At Home Drug Withdrawal

Sobriety Success

The dependence on sobriety is defined as the state of sobriety. When a person is sober, they can live on a daily basis without their thoughts and behaviors being controlled by substance dependence. They do not feel obliged to use it because they manage to live without it. They see and appreciate so much the benefits of living without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. The success product of sobriety is a step-by-step manual for everyone. The product has been said to be beneficial for many people around the world. The reason why the product is gaining so much popularity among individuals. They see and appreciate so much the benefits of life without substance that they do not feel they have to use drugs or alcohol. Therefore, they refrain from using it to continue enjoying this new, healthier lifestyle. This strategy encourages you to maintain the long-term vision of recovery. Recognize that this is not a one-off thing, something you try for a few weeks to several months, then return to your previous life. You will be in recovery if you decide it's the life you want to live for the rest of your life. As such, there is no immediate timeline to which you must adhere, nor should you strive to achieve goals that you are clearly not ready to face. Read more here...

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Thirty Years Since Estelle v Gamble Looking Forward Not Wayward

The purpose of this book is to tackle these questions. The intent is to help develop a persuasive rationale to direct public policy toward seizing the public health opportunities that present themselves in a captive population beset by an extraordinary burden of illness. Much of this burden derives from poverty and drug abuse. This book is

Conundrums1 Behind Bars

The fourth conundrum is the artificial walls between treatment for drug abuse and mental illness behind bars. For a variety of reasons, correctional systems typically provide medical care and drug treatment through parallel, but unrelated programs. And there is not enough drug treatment behind bars to help reduce recidivism. These are barriers to recovery for patients with coexisting illness.

Impact on Human and Social Capital in Poor Communities

African Americans are five times more likely to go to prison than whites, and almost twice as likely as Hispanics. Unlike age and gender data, the prominence of blacks among those who break the law is less clear. For example, blacks in high school are slightly less likely to report illicit drug use than whites, and victims of violent crime report that their assailants were black at a differential far less than 5 1 (Walker et al., 2004). Nonetheless, almost one-fifth of African Americans will go to prison during their lifetimes.

Sources for Further Study

Of most animal experimentation, he gives a clear and thorough discussion of the entire context of animal experimentation from both sides. Includes sections on animal rights, similarities and differences between human and nonhuman subjects, the role of methodological considerations and replicability in scientific progress, and alternatives to animal testing. The author specifically addresses some of the uglier behavioral studies on animals, including some by Harry Harlow. Gross, Charles G., and H. Philip Zeigler, eds. Motivation. Vol. 2 in Readings in Physiological Psychology. New York Harper & Row, 1969. Although there are dozens of newer collections of articles in the area of physiological psychology, this one does a particularly good job of covering the broad diversity of topics in the field. In addition, all the work represented in this particular collection came from animal studies. This or a similar collection can be consulted for illustration of many specific methodologies used...

Active Immunisation

Immunisation against hepatitis B is now recognised as a high priority in preventive medicine in all countries and strategies for immunisation are being revised. Universal vaccination of infants and adolescents is under examination as the strategy to control the transmission of this infection. More than 90 countries now offer hepatitis B vaccine to all children, including the USA, Canada, Italy, France and most western European countries. However, immunisation against hepatitis B is at present recommended in a number of countries with a low prevalence of hepatitis B only to groups that are at an increased risk of acquiring this infection. These groups include individuals requiring repeated transfusions of blood or blood products, prolonged inpatient treatment, patients who require frequent tissue penetration or need repeated circulatory access, patients with natural or acquired immune deficiency and patients with malignant diseases. Viral hepatitis is an occupational hazard among...

Inmate Rights to Medical and Mental Health Under the ADA

In the area of mental health, more and more mentally ill persons are incarcerated because of conduct arising from their mental illness, often exacerbated by homelessness, drug addiction, and alcoholism. The frequency of jail suicide and failure to train staff on issues of mental health have been revealed in civil rights cases.50 However, it bears discussing the increasingly high burdens which the courts have placed on plaintiffs under the civil rights statute to understand how the ADA has changed the landscape.

Benefits of Meditation

Research on the physiological effects of meditation led to the application of meditative techniques as a treatment to combat stress-related illnesses. Meditators have often experienced significant decreases in such problems as general anxiety, high blood pressure, alcoholism, drug addiction, insomnia, and other stress-related problems. Researchers have also found that the scores of meditators on various psychological tests have indicated general mental health, self-esteem, and social openness. Many psychologists argue, however, that these effects are not unique to meditation and can be produced by means of other relaxation techniques. Meditation researcher Robert Ornstein has suggested that the long-term practice of meditation may induce a relative shift in hemispheric dominance in the brain from the left hemisphere, which is associated with such linear processes as language and logical reasoning, to the right hemisphere, which is associated with nonlinear processes such as music...

Special Treatment Considerations with Dual Diagnoses

Drug abuse is a significant complicating factor, associated with medication noncompli-ance, among other issues. Substance abuse also contributes to relapses, homelessness, medical problems, disruption in employment, and many more problems (Krystal, D'Souza, Madonick, & Petrakis, 1999). The issue of combined mental illness and substance abuse will be dealt with extensively in Chapter 8.

Clinical Comorbidity Underlined by Overlapping Biological Mechanisms

Drug addiction is defined as the compulsive seeking and taking of a drug despite adverse consequences. Multiple psychological and social factors come into play, but at its core it represents a biological process underlined by the effects of repeated drug exposure on a vulnerable brain 70 . A dysregulation and resetting of the threshold for reward mechanisms in the brain, termed allostasis, is proposed to occur with long-term drug use and to underlie addiction 71 .

