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 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prescribing practices for patients with cancer pain among populations of doctors in the United Kingdom have been assessed by means of a postal questionnaire. The results indicate that amongst the sample of doctors completing the questionnaire the basic principles of pain control in cancer appear to be understood. Regular oral morphine or diamorphine are most often chosen with the dose being determined mainly by the severity of pain with no arbitrary upper limit. Fears of addiction and respiratory depression, and a relatively long prognosis no longer appear to be major deterrents to the use of strong opioid analgesics. These data indicate considerable shifts in opinion in the doctors responding to the questionnaire and these results and their implications for current and future teaching about the management of cancer pain are discussed.
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PMID:Analgesics in cancer pain: current practice and beliefs. 199 5

Physicians are well aware of the health benefits of exercise, but probably less cognizant of the many psychologic benefits of regular exercise. In recent years more attention has been paid to the psychologic effects of exercise, and much evidence can be found in the literature to support these beneficial effects. Psychologic states such as anxiety, distress, depression, and coronary-prone behavior have been found to be reduced by regular aerobic exercise. Exercise has also been shown to elevate mood, increase intellectual functioning, and improve self-concept. In encouraging their patients to exercise, physicians can more effectively motivate them by following certain psychologic principles, thereby ensuring greater compliance and adherence to the exercise program. Doing an objective fitness assessment establishes a baseline and creates a stimulus for awareness for the patient. The resulting exercise prescription will more likely be followed if the physician helps the patient establish realistic goals, and understand the minimums of exercise that can still lead to improvement, the exercise physiology behind the prescription, and the physical and psychologic gains to be made from exercise. It can also be extremely helpful if the physician individualizes the program to make it convenient and fun, provides supervision and ample positive reinforcement, and teaches by example, that is, not only be a proponent of exercise, but a participant. In spite of the many benefits of exercise, there are certain psychologic liabilities as a result of excessive exercise. Negative states such as exercise addiction, overtraining, and burnout can be attributed to excess exercise, but they are also often a result or symptom of other psychologic problems. By being aware and knowledgeable, the physician can intervene in this system to help the individual confront the real problems and maintain his or her participation in the sport or exercise program.
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PMID:Psychologic aspects of exercise. 201 42

Designer drugs, chemically altered compounds derived from federally controlled substances, have become a major cause of addiction and overdose deaths. These drugs include mescaline analogs, synthetic opioids, arylhexylamines, methaqualone derivatives and crack, a new form of cocaine. Sudden changes in mood, weight loss, depression, disturbed sleep patterns, deteriorating school or work performance, marital problems, and loss of interest in friends and social activities may be signs of drug addiction. Life-threatening complications of acute intoxication, such as hyperthermia, seizures, combative and psychotic behavior, and cardiorespiratory collapse, require prompt diagnosis and supportive intervention.
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PMID:Substance abuse: the designer drugs. 202 Nov 4

Short-term psychiatric hospitalization, developed during the past 2 decades, needs thorough evaluation with regard to its advantages. It is important to be able to identify those patients who might be aided by such treatment. Therefore the psychiatric emergency room physician should have at hand a model which would enable quick and relatively accurate decisions in identifying such patients. Our work shows that they are either without previous psychiatric history or had been admitted for less than 2 months; that they had suffered from depression, anxiety, personality disorder or addiction; that they had a substantial support system; and that when they had been treated, there had been good compliance with prescribed medication. On the other hand, those who probably would not benefit from short-term psychiatric hospitalization had a history of psychiatric hospitalization of usually more than 2 months; were diagnosed as suffering from schizophrenia or affective disorder; lacked substantial family support; and had poor compliance with medication. This data may aid the physician during the initial interview in the psychiatric emergency room in deciding on further treatment. We also found that psychiatric emergency room diagnoses are usually reliable; and that those whose only diagnosis was "for observation" had a fair chance of a successful result after short-term hospitalization (discharge directly from the emergency room unit). We therefore presume that a sharper characterization of patients referred to the psychiatric emergency room may aid in tailoring the most suitable treatment for any particular patient, thus reserving short-term hospitalization only for those who would benefit the most.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Short-term psychiatric hospitalization in an emergency room unit]. 203 38

In this paper we discuss recent experimental and clinical findings which lead us to propose that prolonged rhythmic exercise can activate central opioid systems by triggering increased discharge from mechanosensitive afferent nerve fibers (Group III or A-delta) arising from contracting skeletal muscle. We review evidence that supports the concept that many of the cardiovascular, analgesic, and behavioral effects of exercise are mediated by this mechanism and that the same or similar mechanisms are responsible for the central and peripheral effects of acupuncture. Based on this hypothesis, and supporting evidence from human and animal studies, we suggest a mechanism and a potential therapeutic role for exercise in the treatment of selected patients with disorders as diverse as hypertension, addiction, depression, and anorexia nervosa.
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PMID:Endorphins and exercise: physiological mechanisms and clinical implications. 220 77

