Reductions in Drinking Predict Increased Distress: Between- and Within-Person Associations between Alcohol Use and Psychological Distress During and Following Treatment.

BACKGROUND: As the nature of the association between alcohol use disorder (AUD) and other disorders is not well understood, the ways in which psychological distress changes during the course of treatment for AUD are relatively unknown. Existing literatures posit 2 competing hypotheses such that treatment for AUD concurrently decreases alcohol use and psychological distress or treatment for AUD decreases alcohol use and increases psychological distress. The current study examined the ways in which psychological distress changed as a function of treatment for AUD, including the relationship between psychological distress and drinking behaviors. METHODS: Secondary data analysis was conducted on an existing clinical trial dataset that investigated the effect of cognitive-behavioral therapy and therapeutic alliance feedback on AUDs. Specifically, data collected at baseline, posttreatment, 3-month, 6-month, 9-month, and 12-month follow-up assessments were examined. RESULTS: Results indicated decreases in heavy drinking days, increases in percentage of days abstinent, and decreases in overall psychological distress. Findings also revealed that changes in psychological distress did not predict changes in drinking at the next time interval; however, decreases in drinking predicted higher psychological distress at the next assessment. Further, average levels of psychological distress were positively associated with rates of drinking. CONCLUSIONS: The current study provides some insight into how psychological distress changes during the course of treatment for AUD, including the relationship between changes in drinking and such symptoms. Future research should continue to explore these relationships, including the ways in which treatment efforts can address what may be seen as paradoxical effects.

Takotsubo Cardiomyopathy in the Setting of Hypertrophic Cardiomyopathy Following Pacemaker Implantation.

The presentation of Takotsubo cardiomyopathy (TC) has overlapping features with acute coronary syndrome (ACS), though traditionally developing from different triggers, including both physical and emotional. Additionally, TC is associated with multiple comorbidities and sequelae. We present a multifactorial case of a 73-year-old female with underlying hypertrophic cardiomyopathy who presented with a high-degree atrioventricular (AV) block requiring permanent pacemaker (PPM) placement and subsequently developed TC. Patients with hypertrophic obstructive cardiomyopathy (HCM) have been theorized to have increased cardiac sympathetic activity and sensitivity. Thus, this case report demonstrates the increased relative risk of patients with underlying HCM in the development of TC during PPM placement.

An Old Disease With an Unfamiliar Face: A Case Report of Ocular Syphilis.

Syphilis is an infection caused by the bacterium Treponema pallidum. Patients with syphilis can present with a wide range of symptoms depending on the stage of disease. An underappreciated manifestation of syphilis is ocular involvement, which has been increasingly reported in the last several years. Delay in diagnosis and treatment of ocular syphilis can increase the risk of irreversible vision loss. Syphilis can affect almost every structure in the eye; however, most commonly presents with panuveitis. Ocular syphilis is treated similarly to neurosyphilis with prompt initiation of intravenous penicillin G.