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We relate two cases of amineptine (Survector) overconsumption by patients cured for atypical depression with asthenia and activities deficit as the prevalent symptoms. Prescription of two tablets a day (0,200 g) was respected in one case during six months, and in the other case during two years, with therapeutic benefit on apragmatism. To no obvious reason, within few months both patients had gradually raised the doses to twenty tablets (2 g) and thirty tablets (3 g) respectively: we observed subexcitation, insomnia, sensorial hyperaesthesia, irritability, tachyphemia with dysarthria, anorexia with weight lost of more than 10 kg and amphetamine-like troubles without confusion or delusion, as a result of which both patients were treated for their addiction, in hospital. Treatment with clorazepate perfusions did not cause any physical dependence problems. However, psychological dependence was strong enough for one of the patients to go out, on the third day, against medical decision. As far as we know, in France, only one such case of addiction use at high doses and in single intakes is mentioned in the existing literature. However, our observations suggest that it might be necessary to re-assess the place of amineptine among new antidepressive molecules with psychostimulant abilities.
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PMID:[2 cases of amineptine dependence]. 614 28

The authors have investigated reasons for medication compliance in a population of epileptic patients. The hypothesis that the health care belief model would be predictive of medication-taking behavior was validated. A pilot study was constructed which investigated the comparative responses of compliant and noncompliant epileptic outpatients to questions regarding demographic, clinical history, and attitudinal characteristics. Noncompliant patients were characterized as having a longer duration of epilepsy, more complicated dosage regimens, and more changes in medication. In addition, noncompliant patients both demonstrated more confusion over medication directions and less insight into the need for anticonvulsants and feared addiction to their medication. They had a lower level of satisfaction with their health care and were more frequently subject to the social complications of epilepsy. The authors suggest that a more holistic approach be taken when attempting to reverse noncompliant behavior.
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PMID:Determinants of compliance in epileptic outpatients. 724 32

Confusion exists among physicians over the legal requirements and appropriate prescribing of narcotics to addicted or habitual users of narcotics. The result has often been either (1) the deprivation of appropriate treatment for patients who desire detoxification or adequate pain relief, or (2) illegal prescribing by physicians. Because most narcotics are potent and dangerous substances, certain legal restrictions are necessary to protect the general public. State-approved programs have been established to prescribe methadone and propoxyphene napsylate for addiction treatment. Current laws and regulations in California permit every practicing physician to provide effective and safe treatment for addiction and pain relief.
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PMID:Prescribing narcotics to habitual and addicted narcotic users. Medical and legal guidelines in California and some other Western states. 746 11

Substance use disorders and the anxiety disorders, the two most prevalent mental disorders in the United States, are often comorbid, undiagnosed, and poorly treated. Confusion and controversy over comorbidity can complicate the treatment of both disorders. The author reviews the connections between addiction and anxiety and offers four practical guidelines for clinicians dealing with this comorbidity.
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PMID:Anxiety and addiction: a clinical perspective on comorbidity. 779 72

Fear of addiction to opioid analgesics affects their use in the treatment of pain by physicians, nurses, and the lay public. Imprecise terminology and regulations has led to confusion between the image of the street addict and the patient with pain. Commonly cited definitions are presented, and a comparison of the street addict and the patient with pain is offered. Similarities and differences in terms of increasing medication requirements, tolerance, withdrawal, intoxication, and lifestyle are described. The nurse's unique position and role in influencing the continuing distinction of these terms and the subsequent treatment of the patient with pain based on this distinction are discussed.
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PMID:Street addicts and patients with pain: similarities and differences. 790 60

This article addresses some of the key issues in developing culturally relevant approaches to drug abuse treatment and recovery, using the HAFC/Glide African-American Extended Family Program as a positive example of effective cultural adaptability within recovery. Cultural points of resistance to the recovery process are also addressed, including the perception that 12-Step fellowships are exclusive and confused with religion, confusion over surrender versus powerlessness, and concerns about low self-esteem, dysfunctional family structure, communication difficulties, and institutionalized and internalized racism. The authors also focus on professional resistance in other countries, where different treatment approaches and philosophies block the acceptance of a recovery concept in general and the 12-Step process in particular. In explicating these issues, addiction is presented as a multicultural problem in need of multicultural solutions. The challenge is to adapt the process of recovery to all cultures and races, to counter stereotypes on all sides, and to eliminate the perception that recovery only works for addicts from the White mainstream.
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PMID:Cultural points of resistance to the 12-Step recovery process. 848 54

