Alcohol abuse depression with

In addition, if possible, die nurse obtains a history of any past drug or alcohol abuse. Individuals with a history of previous abuse are more likely to abuse odier drug s, such as the antianxiety drug s. Some patients, such as diose with mild anxiety or depression, do not necessarily require inpatient care. These patients are usually seen at periodic intervals in die primary health care provider s office or in a psychiatric outpatient setting. The preadministration assessments of the outpatient are the same as diose for the hospitalized patient. 

Ciraulo DA, Jaffe JH Tricyclic antidepressants in the treatment of depression associated with alcoholism. Clin Psychopharmacol 1 146—150, 1981 Ciraulo DA, Nace E Benzodiazepine treatment of anxiety or insomnia in substance abuse patients. Am J Addict 9 276—284, 2000 Ciraulo DA, Barnhill JG, Jaffe JH, et al Intravenous pharmacokinetics of 2-hydroxy-imipramine in alcoholics and normal controls. J StudAlcohol 51 366-372, 1990 Ciraulo DA, Knapp CM, LoCastro J, et al A benzodiazepine mood effect scale reliability and validity determined for alcohol-dependent subjects and adults with a parental history of alcoholism. Am J Drug Alcohol Abuse 27 339—347, 2001 Collins MA Tetrahydropapaveroline in Parkinson s disease and alcoholism a look back in honor of Merton Sandler. Neurotoxicology 25 117-120, 2004 COMBINE Study Research Group Testing combined pharmacotherapies and behavioral interventions in alcohol dependence rationale and methods. Alcohol Clin Exp Res 27 1107-1122, 2003a... 

Patients with bipolar disorder have a high risk of suicide. Factors that increase that risk are early age at disease onset, high number of depressive episodes, comorbid alcohol abuse, personal history of antidepressant-induced mania, and family history of suicidal behavior.15 In those with bipolar disorder, 1 of 5 suicide attempts are lethal, in contrast to 1 of 10 to 1 of 20 in the general population. 

Most bulimic patients (60%-80%) have a lifetime history of depression (Braun et ah, 1994). They have problems with interpersonal relationships, self-concept, and impulsive behavior and show high levels of anxiety and compulsivity. Chemical dependency is not unusual in this disorder, alcohol abuse being the most common. Bulimics will abuse amphetamines to reduce their appetite and lose weight (Braun et ah, 1994). 

PTSD is linked with the increased likelihood of other psychiatric disorders occurring at the same time. Some 88% of men and 79% of women with PTSD meet the criteria for another psychiatric disorder. The most common disorders that men have at the same time as PTSD are alcohol abuse or dependence (51.9%), major depressive episodes (47.9%), conduct disorders (43.3%), and drug abuse and dependence (34.5%). The psychiatric disorders that most frequently cooccur with PTSD in women are major depressive disorders (48.5%), simple phobias (29%), social phobias (28.4%), and alcohol abuse/dependence (27.9%). These statistics may indicate that people with PTSD are more susceptible to psychiatric disturbances in general. 

Although depression is the most prominent comorbid illness, a variety of other psychiatric conditions may be associated with panic disorder, for example, agoraphobia [60% of patients with panic disorder], other anxiety disorders (20%), and drug and alcohol abuse [15%] [Klerman 1992). 

Overall, a factor which can be very relevant is parental history of alcoholism, with the additional complications related to this in addict offspring being demonstrated a long time ago by Kosten et al. (1985), including high levels of alcohol abuse again, and depression and personality disorder. 

The relationship between alcohol abuse and suicide has been recognized for many years, with at least one in five suicide victims being intoxicated at the time of their death. Alcohol may lower inhibitions, serving as a precipitant to the act, or the disease of alcoholism itself could be a risk factor. Alcohol also induces biochemical changes (e.g., lowers CSF 5-HIAA and decreases 5-HT2 receptors in the neocortex), similar to changes observed in at least a subset of depressive disorders. Thus, alcohol may aggravate or contribute to the pathophysiology that mediates the depressive syndrome and leads to suicide completions. 

Co-morbidity is frequent. For example. Shore et al. (267) found that among their patients with PTSD, 28% also had GAD, 29% had depression, 12% had phobias, and 10% had alcohol abuse problems. 

Major depressive disorder (MDD) can occur in children as young as 6 years of age. The diagnosis is based on the same criteria as in adults. These patients typically have a high familial loading for psychiatric disorders (110), with more than 70% of mothers having MDD, either pure or complicated by the presence of other psychiatric syndromes. Fathers, however, are more likely to have alcohol abuse or dependence, as opposed to MDD. Given this familial pattern, it is not surprising that many children and adolescents with MDD frequently also meet criteria for other psychiatric syndromes, particularly conduct and oppositional disorder ( 110). 

