ABSTRACT
This study examined cases for possible mental health issues based on a study of 43 deaths in custody that had been supervised by the PCA between 1998 and 2002 involving the use of drugs. In 18 of the 43 cases, there was evidence of one of three groups of mental health symptoms--in five cases, there was evidence of psychosis, in five of previous self-harm or suicidal attempts, and in a further eight, there were indications of anxiety or depression. This constitutes a total of 42% of the cases studied. Those with mental health factors were more likely to have swallowed the drugs used, were more likely to have used prescription drugs and were more likely to have been believed to be faking their symptoms by the officers involved in these cases. While it is recognised that mental health problems are widespread in the criminal justice system, the diversity of conditions and the marked overlap with the use of alcohol and illicit drugs has not been sufficiently recognised, either in the training of officers or in the procedures for intervention in the custody suite.
Subject(s)
Mental Disorders/epidemiology , Police , Prisoners , Substance-Related Disorders/mortality , Adolescent , Adult , Aged , Cause of Death , Diagnosis, Dual (Psychiatry) , Female , Forensic Psychiatry , Humans , Male , Middle Aged , Poisoning/diagnosis , United Kingdom/epidemiologyABSTRACT
Lofexidine is an alpha-adrenoceptor agonist which has proved useful in opiate withdrawal and which, through its attenuation of noradrenergic activity, might be a valuable adjunct in the management of alcohol withdrawal. The objective of this study was to compare the clinical effectiveness and patient retention with adjunctive lofexidine versus placebo in the treatment of alcohol withdrawal under chlordiazepoxide cover. This was done in a prospective double-blind randomized placebo-controlled trial with 72 alcohol-dependent adults referred and admitted for in-patient alcohol detoxification. The adjunctive lofexidine group experienced significantly more severe withdrawal symptoms, greater hypotensive problems, more adverse effects, and no better rates of retention in treatment. Lofexidine provides no discernible benefit as an adjunctive medication (to chlordiazepoxide) in alcohol detoxification and, on the basis of our study, appears to be contra-indicated.
Subject(s)
Alcoholism/drug therapy , Anti-Anxiety Agents/therapeutic use , Chlordiazepoxide/therapeutic use , Clonidine/therapeutic use , Narcotic Antagonists/therapeutic use , Substance Withdrawal Syndrome/drug therapy , Chi-Square Distribution , Clonidine/analogs & derivatives , Double-Blind Method , Drug Therapy, Combination , Humans , Hypotension/chemically induced , Placebos , Prospective Studies , Severity of Illness IndexABSTRACT
Recent reports of the use of lemon juice in the preparation of heroin for injection have failed to recognize the importance of the different forms of heroin (in the form of the salt or the base) and the impact of this on the chemical manipulation required before injection. One hundred and four opiate addicts in London were interviewed about the forms of heroin (white, brown, etc) and their relationship to cook-up techniques (use of heat and acid). White heroin was typically prepared with water and heat; brown heroin was prepared with acid (citric acid or Vitamin C (ascorbic acid) or lemon juice) and heat; pharmaceutical heroin was prepared with water only (i.e. neither acid nor heat). On the last occasion of heroin use, brown heroin had been the form most commonly used, with over 90% of the sample using citric acid or vitamin C. Lemon juice was rarely used, and heat was almost universally applied in conjunction with lemon juice.
Subject(s)
Ascorbic Acid/pharmacology , Drug Compounding/adverse effects , Heroin Dependence/psychology , Heroin/pharmacology , Adult , Citrus , Female , Humans , London , MaleABSTRACT
The problem of dropout rates in outpatient relapse prevention groups for "problem" drinkers is addressed. To test the hypothesis that the dropout rates were due to anxiety and lack of clarity among the participants about the purpose and expectations of the group, a structured induction was developed. The results obtained show that the induction made a significant difference in reducing the dropout rate. These findings can also be applied to other outpatient groups.
Subject(s)
Alcoholism/prevention & control , Ambulatory Care , Interview, Psychological , Patient Dropouts , Adult , Alcoholism/rehabilitation , Female , Humans , Male , RecurrenceABSTRACT
Treating a fellow GP is difficult enough, but when a colleague may have an alcohol problem your attitudes to that and your duty to the patients and profession may complicate matters. Furthermore, the mode of treatment that you choose may affect your colleague's professional standing.
Subject(s)
Alcoholism/diagnosis , Physicians, Family/psychology , Substance Abuse Detection/methods , Alcoholism/psychology , Alcoholism/therapy , Depressive Disorder/diagnosis , Depressive Disorder/etiology , Depressive Disorder/psychology , Diagnosis, Differential , Humans , Male , Middle Aged , Psychoses, Alcoholic/diagnosis , Psychoses, Alcoholic/psychology , Psychoses, Alcoholic/therapy , Surveys and QuestionnairesABSTRACT
Twenty-eight patients admitted to hospital for alcohol withdrawal were treated with lofexidine, an alpha adrenergic agonist of the imidazole type, in an open trial. Twenty-three patients completed the regime. Symptoms were measured on a scale developed for the study: the Alcohol Withdrawal Rating Scale (AWRS). Scores on this scale fell steeply over three days, more slowly over the subsequent four--the period of the trial. Results are compatible with the hypothesis that alcohol withdrawal states are characterised by increased adrenergic activity.