A group of Turkish drug-addicted out-patients (n = 34) is compared to a group of Swiss opiate-addicted outpatients (n = 145) with respect to age, sex, social status, the number of offspring, the age of initiation of drug addiction and the type of the drug used. The results revealed that the Turkish population showed a better prognostic profile when the age of initiation of drug addiction, the familial integration and multiple addiction are taken into account, 97.1% of the Turkish opiate-addicted patients belonged to the second-generation immigrant population. In this group, the median age at immigration to Switzerland was 14.2 +/- 2.1 (excluding the three patients born in Switzerland). The conflict between the group-oriented expectations of their families and the individual-oriented life style of the peer group is the main reason for social role confusion, identity disturbances, for feelings of guilt because of separation or for shame because of dependence from the family. Confusion in social roles as well as in the interpretation of identification and the development and integration of identity permitting the coexistence of both cultures are the main topics of psychotherapy of drug-addicted Turkish immigrants.
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PMID:[Opiate dependence in immigrant from Turkey]. 876 22

Pharmacological/physiological models and social process/cognitive models of addiction are compared. These are discussed both in terms of the types of data produced and the philosophies of knowledge that underlie the two approaches. It is suggested that the notion of addiction confounds these two sets of issues, especially with respect to the notions of volition and compulsion. The problem is highlighted by data that reveal verbal reports to be variable and context dependent. It is concluded that a better understanding of the nature of addiction requires a clearer distinction between the pharmacological/physiological approach and the social process/cognitive approach. Both approaches contribute usefully to knowledge and have predictive value. Confusion arises, however, where workers fail to see not merely the benefits, but also the limitations, of these two approaches to the addiction problem.
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PMID:Pharmacology versus social process: competing or complementary views on the nature of addiction? 988 97

Researchers interested in investigating the possible therapeutic effects and the mechanisms of action of nicotine in neuropsychiatric disorders face a social-scientific-ethical dilemma. This dilemma comprises three components: (1) the known addictive potential of nicotine makes careful evaluation of the therapeutic potential of this compound socially unattractive; (2) the potential misuse of scientifically determined data by the tobacco 'lobby' creates ethical concerns; and (3) the possible confusion between the differential effects of nicotine in human smokers versus non-smokers creates difficulties in study designs in voluntary human subjects. Therefore, it is imperative that, at the onset of this review, the authors stress that they do not advocate cigarette-smoking as a route of nicotine intake under any circumstances on the basis that controlled dosing of nicotine may be of potential benefit in some neuropsychiatric disorders. In this article, we review the psychopharmacology of nicotine and its effects in a variety of neuropsychiatric disorders including schizophrenia, depression, anxiety and Tourette's syndrome. Possible mechanisms of action of nicotine directly or indirectly via its interaction with other neurotransmitter systems (i.e. serotonin, dopamine and noradrenaline) in relation to its potential role in these disorders are discussed. It is postulated that new drugs may need to be developed that selectively interact with nicotinic receptors without addiction potential.
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PMID:Smoking, nicotine and psychiatric disorders: evidence for therapeutic role, controversies and implications for future research. 1034 Feb 89

This paper reviews and describes the natural processes through which the people of a Third World country, Bangladesh, have been trying to provide treatment to drug misusers. As the demand for medical help increases, different organizations develop to cater to the needs. Bangladesh has followed the age-old ashram model and the contemporary medical hospital model to provide services to its addicts. In reality the drug misuse treatment providers are still evolving through different learning stages about the biopsychosocial manifestations of addiction. According to the authors, the stages of learning can be divided into three phases: 1) the early period of confusion and enthusiasm, 2) the period of truism, and 3) the period of pragmatism. The people who have gained experience in running treatment centers in the last decade need to form alliances to share their experiences in order to develop rational models for drug treatment programs in Bangladesh. It is also important that they develop methods to monitor providers' activities and to protect clients' safety and interests.
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PMID:A natural response to drug misuse problems: a review of drug-user treatment services of Bangladesh. 1049 11


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