{"title":"Clinical implications of urinary drug screens","authors":"Michael F. Barber (PharmD)","doi":"10.1016/S1082-7579(97)00061-7","DOIUrl":"10.1016/S1082-7579(97)00061-7","url":null,"abstract":"<div><p>Urine drug screens are routinely used in the substance abuse treatment setting along with other clinical settings when illicit drug use is suspected. With the importance placed on the results of urine drug screens, clinicians should be aware of the strengths and weaknesses of the tests involved when interpreting the results. Such interpretation is quite complicated and depends on a large number of variables. It is incumbent on the clinician to be aware of what methodology is used by the lab, which cross-reactivities may occur with the methodology used, and what changes occur in the procedure. Clinicians should also consider the clinical presentation of a patient when interpreting positive results to avoid frustration and mistrust in lieu of the desired therapeutic alliance between the patient and clinician. When there is doubt about the results, confirmation may be used in certain cases to help clarify the situation. Since the implications of positive drug screens have an impact on patient treatment, diagnosis, and possibly the status of health care benefits, great care should be taken to avoid misinterpretation of drug screens.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Pages 150-153"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00061-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77539270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MD Joaquin Brieva, MD Gary A. McCracken, MD Beth Diamond
{"title":"Update and treatment of acne vulgaris","authors":"MD Joaquin Brieva, MD Gary A. McCracken, MD Beth Diamond","doi":"10.1016/S1082-7579(97)00066-6","DOIUrl":"10.1016/S1082-7579(97)00066-6","url":null,"abstract":"<div><p>Acne vulgaris is the most common cutaneous disorder seen by dermatologists. Nearly 85% of adolescents will be affected by acne in some degree. Although considered a disorder seen only in teenagers, this condition also affects neonates, prepubescent children, and adults. At least one-third of adult females may develop acne. Most cases are seen by primary care physicians with only a small number referred to skin specialists. It is important not to underestimate the negative emotional, psychosocial impact, and overall quality of life that acne can have on individuals. This paper will review the pathogenesis, clinical aspects, and treatment of this commonly encountered skin condition. Some new topical treatments recently approved for use in acne vulgaris will also be discussed.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Pages 161-163"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00066-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88975073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Subject index for volume 2","authors":"","doi":"10.1016/S1082-7579(97)00093-9","DOIUrl":"https://doi.org/10.1016/S1082-7579(97)00093-9","url":null,"abstract":"","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Pages 182-185"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00093-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137228618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The patient with anemia","authors":"MD, FACP Fred Rosner , MD, FACP Hans W Grünwald","doi":"10.1016/S1082-7579(97)00060-5","DOIUrl":"10.1016/S1082-7579(97)00060-5","url":null,"abstract":"<div><p>Anemia is not a diagnosis but usually a sign of a systemic illness. The clinical manifestations of anemia depend on its rate of development and severity. This paper presents a simple pathophysiologic classification of the various types of anemia based on the patient's medical history, physical findings, peripheral blood morphology, and signs of bone marrow activity as reflected in the blood count and indices, blood smear, and the reticulocyte count. Basic guidelines for the management of various types of anemia are readily derived from this simple classification of the anemias.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Pages 177-180"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00060-5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76231510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
MSW, LCSW Laurie A. Peschke , MSW, LCSW Marianne K. Squiller , MA, LCPC Dianna W. Bolen
{"title":"Fallen prey: flunitrazepam and GHB drugging","authors":"MSW, LCSW Laurie A. Peschke , MSW, LCSW Marianne K. Squiller , MA, LCPC Dianna W. Bolen","doi":"10.1016/S1082-7579(97)00065-4","DOIUrl":"10.1016/S1082-7579(97)00065-4","url":null,"abstract":"<div><p>An increasing number of patients are presenting to emergency rooms as a result of physical and emotional trauma associated with drug-induced rape. Flunitrazepam and gamma hydroxybutyrate (GHB) have become the drugs of choice as a means of inducing altered states of consciousness in unsuspecting victims. This article briefly describes the manner of covert drug administration, drug effects and medical treatment. Additionally, this article provides valuable information about the psychological issues that are commonly associated with this type of rape trauma. This information is especially important since the presentation of a drug-induced-rape victims is frequently misunderstood and as a result the treatment rendered is either inadequate or harmful. Guidelines are provided to reduce the likelihood of secondary trauma to the rape victim associated with the responses of well-meaning but poorly informed medical professionals.