A pilot study of antipsychotic prescribing decisions for acutely-Ill hospitalized patients.

Background: Evidence on antipsychotic prescribing decisions is limited. This pilot study quantified factors considered in choosing an antipsychotic and evaluated the influence of metabolic status on treatment decisions.

Methods: Prescribing decisions by 4 psychiatrists were examined based on 80 adult patients initiated on antipsychotic medication diagnosed with schizophrenia, schizoaffective disorder or bipolar disorder by DSM-IV criteria, who were admitted to an acute inpatient psychiatric program of an urban Veterans Affairs Medical Center.

Why patients sign out against medical advice (AMA): factors motivating patients to sign out AMA.

A retrospective review of the against medical advice (AMA) discharges revealed that the majority of the patients left AMA for personal reasons, i.e., sickness or death in the family; reconciliation with spouse, girl friend, or family members; financial problems; and legal issues such as a court date.

Nicotine intervention during detoxification and treatment for other substance use.

This preliminary study evaluated the efficacy of a brief smoking cessation intervention (30 controls, 34 intervention groups) on a smoke-free inpatient unit for substance use detoxification. Controls received usual care, including the transdermal nicotine patch and referral to an outpatient smoking program. The intervention group additionally received a structured motivational enhancement program.

Survey of hepatitis B and C in addiction treatment unit.

The survey on our unit revealed that 80% of injection drug users (IDUs) had hepatitis B core antibody (HBcAB), and 90% had hepatitis C virus antibody (HCVAB). Less than half of each group did not know or were unsure of the mode of transmission and spread of HCV. These findings emphasize the need to focus on education, especially about transmission of hepatitis B and C infection in drug addicts, particularly IDUs.

Can cocaine abuse cause parkinsonism?

Dopamine deficiency is found in both chronic cocaine abusers and Parkinson's disease. The authors sought to determine whether parkinsonian signs occur in chronic cocaine abusers. Fifty male patients with a history of chronic heavy cocaine abuse were examined on the Unified Parkinson Disease Scale (UPDS) and compared with 20 non-cocaine-abusing, age- and sex-matched control subjects.

Absence of parkinsonism among patients in long-term neuroleptic therapy who abuse cocaine.

The study used the United Parkinson's Disease Scale to compare parkinsonian signs and symptoms among 19 patients in long-term neuroleptic therapy who had a history of cocaine abuse with those among 24 similar patients with no history of cocaine use. There was no significant difference between the two groups' scores. The results suggest that chronic cocaine abuse is not a risk factor for parkinsonism among subjects in long-term neuroleptic therapy.

Unscheduled admissions and AMA discharges from a substance abuse unit.

On the inpatient substance abuse service of the Philadelphia Veterans Administration Hospital, we found that patients who were admitted to the hospital "unscheduled" had a disproportionately higher incidence of subsequent AMA (against medical advice) discharge, particularly if they were alcoholic. This finding calls into question the cost-effectiveness of hospitalization as an initial treatment strategy for substance abusers who enter treatment impulsively and points out the need for additional study to determine the most cost-effective treatments for addicts whose primary motivation for treatment may be to obtain relief from precipitating stressors.

A brief survey of the current sexual practices of a population admitted for inpatient treatment of drug dependence.

We studied a population of high-risk drug users concerning their current sexual practices. They had a pattern of inconsistent or infrequent condom use. Only 11.

A randomized double-blind study of neuroelectric therapy in opiate and cocaine detoxification.

Prior research on the use of transcranial neuroelectric stimulation suggested that the application of low-amperage, low-frequency alternating current via surface electrodes placed in the mastoid region could relieve the physiological signs and subjective symptoms of withdrawal and craving during opiate detoxification. These effects were reported without gradual tapering of the opiate or the addition of other medications. To test the efficacy of one particular form of neuroelectric therapy (NET), a double-blind, randomized, placebo-controlled study was conducted comparing active NET and placebo NET in the treatment of withdrawal and stabilization of 18 opiate-dependent and 25 cocaine-dependent subjects.

The relationship of cocaine to headache in polysubstance abusers.

In a questionnaire survey of inpatient polysubstance abusers it was found that cocaine relieved migraine-type headaches much more often in chronic headache sufferers than in those with only occasional headaches (p less than .05). However, cocaine could also bring on headaches after several hours, both in chronic headache sufferers and in those not subject to headaches.

Methadone and edema.

We describe a patient on methadone maintenance who developed distal leg edema after years of treatment. The edema resolved when methadone was discontinued and recurred when it was restarted. This patient is compared to three others reported in the literature who also developed fluid retention shortly after being placed on methadone.

Effect of cocaine on thyroid functions.

Results of routine thyroid function tests in heavy cocaine abusers at the time of treatment admission were not statistically different from normal values for our laboratory or from a similar group of other substance abuse patients in treatment. This suggests that heavy cocaine use per se does not affect thyroid function. Therefore, if the thyroid function tests are abnormal in a cocaine abuser, then a true thyroid dysfunction should be considered and completely evaluated.

Prolonged presence of metabolite in urine after compulsive cocaine use.

The authors studied the pattern of benzoylecgonine excretion in 35 male veterans who had recently used large amounts of cocaine. Following admission to a drug-free environment, the veterans completed a short structured interview and gave daily urine samples for benzoylecgonine analysis. Eleven (31.

Detoxification with phenobarbital of alprazolam-dependent polysubstance abusers.

Alprazolam appears to have an abuse liability among opiate addicts, and detoxification can be prolonged. The authors describe experience with five methadone maintenance patients who were polysubstance abusers and were admitted specifically for detoxification from alprazolam dependence. Phenobarbital in tapering doses adequately suppressed withdrawal symptoms and shortened hospitalization.

Increase in desipramine serum levels associated with methadone treatment.

Five men in a methadone treatment program who were also receiving desipramine had significantly higher desipramine serum levels when taking both drugs than when taking the antidepressant alone. Monitoring of desipramine serum levels may be useful with such patients.

Hypoglycorrhagia does not necessarily indicate infection.

A case is reported illustrating two points: 1. haemorrhage can occur in cerebral infarct even without the use of anticoagulants; 2. this haemorrhage can extend into the subarachnoid space, causing chemical meningitis, and may produce moderately severe low CSF sugar.