摘要:

AbstractAttending physicians routinely encounter patients with signs and symptoms of anxiety and mood disorders as well as psychoactive substance use and psychoactive substance-induced organic mental disorders. These symptoms may represent either primary disorders or pathology that is secondary to other disorders. This article describes some of the relationships between substance use disorders and symptoms of anxiety and depressive disorders. In addition, some patients with these disorders may have a concurrent substance use disorder or be at high risk for developing one. Routine treatment of anxiety disorders with psychoactive drugs can be successful in many patients but may lead to iatrogenic dependence in high-risk patients. Prescribing for high-risk patients should include a stepwise treatment protocol having three progressive levels: (1) conservative, nonpharmacological approaches; (2) nonpsychoactive pharmacotherapy, including the use of anxioselective agents, such as buspirone; and (3) psychoactive pharmacotherapy, such as the use of benzodiazepines. Proper prescribing practices for high-risk patients are described in terms of diagnosis, dosage, duration, discontinuation, dependence, and documentation.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471611

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractDepression is the most common psychiatric disorder in substance abusers, and results in a poorer prognosis and respons e to traditional chemical dependence and mental health treatment approaches. This article focuses on the use of pharmacotherapy in the treatment of the cocaine addict with secondary depression and provides general clinical treatment guidelines. It also reports on a study in which depressed. methadonemaintained cocaine addicts were treated in a 12-week placebo-controlled trial that compared two pharmacological agents. Patients were randomly assigned to receive placebo, amantadine (a dopamine agonist) or desipramine (a tricyclic antidepressant). The effects of pharmacotherapy were assessed on program retention, cocaine craving, cocaine usage, and depressed mood. Compared to the placebo-treated patients, it was found that the medication-treated depressed patients had a dramatic decrease in their reported cocaine usage (84% versus 17%) and cocaine craving (48% decrease versus 29% increase). Also, the medication-treated depressed patients dramatically increased the percentage of cocaine-free urines compared to the placebo-treated depressed patients who actually decreased their percentage of cocaine-free urines. A measure of depressive symptoms (Beck Depression Index score) increased 100% for the placebo-treated depressed patients, yet remained stable for the medication-treated depressed patients.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471612

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThis article examines the effectiveness of the rehabilitation of anesthesiologists who are addicted to alcohol or other drugs. There has been some concern and discussion about allowing anesthesiologists who are addicted to alcohol or other drugs to continue practicing in their specialty. This article analyzes success rates, relapse rates, and failure rates among the anesthesiologists and residents of anesthesiology in the California Physicians Diversion Program for chemically dependent doctors. Of the 255 physicians who have successfully completed the program during the ten years prior to March 1990, 35 were practicing anesthesiologists, including six resident anesthesiologists. Although doctors in this specialty are more at risk for manifesting addiction to alcohol and other drugs, California's experience demonstrates that they have an equal chance of recovery and contradicts the pessimism about recovery in anesthesiologists.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471613

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471614

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471615

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor