PubMed · 14064284
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C ILIC. 1963. [TOXIC DEAFNESS].. https://pubmed.ncbi.nlm.nih.gov/14064284/
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Since 1 January 2004, the German Act for the Modernisation of Health Insurance (GMG) has regulated collection of a so-called practice fee-a charge to patients for their first outpatient health care in any given quarter. We report the case of a slightly inebriated patient who, against his will, was taken to a psychiatric outpatient department by local authorities, where he had to pay the quarterly charge of 10 EUR. Considering that he was forced and therefore had to pay the fee against his will, the present regulation is being discussed with respect to legal and moral implications in psychiatric emergency cases.
Repeated exposure to drugs of abuse results in an increased sensitivity to their behavioral effects, a phenomena referred to as behavioral sensitization. It has been suggested that the same neuroadaptations underlying behavioral sensitization contribute to the maintenance and reinstatement of addiction. Dysregulation of dopamine (DA) neurotransmission in the mesoaccumbens system is one neuroadaptation that is thought to lead to the compulsive drug-seeking that characterizes addiction. Evidence that sensitization to psychostimulants and opiates is associated with an enhancement of drug-evoked DA levels in the nucleus accumbens has also been obtained. Like other drugs of abuse, the acute administration of ethanol (ETOH) stimulates DA release in this brain region. Moreover, repeated ETOH experience results in an enhanced behavioral response to a subsequent ethanol challenge. Data regarding the influence of repeated ethanol intoxication and withdrawal upon mesoaccumbal DA neurotransmission is limited. Studies examining ETOH-evoked alterations in mesoaccumbal DA neurotransmission as a function of withdrawal duration are lacking. The present experiments quantified basal and ethanol-evoked DA levels 14 days and 24 h following the cessation of a repeated ETOH intoxication protocol, which results in sensitization to the locomotor activating effects of ethanol. Locomotor activity was assessed in parallel groups of animals. Studies were conducted in two mouse strains, C57BL/6J and DBA/2J, which differ in their behavioral responses to ETOH. The results indicate the development of transient tolerance to both ETOH-induced behavioral activation and evoked accumbens DA release at early withdrawal. Moreover, no enhanced DA response to a subsequent ETOH challenge could be demonstrated in ETOH experienced animals 2 weeks after withdrawal, in spite of the observation of clear behavioral sensitization at this time point. These results suggest that, at least in the case of ethanol, sensitization of the DA mesolimbic system may not be necessary for the development of behavioral sensitization.
Management of changes in physiologic and mental status due to alcohol is a core skill utilized in the psychiatric emergency service. Blood alcohol concentrations are commonly approximated by measuring breath alcohol at triage. However, the blood-breath ratio is highly variable, and breath tests have produced lower readings than blood tests. The authors assessed the accuracy of breath alcohol readings at triage in a medical emergency department compared with subsequent serum alcohol levels taken in the psychiatric emergency service. The mean breath ethanol concentration was significantly lower than the mean corrected serum ethanol concentration (.15+/-.05 grams per 210 liters and .23+/-.05 grams per 100 milliliters, respectively). The relative accuracy of breath alcohol tests decreased with increasing serum alcohol. Although its low false-positive rate makes the breath test acceptable for legal purposes, the blood alcohol level is more appropriate for clinical use in emergency settings, because breath tests can underestimate the degree of toxicity.