You're the Flight Surgeon.

Levy B. You're the flight surgeon: alcohol-induced psychosis. Aerosp Med Hum Perform. 2018; 89(10):933-935.

A Simplified Protocol for the Treatment of Alcohol Withdrawal.

OBJECTIVES: The aim of the study was to evaluate a novel simplified tool for symptom-triggered treatment of alcohol withdrawal. METHODS: This retrospective cohort study involved inpatients in a county hospital with an International Classification of Diseases, Ninth Revision, Clinical Modification discharge diagnosis of alcohol withdrawal syndrome (AWS) or delirium tremens between January 1, 2007 and December 31, 2008. The study used the Highland Alcohol Withdrawal Protocol (HAWP)-a simplified derivative of the Revised Clinical Institute Withdrawal Assessment for Alcohol. Multivariable regression analysis was performed to compare severity of withdrawal to hospital length of stay, total dose of sedative given, and risk of complications. RESULTS: The study identified 442 patients with a primary diagnosis of AWS or delirium tremens, and those with another primary medical diagnosis complicated by alcohol withdrawal. After adjusting for demographic variables, each one-point increase in the initial and maximum HAWP scores correlated with an increase in the hospital length of stay of 0.3 days [95% confidence interval (95% CI), 0.17 to 0.43 days] and 0.45 days (95% CI, 0.32-0.57 days), and a 15.8 mg (95% CI, 6.6-25.1 mg) and 19.8 mg (95% CI, 11.1-28.5 mg) increase in the total dose of lorazepam given, respectively. The complication rate of seizures, intubations, pneumonia, and death was 13.1%, 12.9%, 6.1% and 0.9%, respectively; a composite endpoint of these outcomes also correlated with initial and maximum HAWP scores (odds ratio 1.09, 95% CI, 1.03%-1.14%). CONCLUSIONS: The HAWP correlates with medication received and complications, and as such appears to give an indication of AWS severity. It is feasible and shorter than prior scales, and merits further study to confirm its effectiveness as part of symptom-triggered protocols to manage alcohol withdrawal in the hospital.

[Gamma-hydroxybutyric acid (GHB): more than a date rape drug, a potentially addictive drug]. / Acide gamma-hydroxy-butyrique (GHB): plus qu'un agent de soumission chimique, une véritable source d'addiction.

According to available information, GHB and its precursors--gamma-butyrolactone (GBL) and 1,4-butanediol (1,4BD)--are used especially in a nightlife scene characterized by the search for amplified sensations through the combination of electronic music, marathon dancing, and substance abuse. Evidence indicates that GHB/GHL is used particularly in some subpopulations and in places, such as in gay nightclubs. Commonly known as Gorliquid ecstasy, it was misused in the 1980s for its bodybuilding effects and in the 1990s as a recreational drug at music venues. In the same period, media coverage of the use of GHB in sexual assault (often referred to as date rape) brought the drug into the spotlight. GHB/GHL addiction is a recognized clinical entity evidenced by severe withdrawal symptoms when the drug is abruptly discontinued after regular or chronic use. There is evidence that negative health and social consequences may occur in recreational and chronic users. Nonfatal overdoses and deaths related to GHB have been reported. These undesirable effects and especially the deaths appear to have prompted campaigns to limit the use of GHB. Clinicians must also be aware of GBL, which is being sold and used as a substitute for GHB.

Representación Social atribuidas al uso del alcohol en el Municipio de Villa Ojo de Agua / social representation attributed to alcohol use in the municipality of Villa Ojo de Agua

Se trata de un estudio cualitativo, centrado en develar las representaciones asociadas al uso del alcohol en el Municipio de Villa Ojo de Agua. Para el trabajo de campo se utilizó una metodología grupal, formándose 3 grupos, los cuales a partir de dos interrogantes planteadas ¿Por qué?, y ¿Para qué usamos el alcohol? pudieron manifestar lo subyacente en las relaciones establecidas con este. Se encontraron muchas similitudes entre los tres grupos, que corresponden a un indicador diagnostico de realidad, como así también de población. El pensamiento y método de análisis utilizado para las representaciones es el Dialectico. De los resultados podemos inferir que las representaciones manifiestan que los límites son indispensables para poder usar el alcohol en medida, y que la función del padre en esto es indispensable. La cultura con sus costumbres y mitos instituyen comportamientos, donde el sujeto no puede pensar lo que quiere, sino lo que la cultura ofrece como construcción simbólica sobre el alcohol. De dichas construcciones se observa que a los sujetos les han convencido de que este talismán, tiene innumerables aplicaciones para una amplia gama de situaciones, estados de ánimos, problemas económicos, etc. La realidad social develada en el trabajo es perversa, en tanto lo normal del uso como abuso, se ha consensuado como natural. Estamos en condiciones de suponer que el alcohol se ha construido de este modo, por que sirve como medio de coerción y control social, ya que un sujeto confundido, obnubilado, borracho, es más fácil de manipular.

[The validation of the expediency of using pimozide in treating the hypomania syndrome of alcoholic origin]. / Obhruntuvannia dotsil'nosti zastosuvannia pimozydu v likuvanni hipomaniakal'noho syndromu alkohol'noho pokhozhdennia.

