are not reliable predictors, but they may be barriers to patient-staff interaction, which in itself may lead to frustration and anxiety for both the staff and patient. In turn, this subconscious conflict may precipitate a violent encounter.

Literature Review Of Cbt For Ptsd

PTSD develops into a chronic disorder when individuals cognitively process the trauma in a manner that leads them to feel constant threat. This feeling of threat exists due to consistent negative appraisal of the traumatic event and to the manner in which the event is encoded and established in the memory. These cognitive distortions prevent individuals from leading productive, normal lives because they are plagued by their past. As well, these aversive cognitions produce maladaptive behaviors such as substance abuse in an attempt to control their emotions. Cognitive restructuring is one type of cognitive therapy used in the treatment of PTSD. It involves recalling the experience and verbalizing what happened and what emotions they felt at the time and subsequently. This sampling of cognitions permits the therapist and the patient to identify faulty cognitions, beliefs, or appraisals. Using Socratic methods, the goal of treatment is to challenge the faulty cognitions that create...

Empirical Basis For

Meta-analytic reviews of randomized studies show more abstinence with family-involved treatment than with individual treatment in drug abuse (Stanton & Shadish, 1997) and in alcoholism (O'Farrell & Fals-Stewart, 2001). Overall the effect size favoring family-involved treatments over individual-based treatments was classified as a medium-size effect. BCT is the family therapy method with the strongest research support for its effectiveness in substance abuse (Epstein & McCrady, 1998). Research shows that BCTpro-duces greater abstinence and better relationship functioning than typical individual-based treatment and reduces social costs, domestic violence, and emotional problems of the couple's children. Details of the following studies are provided elsewhere (O'Farrell & Fals-Stewart, 2000, 2002, 2003).

Temperament And Bipolar Vulnerability

The foregoing findings are consistent with the temperament construct of behavioural disinhibition 81,82 . This temperamental quality, evident in early childhood, is characterized by a tendency to seek out novelty, approach unfamiliar stimuli, and display disinhibition of speech or action. This temperament can often be associated with higher ratings of school behaviour problems, and may be linked with later disruptive behaviour and comorbid mood disorders, especially in high-risk populations such as bipolar offspring. These findings are also consistent with previous data from a study on a nonclinical cohort of high school students, which showed a correlation between decreased flexibility increased distractibility and presence of depression, substance abuse and delinquency 83 .

Physiology and function

Detoxification is one of the major functions of the liver, and important enzyme systems exist to break down substances that are toxic to the body. One of the main systems is the cytochrome p450 system, which aides in oxidative break down of toxic metabolites. Certain medications can induce the cytochrome p450 system, as they are toxic, or inhibit the enzyme system and thereby influence the metabolism of other drugs. This can be very important clinically as patients with histories of substance abuse (i.e., alcohol) will have an induced cytochrome p450 system, which increases the metabolism of pain medications, and some anesthetics affecting their clinical management.

Past and Personal History

History of alcohol consumption, substance abuse and exposure to various toxins should be elicited and documented. Whether consumption of large amount of alcohol, especially adulterated alcohol, is a risk factor for epilepsy is not certain.19 But in a study in Togo,15 attributed epilepsy to alcohol consumption in 8 of the 237 patients studied. The tropical world is the major region for the production and distribution of narcotics. In the developing world psychotropic drug consumption is on the rise. Over indulgence of substance abuse can provoke epileptic seizures.30 Benzene hexachloride, a pesticide used in India, has been associated with seizures.31 Consumption of certain fruits can result in fatal convulsive encephalopathy, this is more often described during famine. In Burkina Faso and other African countries epidemics of fatal convulsive encephalopathy in children have been reported following consumption of unripe ackee fruit (Blighia sapida).32,33 The traditional healers provoke...

