Alcohol abuse cases

Hernandez M, McDaniel CH, Costanza CD, et al GHB-induced delirium a case report and review of the literature of gamma hydroxybutyric acid. Am J Drug Alcohol Abuse 24 179-183, 1998... 

Approximately one-third of patients with MDD do not respond satisfactorily to their first antidepressant medication.37 In such cases, the clinician must evaluate the adequacy of antidepressant therapy, including dosage, duration, and patient compliance.17 Treatment reappraisal also should include verification of the patient s diagnosis and reconsideration of clinical factors that could be impeding successful therapy, such as concurrent medical conditions (e.g., thyroid disorder), comorbid psychiatric conditions (e.g., alcohol abuse), and psychosocial issues (e.g., marital stress).16... 

Gallstones and alcohol abuse account for most cases in the United States. A cause cannot be identified in some patients (idiopathic pancreatitis). 

Abuse. We have all heard the terms substance abuse, drug abuse, alcohol abuse, cocaine abuse, and so on. In one sense, any illicit use of a substance is abuse. For example, from the legal point of view, whenever someone smokes crack (even if it is the only time), (s)he has broken the law and abused cocaine. Likewise, if you borrow a prescription sedative or pain reliever from a friend, then you have similarly abused that medication. That is an appropriate use of the term in many cases, but this is not customarily the way that mental health specialists use the term. From our perspective, substance abuse involves a pattern of repeated use over time that results in problems in one or more areas. These include compromised physical health and well-being, legal proceedings, job status, and relationships as well as overall day-to-day functioning. 

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

In any case, it is quite clear that REM suppression is a robust consequence of prolonged alcohol abuse. This effect becomes increasingly problematic as the addiction is prolonged and the inevitable crisis is made worse even as it is postponed. Barbiturates, another CNS depressant sedative class of drug, offer a similar picture. When barbiturates are used experimentally to suppress REM—and they are very effective REM suppressants—their dose frequency and amount must be increased more and more over time until, at 3-4 weeks, it is virtually impossible to quell the REM rebound. When it finally occurs, it is characterized by such intense phasic activation (PGO waves) that the animals literally fly off their sleeping surfaces in convulsive spasms. 

Abdominal pain is the predominant symptom in patients with AP. Typically, the pain is located in the upper abdomen and often radiates through to the back or both flanks. The onset of pain may be associated with a heavy meal or alcohol abuse. The intensity increases rapidly, but its onset is less sudden than in the case of a perforated peptic ulcer. Mild pain may be partially relieved by sitting up or by lying down, but usually body position has little influence on the intensity of pain. The second most prominent symptoms are nausea and vomiting, which are almost invariably present (B7, R3). 

It must be pointed out specifically that alcohol abuse during pregnancy leads to (embryo-fetal alcohol syndrome (malformations, persistent intellectual deficits). This intrauterine intoxication is relatively common one case per 1000 births (C). 

Two other cases have been reported in patients with no prior history of alcohol abuse or gallstones (189,190). The authors recommended monitoring serum amylase activity during slow increases in the dosage of clozapine if there is leukocytosis or eosinophilia, which may be associated with asymptomatic pancreatitis. 

Four cases of former drug or alcohol abusers with personality disorders have been described all developed dependence while taking high doses of zolpidem (36). 

Gallstones and alcohol abuse account for most cases in the United States. A cause cannot be identified in some patients (idiopathic pancreatitis). Many medications have been implicated (Table 28-1), but a causal association is difficult to confirm because ethical and practical considerations prevent rechaUenge. 

Barbiturates and alcohol both increase the activity of (induce) the enzymes that metabolize paracetamol to the toxic product. A chronic alcohohc or someone who has been prescribed barbiturate drugs will be at greater risk when taking more than the recommended dose of paracetamol because a greater proportion of the dose will be converted into the toxic product. It would be equivalent to taking a larger dose. In the case of an alcoholic the liver may already be compromised by repeated and long-term alcohol abuse and so be more vulnerable and less able to detoxify paracetamol it may also have less protective substances like thiols. 

The two main memory disorders are amnesia and aphasia. Amnesia is a partial or total loss of memory caused by emotional trauma, disease, or brain injury (usually due to head trauma, surgical accidents, or chronic alcohol abuse). Memory loss can occur for events just prior to the amnesia-causing incident (retrograde amnesia), or for events occurring after the incident (anterograde amnesia). In severe cases of anterograde amnesia, the person may be unable to form n memories, although recall of material learned before amnesia s onset is usually unaffected. Many cases of amnesia (even severe) are temporary, so that the person recovers his or her memory. 

Vitamin M Vitamin M is also called pteroylglutaminic add or folic acid. It was isolated from yeast extract by Wills in 1930. Its structure was described by Anger in 1946. Folic add is made up of pteridine + p-aminobenzoic add + glutamic add. There are several known derivatives, called folates, which are capable of mutual restructuring. The coenzyme tetrahydrofolic acid, which plays a role in many biochemical reactions, is formed with the help of Bi2. Around 50% of total body folate are stored in the liver. A folate-binding protein (FBP) is available for transport. Folate undergoes enterohepatic circulation. The release of folate from the liver cells is stimulated by alcohol, which increases urine excretion. Folate deficiency (e.g. in the case of alcohol abuse) is accompanied by the development of macrocytosis. 

Determination of mitochondrial GOT (mGOT = 80%) is recommended as an additional laboratory parameter for the detection of persistent alcohol abuse, particularly in those cases where GDH measurements are inconclusive. Mitochondrial GOT (mGOT) serves as a fatty acid-binding protein (FABP). This might help to explain the increased uptake of fatty acids in hepatocytes due to alcohol abuse. 

Elevated LAP values are found predominantly in biliary and cholestatic diseases - in accordance with AP. In liver diseases due to alcohol abuse, LAP values are exhibited both more frequently and with higher values than AP. In hepatitis mononucleosa, LAP is generally also more clearly elevated than AP. Significant increases in LAP are found in pancreatic and breast cancer as well as in collagenoses of the vascular type. LAP is not found in bone there is no evidence of elevated LAP in bone diseases. Normal LAP in connection with an increase in AP consequently rules out hepatobiliary diseases and requires further investigation. In these cases, parallel determination of AP and LAP is advisable. 

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