In a clinical and psychopathological study of alcohol-dependent patients presenting with emotional disturbances and hypomaniac syndrome, expediency was shown of use of a neuroleptic drug preparation pimozide in the treatment of hypomaniac syndrome of alcohol genesis.

["Folie a deux hallucinatoire"--a new case of induced hallucinatory psychosis. A new entity?]. / "Folie a deux hallucinatoire"--indukált hallucinózis újabb esete. Uj entitás?

The authors in their case report show a case of induced hallucinatory psychosis induced in a wife of a patient with alcoholic hallucinosis. They deal with the nosological position of "folie a deux hallucinatoire" (induced hallucinatory psychosis) and integrate the consequences of the case to the general psychopathological theory of hallucinations.

[Acute intestinal infections and chronic alcoholism]. / Ostrye kishechnye infektsii i khronicheskii alkogolizm.

153 chronic alcoholics were given treatment against food poisoning. 55 of them developed withdrawal syndrome, 98 had alcoholic psychosis including 88 with delirium tremens. The acute intestinal infection in these alcoholics was managed with rehydration using polyionic crystalloid solutions under controlled diuresis. Previous relief of central excitation contributed much to a positive treatment outcome.

[Pellagra--a forgotten disease]. / Pellagra--egy elfelejtett betegség.

In the civilized world the traditional causes of pellagra such as hunger, malnutrition are disappeared, but the disease has not disappeared after all. In the well developed countries the current etiologic causes are the following: alcoholism, psychiatric disorders, diseases causing cachexy, malabsorption and some drugs. In the case reported by the authors the malnutrition, accompanying the chronic alcoholism was the cause of the diarrhoea, dementia and dermatitis. The correct diagnosis was established after four years of repeated psychiatrical and medical treatment.

[Value of serum immunoglobulin assays in early myocardial infarction]. / Intérêt du dosage des immunoglobulines sériques lors de l'installation d'un infarctus du myocarde.

Serum immunoglobulin (Ig) levels were assayed in 672 patients admitted for acute myocardial infarction with onset within 24 hours of hospitalization. Supranormal Ig levels (A > or = 300, G > or = 1,200) or subnormal Ig levels (M < 40 mg/100 ml) were seen in patients with one or several risk factors (diabetes mellitus, alcohol abuse) or a history of previous myocardial infarction. Patients with one or more Ig anomalies were more likely to exhibit unfavorable outcomes, including early death, suggesting that increased viscosity due to aggregation of Ig molecules may occur.

[Therapeutic effects of tianeptine in patients with depression and anxiety disorders with or without associated alcoholism]. / Effets thérapeutiques de la tianeptine chez des patients déprimés et anxieux avec ou sans alcoolisme associé.

Tianeptine is a new tricyclic antidepressant. Double blind studies comparing tianeptine with imipramine and amitriptyline have shown the effectiveness of tianeptine's antidepressor action, its properties of non-specific symptoms related to behaviour disorders (anxiety, inhibition ...) and its action on somatic complaints expressed by depressed patients. Tianeptine is an effective antidepressant in cases of depression with anxiety or alcoholism and also leads to good therapeutic response in cases of dysthemia. In depressions with melancholy and endogenous criteria, the expected percentage of responding patients has been observed with tianeptine. A reinforcement of the therapeutic effect has been demonstrated after 6 months of treatment. Its excellent clinical and parclinical acceptability, especially in long term treatment of patients at risk such as elderly depressed patients or alcoholic patients, makes tianeptine a first intention antidepressant.

[Malignant neuroleptic syndrome associated with myocardial infarction, acute renal insufficiency and rhabdomyolysis]. / Síndrome neuroléptico maligno asociado a infarto de miocardio, insuficiencia renal aguda y rabdomiólisis.

We present a case of malignant neuroleptic syndrome in a 55 years old male diagnosed 3 years ago of alcoholic paranoid psychosis who was chronically treated with haloperidol, clothiapine, and phenobarbital. Twenty one days after neuroleptic drug withdrawal the patient was admitted to the recovery room because of hyperthermia (40.2 degrees C), left basal pneumonia, acute respiratory insufficiency, extrapyramidal rigidity, mutism, dysarthria, deep coma, hypotension, and tachycardia. Two days after he presented massive rhabdomyolysis, atrial flutter with hemodynamic deterioration which reverted to sinus rhythm and acute anterolateral and inferior myocardial infarction documented by enzyme rise and electrocardiographic alterations. Rhabdomyolysis and myocardial infarction were the precipitating factors of the renal insufficiency. A malignant neuroleptic syndrome was suspected and intravenous treatment with dantrolene sodium 1.5 mg/kg every 24 hours was initiated. Bromocriptine was not administered. The patient died 14 days after in the course of a sepsis and cardiogenic shock.

Alcohol withdrawal concealing symptoms of subdural hematoma--a caveat.

Symptoms of significant medical illnesses, in this case subdural hematoma, is easily overlooked in midst of alcohol withdrawal. Unusual symptoms must be regarded with caution.