Long-acting stimulants for the treatment of attention-deficit disorder in cocaine-dependent adults.
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Adult↗
Biomedical subjects
R Castaneda
Publications and source records attributed to R Castaneda.
A review of the effects of moderate alcohol intake on psychiatric and sleep disorders.
In this chapter we discuss the effects of moderate ethanol consumption on the treatment of psychiatric and sleep disorders. A review of the literature on the interactions of ethanol with neurotransmitters and psychotropic medications suggests that although ethanol affects the clinical course of psychiatric and sleep disorders by different mechanisms, it does so principally through perturbations it causes in the balance of central nervous system neurotransmitter systems, which may modify the clinical course of primary psychiatric and sleep disorders and undermine the therapeutic response to psychotropic medications. Neurotransmitter responses may also be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. In addition, ethanol also modifies the clearance and disposition of a variety of psychotropic metabolites and interferes with their clinical effectiveness. We recommend that most psychiatric patients, and all patients with sleep disorders, should abstain from even moderate ethanol use, as this may adversely affect their clinical course and response to treatment.
Alcohol Drinking↗
Psychoactive substance use in forensic psychiatry.
OBJECTIVE: The purpose of this article is to discuss the interface between judicial discipline and behavioral science in the context of substance-related disorders. METHOD: We review the epidemiology of psychoactive drug use and crime and discuss the courts' decisions on relevant landmark cases, particularly as they influence the practice of psychiatry. RESULTS: (1) The phenomenology of addiction and crime is of great epidemiological import. (2) Our legal system inclines toward the view that the use of alcohol or other substances involves an element of choice and therefore would not amount to a legal insanity defense if the substance abuser commits a crime while intoxicated. (3) A state can confine an addict or alcoholic for compulsory treatment if that individual presents a danger to self or others. (4) The law has found that alcoholism and drug abuse are both "willful misconduct" and a disabling condition; the former definition contains the end in view of punitive action. The latter is aimed toward treatment and rehabilitation. (5) The law gives the right to the employer to test a suspected employee for drug abuse. The addicted or alcoholic employee has the choice to either go for treatment or face job termination. (6) Our judicial system gives serious consideration to the welfare of a child whose parents are alcoholic or drug addicted. CONCLUSION: The two disciplines of psychiatry and law follow their own modes in resolving issues in alcoholism and other substance abuse. We need research and new approaches to build a bridge between the two.
Antisocial Personality Disorder↗
A review of the effects of moderate alcohol intake on the treatment of anxiety and mood disorders.
BACKGROUND: There is no published review to help the clinician clarify the potential role of moderate ethanol consumption in patients being treated for anxiety and mood disorders. Product labels and textbook chapters routinely warn the individual against the consumption of ethanol when using prescription psychotropic drugs. A general understanding is that the reason for this recommendation is the potential for adverse synergistic effects or sedation and decreased psychomotor performance. What is overlooked by this emphasis on safety is the effect of alcohol use both on the underlying psychiatric disorder being treated and on the effectiveness of drug therapy. METHOD: We review the available literature on the interactions of ethanol with neurotransmitters and psychotropic medications and explore the clinical consequences of these interactions. RESULTS: Ethanol might affect anxiety and mood disorders by different mechanisms. Principal among these are the effects of ethanol on multiple neurotransmitter systems, which adapt in different ways to the acute and/or chronic presence of ethanol. Perturbations in the balance of CNS neurotransmitter systems may modify the acute clinical course of primary mood disorders and undermine the therapeutic response to psychotropic medications. Ethanol also modifies the clearance and disposition of psychotropic metabolites and interferes with their clinical effectiveness. Neurotransmitter responses may additionally be manifested clinically by rebound phenomena, akin to a subsyndromal withdrawal, which affect sleep and precipitate anxiety and mood symptoms. Recent alcohol use also may alter the subjective interpretation of the patient's "internal milieu," causing confusion and eliciting reactive psychopathology. CONCLUSION: While much research remains to be done, there is abundant evidence that patients with mood and anxiety disorders should abstain from even moderate ethanol use, as this adversely affects their clinical course and response to treatment.