Background and Epidemiology of Hepatitis Viruses in Correctional Settings

Despite laws prohibiting sex between residents of correctional systems (Gaiter & Doll , 1996), 2-30 of inmates have sex while incarcerated (Nacci & Kane, 1983 Decker, Vaughn, Brodie, Hutcheson, & Schaffner, 1984 Tewksbury, 1989 Saum, Surratt, Inciardi, & Bennett, 1995). Only two state prison systems and five city or county correctional systems make condoms available to adult inmates and detainees for use in their facilities (Vermont, Mississippi, New York City, Philadelphia, San Francisco, Washington, DC, Los Angeles). Arrested adults also have a high prevalence of illicit drug use in 2004 inmate surveys, 83 of state prisoners and 79 of federal prisoners reported past drug use, and 56 of state prisoners and 50 of federal prisoners reported using drugs in the month before their offense (Mumola & Karberg, 2006). Among jail inmates, drug use in the month before incarceration was reported by 55 , and injection-drug use (IDU) was reported by 18 (Wilson, 2000 http www.ojp. usdoj.gov bjs pub...

Advances and Insights from Convergent Functional Genomic Studies

Acute methamphetamine administration in rats has been used as an animal model of mania 5 . The candidate genes identified in that study through a convergent functional genomics approach, as discussed in the section on Cocaine enhances dopamine-mediated neurotransmission by blocking dopamine re-uptake at axon terminals. The striatum is one such site of action. Chronic exposure to cocaine up-regulates several transcription factors that alter gene expression and which could mediate the long-term neural and behavioural changes induced by the drug. One such transcription factor is DeltaFosB, a protein that persists in striatum long after the end of cocaine exposure. Using DNA microarray analysis of striatal tissue from both indu-cible transgenic mice engineered to overexpress DeltaFosB and mice treated with cocaine, cyclin-dependent kinase 5 (Cdk5) was identified as a downstream target gene of DeltaFosB 79 . Overexpression of DeltaFosB, or chronic cocaine administration, raised levels of...

Elementary Aspects of Oral Bioavailability

Where AUC is the area under the time-plasma concentration curve after each of the respective administrations (the dose terms cancel when equally sized doses are administered by both routes of administration). A residual of less than 15 (sometimes 10 ) of the total AUC is a commonly-used standard for timing the last plasma sample. These studies are usually conducted under standard conditions, and using crossover protocols, although, occasionally, a double-label study may be used to measure F instantaneously (see Chapter 12). Comparison of generic with innovator's formulations, and slow-release with rapidly absorbed formulations, may be compared using equations of the same form. Similarly, subcutaneous and intravenous injections can be compared. With very rare exceptions, the intravenous administration of a dose is assumed to be 100 bioavailable. For example, very short-acting drugs, e.g. some arachidonate derivatives, remifentanil, esmolol and adenosine, may be metabolized during their...

Other Important Opportunities for HIV Prevention

If a safe syringe needle exchange program is not legal or feasible, both the World Health Organization and the U.S. Centers for Disease Control and Prevention are on record as stating that other measures should be made available to prevent further transmission. WHO states that the provision of other cleaning techniques (e.g., bleach) should be used where there is implacable opposition to NSP (Needle Syringe Programs). The Centers for Disease Control and Prevention states that bleach should be made available where no other safer options are available. The WHO and UNAIDS also recommend that drug-dependence treatment and methadone maintenance programs be offered in prisons if they are provided in the community, and that needle-exchange programs be considered (Okie, 2007).

The Molecules of Memory

One neurotransmitter that has been strongly implicated in memory is glutamate. This transmitter is found throughout the brain but is most highly concentrated in the cerebral cortex and the hippocampus. Drugs that increase the activity of glutamate facilitate learning and improve memory, while drugs that reduce glutamate activity have the opposite effect. The neu-rotransmitter dopamine has also been implicated in memory formation. In small doses, drugs such as cocaine and amphetamine, which increase dopamine activity, have been found to improve memory in both humans and lower animals. Moderate doses of caffeine can also facilitate memory storage, albeit by a less understood mechanism. Other neurotransmitters believed to be involved in memory include acetylcholine, serotonin, norepinephrine, and the endorphins.

Sleep Terror and Sleepwalking NREM Parasomnias Arousal Disorders

Sleep terrors and sleepwalking are more common in children but may be present in up to a few per cent of the adult population. They are not associated with specific physical findings. Developmental, genetic, psychological, and organic factors can contribute to their occurrence. About one-third of individuals with frequent nightmares have a positive family history, and an association with the HLA haplotype DQB1*05 has been suggested. Sleepwalking can be triggered by fever, stress, sleep deprivation, acute brain disorder (stroke, trauma) and treatment withdrawal from drugs.

Nightmares Posttraumatic Stress Disorder

Nightmares are more common in children and are not associated with specific physical findings. About 10 of individuals with frequent nightmares have family history of nightmares. Nightmares are more common in persons with mental retardation, chronic alcoholism, depression, and central nervous system disease, as well as in association with fever and treatment withdrawal from drugs. Nightmares may result from a severe traumatic event and indicate post-traumatic stress disorder.

Self Help and Peer Delivered Services

This chapter outlines the important contributions that people who have been diagnosed with a psychiatric disability make to their own rehabilitation and the rehabilitation of others. Like the field of alcoholism and drug addiction treatment, there is a long tradition of mutual self-help among persons who have severe mental illnesses. Today, consumers are also moving into professional psychiatric rehabilitation service provider positions in larger numbers. They are involved in operating peer support agencies, participating on

Pathways To Homelessness For The Mentally

The comparisons revealed that the mentally ill homeless are more demo-graphically similar to the non-mentally-ill homeless than they are to mentally ill housed persons. Current alcohol and drug dependence follow a similar pattern. Like the non-mentally-ill homeless, the mentally ill homeless are at very high risk of substance abuse. Homeless subjects have almost twice the prevalence of alcohol dependence and six times the prevalence of drug abuse of housed subjects. These comparisons show that homeless persons, whether or not they are mentally ill, are more likely to be socially disadvantaged (less educated, ethnic minorities) and to have a high likelihood to be currently dependent on alcohol or drugs.

