Psychiatric disorders in substance-abusing adolescent inpatients: a pilot study.

In a pilot study of 226 adolescents entering inpatient treatment because of a primary substance use disorder, 82% met DSM-III-R criteria for an Axis I psychiatric disorder. Of this population, 74% had two or more psychiatric disorders. Mood disorders were found in 61%, conduct disorders in 54%, and anxiety disorders in 43%. Substance induced organic mental disorders were found in 16%. The data argue strongly for the simultaneous evaluation of both substance use and psychiatric disorders in this type of adolescent population. The pilot study also demonstrates the relative frequency of dually diagnosed subgroups. The authors propose that the dual diagnosis subgrouping may have specific treatment implications involving a combined psychiatric and substance abuse treatment approach.

Adolescent cocaine abuse. Addictive potential, behavioral and psychiatric effects.

Four hundred seventy-nine drug abusing adolescent patients enrolled in seven Straight, Inc. Adolescent Drug-Abuse Treatment Programs in five geographic regions across the United States were studied to determine the severity and patterns of cocaine abuse. Of these, 341 admitted to cocaine use and became part of this survey. Cocaine use was categorized as heavy, intermediate, or light. Areas examined were the addictive spectrum, psychosocial dysfunction, and psychiatric symptoms. Intermediate and heavy users of cocaine abused significantly less marijuana and inhalants than light cocaine abusers. Heavy and intermediate users were more likely to use cocaine intravenously and to use crack. They developed tachyphylaxis more frequently, progressed to weekly use in less than 3 months more frequently, and became preoccupied with obtaining and using cocaine significantly more frequently. They used more sedative hypnotics to calm themselves and engaged in more criminal behavior, such as stealing from parents and stores and passing bad checks. They had more arrests for possession of drugs, stole more cars, sold more drugs, and were more likely to trade sexual favors to obtain the drug. Heavy and intermediate users were significantly more psychiatrically disturbed than light users, becoming more suspicious, nervous, aggressive, and demonstrating increased symptoms of fatigue, sleeplessness, decreased appetite, and increasing cocaine dysphoria. All of these symptoms could be mistaken for psychiatric disorders. This study suggests that cocaine is as addictive in adolescents as in adults; possibly more so. It also causes psychosocial dysfunction and psychiatric symptoms. Further research into cocaine addiction among adolescents is indicated.

Hepatitis in 101 consecutive suburban cocaine and opiate users.

The records of 101 cocaine and/or heroin drug abusing patients admitted consecutively to Fair Oaks Hospital were evaluated for history of IV drug abuse, antigen and serum antibody evidence of hepatitis A and B infection, and elevation of serum SGPT. One patient, an IV user, had hepatitis B antigen present in his blood. No patient had acute hepatitis A (IgM) antibody present. Forty-five out of fifty-three (84.9%) IV abusers were Hep B Ab positive, while two out of twenty-nine non-IV abusers (6.9%) were positive. Twenty of fifty-three (43.4%) IV users had positive hepatitis A Ab while one of twenty-nine (3.4%) of non-IV users were positive. Thirty-five of fifty-five (63.6%) IV users had elevated SGPT compared to five of forty-one (12.2%) in non-IV users. IV users tended to be older than non-IV users. The data presented in this article indicate that there is a greatly increased incidence of both hepatitis A and B in IV drug users compared to non-IV users and that the hepatitis B incidence is increased in a far greater amount than could be expected in a normal population. The type of drug injected (heroin, other opiates, or cocaine) was not an important determinant. The presence of hepatitis B antibodies in any drug abusing patient who denies IV use is a strong indication that they may not be telling the truth about their past drug abuse. It makes little difference whether drug abusing patients live in the inner city or the suburbs.(ABSTRACT TRUNCATED AT 250 WORDS)

Multifocal neurological impairment caused by infection-induced rise in blood lithium and amitriptyline.

We present the case of a thirty-eight-year-old woman who developed a febrile illness which was associated with a rise of blood lithium and amitriptyline, and subsequently suffered permanent neurological impairment, implicating CNS dysfunction at several levels. Medical, laboratory, radiological and neuropsychological findings are described, and the attribution of the syndrome is discussed. It is crucial to emphasize that the authors are not challenging the frequently useful combination of lithium and antidepressants. Rather, we urge psychiatrists to be vigilant when such patients develop febrile illnesses.

Specificity of the TRH test for major depression in patients with serious cocaine abuse.

The authors administered the thyrotropin-releasing hormone (TRH) test to 17 patients with severe cocaine abuse and without major depression. The results suggest that the test is not specific for major depression when serious cocaine abuse is present.

Medical and psychiatric complications of cocaine abuse with possible points of pharmacological treatment.

Acute and chronic medical complications of cocaine abuse are dependent on cocaine's route of administration, purity and sterility. There is a predictable sequence of events which occur during cocaine withdrawal. Cocaine can cause or exacerbate psychiatric symptoms indistinguishable from a classical psychiatric disorder. IV and freebase abuse is more likely to precipitate psychiatric symptoms. Systematic medical and psychiatric evaluation in addition to detoxification allows the detection and treatment of relapse-causing conditions. This permits more intelligent treatment decisions. Possible points of pharmacological intervention are discussed and new treatments proposed.

Chronic medical complications of drug abuse.

The wide array of chronic medical and dental complications of drug abuse make a thorough working knowledge mandatory for the physician treating patients with addictive illness. The patients must be examined with these disorders in mind and when any drug related illness is found, it must be treated immediately. Detection and treatment of the chronic medical disorders of drug abuse is one critical part of the complex procedures necessary for the comprehensive evaluation of the chronically drug-abusing patient. The other procedures must include: control of the patient's environment; detection and treatment of acute medical complaints; laboratory testing; stabilization of medications; detoxification; and complete psychiatric evaluation before final treatment decisions are made and the patient is triaged to the most appropriate treatment unit.

Drug abuse and bipolar disorders.

Abuse of multiple substances can coexist in many patients who present with symptoms indistinguishable from any Bipolar Disorder. Failure to recognize and treat this coexistent substance abuse may preclude the proper management of the bipolar disorder.