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Sample records for alcohol withdrawal delirium

  1. Alcohol withdrawal

    Science.gov (United States)

    ... parts A severe form of alcohol withdrawal called delirium tremens can cause: Agitation Fever Seeing or feeling things ... watched closely for hallucinations and other signs of delirium tremens. Treatment may include: Monitoring of blood pressure, body ...

  2. Delirium

    Science.gov (United States)

    ... stable, and may last for months or years. Delirium tremens is a serious type of alcohol withdrawal syndrome. It usually happens to people who stop drinking after years of alcohol abuse. People with delirium often, though not always, make a full recovery ...

  3. Inpatient alcohol withdrawal syndrome.

    Science.gov (United States)

    Monte-Secades, R; Rabuñal-Rey, R; Guerrero-Sande, H

    2015-03-01

    A 55-year-old man was admitted for a femur fracture; an alcohol fetor was noted on admission. The following day, the patient began to experience tremors and nervousness. Intravenous haloperidol was administered. Shortly afterwards, the patient experienced two generalized seizures and then began to experience delirium and uncontrollable agitation. The patient was diagnosed with alcohol withdrawal syndrome; high doses of intravenous midazolam were prescribed and infused. A few hours later, the patient presented signs of respiratory depression, requiring a transfer to the intensive care unit. After a review of the medical history, it was determined that the patient had been admitted on 3 previous occasions due to alcohol withdrawal and had progressed to delirium tremens after experiencing seizures. Can the risk of alcohol withdrawal syndrome and the need for prophylactic treatment be assessed on admission? Were appropriate monitoring and treatment measures employed? Would it have been possible to change his outcome? PMID:25559647

  4. Use of propofol infusion in alcohol withdrawal-induced refractory delirium tremens

    DEFF Research Database (Denmark)

    Lorentzen, Kristian; Lauritsen, Anne Øberg; Bendtsen, Asger Ole

    2014-01-01

    in case reports. We aimed to evaluate the treatment of delirium tremens with propofol infusion for 48 h. MATERIAL AND METHODS: This study was a single-centre retrospective cohort analysis of 15 patient journals covering the period from May 2012 to September 2013. RESULTS: Five women and ten men were...... and mechanically ventilated in the intensive care unit. The mean propofol infusion rate was 4.22 mg/kg/h. Thirteen patients received supplemental infusion of opioids, whereas seven required concomitant vasopressor infusion. Once propofol infusion was discontinued after 48 h, 12 patients had a long awakening...

  5. Improving Nursing Knowledge of Alcohol Withdrawal

    OpenAIRE

    Berl, Kimberly; Collins, Michelle L.; Melson, Jo; Mooney, Ruth; Muffley, Cheryl; Wright-Glover, Angela

    2015-01-01

    Christiana Care Health System implemented a Care Management Guideline for Alcohol Withdrawal Symptom Management, which provided direction for inpatient screening for alcohol withdrawal risk, assessment, and treatment. Nurses educated on its use expressed confusion with the use of the assessment tools, pharmacokinetics, and pathophysiology of alcohol withdrawal and delirium tremens. Reeducation was provided by nursing professional development specialists. Pre- and postsurveys revealed that nur...

  6. Alcohol Withdrawal Mimicking Organophosphate Poisoning

    Directory of Open Access Journals (Sweden)

    Nezihat Rana Disel

    2014-02-01

    Full Text Available Organophosphates, which can cause occupational poisoning due to inappropriate personal protective measures, are widely used insecticides in agricultural regions of southern Turkey. Therefore, the classical clinical findings of this cholinergic poisoning are myosis, excessive secretions, bradicardia and fasciculations are easy to be recognized by local medical stuff. Diseases and conditions related to alcoholism such as mental and social impairments, coma, toxicity, withdrawal, and delirium are frequent causes of emergency visits of chronic alcoholic patients. Here we present a case diagnosed and treated as organophosphate poisoning although it was an alcohol withdrawal in the beginning and became delirium tremens, due to similar symptoms.

  7. The alcohol withdrawal syndrome.

    LENUS (Irish Health Repository)

    McKeon, A

    2008-08-01

    The alcohol withdrawal syndrome (AWS) is a common management problem in hospital practice for neurologists, psychiatrists and general physicians alike. Although some patients have mild symptoms and may even be managed in the outpatient setting, others have more severe symptoms or a history of adverse outcomes that requires close inpatient supervision and benzodiazepine therapy. Many patients with AWS have multiple management issues (withdrawal symptoms, delirium tremens, the Wernicke-Korsakoff syndrome, seizures, depression, polysubstance abuse, electrolyte disturbances and liver disease), which requires a coordinated, multidisciplinary approach. Although AWS may be complex, careful evaluation and available treatments should ensure safe detoxification for most patients.

  8. Emergency management of acute alcohol problems. Part 1: Uncomplicated withdrawal.

    OpenAIRE

    Etherington, J. M.

    1996-01-01

    Alcohol-related problems are common among patients in emergency departments. Primary care physicians must recognize and treat a variety of alcohol-related and alcohol-induced problems: alcohol withdrawal, alcohol-related seizures, delirium tremens, malnutrition, concomitant illness, poisoning, trauma, and lack of social support. This paper focuses an recognizing and managing acute alcohol withdrawal.