The authors report a case of tranylcypromine addiction and review the literature on the subject. Since the drug was first marketed in 1960, a total of 18 cases have been described. Predisposing risk factors and potential mechanisms for addiction are discussed. Given the current trend toward using tranylcypromine more frequently and in higher therapeutic doses for refractory depression, a greater index of suspicion for self-medication with this drug is warranted.
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PMID:Tranylcypromine addiction: a case report and review. 221 41

We examined factors associated with participation in an HMO-based, self-help smoking cessation trial by comparing participants with nonparticipating smokers who responded to a prior health survey. Recruitment to the trial was accomplished through the HMO's monthly magazine sent to all enrollee households, and the health survey involved a random sample of the enrollee population. Participants were more likely to be female, older, better educated, and heavier smokers with more attempts to quit in the past. Participants consistently reported poorer levels of health status (self-perceived health and energy, life satisfaction, depression, and symptoms), less healthy lifestyles (exercise and dietary fat), and a greater conviction that smoking cessation would improve how they feel than nonparticipants. These findings confirm previous suggestions that formal cessation programs attract those with a more extensive history of addiction, prior failure, and pathophysiologic effects and may provide clues to increasing motivation among smokers with a greater likelihood of treatment success.
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PMID:Participation in a smoking cessation program: a population-based perspective. 226 54

Follow-up interviews on a sample of 298 ex-heroin addicts 12 years after they entered treatment were used to examine alcohol use and substitution of alcohol for heroin. Almost one-fourth of the sample were classified as heavy drinkers in Year 12, and half had previously used alcohol in a substitution pattern. Classifications into one of three substitution groups (none, low and high) and multivariate analysis of variance were carried out to identify background and baseline factors related to substitution and long-term behavioral outcomes 12 years after entering treatment. Substitution was found to be related to higher levels of alcohol problems and treatment before addiction, parental alcohol problems, to vulnerability to peer influence in starting drug use and to feelings of rejection by peers during adolescence. In terms of 12-year outcomes, substitution was related to more use of nonopioid drugs, more heavy drinking and alcohol-related problems and more psychological dysfunction symptoms (such as depression). These results showed a strong relationship between substitution and preaddiction as well as postaddiction alcohol abuse. However, to delineate the effects of substitution apart from the effects of previous alcohol abuse, additional analyses were computed in which substitution was examined after controlling for previous alcohol abuse. The results confirmed the validity of substitution as a powerful construct in identifying behavioral differences before and after addition.
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PMID:Alcohol use by heroin addicts 12 years after drug abuse treatment. 234 63

Pain is a complex somato psychic experience that requires a multimodality approach to treatment. Pharmacologically, pain in cancer can be divided into opioid non-responsive, opioid partially responsive, opioid responsive (but do not use opioids) and opioid responsive (do use opioids). Three concepts govern the use of analgesics in opioid responsive pains: 'by the mouth', 'by the clock' and 'by the ladder'. Adjuvant drugs may also be necessary. Morphine is the strong opioid of choice for cancer pain. In patients unable to take oral medication, morphine can be administered by suppository, by injection or peridurally. Useful alternative strong opioids include phenazocine, hydromorphone and buprenorphine. A number of controversial issues are discussed. These include the oral to parenteral potency ratio of morphine; the main site of metabolism of morphine; the relative merits of morphine and diamorphine; the risk of respiratory depression; the development of tolerance; and the risk of addiction.
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PMID:Opioid analgesics in cancer pain: current practice and controversies. 245 42

The rapidly rising number of HIV-infected intravenous drug users in Buenos Aires has produced unprecedented difficulties in the physician-patient relationship and a need for greater involvement on the part of mental health specialists. At present, 35% of these drug users are HIV-positive. When hospitalized for various medical complications of the virus, drug users often manifest acting out behaviors, denial of their addiction, and other psychopathic personality traits. They are likely to be noncompliant with treatment regimens and demanding of special treatment from hospital staff. In many cases, physicians seek to protect themselves from involvement with these difficult, highly anxious patients by making a referral to a psychiatrist. Although such a referral is usually appropriate, physicians should seek to work through the crisis in the physician-patient relationship and address psychosocial as well as medical issues. Failure on the part of the physician to navigate the initial disorganizing crisis and symbiotic stages can produce serious depression in the patient, a sense of abandonment, and a worsening of the medical condition.
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PMID:AIDS and drug abuse: some aspects of psychiatric consultation. 251 87


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