Alcohol Drinking↗
Age at onset of alcoholism as a predictor of homelessness and drinking severity.
The relationships between drinking history, housing history, several clinical variables and treatment retention after detoxification were evaluated in 109 inner-city alcoholics. Compared to men with a fixed abode, homeless subjects (N = 50) reported a history of alcoholism of early onset and increased severity. No differences in aftercare retention were found between homeless and non-homeless subjects.
Adult↗
Treatment compliance after detoxification among highly disadvantaged alcoholics.
An outcome study was carried out on a series of 109 highly disadvantaged alcoholics discharged from the detoxification unit of a large municipal hospital in New York City. We examined the impact of a variety of clinical and demographic factors on retention in the initial phases of outpatient and inpatient treatment following discharge. Both high school completion and a history of at least 6 months of employment in the two years preceding admission correlated with frequency of registration for continued aftercare. Measurements of cognitive flexibility correlated with frequency of aftercare completion. An association strongly approaching significance was also found between length of hospital stay and aftercare completion. Some suggestions are made as to the assessment and aftercare planning for highly disadvantaged alcoholics.
Adult↗
Crack cocaine use and sexual behavior among psychiatric inpatients.
Rises in both crack cocaine use and incidence of sexually transmitted diseases have been recently reported. In this study, we investigated the relationship between crack cocaine abuse and sexual behavior in 50 psychiatric inpatients. The relationship between crack use and sexual behavior is a very complicated one, influenced by many variables such as the dose of crack used, the user's preexisting sexuality, gender, and psychiatric illness. Results indicated that while most of the subjects developed sexual disinterest and dysfunction with prolonged crack cocaine use, some of them became more sexually promiscuous and consequently contracted more sexually transmitted diseases. The implications of these findings regarding transmission of HIV among crack cocaine users are discussed.
Adult↗
Effect of drugs of abuse on psychiatric symptoms among hospitalized schizophrenics.
In a group of 71 inpatient schizophrenics with no other concurrent psychiatric diagnosis except for dependence on one drug, we ascertained the subjective effect their drug of abuse had on their psychiatric symptoms 2 weeks prior to hospitalization. Psychiatric symptoms were assessed by means of the Hopkins Symptom Checklist (Revised) (SCL-90R). Cocaine addicts, but not alcoholics, reported aggravation more often than improvement of symptoms. Alcoholics reported alcohol-induced symptom improvement with a similar frequency as alcohol-induced symptom aggravation.
Adult↗
Plasma MHPG and age in detoxified alcoholics.
Plasma levels of 3 methoxy, 4-hydroxy phenylethyl glycol (MHPG) of detoxified alcoholics were found to be positively correlated with age as previously found with normal subjects. The slope of the regression line of plasma MHPG and age of the alcoholics in remission was significantly steeper than that of normal controls, indicating a faster age-related increase of MHPG in alcoholics.
Adult↗
Cocaine/"crack" dependence among psychiatric inpatients.
The authors studied 40 cocaine-dependent subjects admitted to psychiatric inpatient wards of a metropolitan hospital because of general psychiatric symptoms. The results indicate that the predominant form of cocaine administration (88%) was freebasing "crack." DSM-III-R cluster B personality disorders (N = 17) and schizophrenia (N = 13) constituted the diagnoses for 75% of the sample. Compared to the schizophrenic patients in this cohort, the patients with cluster B personality disorders used cocaine in greater quantities and more frequently and began abuse of the drug at an earlier age. The escalation in urban areas of psychiatric hospitalizations attributed to use of crack may be largely related to psychiatric symptoms in cocaine-dependent patients with personality disorders as well as cocaine-induced psychopathology in schizophrenic patients.
Adolescent↗
Low basal levels of cortisol distinguish detoxified alcoholics with major depressive disorder from non-MDDs.
