The association of alcohol-induced blackouts and grayouts to blood alcohol concentrations.

The primary aim of this study was to investigate the association between measured blood alcohol concentration (BAC) and the presence and degree of amnesia (no amnesia, grayout, or blackout) in actively drinking subjects. A secondary aim was to determine potential factors other than BAC that contribute to the alcohol-induced memory loss. An interview questionnaire was administered to subjects regarding a recent alcohol associated arrest with a documented BAC greater than 0.08 g/dL for either public intoxication, driving under the influence, or under age drinking was administered. Demographic variables collected included drinking history, family history of alcoholism, presence of previous alcohol-related memory loss during a drinking episode, and drinking behavior during the episode. Memory of the drinking episode was evaluated to determine if either an alcohol-induced grayout (partial anterograde amnesia) or blackout (complete anterograde amnesia) occurred. Differences in (1) mean total number of drinks ingested before arrest, (2) gulping of drinks, and (3) BAC at arrest were found for those having blackouts compared with no amnesia; while differences in drinking more than planned were found between the no amnesia and grayout groups. A strong linear relationship between BAC and predicted probability of memory loss, particularly for blackouts was obvious. This finding clinically concludes that subjects with BAC of 310 g/dL or greater have a 0.50 or greater probability of having an alcoholic blackout.

Self inflicted corneal abrasions due to delusional parasitosis.

The authors report a case of self inflicted bilateral corneal abrasions and skin damage due to ophthalmic and cutaneous delusional parasitosis. A male in his 50s presented with a 10 year history of believing that parasites were colonizing his skin and biting into his skin and eyes. The patient had received extensive medical evaluations that found no evidence that symptoms were due to a medical cause. He was persistent in his belief and had induced bilateral corneal abrasions and skin damage by using heat lamps and hair dryers in an attempt to disinfect his body. The patient was treated with olanzapine along with treatment for his skin and eyes. His delusional belief system persisted but no further damage to his eyes and skin was noted on initial follow-up.

Relapse rates in patients with schizophrenia receiving aripiprazole in comparison with other atypical antipsychotics.

OBJECTIVE: Aripiprazole is the first of a new generation of antipsychotics that possesses a unique mechanism of action as a partial dopamine agonist. After the release of aripiprazole, case reports appeared conveying an acute psychosis/agitation reaction occurring after the initiation of treatment, most specifically after patients were switched from a previous antipsychotic to aripiprazole. The primary objective of this study was to compare relapse rates among patients with schizophrenia who were switched to aripiprazole with those who switched to a second-generation antipsychotic (SGA) from another antipsychotic. METHOD: The design was a retrospective cohort study based on Kansas Medicaid enrollees with an ICD-9-CM diagnosis code for schizophrenia during calendar year 2002 who switched antipsychotic agents. Six-month psychiatric relapse rates, defined as hospitalization for a psychiatric event, were compared between those subjects who switched to aripiprazole and those who switched to another SGA. Time to relapse was modeled using Cox proportional hazards, adjusting for demographic characteristics, major comorbid conditions, and prior psychiatric-related health care use. RESULTS: Four hundred forty-four aripiprazole and 521 SGA switchers were comparable with respect to gender, race, comorbidities, and health care utilization, though the aripiprazole group was 4.5 years younger. Twenty percent of aripiprazole patients and 19.4% of patients receiving SGAs were hospitalized 6 months after being switched (relative risk = 0.92; 95% CI = 0.67 to 1.26). Mean times to psychiatric hospitalization for the aripiprazole and SGA groups were 65.7 and 73.8 days, respectively (p > .05). Factors associated with hospitalization were prior psychiatric hospitalizations and comorbid depression, substance abuse, and neurotic, personality, and nonpsychotic mental disorders. CONCLUSION: Our study found that rates of relapse and time to relapse with aripiprazole were comparable to other SGAs during a 6-month period. Thus, aripiprazole appears to be an appropriate first-line agent along with the other SGAs.

Comparison of desipramine or carbamazepine to placebo for crack cocaine-dependent patients.

The authors compared the effects of desipramine or carbamazepine to placebo in an intensive outpatient program for cocaine abuse. Subjects recruited from an urban drug treatment program were randomly assigned to a double-blind, placebo-controlled, eight-week trial of desipramine, carbamazepine, or placebo. Patient ratings, urine drug screens, and blood samples were obtained weekly. Using survival analysis, the three groups did not differ in time to drop out of treatment. While subjects improved over time on all self-ratings related to cocaine use, mood, and craving, only two items related to mood were significantly different over time as a function of treatment group. Subjects in the two treated groups reported significantly more improvement on self-ratings of depression and irritability. No treatment differences were noted for sustained abstinence or for proportion of positive urine drug screens. Desipramine subjects who attained a minimum blood level were retained in treatment significantly longer than placebo or other non-compliant treatment groups. This finding supports previous reports of a possible role for desipramine in cocaine abuse treatment.