Basic Tenets And Philosophy

Relative to other treatment approaches, CBT for children has received strong empirical support. Today CBTs are applied to a wide range of childhood problems and disorders including anxiety and phobic disorders, depressive disorders, aggressive and disruptive behavior problems, substance abuse and eating disorders, as well as pediatric or medical concerns (e.g., coping with painful medical procedures, enuresis, and irritable bowel syndrome). Although reviews clearly highlight the need to develop more and better empirically supported treatments for youth, CBTs for children and adolescents stand out in that they have led the way in doing so. For example, a recent review of the empirically supported treatment literature finds support for CBTs in the treatment of anxiety disorders and phobic disorders, conduct disorder oppositional defiant disorder, chronic pain, depression, distress due to medical procedures, and recurrent abdominal pain (Chambless & Ollendick, 2001). In addition,...

Hanging During Incarceration

Imprisoned suicide victims had made a prior suicide attempt, about two-thirds had made at least one attempt during their imprisonment, and about two-thirds had a history of alcohol and substance abuse (88). Other studies have shown a similar high incidence of drug abuse and suicide attempts (76,83). Lack of access to alcohol and drugs may reduce the ability of the inmate to deal with the stresses of prison life (88). The majority (60 ) of prisoners in a British study killed themselves within the first 3 mo of incarceration (89). Studies have shown that many hanging suicides tended to happen between midnight and 8 00 am, when supervision was reduced (80-82,87). Some suicides occur during the day with the expectation by the victim that imminent resuscitation by staff is possible (89). An inmate may stage a hanging to stimulate apparent unconsciousness. Consequent hospitalization can provide a means of escape (78). The majority of victims are male

Recommended Readings

Anger-control problems are an often-overlooked disorder and they have received limited attention in the treatment literature. An examination of the American Psychiatric Association DSM-IV reveals nine diagnostic categories for Anxiety Disorders and ten diagnostic categories of Depressive Disorders, but only three diagnostic categories for anger-related problems, namely, Intermittent Explosive Disorders, and two Adjustment Disorders with Conduct-Disorder features. The dearth of research on anger is further highlighted by DiGiuseppe and Tafrate (2001) who noted that for every article on anger over the past 15 years, there are ten articles in the area of depression and seven articles in the area of anxiety. The absence of research activity on anger is somewhat surprising given that anger-related behaviors are one of the most common psychiatric symptoms that cut across some 19 different psychiatric conditions. Anger, hostility, and accompanying violence are often comorbid with other...

TABLE 341 Psychological Characteristics of Chronic Pain Patients

Substance abuse is a frequent problem in chronic pain patients. Patients referred to chronic pain clinics meet Diagnostic and Statistical Manual of Mental Disorders, third revised edition (DSM III-R) criteria for active substance abuse disorders in 12 to 24 percent of cases, while 9 percent meet criteria for remission diagnosis. 67 Drug detoxification is often the first step of the therapeutic plan for new patients referred to a pain clinic.

Stroke Risk Factors

The Stroke Belt States Affected

Homocysteinemia, obesity, alcohol intake, and sedentary lifestyle. In addition, there are numerous predisposing factors, or stroke etiologies, including genetically inherited hematologic conditions (e.g., sickle cell disease and protein C deficiency), vascular malformation, connective tissue diseases, vasculitis, substance abuse, trauma with arterial dissection, and patent foramen ovale (Table II).

Timothy J OFarrell and William Fals Stewart

Although alcoholism and drug abuse have been historically viewed as individual problems best treated on an individual basis, there has been a growing recognition over the last three decades that couple and family relationship factors often play a crucial role in the maintenance of substance misuse. The relationship between substance abuse and couple relationship problems is not unidirectional, with one consistently causing the other, but rather each can serve as a precursor to the other, creating a vicious cycle from which couples that include a partner who abuses drugs or alcohol often have difficulty escaping.

Cbt In The Treatment Spectrum

Though one of the most widely researched treatments for numerous Axis II and other Axis I disorders, CBT is not currently the most widely used in the treatment of SUDs, particularly alcohol. Fuller and Hiller-Sturmhofel (1999) reported that the 12-step programs, such as Alcoholics Anonymous, are most commonly used to treat alcoholism, with CBT a distant second, and pharmacological treatments such as disulfiram (Antabuse), acamprosate (Campral), and naltrexone (Revia) an even more distant third. In the field of substance abuse treatment, CBT is more commonly used in relapse prevention, and in academic and VA hospitals (Longabaugh & Morgenstern, 1999).

