The argument for HIV-antibody testing in chemical dependence treatment programs.

Controversy surrounds the issue of human immunodeficiency virus (HIV) antibody testing in chemically dependent patients. However, HIV testing can be clinically and therapeutically useful in chemical dependence treatment programs. Prerequisites for HIV testing include: staff education, high-quality pre- and posttest counseling for patients, assurance of confidentiality of results, and the use of accurate screening and confirmatory tests. Reasons to offer voluntary HIV testing in chemical dependence treatment programs include: appropriate medical evaluation and treatment, prevention of the spread of HIV infection, and support for working through the crisis of a positive diagnosis. Voluntary informed consent should be obtained prior to HIV testing; involuntary testing and mass screening are not justified. Testing decisions should be individualized, with the focus on the patient's participation based on treatment- and health-related decisions.

A controlled study of lithium carbonate in the treatment of alcoholism.

A prospective double-blind placebo-controlled trial conducted during a 6-month period showed that lithium carbonate was no better than placebo in producing total abstinence in patients with alcoholism, regardless of whether they were depressed. A high dropout rate, the effect of compliance, and difficulties in measuring improvement in these patients impose some limitations in interpreting the results of this study.

Alcoholism and orthotopic liver transplantation.

KIE: The authors, who are affiliated with the National Council on Alcoholism, reject policies that preclude consideration of liver transplantation based solely on a diagnosis of alcoholism. They urge public and private third party payers to cooperate with clinicians experienced in the field of alcoholism in the preparation of guidelines, based on careful research, that avoid arbitrary abstinence requirements and take into account the successes of treatment for alcoholism. The authors assert that a "dangerous precedent is set when decisions regarding either the indications for a procedure or criteria for funding of such becomes based on social rather than clearly documented, objectively established medical criteria corroborated by sound data."^ieng

Adolescent drug abuse.

The author reviews general principles for assessing, intervening in, and treating adolescent drug abuse. Assessment involves uncovering the extent of the drug problem and the reasons behind it, including the role of family psychodynamics. In the intervention phase, the clinician should clearly explain the diagnosis to the family and firmly recommend further actions, being prepared to encounter resistance. Treatment should enable the adolescent to become free of acute drug effects, understand the disorder, and become physically and emotionally capable of abstinence. Involvement in mutual self-help groups modeled after Alcoholics Anonymous is helpful in achieving long-term abstinence. The author also discusses trends in adolescent drug abuse, treatment of medical and psychiatric complications of drug use, and strategies for handling violent drug abusers.

Prognosis of physicians treated for alcoholism and drug dependence.

Data on 73 physicians are compared with data on 185 middle-class patients similarly treated for alcoholism or drug dependence in a hospital-based inpatient program. General patients were contacted on year after treatment and physicians, one to five years later. The prognosis was more favorable for physicians than for general patients. When the groups were selected for study on the basis of completion of inpatient treatment, availability at time of contact, and not having died, 83% of physicians and 62% of the general group were noted to have favorable outcomes. Close monitoring may account, in part, for the better prognosis for physicians.

Alcoholism in physicians.

The Self-Administered Alcoholism Screening Test was completed by physicians attending an annual continuing medical education meeting. Of the responding physicians, 12% were identified as abstainers, 81% were classified as not alcohol-dependent drinkers, 5% were classified as possibly alcoholic, and 2% were classified as probably alcoholic. These results were similar to those obtained in a nonphysician general medical patient population previously given the same questionnaire. The data show that the prevalence of alcoholism among a group of physicians is not substantially different from that in a general medical population.

Thyroid function in the alcoholic.

Se estudio la funcion tiroidea y el eje hipotalamo-hipofisis-tiroides en 54 enfermos alcoholicos y los resultados se compararon con los obtenidos en un grupo de 42 sujetos sanos. Todos los pacientes se encontraron clinicamente eutiroideos y en ninguno se observo evidencia clinica de dano hepatico severo. Los niveles circulantes de T3 en los alcoholicos fueron menores que los encontrados en el grupo testigo. Se discuten los posibles mecanismos que pueden haber contribuido a este hallazgo. La secrecion de TSH inducida por TRH en 7 pacientes se encontro francamente disminuida. Estudios subsecuentes en esta misma direccion pueden aclarar el significado real de las observaciones aqui descritas

Prolactin secretion in alcoholics. / Prolactin secretion in alcoholic patients

Se determinaron los niveles de prolactina circulante en condiciones basales y la respuesta de la misma a estimulacion con tiroliberina, en un grupo de 22 pacientes alcoholicos y un grupo de sujetos sanos con caracteristicas demograficas similares El objetivo fue establecer los efectos del consumo cronico y excesivo de alcohol sobre la secrecion de prolactina por la hipofisis. Los pacientes fueron estudiados tres semana despues de haber cesado su ingestion de alcohol. Los resultados sugieren, que el consumo exagerado de alcohol por si mismo no tiene efectos permanentes en la secrecion de prolactina ni en la respuesta a tiroliberina, aun cuando en algunos pacientes se encontraron valores ligeramente menores que en sus controles.Los autores discuten la importancia que tienen las alteraciones hepaticas de causas diversas en la secrecion de prolactina asi como las diferencias y similitudes de los datos aqui descritos con otros reportados en la literatura

Lorazepam-related withdrawal seizures.

Lorazepam is a new member of a constantly growing benzodiazepine family. It has been demonstrated to be an effective anxiolytic agent, but as with use of other drugs of this nature, tolerance and dependence may occur. These unwanted effects can constitute a serious clinical problem. We report on two patients with grand mal seizures, which were thought to be secondary to abrupt withdrawal of lorazepam. Because these types of agents are the most widely used drugs in medical practice, their potential risks must be emphasized.

Tardive dyskinesia: relationship with a primary affective disorder.

We reviewed all Mayo Clinic case histories in which a diagnosis of tardive dyskinesia or dyskinesia might have been recorded during the years 1965 through 1973 and interviewed 18 consecutive patients in the Department of Psychiatry and Psychology. Among the histories and patients, we found a high incidence of primary affective disorders. Four of the five men had a history of chronic alcohol abuse and symptoms of depression. We recommend that people who have primary affective disorders and chronic alcohol abuse with depression should be given antipsychotic medication, stimulants, or diazepam only after extremely careful consideration.

Psychologic adjustment to coronary artery disease.

As improvements in therapy have extended the survival rate of patients with ischemic heart disease, increasing attention to the quality of survival has resulted in an appreciation of the profound effect of psychologic factors on the patient's life. A multidisciplinary approach, including evaluation and management of pertient psychologic factors, should be part of the treatment of all patients with coronary heart disease. Ischemic heart disease often requires both patient and family to make difficult changes in personality and life-style. As soon as the physiologic stress begins to subside, the physician should begin to provide sympathetic, specific guidelines toward acceptance of the disease and accommodation to its limits. Potential problems and their management are discussed within the framework of the three stages of chronic illness.