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Pages 169-171"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00065-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81101220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Carcinoma of the prostate","authors":"MD Theodore T. Wagner, MD Robert R. Bahnson","doi":"10.1016/S1082-7579(97)00064-2","DOIUrl":"10.1016/S1082-7579(97)00064-2","url":null,"abstract":"","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Pages 164-168"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00064-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76994812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"About this issue","authors":"MD Nada L. Stotland (Editor-in-Chief)","doi":"10.1016/S1082-7579(97)00085-X","DOIUrl":"https://doi.org/10.1016/S1082-7579(97)00085-X","url":null,"abstract":"","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 6","pages":"Page 149"},"PeriodicalIF":0.0,"publicationDate":"1997-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00085-X","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137228620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
PharmD Todd S. Krueger (Pharmacy Practice Resident) , PharmD Patricia Marken (Assoc. Professor of Pharmacy Practice and Psychiatry)
{"title":"A review of sexually transmitted diseases for the psychiatric practitioner","authors":"PharmD Todd S. Krueger (Pharmacy Practice Resident) , PharmD Patricia Marken (Assoc. Professor of Pharmacy Practice and Psychiatry)","doi":"10.1016/S1082-7579(97)00044-7","DOIUrl":"10.1016/S1082-7579(97)00044-7","url":null,"abstract":"<div><p>Sexually transmitted diseases (STDs), including gonorrhea, chlamydia, syphilis, trichomoniasis, and bacterial vaginosis are a significant concern in patients with mental illnesses. In 1993, the Centers for Disease Control and Prevention (CDC) published recommendations for the treatment of STDs. Patients with gonococcal infections should be treated with a single-dose of ceftriaxone. In addition, patients with gonorrhea should be treated with a single dose of azithromycin for suspected chlamydial infections. In each of the four stages of syphilis, the CDC recommends treatment with penicillin, with differences in the frequency and duration of the regimen. In patients who are positive for infection with Trichomonas vaginalis, the CDC recommends a single dose of metronidazole. Patients with bacterial vaginosis should also be treated with metronidazole, but for a period of 7 days. Because some patients with mental illness may not have adequate access to regular medical care, the psychiatric clinician needs to have knowledge of diagnosis and treatment of the more common STDs that are likely to infect their patients.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 5","pages":"Pages 145-148"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00044-7","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75727512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DO Janet Eng, MD, FACP, FACEP Jerrold B. Leikin, MD, FACEP Paul K. Hanashiro, DO Steve Aks
{"title":"Approach to the cardiac effects of beta blocker and calcium channel blocker overdose","authors":"DO Janet Eng, MD, FACP, FACEP Jerrold B. Leikin, MD, FACEP Paul K. Hanashiro, DO Steve Aks","doi":"10.1016/S1082-7579(97)00041-1","DOIUrl":"10.1016/S1082-7579(97)00041-1","url":null,"abstract":"<div><p>Beta adrenergic blocking agents and calcium channel blockers are two of the most frequently used cardiac/antihypertensive medications that can be quite lethal in an overdose setting. Glucagon should be considered in the treatment of both agents, although calcium therapy alone has met with variable success in calcium channel blocker overdose. These drug overdoses should be managed in the intensive care unit.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 5","pages":"Pages 121-129"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00041-1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77920593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
W. Victor, MD R. Vieweg, PhD Linda M. Dougherty, MD Christopher S. Nicholson
{"title":"Mental stress and the cardiovascular system part II: Acute mental stress and cardiovascular disease","authors":"W. Victor, MD R. Vieweg, PhD Linda M. Dougherty, MD Christopher S. Nicholson","doi":"10.1016/S1082-7579(97)00045-9","DOIUrl":"10.1016/S1082-7579(97)00045-9","url":null,"abstract":"<div><p>As in normal subjects, acute mental stress increases blood pressure measurements (sometimes to hypertensive levels) in subjects with cardiovascular disease. We found examples in the literature of acute mental stress increasing peripheral vascular resistance (as in isometric exercise) in patients with cardiovascular disease. We did not, however, find examples of acute mental stress decreasing peripheral vascular resistance (as in isotonic exercise) in subjects with cardiovascular disease.</p><p>Acute mental stress commonly increases heart rate in subjects with cardiovascular disease. Angina pectoris or other evidence of ischemia may accompany this increase in heart rate. Acute mental stress may alter cardiac electrical stability and lead to arrhythmias—some life-threatening.</p><p>Acute mental stress may provoke coronary artery vasoconstriction, reduce left ventricular ejection fraction, or induce or exacerbate left ventricular wall motion abnormalities in subjects with cardiovascular disease. In particular, anger among subjects with cardiovascular disease may leave them vulnerable to cardiac complications.</p></div>","PeriodicalId":100909,"journal":{"name":"Medical Update for Psychiatrists","volume":"2 5","pages":"Pages 130-133"},"PeriodicalIF":0.0,"publicationDate":"1997-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/S1082-7579(97)00045-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81239092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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