Types Of Consequences

Contracts are often used with parents and children but can also be used for other clinical populations. For example, a person with substance abuse can contract with co-workers to attend work sober, a person with schizophrenia can contract with a therapist to maintain medication use, and a person with depression can contract with friends to increase attendance at social events. Contracting is also preferable in chaotic situations where increased structure for problem-solving and consequence administration is desired.

Social Cost Outcomes and Benefitto Cost Ratio

Three BCT studies (two in alcoholism and one in drug abuse) have examined social costs for substance abuse-related health care, criminal justice system use for substance-related crimes, and income from illegal sources and public assistance. The average social costs per case decreased substantially in the 1-2 years after as compared to the year before BCT, with cost savings averaging 5000- 6500 per case. Reduced social costs after BCT saved more than 5 times the cost of delivering BCT, producing a benefit-to-cost ratio greater than 5 1. Thus, for every dollar spent in delivering BCT, 5.00 in social costs is saved. In addition,

Personality Differences by Gender

Many psychological problems are gender specific. While boys and men tend to suffer from aggression-related problems, women are more apt to experience depression. Substance abuse and alcoholism are also gender specific. While men form the majority of heavy drinkers and alcoholics, women form the majority of psychiatric drug abusers. While male alcoholics attract public attention because they usually behave noisily and aggressively,

Risk Factors and Characteristics

A comparison of 328 cases by abuse type revealed three distinct profiles (Wolf et al.). Perpetrators of physical psychological abuse were more likely than perpetrators of neglect to have a history of mental illness and alcohol abuse, and to be dependent on the victim for financial resources. The victims were apt to be in poor emotional health but relatively independent in the activities of daily living. In contrast, those cases involving neglect appeared to be very much related to the dependency needs of the victim. Neither psychological problems nor financial dependency was a significant factor in the lives of these perpetrators instead, the victims were a source of stress. Financial abuse represented still another profile. The victims were generally widowed and had few social supports. The perpetrators had financial problems and histories of substance abuse. Rather than interpersonal pathology or victim dependency, the salient factor in explaining these cases was the desire for...

Can Substance Misuse Trigger a Premature Onset of the Prepsychotic Prodromal Stage

In the ABC Schizophrenia Study, the lifetime prevalence of alcohol abuse until age at first admission was 24 for the first-episode sample and 12 for matched controls from the same population 119,136,137 , and that of drug abuse 14 for patients and 7 for controls. Studies on the topic almost invariably show a preponderance of men in substance abuse. We found a cumulative prevalence (until first admission) of any type of substance abuse of 39 for men and 22 for women. Cannabis was the most frequently abused substance (88 ), followed by alcohol (58 ). In this study, 35 of the patients with drug abuse and 18 of those with alcohol abuse started with the abuse behaviour in the same month as the onset of schizophrenia occurred. In this small group, precipitation of illness onset by substance abuse cannot be excluded, especially since these patients were significantly younger (8 years) at illness onset than non-abusing patients. In contrast, we could not support in our study the...

Addiction and dependence

While addiction has been called a victimless crime, nothing could be further from the truth. Research consistently demonstrates that acts of violence against self and others, accidents, decreased productivity, health problems, and a number of other social ills have links to alcohol and drug abuse and addiction. Every day we read about, hear about, or know someone who is a victim of a crime caused by those who use or seek drugs. For some, it is tempting to ignore the ravages of addiction by rationalizing their lack of substance use. However, much like recent findings on secondhand smoke, researchers are identifying other deleterious secondhand effects of substance abuse and dependence. These events include dealing with noise from intoxicated partiers, assault from intoxicated persons, and encountering intoxicated drivers (Wechsler, Lee, Nelson et al.). Few people disagree that substance abuse and dependence are destructive health behaviors, yet there seems to be a vast sea of confusion...

