Faculty Bibliography

The purpose of this study was to implement an empirical assessment of the clinical response to standard alcohol detoxification during withdrawal from both alcohol and cocaine. One hundred forty-nine males consecutively admitted in acute alcohol withdrawal to a hospital-based detoxification unit were studied. All subjects completed a 4-day chlordiazepoxide detoxification. Patients who used drugs other than cocaine were excluded. Fifty-five subjects withdrawing only from alcohol and 94 subjects withdrawing from both alcohol and cocaine, as evidenced by positive urinalysis and history, were studied. Both groups reported similar amounts of daily alcohol intake and had a similar age of onset of alcohol dependence. Parental alcoholism was equally frequent in both groups. Statistically, several variables were directly related to severity of alcohol withdrawal, including associated cocaine abuse, age, abnormal laboratory values, and duration of homelessness. As measured by the Alcohol Withdrawal Scale (AWS), alcohol withdrawal was less severe among cocaine users, not only at intake but throughout the 4-day detoxification. Singly addicted alcoholics were older and had longer drinking histories, more prior detoxifications, and more abnormal laboratory values than cocaine users. A multiple regression analysis demonstrated a significant relationship between cocaine and severity of alcohol withdrawal. Cocaine users more frequently requested reductions in chlordiazepoxide dosages than singly addicted alcoholics, complaining of dysphoria, sedation, and weakness. The severity of alcohol withdrawal was associated with recent cocaine use, age, laboratory abnormalities, and duration of homelessness. Concurrent cocaine withdrawal in the sample was associated with reduced severity of alcohol withdrawal. Possible neurobiological mechanisms, as well as study limitations affecting interpretation of the findings, are discussed. Tailored detoxification as opposed to standard detoxification regimens may be more appropriate for the clinical management of combined alcohol-cocaine withdrawal

How can physicians make appropriate treatment decisions in substance abusers who have serious medical illness, especially when patients may not offer the information needed? Drs Westreich and Rosenthal summarize common physical findings that suggest abuse of specific substances. Recognizing these signs allows physicians to reliably diagnose chemical use, leads to improve outcomes, and lends weight to recommendations for substance-abuse therapy

Preview How can physicians make appropriate treatment decisions in substance abusers who have serious medical illness, especially when patients may not offer the information needed? Drs Westreich and Rosenthal summarize common physical findings that suggest abuse of specific substances. Recognizing these signs allows physicians to reliably diagnose chemical use, leads to improved outcomes, and lends weight to recommendations for substance-abuse therapy.

We wished to ascertain whether the addition of an informational video to the informed consent procedure for electroconvulsive therapy (ECT) results in improved patient knowledge about ECT. Eighteen ECT patients were randomized to consent using the usual written document or using the written document and an informational video. The two groups were similar when compared on demographic variables and scores on the Brief Psychiatric Rating Scale (BPRS) and Mini-Mental State Examination (MMSE). Each subject, just after signing the informed consent document, was administered an 8-question ECT knowledge questionnaire. The addition of an informational video to the consent process for ECT did not result in improved knowledge about ECT. Poor knowledge about ECT might be accounted for by unsuccessful communication from the doctors or cognitive impairment and apathy on the part of the patients. One benefit of the video was increased interest from family members in ECT and the consent process

Management of a delirious or acutely psychotic patient calls for rapid but well-considered decision making by the treating physician. Clear diagnostic thinking is vitally important in making a presumptive diagnosis and forming a treatment plan. Appropriate treatment usually returns patients to a less agitated state and allows for definitive treatment of any underlying illness