Investigating the management of alcohol-related presentations in an Australian teaching hospital.

INTRODUCTION AND AIMS: Alcohol-related morbidity is estimated to range from 10-38% of the presentations to hospital emergency departments. This study aims to investigate the actual management process for alcohol-related presentations in a teaching hospital in Australia. DESIGN AND METHODS: Retrospective audit was conducted on the electronic medical records of 210 presentations with a primary or secondary diagnosis of 'alcohol use disorder' at discharge between November 2016 and February 2017. Six key management steps were investigated: identification of alcohol use disorder, documentation, thiamine, alcohol withdrawal assessment, benzodiazepine for alcohol withdrawal and referral to the drug and alcohol consultation liaison service. RESULTS: Of all the 210 presentations, 77.1% (162) were identified with alcohol use disorder in the initial assessments; 64.3% (135) were documented with alcohol use history, 49.5% (104) were prescribed with thiamine, 48.1% (101) were assessed with the alcohol withdrawal scale, 41% (86) were prescribed with benzodiazepine for alcohol withdrawal and only 38.6% (81) were referred to the drug and alcohol consultation liaison service. Only 8.6% (18) of the initial presentations were directly related to alcohol. These presentations had a higher completion rate in each of the six steps than those (91.4%, 192) not directly related to alcohol. Only 6.2% (13) were formally screened for alcohol use. DISCUSSION AND CONCLUSIONS: The findings suggest a need to improve the alcohol management practice in the hospital. Routine use of an alcohol screening tool can enable early identification of the alcohol use disorder and to improve the management of this problem in the hospital.

Quantitative EEG analysis in dexamphetamine-responsive adults with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (AD/HD) is recognized as a disorder affecting children and adolescents and has more recently been documented to continue into adulthood in a proportion of patients. One of the common treatments for AD/HD is the use of stimulant medications. Numerous studies have examined the therapeutic effects of stimulant medications in children, adolescents and adults with the disorder, reporting improvements in attention, concentration, and hyperactive and impulsive behaviours. Several studies have also examined the effects of stimulants on the electroencephalograph (EEG) of children and adolescents with the disorder, but to date, there have been no studies examining the effects of stimulant medication on the EEG of adults with AD/HD. In the present study, we aimed to replicate previous EEG findings in adults with AD/HD relative to controls and to examine whether there was any change in this profile following treatment with dexamphetamine. The EEG was recorded at rest in an eyes-open condition from 50 adults diagnosed with AD/HD and assessed as good responders to treatment, both before and after treatment with dexamphetamine, and 50 control subjects. The pre-medication results are similar to those found in previous research that compared the EEGs of adults with AD/HD and control subjects. Following medication, there was a significant reduction in slow wave activity in the AD/HD group to levels similar to those in the control group. These results suggest that changes in brain function of good responders to dexamphetamine, as reflected in the EEG, may underlie the behavioural improvements observed in the clinical setting.

Specificity of quantitative EEG analysis in adults with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) in children and adolescents is characterised by excessive restlessness and an extremely poor concentration span, resulting in impulsive and disruptive behaviour. Clinical observation of ADHD in adults suggests that the early hyperactivity is diminished in terms of its impact on social and academic function, while impulsive-type behaviours remain unchanged. EEG studies in children and adolescents with ADHD have reported significantly more low-frequency power (predominantly theta) and less high-frequency power (predominantly beta) than in normal subjects. In normal children and adolescents, a decrease in theta power and an increase in beta power are found with increasing age, leading some researchers to interpret the EEG anomalies in ADHD as evidence of developmental delay. Studies of adults with ADHD compared with normal adult control subjects have found a reduction in the difference between the two groups, suggesting that the reduced beta activity apparent in ADHD children and adolescents changes with age. Adults with ADHD thus appear to have elevated low-frequency power as their predominant EEG difference from normal control subjects. The present study examined whether this EEG profile was specific to adult ADHD patients. Quantitative EEGs were recorded at rest in an eyes-open condition and used to compare 50 adult patients diagnosed with ADHD with 50 non-ADHD subjects (who presented for ADHD assessment but failed to meet the diagnostic criteria) and 50 control subjects. The ADHD group differed from both the non-ADHD and the control groups on the basis of elevated theta activity. The ADHD and control groups did not differ in beta activity, but relative theta was reduced and relative beta power was elevated in the non-ADHD group compared with both the ADHD and control groups. These results suggest that quantitative EEG may be used to differentiate ADHD adults from both normal adults and adults who display some of the symptoms of ADHD, but fail to meet the diagnostic criteria of ADHD.