Outcome Research On Cbgt

Group treatment models, CBGT, disease and recovery approach, and a usual treatment comparison group. The CBGT condition consisted of interventions to enhance self-efficacy, provide more realistic and appropriate expectations about the effects of the abused substance on symptoms of personality disorders, increase adaptive coping skills, and enhance relapse prevention capacity. The disease and recovery group approach consisted of interventions to develop an alcoholic or addict identity, acknowledge a loss of control over the substance abuse and the effects of the personality disorder, accept abstinence as a treatment goal, and included participation in support group activities such as AA. Both experimental groups met for three 45-minute weekly sessions for 4 weeks. The usual treatment comparison group did not receive experimental interventions and met three times weekly in an open-ended group format. The analysis revealed that within the outpatient setting, the CBGT was significantly...

Pharmacological Treatment

To date, there is only a single published double-blind randomized controlled trial of lithium in adolescents. This was a prospective placebo-controlled investigation of lithium in adolescents with bipolar disorder and comorbid substance abuse (n 25). In this study, the adolescents' diagnosis of bipolar disorder preceded their substance abuse by several years. After 6 weeks of treatment, subjects treated with lithium showed a statistically significant decrease in positive urine toxicology screens and a significant improvement in GAF (46 in the lithium-treated group versus 8 in the placebo group). This study demonstrated the efficacy of lithium for the treatment of substance use disorders in bipolar adolescents, but did not report on the effect of lithium on the bipolar disorder in these adolescents 89 .

Medical Management of Terrorist Related Injuries

Of patients with urgent and salvageable life-threatening injuries (undertriage) (Frykberg 2004 Kluger 2003 Stein and Hirshberg 1999). In these circumstances, prioritization of treatment regimens is mandatory and definitive therapy should be delayed until the patient is hemodynamically stabilized damage control principles should be applied. However, identifying those critically injured patients who are candidates for damage control maneuvers, which aims to achieve hemostasis and prevent uncontrolled spillage of bowel contents and urine, is undoubtedly a challenge. Throughout the management of the event, coordination between the primary on-scene teams responsible for the primary triage and evacuation is obligatory, followed by similar close interaction between the in-hospital teams conducting the triage, the initial treatment, the surgical interventions and the intensive care, as well as between neighboring hospitals, in order to optimize utilization of the hospitals' personnel and...

The Social Force of Diagnosis

Historical perspective can increase our awareness that medical practitioners and researchers have tended to discover what already was assumed. More recent political uses of disease concepts (e.g., in psychiatry) have been closely connected with repressive goals and political agendas of certain governments. Social employment of disease definitions is often meant to be benevolent, however, such as advocating a view of alcoholism and drug addiction as diseases so as to recruit the forces of medicine to aid in their control. Moreover, such conditions may be termed diseases in order to relieve alcoholics and drug addicts of the social opprobria that attend what is often viewed as immoral behavior.

Family Interaction Environment and Psychopathology

Distinguish families with a BN daughter from families of healthy controls and families with restricting AN daughters 59 . Kendler et al. 11 reported low levels of paternal care as well as parental substance abuse and parental depression associated with definite and probable cases of BN. In another analysis, Kendler et al. 53 reported that familial-environmental influences substantially influenced the liability to BN. Fairburn et al. 51 recorded low parental contact, more negative comments from family members about appearance, eating habits and weight, and parental arguments in comparison to psychiatric controls. Rates of parental alcoholism, depression and drug abuse were also increased. A significant problem with Fairburn et al.'s risk factor studies in eating disorders 24,51 is that all information concerning the families, including the psychiatric diagnoses, was obtained from the patients and not derived from independent interviews of family members.

