ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471601

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThe physician who prescribes controlled substances is faced with an array of laws, regulatory policies, and professional attitudes about their use. Prescriptions for these scheduled drugs are furthermore monitored by the pharmacists who dispense them. Certain drugs, such as the opioids and the benzodiazepines, are considered so potentially abusive that special programs have been recommended to track the behavior of physician prescribers. Multiple copy programs have been implemented in some states. More recent proposals recommend electronic data transfer (EDT) of pharmacy information to centralized processing points so that misprescribing physicians and doctor-shopping patients can be identified. Regulators concerned about physician behavior and confronted by demands of nonphysicians to prescribe controlled substances may find EDT a good solution. Physicians should be concerned about being censured for misprescribing, because such actions may lead to inclusion in the National Practitioner Data Bank. With all of the regulatory concerns about controlled substances, those physicians who would employ long-term opioid therapy for their chronic pain patients must follow certain basic guidelines to be able to defend themselves against allegations of deviant professional behavior. Such procedures as conducting a history and physical examination, maintaining a written treatment plan, consulting with knowledgeable colleagues, and assessing for addictive behavior can provide the practitioner with safeguards.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471602

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractPanic disorders are medical conditions requiring an eclectic treatment approach that often combines pharmacotherapeutics with education, cognitive-behavior therapy, and psychodynamic therapy. This article focuses on the management of medication within this framework. The medications that have been found to be effective include tricyclic antidepressants, fluoxetine, monoamine oxidase inhibitors, and higher potency benzodiazepines. Although alprazolam is the most studied medication and acts very rapidly, each type of medication has unique advantages and liabilities. The general treatment strategy with all the medications is to start with a low dose and increase it slowly until side effects develop or panic attacks cease. The treatment approach should be oriented toward a chronic illness that often requires long-term medication.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471603

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractInsomnia is a commonly encountered condition in clinical practice. The prevalence of self-reported poor sleep increases with age and is more common in women. There are clear associations between poor sleep and psychiatric disturbance; however, causality in this regard may be complex, and there are at least some insomniacs who show high somatic tension without marked psychopathology. The development of chronic insomnia can be conceptualized as involving predisposing, precipitating, and perpetuating factors. Pharmacological treatments for insomnia most typically involve judicious and intermittent usage of a benzodiazepine hypnotic. A variety of such medications are available, with varying absorption and elimination characteristics. Benzodiazepines are preferred over antidepressants in the treatment of insomnia inindividuals without major psychiatric disorder because of fewer side effects and a larger margin of safety. Nonpharmacological treatments typically rely on elements of sleep hygiene, stimulus control, sleep restriction, and chronotherapy. The establishment of good patient-clinician rapport and the working through of unfounded beliefs and unrealistic expectations of the sleep experience are also important components of the behavioral treatment of insomnia. Use of such techniques, particularly when combined in a treatment package, has shown appreciable benefits in improving sleep.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471604

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractAlthough psychotherapeutics are among the most tightly regulated commodities in the world, some small but significant number are regularly diverted from legitimate use for the purpose of sustaining abuse and dependence. Contemporary concerns about such diversion have prompted renewed interest in methods to curb physicians' prescriptive authority and monitor actual prescribing practices. In order to manage these proposed solutions in a rational way, all interested parties need to become involved in decisions about system design and oversight. Practitioners (physicians, pharmacists, and other health professionals) should have input into decisions regarding program structure and exception criteria. Patients must insist on appropriate safeguards of their legitimate interests in maintaining personal privacy and access to medical care. Policymakers need to accurately assess (1) the nature and severity of the diversion problem to be addressed, (2) the resources to be allocated to the system, as well as the effect of such an allocation on the state's ability to meet other service needs, and (3) the“social algebra”of the system—that is, the extent to which the system, will foster undermedication of some patients as the cost of reducing overmedication of others.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471605

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractIn the 17 years since the publication ofPills, Profits, and Politicsby Silverman and Lee, not one of that book's proposals has been fully implemented. This article begins by identifying the elements of prescription drug abuse: inappropriate physician prescribing, patient noncompliance, and poor doctor-patient communication. It then offers 15 solutions to these problems; these are divided into nonregulatory and regulatory solutions. Multiple prescription form laws are singled out for special attention and the experience with such a law in New York is discussed. Finally, the article offers some reflections on the optimal balance between nonregulatory and regulatory approaches to the problem of prescription drug abuse.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471606

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThe history of medical education in treating and prescribing for addictive disorders is primarily one of omission. This began to change in the 1970s, leading to positive developments in medical education; however, much still remains to be done. Training in writing prescriptions should cover four areas: (1) prescribing to prevent addiction; (2) prescribing for alcohol or other drug dependent patients: (3) prescribing for withdrawal from alcohol or other drugs; and (4) prescribing for patients in recovery from alcohol or other drug addiction. Other areas of importance to medical education are inappropriate prescribing practices, self-prescribing, and prescribing for dual diagnosis patients. Physicians need to know how to avoid becoming duped, dated, impaired or“script doctors.”The educational techniques used in attaining these goals emphasize adult, or andragogical, education, sequencing curricula over the years of medical school and residency training, utilizing a variety of instructional techniques, and evaluating the results after each educational unit. The use of clinical vignettes, patient management problems and simulated patients is recommended.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471607

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractMedication has become an increasingly accepted adjunct to other forms of drug abuse treatment. Its acceptance is due in part to clinicians' frustration in treating crack cocaine abusers and to increasing integration of drug abuse treatment into mainstream medicine. A rapidly growing body of literature attests to clinical researchers' interest in pharmacotherapy of substance abuse. Medications can be a useful adjunct to drug abuse treatment in many different ways. The clinical challenge is to decide who should be treated with what medication and at what stage of recovery medications are helpful. This article discusses medications currently in use for treatment of addictive disease, describes some aspects of medication development, and suggests more cost-effective methods of exploring the efficacy of medications for treatment of drug abuse.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471608

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractAlternative explanations for symptoms that occur during the period of drug (medical or nonmedical) withdrawal are examined. These symptoms are not necessarily due to the discontinuation of the drug and should be considered when treating a patient for a withdrawal syndrome. The rationale behind treating withdrawal syndromes and criteria to consider for hospitalizing a patient during the withdrawal period are discussed. The main focus of this article is the appropriate use of prescription drugs for treating withdrawal syndromes. In addition, protocols of the Drug Detoxification, Rehabilitation, and Aftercare Project of the Haight Ashbury Free Clinics are reviewed in detail. Finally, information is provided on some potentially promising medications that are currently being investigated for the treatment of withdrawal.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471609

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor

摘要:

AbstractThis article examines several circumstances in which psychotic symptoms coexist with substance abuse. It reviews psychotic states that may occur as a result of alcohol and other drug use, including intoxication, overdose and withdrawal, offering medication guidelines for managing these situations. It also examines psychiatric disturbances in which psychotic symptoms are recurrent features, exploring patients' self-medication practices and some strategies to address them, as well as difficulties commonly encountered with prescription medications. It briefly discusses other psychosocial interventions that play a significant role in the treatment of the dual diagnosis patient.

ISSN:0279-1072    

DOI:10.1080/02791072.1991.10471610

出版商:Taylor&Francis Group    

年代:1991

数据来源: Taylor