Substance Abuse and Mental Health Statistics

It is difficult to assess the prevalence of mental illness and substance abuse in many correctional systems with any certainty since in many women's prisons there is inadequate screening when inmates arrive making it impossible to determine the severity of some of these problems. A 2001 survey of services found only 72 of jails for women screen for substance abuse, only 70 screen for mental health problems, 60 screen for physical problems, and fewer than 30 screen for math and reading ability, childhood abuse, spousal abuse, or parenting needs. Worse still, only 10 of women prisoners who are drug abusers are offered treatment (BJS, 2000 Richie et al., 2001). Justice Department figures indicate that in 2002, more than two-thirds of female jail inmates were dependent on or abused alcohol or drugs. Inmates who were dependent were more likely to have previous criminal records (Staton et al., 2003). A 1993 study, published in the American Journal of Public Health, reported that 80 of New...

Research and Prevention

Consistent with other studies, Hoberman and Garfinkel found that suicide was related to both age and sex. Males accounted for 80 percent of the suicides, females for only 20 percent. Adolescents aged fifteen to nineteen years composed 91 percent of the sample, with children aged fourteen and under 9 percent. In addition, Hoberman and Garfinkel found that a full 50 percent of the sample showed evidence of one or more psychiatric disorders. Most common were depression and alcohol or drug abuse. Finally, Hoberman and Garfinkel found that a substantial number of the suicide victims had been described as loners, lonely, or withdrawn. Thus, several of the indicators of suicide in adults also are related to suicide in children and adolescents.

Tissue Remodelling

A recent study with methamphetamine users illustrates this point. While illicit stimulants are often used to enhance attention and alertness and generally speed up the thought process, chronic users had a dose-dependent decrease of performance in neuropsychological tests that assess recall, ability to manipulate information, ability to ignore irrelevant information, and abstract thinking 75 . A positron tomography study in methampheta-mine abusers revealed an association of dopamine transporter reduction with psychomotor impairment 76 . A parallel study from the same group of investigators found higher cortical and lower subcortical metabolism in detoxified methamphetamine abusers 77 . These results suggest that, in humans, methamphetamine abuse results in lasting changes in the function of dopamine- and non-dopamine-innervated brain regions. One such molecular switch underlying long-term neural plasticity is DeltaFosB, a transcription factor that has been implicated in drug addiction...

Dacryocystorhinostomy indications

Dacryocystorhinostomy Scar

1-2m of 12-5mm ribbon gauze thoroughly moistened with 2ml of a 10 cocaine solution, this producing very effective intranasal anaesthesia and mucosal vasoconstriction. Using angled nasal forceps, short loops of the ribbon gauze are firmly packed far anteriorly and superiorly within the nasal space - high against the lateral wall of the nose and the anterior aspect of the middle turbinate, at the site of the proposed rhinostomy. Although not essential, the headlight and nasal speculum may aid correct placement of the nasal pack. A regional block of the anterior ethmoidal branch of the nasociliary nerve is given by infiltration of During local anaesthesia, nasal packing with cocaine generally provides sufficient vasoconstriction of the nasal mucosa, although during surgery it can be supplemented by the intramucosal or submucosal injection of a local anaesthetic (such as 2 lidocaine) with 1 200,000 adrenaline. With this technique, intraoperative bleeding tends to be minimal and any oozing...

Role of Transporters in Drug Distribution

In addition to MDR-1 and MRP1, several other blood-brain barrier and choroid plexus transporters have been recognized (98). These include the organic anion-transporting polypeptides (OATP1 and OATP2), organic cation transporters (OCTs), and several additional MRP isoforms. These transporters play roles in uptake and efflux of physiologically important brain chemicals as well as drugs. For example, sodium-independent OATP2 transports some steroids and their conjugates, the amino acids glutamate and aspar-tate, and the peptide Leu-enkephalin, as well as pravastatin, fexofenadine, and digoxin. The potential dependent OCTs on the apical surface of the choroids plexus appear to serve as efflux transporters, taking organic cations from the CSF into the epithelial cell. OCT-3 is expressed at high levels in brain cells and has been shown to transport cimetidine, amphetamine, and methamphetamine, as well as serotonin and dopamine.

Epidemiology and Geographical Distribution

It should be noted that transmission of the infection may result from accidental inoculation of minute amounts of blood or fluid contaminated with blood during medical, surgical and dental procedures immunisation with inadequately sterilised syringes and needles intravenous and percutaneous drug abuse tattooing ear, nose and body piercing acupuncture laboratory accidents and accidental inoculation with razors and similar objects that have been contaminated with blood. Additional factors may be important for the transmission of hepatitis B infection in the tropics these include traditional tattooing and scarification, blood letting, ritual circumcision and repeated biting by blood-sucking arthropod vectors. Investigation of the role that biting insects may play in the spread of hepatitis B has yielded conflicting results. HBsAg has been detected in several species of mosquitoes and in bed bugs that were either trapped in the wild or fed experimentally on infected blood, but no...

An Overview of Female Infertility

Medical Algorithm

A general medical history is imperative in determining other major medical problems affecting a patient's fertility. A patient should be in optimal health prior to initiating fertility therapy. Many common chronic medical conditions such as diabetes mellitus, hypertension and obesity will increase a patient's risk for miscarriage and pregnancy complications. Lastly, taking a social history will identify any habits which may influence a patient's fertility. Tobacco, marijuana, and cocaine use will affect fecundity rates in women as well as men. There is a known dose-response relationship between the number of cigarettes smoked and length of time it takes to achieve pregnancy. Marijuana affects the fertility directly by inhibiting secretion of GnRH in both men and women. Cocaine is also known to decrease spermatogenesis.

Principles of Teratology

This concept developed from Brent's studies of the effects of radiation on the developing embryo and may or may not apply to fetal exposure to chemicals (106). After implantation, during the process of differentiation and embryogenesis, the embryo is very susceptible to teratogens. However, since terato-gens are capable of affecting many organ systems, the pattern of anomalies produced depends on which organ systems are differentiating at the time of ter-atogenic exposure. A difference of one or two days can result in a slightly different pattern of anomalies. After organogenesis, a teratogen can affect the growth of the embryo by producing growth retardation, or by changing the size or function of a specific organ. Of particular interest is the effect of psychoac-tive agents, such as cocaine, crack, or antidepressants, on the developing central nervous system during the second and third trimesters of pregnancy, as these drugs can potentially affect the function and behavior of the...

Differential Diagnosis of Dysthymic Disorder

Alcohol, benzodiazepines and other sedative-hypnotics can mimic dysthymia symptoms, as can chronic use of amphetamines or cocaine. Anabolic steroids, oral contraceptives, methyldopa, beta adrenergic blockers and isotretinoin (Accutane) have also been linked to depressive symptoms. Rule out with careful history of drugs of abuse and medications.

Prospective Memory in Substance Abuse

Overview Over the past decades, there has been an increasing use of recreational drugs in many countries. Cognitive deficits due to the abuse of drugs such as alcohol, MDMA (ecstasy), or cannabis have been well described in various domains (Parrott, 2001 Pope, 2002 B. Rodgers et al., 2005). A considerable number of studies have begun to address whether drug abusers have impaired prospective memory abilities. The hypothesis was tested that prospective memory is disrupted due to the abuse of drugs that have been found to produce deficits in retrospective memory or particularly in executive functioning. There is increasing evidence that long-term abuse of psychoactive drugs such as alcohol, MDMA, or cannabis, and even drugs with relatively weak psychostimulant effects such as nicotine (Heffernan et al., 2005 but cf. Rusted, Trawley, Heath, Kettle, & Walker, 2005) has detrimental effects on everyday prospective memory functioning. Recreational Drugs Another line of research has...

Other Social Programs

It has also been discussed in this report that abstention from drugs, particularly cocaine may play a role in reducing preterm birth. Public health programs such as educational interventions could potentially be used to address these issues. Further, some evidence suggests that healthy diets and exercise may be important. Educational interventions may also be useful in promoting healthy behaviors. As noted above, changes in the built environment of disadvantaged neighborhoods, such as the presence of safe parks and grocery stores, could also potentially reduce the rate of preterm birth by promoting healthy behaviors.

Steroid Hormone Regulation Of Telomerase In The Prostate

2'-O-(2-methoxy ethyl) RNA oligonucleotides have also been studied, producing telomere shortening and eventual total cell killing in LNCaP and DU-145 cells treated in vitro (239,240). Importantly, these effects were reversible after drug withdrawal and were not observed with a control mismatched sequence oligonucleotide. The match oligonucleotide was found to have significant negative effects on cell proliferation, anchorage-independent growth, and colony formation relatively early during treatment. Thus, it should be borne in mind that a strict focus on end points such as complete cell cycle arrest or apoptosis may lead to an underestimate of potentially significant clinical effects from telomerase inhibitors. Antitumor activity was also observed in a xenograft model and combined efficacy with various chemotherapeutic agents was observed in vitro with these oligo-nucleotides, however, this effect was complex, being dependent on the particular agent and cell line used. For example,...

Women of Freudian psychology

Sigmund Freud's words, written to his friend Wilhelm Fleiss (also his cocaine-supplier) in 1895 upon the birth of his daughter Anna show the bias encountered by early female psychologists. From birth, Anna had a poor relationship with her mother and siblings, describing herself as not part of them, but not her famous father. Early in life, Anna became her father's favored child and showed herself to be brilliant. She was self-taught for the most part as she hated school, but availed herself of the many members of the intelligentsia that frequented the Freud household. (In her teens she spoke five languages.) At 14, she wrote to her father I have read some of your books, but you should not be horrified by that, for I am already grown up and so it is no surprise that I am interested. Her father's possessiveness and her total loyalty to him kept her tied to him, and she never strayed very far from his rigid beliefs. Anna taught in England, wrote several books, and together with Melanie...

Functional Assessment of PTSD

A thorough Substance Abuse assessment should be included in the PTSD evaluation. Ruling in or ruling out Substance Disorders will help in all phases of patient interaction, diagnosis, treatment, and follow up. Instruments of particular use are the Addiction Severity Index, the Michigan Alcohol Screening Test, or the Drug Abuse Screening Test.

Effects of Drugs and Natural Reinforcers

Many people commonly take stimulant drugs like nicotine, amphetamine, cocaine, or depressant drugs like morphine or alcohol, all of which affect behavior and are thus said to be psychoactive. The long-term consequences of abusing psychoactive drugs are now well-documented, and it has been hypothesized that some of the behavioral symptoms observed in drug addicts or alcoholics are related to abnormalities in the functioning of the prefrontal regions (Robbins and Everitt, 2002). One experimental demonstration of

History of the Concept of Schizophrenia

Eugene Bleuer

The next dramatic change in understanding schizophrenia came in the 1960's with the discovery of monoamine neurotransmitters, including dopamine, and the discovery that these chemical systems in the brain are strongly affected in opposite ways by psychotogenic drugs, such as cocaine and amphetamine, and antipsychotic drugs, such as chlorpromazine. Carefully conducted twin and adoption studies confirmed the role of genetic factors in schizophrenia and encouraged the search for the mechanism by which genes influenced the risk for developing schizophrenia. In the following decades, evidence that prenatal and perinatal factors are instrumental in the development of schizophrenia has led to the emerging consensus that schizophrenia should be considered from a neurodevelopmental perspective.

