Intoxicated persons showing challenging behavior demand complexity interventions: a pilot study at the interface of the ER and the complexity intervention unit.

Intoxicated persons showing challenging behavior (IPCBs) under influence of alcohol and/or drugs frequently have trouble finding appropriate acute care. Often IPCBs are stigmatized being unwilling or unable to accept help. Separated physical and mental healthcare systems hamper integrated acute care for IPCBs. This pilot aimed to substantiate the physical, psychiatric, and social health needs of IPCBs visiting the emergency room (ER) during a 3-month period. All ER visits were screened. After triage by the ER physician, indicated IPCBs were additionally assessed by the consultation-liaison-psychiatry physician. If needed, IPCBs were admitted to a complexity intervention unit for further examinations to provide integrated treatments and appropriate follow-up care. The INTERMED and Health of the Nation Outcome Scale (HoNOS) questionnaires were used to substantiate the complexity and needs. Field-relevant stakeholders were interviewed about this approach for acute integrated care. Alongside substance abuse, almost half of identified IPCBs suffered from comorbid psychiatric disturbances and one third showed substantial physical conditions requiring immediate medical intervention. Almost all IPCBs (96%) accepted the acute medical care voluntarily. IPCBs showed high mean initial scores of INTERMED (27.8 ± 10.0) and HoNOS (20.8 ± 6.9). At discharge from the complexity intervention unit, the mean HoNOS score decreased significantly (13.4 ± 8.6; P < 0.001). Field-relevant stakeholders strongly supported the interdisciplinary approach and ER-facility for IPCBs and acknowledged their unmet health needs. A biopsychosocial assessment at the ER, followed by a short admission if necessary, is effective in IPCBs. This approach helps to merge separated healthcare systems and may reduce stigmatization of IPCBs needing help.

Extremely dilution of strychnos Nux vomica mitigates alcohol-induced reduction in enthalpies associated with free water molecules in a fish brain

Introduction: Alcohol intoxication affects aquaporins in the glial cells of brain resulting in oedema. Nux vomica, a homeopathic drug of plant origin, is known to counteract alcohol effect. The objective of this present study is to find out the level of free water molecules in the brain of a teleost fish under ethanol intoxication. The second objective is to determine whether Nux vomica could restore the level of free water in the alcohol treated fish. Materials and methods: One group of fish was exposed to 456 mM ethanol for 30 min, another exposed first to a solution of Nux vomica 200c for 20 min and then to 456 mM ethanol for 30 min. The third group served as an untreated control. The mid brain of each fish was kept in an aluminium sample pan and its free water level was assessed by differential scanning calorimetry (DSC). Results: All alcohol treated fish showed significant reduction in the level of free water molecules as compared to the untreated control. Treatment with Nux vomica increased the level of free water in the brain significantly as compared to the untreated alcoholic group. Conclusion: Alcohol intoxication reduces free water molecules in the fish brain. Nux vom might have acted on aquaporins in the glial cells thereby increasing the level of free water in the brain. (AU)

Treatments for alcohol-related disorders in China: a developing story.

AIMS: Alcohol-related disorders (ARDs) have become an increasing mental health and social challenge in China. Research from China may provide important clinical information for researchers and clinicians around the world. However, most of the Chinese research on ARDs has only been published in Chinese language journals. This article summarizes publications related to treatments for ARDs found in the Chinese literature. METHODS: A descriptive study based on literature identified from searches of the China National Knowledge Infrastructure (1979-2012), Pubmed databases and hand-picked references with emphasis on traditional Chinese medicine (TCM). RESULTS: More than 1500 Chinese language papers on treatment for ARDs were found and ~110 were selected. Many medications used in the Western countries (e.g. disulfiram and acamprosate) are not available in China, and no drugs have been officially approved for alcohol dependence. TCM approaches (including acupuncture, electroacupunture and herbals) have played a role in treatment for ARDs with some positive results. These unique methods are reviewed and the need for additional controlled studies is noted. CONCLUSION: Currently, very limited facilities, medications or programs are available for patients with ARDs in China, thus much improvement is needed in the field, including setting up intervention/treatment programs.

Retrospective case note review of patients brought to Ipswich emergency department under mental health emergency examination orders: does intoxication alter outcome?