Is Addiction a Real Disease

In addition to genetics, addiction as a disease is supported by the common signs and symptoms among the homeless and physician drug addicts. The target for drugs of abuse is the brain and changes in the neuroanatomy of the brain occur in all addicts and underlie the disease of addiction. Recent research in neuroscience has identified a specific area of the brain described as the reward center. This area of the brain makes essential survival behaviors such as eating, drinking

Dialectical Behavior Therapy

Borderline personality disorder A psychiatric disorder characterized primarily by intense negative emotions (including depression, anger, self-loathing, and despair), disturbed interpersonal relationships, and self-damaging impulsive behaviors such as substance abuse and para-suicide. Marsha Linehan and her research team at the University of Washington developed DBT during the 1980s as a treatment for the chronically suicidal patient who had a pattern of both suicide attempts and or nonsuicidal self-injurious behaviors (i.e., parasuicidal behavior). DBT was soon extended to treat individuals meeting criteria for borderline personality disorder (BPD), a disorder often characterized by parasuicidal behaviors. DBT has since been standardized in Linehan's 1993 treatment manuals, and evaluated in randomized clinical trials. The data (to be reviewed later in this article) suggest that it is more effective than usual psychother-apies offered in the community for treating women with BPD with...

Future Directions

The best estimates available at this writing suggest that in 1998 the combined cost to the U.S. economy of alcohol and drug abuse totals more than 325 billion. This includes the costs of substance abuse treatment and prevention, as well as lost job productivity, unemployment, crime, and social welfare costs. This represents an increase of nearly 50 from the total in 1992 (Harwood, 2000 Office of National Drug Control Policy, 2001). Given this trend, it is clear that SUD treatment will become even more important, making it imperative to identify critical factors in treatment and in patients. See also Addictive behavior nonsubstance abuse, Couples therapy substance abuse, Motivational interviewing, Relapse prevention

Empirical Support

The complications that did occur were serious, however, and included exacerbation of vegetative depressive symptoms, increased suicidal ideation, relapse of alcoholism, and precipitation of panic disorder. It is likely that comorbidity with other Axis I disorders increases the risk of negative outcome of flooding. Therefore, flooding may not be the treatment of choice if, in addition to anxiety symptoms, the client is diagnosed with Major Depressive Disorder or Substance Abuse Dependence. There are no known studies that have demonstrated an increased risk of physical problems due to flooding. However, it is possible that intense exposure to anxiety-inducing stimuli may aggravate medical conditions such as high blood pressure and asthma. Therefore, clinicians should require clients with physical ailments or on medications to obtain medical clearance prior to implementing flooding techniques.

Empirical Evidence

Since that time, two additional randomized clinical trials have been reported comparing DBT to TAU. Linehan and her colleagues adapted standard DBT for substance abusers diagnosed with BPD and again found superior outcomes for one-year DBT as compared to one-year TAU. Furthermore, a research group independent of Linehan and colleagues found that six months of DBT produced better patient outcomes than six months of TAU in treating women with BPD. In sum, the research evidence to date suggests that across studies, DBT reduces severe dysfunctional behaviors that are targeted for intervention (e.g., parasui-cide, substance abuse, and binge eating), enhances treatment retention, and reduces psychiatric hospital- ization. The data also suggest that, although DBT was developed for the treatment of patients with suicidal behavior, it can be adapted to treat BPD patients with comorbid substance abuse disorder and to other patient populations and settings.

Changing Role of Emergency Department Physicians

In light of the enormous impact of alcohol and other drug abuse on society and individuals, it is no longer sufficient to treat only the emergency condition and the medical complications of substance abuse without providing proper screening, brief counseling, and referral to further treatment when appropriate. Connecticut State Law 472 mandates universal screening in the health care setting and requires documentation of training in intervention for all personnel working in health care institutions and clinical settings licensed by that state. In the current managed-care environment where hospitals and physicians are competing intensely for market share and beginning to share economic risks with payers of health care, the desire to contain costs has given impetus to efforts to provide a more consistent approach to the needs of the patient with substance abuse. There is a growing recognition of the importance of a public health approach and the need for early identification,...