Specific Infections Affecting The Eyes In Travellers

Mio Mondo Una Sfera Cristallo

The treatment is either physical removal or oral diethyl carbamazine. Physical removal is easier said than done. It involves the patient waiting in a darkened room until they feel the worm moving around the eye. At that point the clinician instils topical anaesthetic, preferably cocaine, and then makes a grasp for the worm with artery forceps. Then an incision is made in the conjunctiva to remove the worm. This usually involves some degree of skill and experience.

Summary And Future Directions For Research

Among the behavioral and psychosocial factors considered, the one that shows the most consistent evidence of having an adverse impact on the risk of preterm birth is cocaine use. Dietary constituents have been examined to a limited degree, with mixed evidence on the potential

Differential Diagnosis of Obsessive Compulsive Disorder

Substance-Induced Anxiety Disorder or Anxiety Disorder Due to a Medical Condition. Amphetamines, cocaine, caffeine and other symptomatic agents may mimic some of the anxiety symptoms associated with OCD. On rare occasions a brain tumor or temporal lobe epilepsy can manifest with OCD symptoms.

The Implications Of Dual Diagnosis For Community Mental Health Services

In Washington, an integrated programme combining mental health, substance abuse and housing interventions was compared with standard management for homeless individuals with dual diagnosis 122 . There was some evidence of benefit from the integrated programme, with fewer days in institutions, more stable housing and greater improvement in alcohol problems. Differences between the programmes in degree of recovery from drug problems and in changes in psychiatric symptoms, social functioning and quality of life were unremarkable.

Physical Examination

Intranasal cocaine use may cause damaged nasal mucosa. B. IV drug abuse may be associated with injection site scars and bacterial endocarditis. D. Mydriasis (dilated pupils) is often seen in persons under the influence of stimulants or hallucinogens, or in withdrawal from opiates. Miosis (pinpoint pupils) is a classic sign of opioid intoxication.

Drug Discovery in Neuroscience

PET is frequently used to evaluate neuroreceptor ligands. Salazar and Fischman evaluated BMS 181101, a drug with agonist and antagonist activity at various sites in the serotonin system 10 . The 11C labelled form of the drug was used to show that the residence time in the brain was short and, as a result, specific binding could not be determined by external imaging. These studies showed that the drug may have a narrow therapeutic index and may not be suitable for once or twice daily dosage. In this case the drug itself was radiolabelled, but the remaining examples used an established radiotracer with varying concentrations of the potential drug. The main goal of these studies was to measure saturable binding site occupancy. Fowler 11 showed techniques for measuring occupancy for the dopamine transporter (DAT) and for monoamine oxidase B (MAO-B). In the case of dopamine transporter , the occupancy of the dopamine transporter by cocaine was faster than that found by methylphenidate...

Potential Mechanisms of PPROM

The mechanisms by which infection causes PPROM are likely multifactorial. Bacteria may directly secrete proteases that degrade collagen (MacGregor et al., 1987). Some bacterial species produce phospholipase A2, which acts to increase the levels of arachidonic acid, a pros-taglandin precursor (Bejar et al., 1981). PGE2 decreases collagen synthesis in fetal membranes. Prostaglandin increases MMP-1 and MMP-3 levels in fibroblasts. Proinflammatory cytokines such as IL-1 and TNF-a also increase MMP levels and decrease TIMP levels in cultured amnio-cytes (So, 1993). In nonhuman primates, intrauterine infection with group B streptococci stimulates both proinflammatory cytokine and MMP-9 production (Vadillo-Ortega et al., 2002). Reactive oxygen species (ROS) resulting from immune cell signaling may also increase MMP levels and contribute to PPROM (Woods, 2001). Many clinical risk factors for PPROM, such as smoking, vaginal bleeding, cocaine use, and intra-amniotic infection, may also increase...

Behavioral Influences On Preterm Birth

A special interest in behavioral influences on preterm birth is well justified, given that these are subject to change and could reduce the frequency of preterm birth directly. As previously reviewed in some detail (Berkowitz and Papiernik, 1993 Savitz and Pastore, 1999), a large number of observational studies of a range of health behaviors, including tobacco and alcohol use, nutrition, and physical activity, have been conducted. Although each of these behaviors poses specific challenges in discerning cause-and-effect relationships, two key, generic concerns crosscut them all. First, it is a challenge to measure many of these behaviors with accuracy because of their inherent complexity, the inability of individuals to completely recall past behaviors (e.g., diet and physical activity), or the stigma associated with the behavior (e.g., alcohol and illicit drug use). The challenge is especially heightened for women who are pregnant. This inaccurate recall ability is accompanied by the...

Specific Brain Imaging Methods Computed Tomography

Aplicaciones Del Fosforo

The first systematic application of the CT technique in psychiatric research was made by Johnstone et al. 4 , These authors demonstrated unequivocally the occurrence of wide ventricles, wide cortical sulci and reduced size of cortical gyri in patients with schizophrenia as compared to healthy control subjects. Since then many studies have replicated these findings, and recent meta-analyses of studies in schizophrenic patients demonstrate a high consistency in this regard 5 . Alterations of the attenuation property of brain tissue and a reduced volume of specific neocortical and cerebellar regions in schizophrenia have also been reported in studies using the CT technique 6-9 . However, similar changes are often observed in pre-senile and senile dementia as well as in many cases of affective disorders, chronic alcoholism and drug abuse. Brain morphology as examined by CT also varies considerably with regard to the age of the patient and other individual factors. For this reason, all CT...

Limbic System and Emotions

Neurotransmitters such as serotonin and dopamine are believed to play roles in these behaviors. The effects of recreational drugs on behaviors and emotions may in part be due to the similarity of action between these drugs and neurotransmitters. For example, the high associated with amphetamine use or abuse may result from stimulation of these neurotransmitters. Cocaine blocks the movement of dopamine, resulting in the continual activation of neurons which use dopamine as a neurotransmitter. The addiction associated with cocaine results from alterations in the affected neurons, resulting in an increase in need for stimulation by these pathways.