OBJECTIVE: To alter staff perceptions, and to examine alternative management processes for intoxicated patients brought to Ipswich ED under mental health emergency examination orders by comparing disposition outcomes with non-intoxicated patients. METHODS: Consultation-Liaison mental health nursing staff completed surveys on all patients assessed under emergency examination orders over a 6 month period in 2008. Patients were classified as intoxicated if they recorded alcometer readings of greater than 0.05%, or self-reported drug use during the events leading to their transport to the ED. Outcomes were retrospectively collated with entries in Clinical Liaison nursing logbooks. Outcome measures recorded were rates of admission, outpatient referrals to the Integrated Mental Health Service, follow up by other community services or no follow up. Differences in outcomes for intoxicated and non-intoxicated patient groups were tested for significance using χ(2) or Fisher's exact test. RESULTS: One hundred and sixty-eight cases were included in the audit. No cases were excluded. Sixty patients were identified as intoxicated. The age and sex distributions were similar between intoxicated and non-intoxicated patients. There were no significant differences in admission or referral rates. The average length of assessment time in the ED was longer in the intoxicated group. DISCUSSION: This audit showed similar outcomes for both patient groups contrary to the perceptions expressed by ED staff in informal surveys. The admission and referral rate for both groups indicate they are an at-risk population. The admission rate of 16% has led to this department negotiating alternative accommodation for patients while they sober up.

Treatment and prevention of alcohol hangover.

The search for alcohol hangover cures is as old as alcohol itself. Many cures and prophylactic agents are available, but scientific evidence for their effectiveness is generally lacking. This review summarizes and discusses the limited number of studies that examined the effectiveness of alcohol hangover treatments. From these studies it must be concluded that most remedies do not significantly reduce overall hangover severity. Some compounds reduce specific symptoms such as vomiting and headache, but are not effective in reducing other common hangover symptoms such as drowsiness and fatigue. Hangover cures that showed positive effects were those inhibiting prostaglandin synthesis or accelerating alcohol metabolism. Future studies should elucidate the pathology of alcohol hangover. Until then, it is unlikely that an effective hangover cure will be developed.

Fracaso renal agudo prolongado y polirradiculopatía severa en paciente intoxicado con etilenglicol / Prolonged acute renal failure and severe polyradiculopathy in ethylene glycol intoxication

La intoxicación por etilenglicol se manifiesta con acidosis metabólica severa y fracaso renal agudo (FRA). La evolución del FRA puede ser prolongada pero la progresión hacia una insuficiencia renal crónica terminal (IRCT) ha sido descrita en muy pocos casos. Presentamos el caso de un paciente que tras ingestión de 920 ml de etilenglicol padeció un FRA de curso prolongado precisando hemodiálisis (HD) durante 37 días. La evolución posterior fue favorable con recuperación parcial de la función renal tras un año de seguimiento. El cuadro se acompañó de una grave afectación neurológica con polirradiculopatía sensitivo-motora y autonómica

Ethylene glycol intoxication involves acute renal failure and severe metabolic acidosis. Prolonged renal insufficiency can occur but terminal chronic renal failure has been reported in very few cases. We describe a patient who after ingestion of 920 ml of ethylene glycol developed prolonged acute renal failure needing hemodyalisis for 37 days and then he partly recovered renal function. The patient developed a severe sensitive-motor and autonomic polyradiculopathy

Driving while impaired (DWI) by alcohol convictions among alcohol, cocaine, and cannabis clients in treatment.

OBJECTIVE: Although studies have demonstrated that clients in treatment for alcohol abuse are more at risk of driving while impaired (DWI) by alcohol than normal licensed drivers from the general population, no research was found on DWI convictions among those in treatment for abusing cannabis or cocaine. The purpose of this article is to compare DWI convictions among clients in treatment for alcohol, cannabis, cocaine, or various combinations of these substances, compared to a matched population control group. METHOD: A stratified random sample of driver records was drawn from seven client groups who sought treatment in 1994 for alcohol, cannabis, cocaine, or any combination of these substances (n = 445). A random sample of drivers, frequency matched by age and sex (n = 566), served as control subjects. RESULTS: Logistic regression analysis, controlling for sex and age, was conducted to assess whether DWI convictions were elevated for each of the client groups, compared to controls. Two sets of analyses were conducted, before treatment (from 1985 to 1993) and after treatment (from 1995 to 2000). In the time period before treatment, every drug group except the "cannabis only" group had significantly more DWI convictions than controls (p < .05). In the period after treatment, the "alcohol only," "cocaine only," "alcohol and cocaine," and the "cocaine and cannabis" groups still had significantly more DWI convictions than controls (p < .05). CONCLUSION: The results show that DWI convictions are elevated among those who abused cocaine but not among those who abused cannabis. The results suggest that cross-addiction of alcohol and cocaine is common, and problematic drinking among cocaine clients can go undetected when clients are being diagnosed for treatment.

Acute carbon monoxide poisoning and alcohol intoxication: a rare condition that is complex to manage.