Michael J Lambert and David A Vermeersch

In addition to finding that the road to recovery is relatively short for many patients, researchers have discovered that improvement tends to be lasting. There is no evidence to suggest that psychotherapy will permanently safeguard a person from psychological disturbance, but many patients who undergo therapy achieve healthy adjustment for an extended period of time. Many studies, including meta-analytic reviews, have shown that the effects of psychotherapy are relatively lasting. However, there is some evidence to suggest that maintenance of treatment effects is worse in cases of substance abuse disorders, eating disorders, recurrent depression, and personality disorders. Research has also shown that the maintenance of treatment effects

TABLE 2802 Behavioral Characteristics that Suqqest Various Clusters of Personality Disorders

Management of the antisocial patient in the emergency department is often frustrating, but anger toward the patient can be minimized and the interaction hastened along by setting firm limits on behavior, focusing on the chief complaint, and providing the patient with necessary information about the medical problem at hand. No effective psychiatric intervention can be forced on the patient, although certain patients may benefit from substance abuse treatment, psychotherapy, or organized

Future Directions In Primary Care Therapy

As a primary care therapy, cognitive-behavioral approaches have much to offer patients. Examples of the application of cognitive-behavioral principles abound and include, but are not limited to, the following promoting weight reduction, smoking cessation, increasing exercise, decreasing substance abuse, controlling sodium intake, promoting adherence to medical regimens, coping with chronic illness, preparing patients for stressful medical procedures, and enhancing self-care behaviors. As the field of cognitive-behavioral therapy and primary care continue to interface, the development and application of more effective treatments is likely to continue to grow.

Neuropsychology Defined

Functioning can be seen in a number of varied settings with respect to physical and organizational aspects. Impaired functioning may be relatively obvious in terms of a stroke victim or relatively subtle in terms of a child with attention deficit disorder syndrome. The range of settings in which disordered brain functioning may cause behavioral disturbances can encompass a private practice setting, an educational setting, an industrial or occupational setting, a substance abuse treatment facility, a rehabilitation setting a neurology or psychiatry ward in a major teaching hospital or in a community hospital. In all of these settings, or impaired brain functioning may cause disturbances that are responsible for specific problems in terms of adapting to the behavioral demands of the setting. The sorts of problems that the biological insult causes may be related to cognitive skills, sensory-perceptual abilities, motor skills, or emotional personality functioning. This may have...

Differences in Personality

Females express more fear, are more susceptible to anxiety, are more lacking in task confidence, seek more help and reassurance, maintain greater proximity to friends, score higher on social desirability, and at the younger ages at which compliance has been studied, are more compliant with adults (Block, 1976, p. 307). There is much evidence showing that women have stronger guilt feelings, and are more intropunitive than men (Wright, 1971). It has been stated that women experience higher rates of childhood abuse, especially sexual abuse, which is a predictor of later depression, and may have depressions related to hormonal changes and to sex-role conditioning that encourages patterns of negative thinking and passivity (McGrath, Keita, Strickland, & Russo, 1990). In the United States, it has been estimated that between 2.3 and 3.2 of men, and between 4.5 and 9.3 of women, meet the diagnostic criteria for major depressive disorder at any given moment (Depression Guideline Panel, 1993)....

Duration Of Untreated Illness And Untreated Psychosis As Indicators Of An Unfavourable Further Illness Course

The results on the association between DUP or DUI and medium- or long-term outcome are less clear-cut. McGorry et al. 16 , in their investigation of 200 patients (about 50 with schizophrenia), demonstrated a positive association between DUP and positive and negative symptoms, global functioning and quality of life 12 months after first assessment. Johnstone et al. 42 , Larsen et al. 51 and McGorry et al. 16 observed an increased frequency and severity of relapses. Helgason 52 found a higher risk of relapse and a longer duration of hospitalization and less compliance. A greater burden on the family and a higher expressed emotions level have also been reported 53,54 . Other effects observed are a less supportive social network 51 , higher risk of depression and suicide 55-58 , more stress in work- and education-related situations 59,60 and more substance abuse and delinquent behaviour 61 . In sum, almost all the characteristics that make up an unfavourable course of schizophrenia have...