Why Do Some Develop PTSD and Some Do

An interesting question has been researched asking whether having a preexisting mental disorder increases one's risk for exposure to traumatic stressors or events. Research has shown that someone with a prior history of major depression and illicit drug use is at a higher risk for exposure to traumatic stressors.

Timing of Mutagenicity Fertility and Teratogenicity Testing

Volunteer dose-ranging studies will, by design, include high enough doses to provoke unpleasant adverse effects also, information on 'target organs' (organs likely to be most affected or harmed) is usually predictable but unconfirmed at this point. Generally, as a result of animal studies, it is thought that the effect of drugs on reproductive function in males is less than that in females and only affects the sperm viability or, rarely, the size and function of the testicles, which is usually reversible. This is unduly optimistic, as one report by Yazigi et al (1991) suggests that spermatozoa may not be immobilized or destroyed by cocaine, but may interact, and the spermatozoa themselves have

Behavioral and Social Emotional Problems

Adolescents and adults born preterm are less likely to demonstrate risk-taking behaviors than controls who were born full term. A recent study of young adults born from 1980 to 1983 in Britain found that fewer of those born with birth weights less than 1,500 grams than controls born full term drank alcohol or used illicit drugs, but there were no differences in the rates of smoking or sexual activity (Cooke, 2004). In the United States, young adults with birth weights less than 1,500 grams reported lower rates of alcohol and illicit drug use than controls with normal birth weights, but the two groups showed similar rates of tobacco use (57 and 50 percent of the men, respectively, and 40 and 48 percent of the women, respectively) (Hack et al., 2002). The men in the sample were also less likely to violate the law (37 and 52 percent, respectively), and this was primarily due to the lower rates of illicit drug use and truancy. The women were less likely to have had intercourse by age 20...

Dual Diagnosis

The term dual diagnosis refers to the presence of two coexisting conditions. The two dual diagnoses most often encountered in PsyR services are mental illness and substance abuse (i.e., drug or alcohol) and mental illness and developmental disability. In both cases, the presence of a dual diagnosis has historically been a complicating factor in receiving adequate and appropriate services. Mental health providers often knew little about drug abuse or developmental disability and may have either declined to provide services to someone with a dual diagnosis or provided mental health services without addressing the coexisting disability. Similarly, substance abuse service providers and developmental disability service providers often either addressed only the issues with which they were familiar or declined to provide services altogether. Recently the presence of coexisting conditions, and the ways in which those conditions affect each other, have received greater attention.

Screening

Drug dependence requires the same thorough evaluation by both a psychiatrist and an addictions specialist. Data are emerging to support the hypotheses that patients with polysubstance abuse are at higher risk to return to substance use than those who abuse only alcohol. Although current drug dependence is usually considered a contraindication to transplantation, methadone-dependent patients in a standing methadone maintenance program have been successfully transplanted several times in our program. The transplant program should be in close contact with the methadone program and look for patient compliance with the program's treatment plan and a stable relationship with the counselor. Dependence on prescription drugs poses a difficult challenge. The prognosis is improved if the patient maintains a good relationship with one physician, does not develop tolerance, and is on a minimum of medications. 2. Positive drug screen for nonprescribed controlled substances including cocaine)...

Intranasal

The absorptive capacity of the nasal mucosa has been known for centuries. Even if unexploited by pharmaceutical scientists, the abuse of cocaine (including by primitive peoples), and nicotine (snuff) has routinely used this route of administration for systemic delivery. Vast annual tonnages of anti-allergy and decongestant drugs are now administered to the noses of the developed world. These are intended to treat local symptoms, and avoidance of systemic absorption is a favourable feature. a-Adrenergic agonists, antihistamines, and steroids probably lead the list for this topical route of administration.

Race and Ethnicity

Although cocaine use is more common among socioeconomically disadvantaged women and is associated with preterm birth, it has a small etiological effect on preterm birth and thus is unlikely to be an important mediator. In poor, inner-city areas in the United States, however, the prevalence of cocaine use may be high, and in these settings, the mediating role of cocaine use is likely to be more important. Marijuana, alcohol, and narcotic use are also more common among

Attachment

Amphetamine and cocaine induce excitement and anxiety, arousing expectations and satisfaction-seeking, while the opiates induce feelings of satiety and weaken attachment. Lactate injected into the locus coeruleus, which produces 60 of the brain's noradrenaline, can induce a panic attack in predisposed subjects 7 . A benzodiazepine or selective serotonin re-uptake inhibitor (SSRI) injected into the amygdala reduces the manifestations of anxiety. The benzodiazepines and imidazopyridine act promptly on free anxiety, promoting GABAergic inhibitory action. Tricyclic antidepressants, anti-MAO agents, and SSRI relieve the symptoms of other forms of anxiety, increasing the availability of monoamines and serotonin 4 .

Background

Drug abuse and control amendments were enacted in 1965 in response to abuse of depressants, stimulants and hallucinogens. In 1966 the FDA, in cooperation with the National Academy of Sciences and the National Research Council, began an evaluation of the effectiveness of approximately 4000 drugs that had been approved between 1938 and 1962 on the basis of safety alone. The Fair Packaging and Labeling Act was passed in the same year and required true and informative labeling for all consumer products involved in interstate commerce. A review of the safety and effectiveness of over-the-counter drugs sold without prescription began in 1972, and was followed 10 years later by FDA-mandated tamper-resistant packaging regulations, in reaction to reports of deaths from Tylenol capsules laced with cyanide.