Since the changeover in the gas used in domestic appliances, the prevalence of acute carbon monoxide (CO) poisoning has been dramatically reduced. In suicide attempts with car exhaust fumes lies the most common cause of the disorder. As a consequence, patients are more complex to manage as they often have other associated diagnoses such as substance use disorder, depressive disorder, or long-standing personality disorder. This report details such a case. The medical treatment was based on the carboxyhemoglobin (COHgb) levels at the time of admission. The patient developed permanent cognitive and functional deficits consistent with the observed brain scan changes. The author discusses the importance of an appropriate early diagnosis of the condition, the difficulties associated with it, and the validity of using the carboxyhemoglobin levels as a guide to treatment.

Un rubro poco considerado: borrachera condilomatosis perianal, caso clínico / A rubric scanty considerated: drunkenness perianal condylomata, a clinical case

Se trata de una enorme condilomatosis perianal, donde fallaron Thuja y Nitric acid, habiendo curado el caso el medicamento de fondo, el cual fue hallado al considerar modalidades del rubro BORRACHERA. El mismo medicamento resolvió satisfactoriamente un cuadro clínico agudo que aconteció varios años más tarde, el cual poseía síntomas característicos con las modalidades del medicamento de fondo

Un rubro poco considerado: borrachera condilomatosis perianal, caso clínico / A rubric scanty considerated: drunkenness perianal condylomata, a clinical case

Se trata de una enorme condilomatosis perianal, donde fallaron Thuja y Nitric acid, habiendo curado el caso el medicamento de fondo, el cual fue hallado al considerar modalidades del rubro BORRACHERA. El mismo medicamento resolvió satisfactoriamente un cuadro clínico agudo que aconteció varios años más tarde, el cual poseía síntomas característicos con las modalidades del medicamento de fondo (AU)

[Drug addiction--origin, development and pharmacological intervention]. / Zur Drogensucht--Entstehung, Entwicklung und pharmakologische Interventionen.

The present essay on drug addiction deals, under the escort of empirical knowledges emanating from medico-legal toxicology, mainly with the behavioural, neurobiological, forensic and pharmacotherapeutical aspects of drug seeking and taking behaviour. The article emphasizes the idea that treatment of drug dependence [including that of the associated diseases and complications] should be performed according to the specific pharmacological and toxicological properties of the drugs involved. Furthermore, the treatment of drug dependence should be carried out in agreement with the individual needs of the patient, and in concordance with the multiple factors involved in the development and maintenance of drug addiction.

[The effect of electrotranquilization on the hormonal indices of alcoholic patients]. / Vliianie élektrotrankvilizatsii na nekotorye gormonal'nye pokazateli u bol'nykh alkogolizmom.

The correlation between clinical signs of alcoholism dynamics and hormonal status indices was analysed in 26 patients during medical electrotranquilization sessions. Electrotranquilization (ET) was carried out by "Lénar" (Russia) apparatus. There were estimated the concentrations of the following hormones: adrenocorticotropic hormone, hydrocortisone, prolactin, follicle stimulating, luteinizing hormones, estriol, testosterone, somatotropic, thyrotropic hormones, triiodothyronine, tyrosine and insulin. The inverse correlation was observed between the estriol, testosterone and tyrosine levels on the one hand and the clinical signs of the reaction to alcohol administration on the other hand. So far as the disease severity strengthened, both the elevation of estriol and the decrease of testosterone levels were observed. The prolactin concentration correlated directly with meta-alcoholic clinical signs gravity. This confirmed the prolactin role both in postalcoholic haemostasis restoration and in pathogenesis of meta-alcoholic clinical signs. In alcoholic patients the ET normalized the serum prolactin level as well as promoted the trend to normalization of estriol and testosterone levels.

Ingestions considered nontoxic.

We have compiled a list of common household products and drugs that are frequently ingested by children and may be considered nontoxic unless taken deliberately or in large amounts. An understanding of the nontoxic ingestion should prevent overtreatment, decrease emergency room visits, and allow physicians and poison control centers the opportunity to practice poison prevention. The reporting of all ingestions is encouraged to obtain information on the human experiment that occurs when a non-edible material is ingested. Only as we accumulate this knowledge will we be able to advise with a degree of certainty what treatment is needed.

Poisoning in childhood.

Several variables must be considered in the treatment of a poisoned child, including the particular substance, the individual child, and the child's home environment. General principles of treatment are described, and the management of particular substances, including household cleaning products, petroleum distillate hydrocarbons, and salicylates, is detailed. The family should not leave the emergency room without instruction on prevention of poisoning.