Pathology and Risk Factors

Risk factors for PID within a sexually active population include multiple sexual partners, history of other STDs, substance abuse, and frequent vaginal douching. Younger age is associated with increased risk, possibly because of a larger zone of cervical ectopy in young women, increased cervical mucosal permeability, lower prevalence of protective chlamydial antibodies, risk-taking behavior, or a combination of these factors. 4 Barrier contraception is associated with lower risk of PID. IUD use is associated with a 2 to 9 fold increased risk for PID, with the highest risk in the first four months after insertion. 56 Oral contraceptive pills (OCPs) increase the risk of endocervical infection, probably by increasing the zone of cervical ectopy. However, OCPs decrease the risk of symptomatic PID, possibly by increasing the viscosity of cervical mucus, decreasing menstrual blood flow (and hence decreasing retrograde menstruation), or modifying local immune responses. 7 Bilateral tubal...

Emergency Department Presentations

In addition to being a direct cause of traumatic injury, domestic violence also contributes to other conditions frequently seen in emergency departments, such as depression, anxiety, hyperventilation, substance abuse, suicide attempts, sexually transmitted diseases (including HIV), complications of pregnancy, and headaches and other chronic pain syndromes.18 Both batterers and their victims may abuse alcohol and drugs. Abused individuals with chronic medical conditions may present with exacerbations of their illnesses because the batterer withholds their medications or because they are not allowed to keep appointments with their office-based physician. A history of exposure to violence in the home during childhood has recently been associated with an increase in health risks and health-risk behaviors in adults (such as depression, substance abuse, and high-risk sexual behaviors).19 It should be considered, therefore, a contributing factor to many conditions commonly treated in...

The Practice Of Cbt For Older Adults With Depression And Personality Disorders

It is imperative to evaluate cognitive status, comorbid physical and mental health problems, medication adherence, substance use and abuse, risk of suicide, social support, mobility, and self-care (e.g., grooming, shopping, cooking, medication management). Each of these areas can dramatically impact treatment outcomes and how treatment is implemented. During the assessment process it is important to bear in mind that some dementias, anxiety disorders, Parkinson's disease, and substance abuse problems may resemble depressive disorders. It is also important to consider how age of onset and course of disorders may impact treatment.

Spectrum Of Child Abuse And Neglect

The concept of child maltreatment, defined as harm to a child because of abnormal child-rearing practices, is a broadening of the initial description of the battered child syndrome. Child maltreatment is an all-inclusive term covering physical abuse sexual abuse emotional abuse parental substance abuse physical, nutritional, and emotional neglect supervisional neglect and Munchausen syndrome by proxy.1

Dimensions of Costs

There have been many studies of the cost-effectiveness for specific disorders or illnesses. A few selected topics are addressed here. These are anxiety disorders, affective disorders, physical illnesses, borderline personality disorder, substance abuse, schizophrenia, and general considerations.

Panic Disorder And Agoraphobia

Panic disorder is characterized by unexpected panic attacks. These may be followed by panic attacks in response to particular stimuli, and by agoraphobia. Panic disorder with or without agoraphobia is a prevalent and disabling disorder. Panic-depression is a particularly common comorbidity, and contributes to the potentially negative impact of panic disorder 28 . Alcohol and substance abuse and dependence are also frequent comorbidities in panic and other anxiety disorders.

The Ethics and Goals of Advertising

Though many physicians have shown reluctance (or an aversion) to advertising their services, healthcare institutions have readily accepted the imperative to advertise in an attempt to create markets, capture market share, and find niches in the marketplace. Notable in this regard is advertising directed at target populations, for example, women, cancer patients, and those needing psychiatric and substance abuse services.

Substance Induced Disorders

As a general rule, the diagnosis of intoxication can be rather easy when laboratory analysis reveals the type and amount of intoxicant circulating in the system. The clinical features of alcohol intoxication are familiar to experienced emergency physicians and range from impaired judgment and coordination through ataxia, lethargy, and coma. When repeated episodes of intoxication occur in a brief period of time, the individual by definition has a substance abuse disorder, and the additional diagnosis is made.