Posttraumatic stress disorder (PTSD) is another anxiety disorder that can be characterized by attacks of anxiety or panic, but it is notably different from panic disorder or social phobia in that the initial anxiety or panic attack is in response to a real threat (being raped, for example) and subsequent attacks are usually linked to memories, thoughts, or flashbacks of the original trauma. The lifetime incidence of PTSD is about 1%. Patients have disturbed sleep and frequent sleep complaints. Comorbidities with other psychiatric disorders, especially depression and drug and alcohol abuse, are the rule rather than the exception. The DSM-IV diagnostic criteria are given in Table 9—11. 

Understand the major psychiatric disorders treated with psychotropic agents, including depression, anxiety disorders, psychosis, cognitive disorders including dementia and drug and alcohol abuse. 

Acute endogenous depression is not generally considered to be an indication for treatment with lithium. Alcohol and substance abuse have a high association with bipolar illness. However, recurrent endogenous depressions with a cyclic pattern are controlled by either lithium or imipramine, both of which are superior to a placebo. 

Myoclonus due to maprotiline has been reported (13). Further neuromuscular symptoms that have been reported with maprotiline include cerebellar ataxia in a 54-year-old man with a history of unipolar depression and chronic alcohol abuse who was taking maprotiline 200 mg/day (14). The question of whether his history of alcohol abuse contributed by sensitizing his cerebellum to maprotiline-induced ataxia was unresolved. 

The therapist continues to work collaboratively with Dr. D to address Ms. A s many health concerns her skin disorder, her symptoms of anxiety and depression, her weight gain, and her continued alcohol abuse. Physician, therapist, and patient make explicit that connection among the various problems she experiences her inability to identify the source of her stress and her reluctance to express that stress seem to cause her skin disorder to flare up. She seeks alcohol in order to soothe herself, and as the months pass with no improvements in her physical or emotional health, she continues to turn to drink as the only way to combat the anger and frustration she feels about many aspects of her life. 

Dr. P decides to first address the alcohol abuse of Mr. B by asking him to stop drinking completely, which he agrees to do. But Dr. P is less sure about the dramatic presentation of Mrs. B s life story and the intensity of her affect. Although she says she is not suicidal, she does indicate deep despair. Dr. P internally considers possible diagnoses like depression, borderline personality disorder, or histrionic personality disorder. In addition. Dr. P attempts to clarify the terms for therapy Are they looking for individual or marital therapy Dr. P decides to address these questions directly with Mr. and Mrs. B. They both say that they want marital therapy but feel that Mrs. B s pain needs prompt attention also. She s looking for some relief. 

Complications of major depression are significant. Persons with major depressive disorder have higher rates of physical illness (Katon and Sullivan, 1990). They are also more likely to develop substance use disorders, particularly alcohol abuse and dependence (Sullivan et ah, 2005). Persons with major depressive disorder experience considerable social, vocational, and family impairment, due, in part, to problems with memory, concentration, and poor judgment. 

Panic disorder is characterized by recurring, intense panic attacks. Many times these attacks appear to be spontaneous, not provoked by identifiable stressors. As the disorder progresses, most patients begin to develop considerable anticipatory anxiety (a rather continuous, mild-to-moderate generalized anxiety as they come to worry when the next attack will occur)—and phobias (agoraphobia is especially common). With time, alcohol abuse and depression commonly develop. 

Often, especially in more chronic cases, major depression, alcohol abuse, dependency, or both develop along with primary panic symptoms. In that event, appropriate antidepressant medication treatment and/or involvement in Alcoholics Anonymous or a chemical-dependency treatment program becomes necessary. 

About one quarter of the U.S. population experience some form of mental disorder in any given year. Most have symptoms associated with anxiety, depression, or alcohol abuse. 

Interpretation In normal subjects, serum cortisol concentration is suppressed to 2 pg/dL or less after administration of 1 mg of dexamethasone. Most patients with Cushing s syndrome do not show adequate suppression, and 0800 hours cortisol concentrations are usually >10pg/dL. Serum cortisol >2pg/dL may also be seen in cases of stress, obesity, infection, acute or chronic illness, alcohol abuse, severe depression, oral contraceptive use, pregnancy, estrogen therapy, failure to take the dexamethasone, or treatment with phenytoin or phenobarbital (enhancement of dexamethasone metabolism). 

Anxiety and dissociative symptoms (e.g., sense of numbing or absence of emotional responsiveness, derealization, depersonalization, inability to recall important features of the event) emerging within 1 month after exposure to a traumatic stressor are classified as ASD. Symptoms of ASD are experienced during or immediately after the trauma, last for at least 2 days, and resolve within 4 weeks. The age of onset and course of PTSD are variable. PTSD can occur at any age. The presentation is not predictable because symptoms are related to the duration and intensity of the trauma, the presence of other psychiatric disorders, and how the patient deals with the trauma. The average duration of symptoms in patients in treatment is about 36 months. In those not receiving treatment, symptoms can last for a mean of 5 years. About one-third of patients with PTSD have a poor prognosis for recovery. About 80% of patients with PTSD have a concurrent depression or anxiety disorder. Over half of men with PTSD suffer from comorbid alcohol abuse or dependence. About 20% of patients with PTSD attempt suicide. ... 

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