Group Composition

Cognitive impairments, mental illness, and drug addiction. Members were also diverse by nature of socioeconomic conditions, age, and gender. Participants had the commonalities of being African American, consumers of RSA, of working age (primarily under 55), and unemployed at the time of initiation. All participants also had the potential to become employable. In spite of diverse backgrounds, group members came together and worked cohesively as a group.

Prior Abuse

Girls are more likely to be abused if they grow up in foster care than if they live with at least one parent. They are twice as likely to have been abused if they grew up in a family where there is drug abuse, and a third more likely to be abused if a member of the family was incarcerated. Childhood sexual abuse has been linked to a variety of high-risk behaviors, including unprotected sex with multiple partners and sharing needles. Those who have been abused are more likely to exhibit these behaviors. Neglected children who grow up with little supervision are less likely to learn coping skills. They are less likely to learn to plan. They are more likely to turn to prostitution than girls who have not been abused, and are younger at their first incarceration (Mullings, Marquart, & Hartley, 2003).

Eclampsia

The differential diagnosis of seizure activity in pregnancy is extensive and includes epilepsy, systemic lupus erythematosus, acute fatty liver of pregnancy (hepatic encephalopathy), thrombotic thrombocytopenic purpura, amniotic fluid embo-lus, cerebral venous thrombosis, herpes encephalitis, malaria and cocaine intoxication (Clark et al., 1995 Hauser and Kurland, 1975 Towers et al., 1993). Late postpartum eclampsia (seizures first developing between 48 h and 4 weeks after delivery) require neuroradiological investigation to exclude alternative diagnoses (Douglas and Redman, 1994 Lubarsky etal., 1994 Tetzschner andFelding, 1994).

Medical Problems

Access to health services is strained in our society in general, in prisons in particular, and in women's prisons most of all. Despite their rapidly growing numbers, women are still a small percentage of the prison population, and for that reason it has sometimes been considered less cost-effective to provide care for drug abuse and addiction, mental health issues, and counseling for trauma and posttraumatic stress disorder for incarcerated females (Teplin et al., 1997 Zaitzow, 2001). While these are issues for both men and women, they become gender specific, or perhaps more accurately gender critical, because without successful treatment and reentry programs women will have little choice but to return to a cycle of drug addiction, crime, and or the sex trade.

Withdrawal

Major categories include alcohol sedatives hypnotics nicotine marijuana opioids, such as heroin stimulants, including amphetamines, cocaine, crack, and caffeine inhalants, such as glue, paint, nitrous oxide (laughing gas), and shoe polish hallucinogens, including phencyclidine (PCP or angel dust ), LSD ( acid ), MDMA (an amphetamine-like drug with hallucinogenic effects, also known as X or ecstasy) anabolic steroids and even some types of prescription drugs, such as Valium. When diagnoses are given for substance use disorders, diagnoses should be given in terms of a specific type of substance. A diagnosis of substance abuse would be too general because it does not specify the substance causing the problem. Having problems with one substance does not automatically mean that a person has problems with all substances. Thus, any diagnosis for a substance use disorder should be substance-specific examples might include alcohol abuse, inhalant abuse,...

Future Possibilities

In psychology, the systemic and popular study of substance use became most extensive as the field of pharmacology blossomed and access to substances of abuse increased. The creation of the National Institute of Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse helped to fuel research in this area in the 1970's and later. During the 1980's and 1990's, there was an increase in exploration of the biological mechanisms underlying substance use disorders and the possibility that pharmacological interventions might be useful to prevent and treat substance use disorders. The 1990's also brought an increase in awareness among the research and clinical communities that attention to specific demographic characteristics, such as age, gender, and ethnicity, was also important for understanding the etiology, pre

Primate research

Today, the Yerkes laboratory is one of eight National Primate Research Centers funded by the National Institutes of Health. The goal of these centers is to establish nonhuman primate models of human health and disease for biomedical research. All of the current centers are affiliated with academic institutions. They are devoted to primate research related to major human diseases, such as AIDS, cancer, Alzheimer's disease, Parkinson's disease, and cardiovascular disease. At the Yerkes National Primate Research Center, current research interests include aging, AIDS, drug addiction, malaria, Parkinson's disease, transplantation, and vision disorders. They also include primate evolution and social behavior two subjects that have long been at the core of comparative psychology.

Other Conditions

(Buckley et al., 1995) and alcohol-related diseases (Sullivan and Hefferbaum, 2001 Park et al., 2001). The majority relied on only qualitative assessment however, where quantitation was performed, increased sensitivity was demonstrated. In a study of central pontine T2 relaxation times in patients with alcoholic Korsakoff's syndrome and asymptomatic alcoholic patients, prolonged T2 values were detected in more patients with Korsakoff's syndrome than was apparent from visual assessment. Furthermore, in asymptomatic patients, T2 values increased with advancing patient age a trend not observed in control subjects (Sullivan and Pfeffesbaum, 2001). Using a semiquantitative visual rating scale, Bartzokis et al. (1999) demonstrated a similar effect in cocaine-dependent patients. The relationship of age and risk of WMH among cocaine-dependent patients was similar to that in control subjects, but was seen approximately 20 years earlier, suggesting that cocaine-dependent patients had a...

Cytotoxic damage

The zone of the liver damaged may depend on the mechanism, but may also be the result of the microcirculation. Damage may be zonal, diffuse or massive. For example, cocaine and allyl alcohol cause zone 1 (periportal) necrosis. With allyl alcohol this is partly as a result of the presence of alcohol dehydrogenase and partly because this is the first area exposed to the compound in the blood. Conversely, carbon tetrachloride, bromobenzene and paracetamol cause zone 3 (centrilobular) necrosis as a result of metabolic activation occurring primarily in that region (see Chapter 7). Midzonal, zone 2 necrosis is less common, but has been described for the natural product ngaione and beryllium. Galactosamine causes diffuse hepatic necrosis (see Chapter 7), presumably because it interferes with a metabolic pathway which occurs in all regions of the liver lobule. The explosive trinitrotoluene (TNT) can cause massive liver necrosis.