Robert Ostroff

Adjunctive therapy Two or more therapies used in an integrative fashion to treat an individual with mental illness. conjoint therapy Therapy consisting of two distinct treatment models (1) The treatment of two or more related individuals in the same setting, for example, couples treated in a group therapy or family therapy groups and (2) treatment used interchangeably with adjunctive therapy. In this chapter, the second meaning always applies. integrative treatment Treatment that attempts to theoretically reconcile different therapeutic approaches into a single therapeutic approach, for example, psychodynamic and behavioral. May also be used interchangeably with ad-junctive therapy. psychopharmacotherapy The use of medication to treat mental illness. This therapy is performed primarily by a psychiatrist but may also be practiced by primary care physicians, physician assistants, and advanced nurse practitioners. sociotherapy The consideration of the patient's entire social milieu as an...

Models of Addiction

Cell biology and neurochemistry studies in humans and model systems have identified many molecules that have altered abundance and distribution, enzymes with altered activity, and genes with altered expression resulting from substance abuse. In particular, the dopamine and serotonin neurotransmitter systems have been the focus of intense studies. These are brain systems directly involved in many basic responses, including pleasure and reward systems.

What Is Tolerance

Interestingly, the emphasis on drug reward in the addiction process paves the way for other conditions, such as eating disorders and even sexual or gambling disorders, to be considered addictions. Eating disorders, in particular, share common behavioral symptoms, biological reward pathways, high relapse rates, and treatment strategies with other forms of substance abuse. More research is necessary to establish

Summary

While studies have confirmed an encouraging decline in the number of illicit drug users, substance abuse continues to be a national problem. National Household Survey suggests that over 14 million Americans are users of illicit drugs (National Household Survey, 2000). Estimates of the presence of drugs like cocaine and opiates in trauma victims has increased several hundredfold from less than two decades before. Ecstasy use among adolescents jumped almost 25 percent between 1999 and 2000. In 2001, 5.2 percent of 8th graders, 8.0 percent of 10th graders, and 11.7 percent of high school seniors had used Ecstasy in their lifetimes (NIDA Infofax). Increased use has resulted in a dramatic increase in emergency room visits. According to data from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network, Ecstasy-related hospital emergency room incidents increased from 253 in 1994 to over 4,500 in 2000. The number of MDMA related deaths has also been...

Aims of Treatment

Prevention of future harm is an important aim. Long-term outcomes will be compromised if the young person experiences persistent negative symptoms, persistent positive symptoms, suicidal impulses or substance abuse. It has been suggested that the experience of psychosis is itself ''toxic'' to the brain 34 , although this hypothesis has been challenged 35 . Psychological consequences of psychosis include a loss of self-esteem and confidence, developmental stagnation, and secondary disorders such as depression and post-traumatic stress disorder. Social costs of psychosis include disruption of family networks, peer networks, sexual relationships, Prevent or treat negative symptoms and coexisting problems such as depression, mania, anxiety or panic attacks and substance abuse.

Comorbidity

Individuals with BED endorse high rates of psychiatric symptoms and disorders. For example, when compared to equally overweight individuals without binge eating problems, individuals with BED report significantly higher lifetime rates of major depressive disorder, substance abuse or dependence, and anxiety disorders. Some studies have shown that patients with BED report levels of eating disorder symptomatology, such as eating, shape, and weight concerns, that are comparable to those of normal weight patients with BN. Individuals with BED also have considerably higher rates of personality disorders than overweight individuals without an eating disorder. Thus, among individuals with BED, psychiatric symptomatology appears to be related to the binge eating rather than to the degree of obesity.

Treatment Methods

The purpose of BCT is to build support for abstinence and to improve relationship functioning among married or cohabiting individuals seeking help for alcoholism or drug abuse. The BCT intervention for substance abuse is founded on two fundamental assumptions. First, family members, specifically spouses or other intimate partners, can reward abstinence. Second, reduction of relationship distress and conflict reduces a very significant set of powerful antecedents to substance use and relapse, thereby leading to improved substance use outcomes. See O'Farrell (1993) for more details.

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