Pharmacologic management of acute abstinence syndromes.

Patients addicted to alcohol and other psychoactive substances are frequently seen by family physicians. When admitted to the hospital, these patients may develop abstinence syndromes that require pharmacologic intervention. The pharmacologic management of acute abstinence syndrome from discontinuation of central nervous system depressants involves substitution of another sedative-hypnotic agent and gradual tapering of the dose over a few days. The same principle applies to opioid detoxification. Pharmacologic detoxification is generally not required in the management of abstinence syndromes involving central nervous system stimulants, cannabinoids, hallucinogens, inhalants or phencyclidine.

Alcoholism in women.

Women differ from men in their drinking patterns and in the biologic consequences of alcohol use. Women more often drink at home and conceal their drinking behavior. Because women have a higher percentage of body fat and a lower percentage of body water than men, the same amount of alcohol causes more severe toxic effects in women than in men. Heavy alcohol consumption in women is associated with gynecologic dysfunction and fetal alcohol syndrome. Depression, anxiety or other psychiatric illness is also common in women alcoholics. Family physicians should be alert to the subtle behaviors that suggest alcoholism and be familiar with the available community resources and treatment options.

Diagnosis and management of phencyclidine intoxication.

Because phencyclidine intoxication has both psychiatric and physical manifestations, it continues to present a challenge to physicians. Intoxication may be viewed as occurring in three stages. Mild intoxication, the first and most common stage, is manifested primarily by psychiatric signs and symptoms. In the second stage, patients are stuporous to comatose, but they have intact deep pain responses. In the third stage, patients do not respond to deep pain stimuli. Treatment depends on the stage of intoxication.

Cigarette smoking: more than a habit.

The author states that the pharmacologic and behavioral processes that determine nicotine addiction are similar to those that determine addiction to heroin and cocaine. He maintains that treatment of nicotine addiction should be more widely available, and suggests that many physicians still view cigarette smoking erroneously as a habit rather than a true drug addiction.

Nicotine dependence.

Nicotine is a psychoactive drug with effects that reinforce tobacco use despite known adverse health consequences. Nicotine dependence can be effectively treated. Family physicians are in an excellent position to promote both smoking cessation and smoking prevention.

The diagnosis of alcoholism.

Alcoholism is underdiagnosed by many physicians, for various reasons. The physician may feel that alcoholism is a weakness rather than an illness or may believe that alcoholics differ in appearance from other patients. Patients and family members frequently deny the problem, and some physicians are reluctant to diagnose a disorder they do not know how to treat. Diagnosis depends mainly on the medical, social and psychologic histories. Questionnaires are useful for routine screening of patients.

Electrocardiograms in office practice.

Electrocardiograms (EKGs) are a widely used diagnostic tool in primary care. The indications for EKGs are widespread. We reviewed all EKGs performed over a two year period at the two model practice units of the University of Mississippi's Department of Family Medicine. Four hundred and sixteen EKGs were reviewed and subdivided according to indication, outcome, and age. One hundred and sixty-six EKGs were read as abnormal. Overall, the percentage of abnormal findings increased in proportion to age. Seventy nine percent of the EKGs were obtained for 4 indications: (1) chest pain (28%), (2) health screening (24%), (3) abnormal rhythm (15%), and (4) hypertension (12%). The percentage of abnormal EKGs was found to increase with age for all four indications. Screening EKGs were essentially unremarkable prior to age 51. EKGs on the under 30 age group were by far more helpful when performed for abnormal rhythm. No abnormalities were found on patients under age 41 when performed for chest pain.

Gross hematuria in a patient with sickle cell trait.

Sickle cell trait must be included in the differential diagnosis of hematuria in black patients. Therefore, diagnostic workup should include hemoglobin electrophoresis, urine culture, coagulation studies, intravenous pyelography, cystoscopy, renal ultrasonography, and renal arteriography. If the patient is found to have hemoglobin AS and no other abnormality, initial therapy consists of bed rest and intravenous fluids, with transfusion of red cells if needed. Intravenous epsilon-aminocaproic acid (EACA) has been used effectively to reverse hematuria in patients who do not respond to conservative management. In the case reported here, gross hematuria in a 24-year-old black woman resolved with use of EACA therapy.