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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bulimia, a disorder of episodic binging and purging, remains without a known etiology. A case report is presented of a patient who attributed bulimic episodes to efforts at inducing euphoria. Experimental pain tolerance was increased by bulimic vomiting, blocked by naloxone, but not by saline. Vomiting was also associated with falls in depression and anxiety. Plasma ACTH and cortisol, putative markers for beta-endorphin, also rose following vomiting. It is hypothesized that in some bulimics, the disorder arises by virtue of an addiction to one's own internally released endogenous opioid peptides.
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PMID:Bulimic vomiting alters pain tolerance and mood. 303 Sep 47

A review on indications, target points and results of stereotactic operations for treatment of psychiatric diseases is given, based on personal experiences and reports in the literature. As a conclusion the author suggests that the anatomical target should be chosen selectively. There is strong evidence that different approaches lead to different results. Cingulotomy is effective for chronic pain with addiction and depression, anterior capsulotomy for obsessive-compulsive and anxiety neurosis, innominotomy for chronic and recurrent depression, and postero-medial hypothalamotomy for restless, aggressive and destructive behaviour. Therefore, the target should be selected according to the individual symptoms of the patient. The results of operation are usually good and most patients can return to a normal life. The side-effects are infrequent and seldom serious. Modern psychosurgery does not modify the personality of the patient. On the contrary it often relieves it from disturbing symptoms of illness.
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PMID:Psychosurgery today. 306 32

Alcohol and drug addiction are defined in behavioral terms as the preoccupation with, compulsive use of, and relapse to drugs that are descriptive and confirmatory. The basis of addiction may involve neurochemical changes in the brain that distort and redirect the drive states (instincts). Tolerance and dependence may only be incidentally associated with addiction as a result of a nonspecific adaptation by the body to the presence of a drug. The cellular adaptation may be the same in all organs. Addiction to alcohol and drugs may have no specific relationship to tolerance and dependence. Addiction occurs in the absence of observable tolerance and dependence to alcohol and drugs. Alcohol and drug addiction is probably more complex than tolerance and dependence. Addiction is difficult to study because of the variability of behavioral phenomena and the underlying intricacies of the neurosubstrates. Tolerance and dependence are still useful as they are indicators of drug use. It is a misconception that long term chronic use is necessary for tolerance and dependence to develop. Some studies have shown that tolerance can develop within hours and days to a single dose of alcohol or other drugs. Anxiety, depression and insomnia can occur after a single dose of ethanol in humans. These symptoms of withdrawal from the alcohol or drug constitute dependence. Redefining the criteria for addiction tolerance and dependence to alcohol and other drugs may be in order. A neurochemical model may provide a more definitive and uniform basis for considering addiction, tolerance, and dependence to alcohol and drugs.
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PMID:The relationship of addiction, tolerance, and dependence to alcohol and drugs: a neurochemical approach. 332 55

Male admissions to six methadone maintenance programs in three cities were interviewed. The characteristics of these patients in the seven Addiction Severity Index (ASI) scales--medical, employment/support, alcohol, drug, legal, family/social and psychiatric--were described. The characterization of drug addicts was not found to be unidimensional. Though the admissions, as a group, had some positive characteristics (e.g., over 50% reported full time employment over the past three years), they also reported severe problems. For the 30 days prior to interview, heroin was the most commonly used drug, followed by cannabis, cocaine, and alcohol. Less than 10% had never been arrested and subjects reported engaging in crime on 6.4 of the past 30 days. The majority of these subjects had never married, but very few lived alone. The most common psychiatric symptoms reported were depression and anxiety. Characteristics were compared between programs and differences were found in race and age as well as two of the seven ASI areas. Thus, despite differences in demographics there was a great commonality in terms of the characteristics of admissions to these programs. The implications of this for the behavioral problems related to drug abuse and for the development of treatments aimed at specific areas (such as measured by the ASI) were discussed.
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PMID:Admissions to methadone maintenance: comparisons between programs and implications for treatment. 343 83

In a placebo-controlled, double-blind study we evaluated the ability of a single 50 mg oral dose of nalmefene to block the effects of intravenous opioid challenge (2 micrograms/kg fentanyl). Fentanyl-induced respiratory depression (CO2 responsiveness), analgesia (tourniquet ischemia), and subjective effects were totally blocked for 48 hours and showed only minimal breakthrough 72 hours after nalmefene. Plasma concentration-time data for nalmefene indicate good oral bioavailability and a prolonged terminal elimination phase (mean t1/2 11.1 hours). These findings suggest that nalmefene could provide prolonged effectiveness in limiting emergence of opioid effects during addiction therapy.
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PMID:Prolonged blockade of opioid effect with oral nalmefene. 353 70

Adolescent sexual abuse is an overwhelming issue for society and the medical community. Adolescent medicine has only begun to emerge in the mainstream of medical practice. Sexual medicine, adolescent chemical dependency, and abusive medicine are emerging subspecialties of mainstream medicine, with victimization syndromes just beginning to be explored. Adolescent sexual abuse, sexual addiction disorders, family incest, eating disorders, depression, and suicide in adolescents all need to be viewed from epidemiologically regarding family and community orientation. I refer to physician and troubled adolescent relations as the quadruple passivity syndrome. The ego-centered, troubled adolescent denies he or she has problems but no desire for treatment; the physician denies that the adolescent has health problems and has no desire to evaluate them. Physicians need to take an aggressive role in identifying, treating, and preventing the victimization process in children, adolescents, adults, spouses, families, and geriatric patients. Physicians need to be trained to identify these patients and to develop treatment protocols. The victimization syndrome needs more research, publication, and surveillance by all medical associations, but primarily by family physicians and pediatricians. In conclusion this clinical discussion describes four main points: Sexually abused adolescents can be successfully treated by a multidisciplinary advocacy team. A community multidisciplinary team can work in a unified approach for the good of the community by putting an end to future generations of victimized adolescents and families. The medical community has the greatest challenge in training, educating, and becoming more aware about adolescent sexual abuse. The community must provide support for victims of sexual abuse.
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PMID:Adolescent sexual abuse: clinical discussion of a community treatment response. 360 60