Rogers Story

Of the time in school he seemed gloomy and withdrawn. When he did emerge from this withdrawn state, he was animated and loud, arguing with his foster parents, teachers, and fellow students. During these arguments he frequently became physically aggressive, slamming doors, plates, textbooks, even punching or kicking holes in walls. He hardly slept at all during these periods. His classmates thought he was weird and dangerous. His teachers routinely kicked him out of the classroom for his behavior until finally he ended up in a special school for kids who are emotionally disturbed. Here, he found other kids he thought were as weird as he was. He learned how to cope with his mood swings cocaine when he needed to perk up, pot when he needed to calm down, and alcohol when he couldn't get anything else.

Death vs Immortality

While old age is approached gradually, without any specific physiologic markers of its onset, death is the terminal event that ends life. In broad terms, causes of death may be classified as trauma, accidents, and disease (Chapters 2 and 3). Trauma and accidents (e.g., high-speed vehicle crashes, dangerous occupations, drug abuse, cigarette smoking) are the major causes of

Biochemical Studies

Further evidence comes from a condition called amphetamine psychosis, which occurs in people who abuse amphetamine and similar stimulants such as cocaine. Amphetamine psychosis so closely mimics some forms of schizophrenia that misdiagnoses have been common. Furthermore, amphetamine psychosis is not an artifact of disturbed personality experiments show that normal control subjects will develop the condition if they are given high doses of amphetamines every few hours for several days. Amphetamine psychosis, which is believed to result from the overactivation of dopamine systems in the brain, is treated with antipsychotic drugs such as chlorpromazine.

Types of Dementia

Risk factors for dementia include a family history of dementia, head trauma, lower educational level, and gender (women are more prone than men to dementia). Alcohol and drug abuse, infections, cardiovascular disease, and head injuries are also causes for the development of dementia.

Burden of Illness

As a result of poverty and drug abuse, prisoners have a uniquely high prevalence of communicable disease, including HIV AIDS, tuberculosis, sexually transmitted diseases, and viral hepatitis B and C (NCCHC, 2002) owing in part to their drug abuse. As a result of their poverty, inmates have high rates of mental illness and chronic diseases, such as asthma, diabetes, and hypertension. Drug addiction, poor access to health care, poverty, substandard nutrition, poor housing conditions and homelessness contribute to increased morbidity from these and other debilitating conditions.

Cluster B

Tive and negative feelings about significant people in their lives. This behavior is referred to as splitting and may contribute to the emotional instability displayed by these people. People with BPD often engage in self-destructive behavior, such as self-mutilation, suicidal acts, or drug abuse. Those with BPD report chronic feelings of emptiness.

Underlying Factors

Does classical conditioning account for any human behaviors At first glance, these processes might seem a bit simplistic to account for human behaviors. However, some common human reactions are quite obviously the result of conditioning. For instance, nearly everyone who has had a cavity filled will cringe at the sound of a dentist's drill, because the sound of the drill (CS) has been paired in the pastwith the unpleasant experience of having one's teeth drilled (US). Cringing at the sound of the drill would be a conditioned response (CR). Psychologists have found evidence implicating classical conditioning in a variety of important human behaviors, from the emotional effects of advertising to the functioning of the immune system to the development of tolerance in drug addiction.

Encephalopathy

Between 30 and 70 of decompensated cirrhotics will have some degree of clinically obvious encephalopathy, which can range from subtle neurologic dysfunction to frank coma. The onset of encephalopathy requires a rigorous approach to identify and correct potential precipitants, as indicated in Figure 3.2 and Table 3.4. Serum electrolytes, blood urea nitrogen, and serum creatinine should be obtained, as well as a complete blood count to look for evidence of sepsis or blood loss. A urine toxicology test should be performed if there is clinical suspicion of illicit drug use, and ascites, if present, should be tapped to exclude SBP. Failure to respond to therapy within 48 hours should prompt a search for alternative mechanisms of intractable encephalopathy, such as portal vein thrombosis or occult hepatocellular carcinoma. Use of TIPS can lead to severe encephalopathy.

Psychotropic

This psychotherapeutic drug revolution has had some negative consequences, however. Drug side effects range from the annoying to the life threatening. Community mental health treatment centers have not grown in number or received funding sufficient to meet the needs of all the patients released from long-term care facilities. Many mentally ill patients have fallen through the cracks of community-based care and live on the streets or in shelters for the homeless. In addition, some physicians and patients have come to expect a pill for every ill and fail to use other, equally or more effective treatment methodologies. Researchers estimate that 15 percent of the population of the United States receives a prescription for a psychotropic drug each year, greatly adding to the nation's health care costs. The majority of these prescriptions are written by generalist physicians rather than by psychiatrists, raising concerns about excessive or inappropriate prescribing. Some people abuse these...

Brain Chemistry

Some of the pharmacological effects of very different drugs are quite similar. Marijuana and alcohol affect at least three of the same brain biochemical systems. Alcohol can become a form of opiate in the brain following some specific chemical transformations. These similarities raise an old and continuing question in the substance use field Is there a fundamental addictive mechanism common to everyone that differs only in the level and nature of expression Older theories of drug-abuse behavior approached this question by postulating the addictive personality, a type of person who would become indiscriminately addicted as a result of his or her personal and social history. With advances in neuroscience have come theories concerning the possibility of an addictive brain, which refers to a neurological status that requires continued adjustment provided by drugs.

Possible Causes

Smoking during pregnancy, use of certain drugs such as cocaine or heroin, poor maternal nutrition, and extremes of maternal age greatly increase the chances of fetal brain damage or premature delivery and low birth weight. Babies with low birth weights are three times more likely than normal-weight babies to have developmental disabilities. Approximately 61 percent of premature infants have a developmental disability of some kind.

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