Basal plasma levels of cortisol and its suppression by dexamethasone were measured in 60 inpatient alcoholics 12-13 days after detoxification. Both hypothalamic-pituitary adrenal system parameters were essentially within normal limits in most patients--those who did not meet criteria for major depressive disorder (n = 43) as well as those who met criteria for MDD per their episode (n-17). Basal levels of cortisol below 7 micrograms/dl distinguished alcoholics without MDD from those who met criteria for MDD per current episodes.
Adult↗
Alcohol withdrawal: a review of clinical management.
The authors review recent developments in the management of alcohol withdrawal, including its clinical components, available treatment strategies, and some recent neurochemical and endocrine research in the area.
Adrenergic beta-Antagonists↗
Ethnic differences in drinking practices and cognitive impairment among detoxifying alcoholics.
The purpose of the present study was to determine whether ethnic differences existed among detoxifying alcoholic inpatients regarding drinking practices, psychosocial variables and cognitive impairment. Patients of Puerto Rican extraction (Hispanics) were found to be more often afflicted than Whites and Blacks by cognitive impairment, daily drinking, heaviest average amount drunk, unemployment and lack of residence. Whites were less affected by these variables than the other two ethnic groups. Amount and frequency of drinking predicted the occurrence of cognitive impairment to a degree that approached significance. Cognitive impairment was defined as inability to score less than 5 points in the Blessed Orientation-Memory-Concentration test. In a follow-up study, nearly all CT scans obtained on a similar group of 20 detoxifying alcoholics (mean age 40), who had cognitive impairment as defined in the first study, were found to demonstrate brain atrophy. Contrasting drinking practices rather than ethnicity may have accounted for the different rates of cognitive impairment observed among the three ethnic groups.
Adult↗
Substance abuse among general psychiatric patients: place of presentation, diagnosis, and treatment.
This paper reviews the literature on patients presenting for general psychiatric treatment who are also substance abusers. Place of presentation, diagnosis, and treatment are considered. A considerable portion of patients seen in emergency rooms, as much as half in some settings, are substance abusers, and over a third of general psychiatry admissions have been found to have their presenting problems materially influenced or precipitated by substance abuse. Substance abuse is also frequently found among psychiatric inpatients. Diagnostically, the differentiation of general psychiatric and addictive syndromes can be difficult: primary and secondary affective disorder from consequences of long-term substance abuse; and self-medication patterns from primary general psychiatric syndromes. Treatment studies are often focused on concomitant psychotherapeutic management for patient being treated for addiction. Often, emphasis is placed on pharmacotherapy for enhancing outcome in the dually diagnosed. Qualitatively, new options tailored to this population still remain to be studied, however, as do the changes necessary in the treatment system to assure proper long-term management.
Alcoholism↗
Institutional self-help therapy for alcoholism: clinical outcome.
Self-help peer-led therapy can yield improved cost effectiveness and clinical outcome in hospital-based alcoholism treatment. This was demonstrated by comparing two ambulatory alcoholism treatment programs: a control program operated solely by professional staff, and an experimental one based on peer-led self-help (SH). The SH program was staffed by only half as many primary therapists as the control. Patients in both programs were evaluated over the course of one year. By means of the Patient Status Form, a clinical assessment instrument applied monthly, SH patients were found to score significantly higher on social adjustment, although retention and drinking rates, and utilization of Alcoholics Anonymous and disulfiram were no different from controls. This study is the continuation of an initial comparison in which SH patients were found to have enhanced retention in treatment after discharge from an impatient service.
Adult↗
Epidemiology of borderline personality disorder.
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Borderline Personality Disorder↗
Sex and ethnic distribution of borderline personality disorder in an inpatient sample.
Among 1,583 psychiatric inpatients, fewer men than women were diagnosed as having borderline personality disorders among whites and blacks but not among Hispanics. No significant differences in the prevalence of borderline personality disorder were found among whites, blacks, and Hispanics.
Adult↗
Self-destructive behavior in the substance abuser.
This article considers some of the psychophysiologic mechanisms that underlie the driven, apparently self-destructive behavior of addicted persons. The authors review the available literature on the association between suicidal behavior and substance abuse. These issues are discussed in the context of the epidemiology and phenomenology of self-destructive behavior.
Adolescent↗