With the increasing use of cocaine in the United States, there has been growing concern regarding its effects on the fetuses and neonates of pregnant cocaine abusers. Fifty-two cocaine-using women enrolled in a comprehensive perinatal addiction program were evaluated and compared with 73 women who had used narcotics in the past and were maintained on methadone during pregnancy. The groups were similar in maternal age, socioeconomic status, number of pregnancies and cigarette, marijuana and alcohol use. The cocaine-using women had a significantly higher rate of premature labor, precipitous labor, abruptio placentae, fetal monitor abnormality and fetal meconium staining than the women in the methadone group. Neonatal gestational age, birth weight, length and head circumference were not affected by cocaine use compared to methadone use. However, the Brazelton Neonatal Behavioral Assessment Scale revealed that infants exposed to cocaine had significant depression of organizational response to environmental stimuli (state organization) when compared to methadone-exposed infants. In another aspect of the study, an increased rate of SIDS (15%) was found for 66 cocaine-exposed infants as compared to a 4% rate of SIDS in 50 methadone-exposed infants.
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PMID:Cocaine use in pregnancy: perinatal morbidity and mortality. 368 46

On the basis of a clinico-psychopathological examination of 158 patients with chronic alcoholism in the period of abstinence the author has specified 4 types of affective disturbances: astheno-vegetative sub-depression, dysphoric sub-depression, melancholic sub-depression and dissociated sub-depression. The phenomenology of these disorders is described. The present a series of disorders with an increasingly complicated structure, which make up the internal picture of alcoholic addiction and, to a certain degree, determine it.
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PMID:[Affective disorders in alcoholic patients during periods of abstinence]. 375 30

Few studies have been published about analgesic management practices during sickle cell pain crisis. Therefore, we reviewed the records of all hospitalized children with this complication during a recent five-year period. The 38 patients (98 painful episodes) who received intravenous narcotic therapy were the subjects of this review. In 76 patients, an initial intravenous bolus injection of morphine sulfate or meperidine hydrochloride was followed by a continuous intravenous infusion of one of these two drugs. To achieve adequate pain control, adjustments in infusion rates were made according to a written protocol. In 22 other patients, subsequent narcotic treatment consisted only of intermittent intravenous bolus injections of meperidine. Satisfactory pain relief was achieved in all 98 episodes. Patients given continuous infusions required more narcotic to control their pain and had more side effects than those treated with bolus injections alone, suggesting a dose-response relationship between narcotic dose and several known side effects. Common side effects included nausea and vomiting, lethargy, and abdominal distention. Although clinically evident respiratory depression was quite uncommon, chest syndrome was a frequent complication, and severe respiratory distress occurred in three patients. Narcotic withdrawal or addiction was not observed. With careful monitoring (including special attention directed to avoiding dosing error), continuous intravenous narcotic infusions are safe and provide effective pain relief for severe sickle cell pain crisis.
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PMID:Intravenous narcotic therapy for children with severe sickle cell pain crisis. 377 42

Presented here is a model for the diagnosis and treatment of cocaine dependence. Intrinsic in the understanding of this model is the use of the disease concept of chemical dependence. Within the construct of this model we regard cocaine dependence or "cocainism" as a disease process and part of the spectrum of the disease of chemical dependence. We note that "pure" cocainism is rare and cocaine is usually just another chemical used in the polyaddicted patient. We call cocaine the "Great Precipitator" as it often brings the polyaddicted chemically-dependent person into a crisis that requires a treatment intervention. Cocainism, with its overwhelming compulsion and destruction, often precipitates a crisis in a matter of months from first use. As psychiatrists practicing addictionology, we understand the need to deal with cocainism as a primary disease process rather than a symptom of an underlying psychiatric illness. We deal with cocainism as we deal with alcoholism. While the DSM-III requires withdrawal and tolerance changes to be an essential feature for dependence, we more easily identify the disease of cocainism by its production of intense psychological addiction. Thereby the diagnosis of the disease of cocainism, as with other drugs (including alcohol) in the spectrum of chemical dependence, is characterized by the persistent, uncontrolled, compulsive use of cocaine. This illogical, irrational compulsion with continued, repeated use of cocaine as it destroys the individual's life, is the primary symptom of this disease. In regards to specific considerations, the psychiatric complications of cocainism, which can include cocaine induced psychosis, can persist beyond the intoxication period. We also note the depression that can accompany abstinence from cocaine and often has a protracted course following initial abstinence as well. We advocate the very cautious use of any psychotropic medications after an alloted period of time since we find that many of these additional symptoms seem to dissipate during the treatment process when involved in our suggested setting. In the cases of where it is determined that additional psychiatric illness co-exist with cocaine and chemical dependence such as in "dual diagnosis" patients, we have had that success by treating both illnesses concomitantly and aggressively. The "contract" with the dual diagnosis patient has afforded excellent results in this instance. The treatment modalities most effective in this model include a treatment team with its multidisciplinary and recovering and non-recovering characteristics, and the use of the group process and peer group therapy.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cocainism--a workable model for recovery. 387 Jul 54


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