  9. Improving Nursing Knowledge of Alcohol Withdrawal

    Science.gov (United States)

    Berl, Kimberly; Collins, Michelle L.; Melson, Jo; Mooney, Ruth; Muffley, Cheryl; Wright-Glover, Angela

    2015-01-01

    Christiana Care Health System implemented a Care Management Guideline for Alcohol Withdrawal Symptom Management, which provided direction for inpatient screening for alcohol withdrawal risk, assessment, and treatment. Nurses educated on its use expressed confusion with the use of the assessment tools, pharmacokinetics, and pathophysiology of alcohol withdrawal and delirium tremens. Reeducation was provided by nursing professional development specialists. Pre- and postsurveys revealed that nurses were more confident in caring for patients with alcohol withdrawal. (See CE Video, Supplemental Digital Content 1, http://links.lww.com/JNPD/A9) PMID:25816126

  10. Improving Nursing Knowledge of Alcohol Withdrawal: Second Generation Education Strategies.

    Science.gov (United States)

    Berl, Kimberly; Collins, Michelle L; Melson, Jo; Mooney, Ruth; Muffley, Cheryl; Wright-Glover, Angela

    2015-01-01

    Christiana Care Health System implemented a Care Management Guideline for Alcohol Withdrawal Symptom Management, which provided direction for inpatient screening for alcohol withdrawal risk, assessment, and treatment. Nurses educated on its use expressed confusion with the use of the assessment tools, pharmacokinetics, and pathophysiology of alcohol withdrawal and delirium tremens. Reeducation was provided by nursing professional development specialists. Pre- and postsurveys revealed that nurses were more confident in caring for patients with alcohol withdrawal. PMID:25816126

  11. Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Anand T Talikoti

    2012-01-01

    Full Text Available Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy.

  12. Alcoholic delirium tremens with hollow viscus perforation scheduled for emergency laparotomy.

    Science.gov (United States)

    Talikoti, Anand T; Sindhu, Bs; Kavyashree, Sp; Kumar, Ks Kishore

    2012-03-01

    Alcohol is a drug consumed at some time in life by up to 80% of the population according to western statistics. Wide differences in socioeconomic status in India contribute to various degrees and severity of alcoholism and its associated complications. The symptoms of alcohol withdrawal range from such minor ones as insomnia and tremulousness to severe complications such as withdrawal seizures and delirium tremens. Although alcohol withdrawal syndrome has been reported in the literature in post-operative periods and in Intensive Care Unit, there is paucity of information on treatment and preparation of a patient with alcohol withdrawal syndrome coming for emergency surgical procedures. The surgical stress and deranged liver function in such cases poses an additional challenge to the anaesthesiologist. Here, we report the successful management of a case of acute alcoholic delirium tremens who presented with hollow viscous perforation for emergency exploratory laparotomy. PMID:22701216

  13. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond.

    Science.gov (United States)

    Sachdeva, Ankur; Choudhary, Mona; Chandra, Mina

    2015-09-01

    Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on 'Alcohol withdrawal syndrome' in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review. PMID:26500991

  14. [Delirium tremens].

    Science.gov (United States)

    Karila, Laurent; Zarmdini, Rim; Lejoyeux, Michel

    2014-12-01

    Delirium tremens (DT) is a specific type of delirium occurring in patients who are in alcohol withdrawal states. It has a high mortality of about 8%. Hence, it is important for clinicians to be able to predict it. Treatment of DT is best achieved by the use of intravenous diazepam administered at frequent intervals while closely monitoring the patient during the procedure. Refractory DT is defined by a high requirement of intravenous diazepam with poor control of withdrawal symptoms. Once the acute phase medically controlled, the patient should be managed for his addiction to alcohol. PMID:25668827

  15. Inpatient management of acute alcohol withdrawal syndrome.

    Science.gov (United States)

    Perry, Elizabeth C

    2014-05-01

    Alcohol withdrawal is a common condition encountered in the hospital setting after abrupt discontinuation of alcohol in an alcohol-dependent individual. Patients may present with mild symptoms of tremulousness and agitation or more severe symptoms including withdrawal seizures and delirium tremens. Management revolves around early identification of at-risk individuals and symptom assessment using a validated tool such as the revised Clinical Institute Withdrawal Assessment for Alcohol score. Benzodiazepines remain the mainstay of treatment and can be administered using a front-loading, fixed-dose, or symptom-triggered approach. Long-acting benzodiazepines such as chlordiazepoxide or diazepam are commonly used and may provide a smoother withdrawal than shorter-acting benzodiazepines, but there are no data to support superiority of one benzodiazepine over another. Elderly patients or those with significant liver disease may have increased accumulation and decreased clearance of the long-acting benzodiazepines, and lorazepam or oxazepam may be preferred in these patients. Patients with symptoms refractory to high doses of benzodiazepines may require addition of a rescue medication such as phenobarbital, propofol or dexmedetomidine. Anticonvulsants (carbamazepine, valproate, gabapentin) may have a role in the management of mild to moderate withdrawal. Other medications such as β-antagonists or neuroleptics may offer additional benefit in select patients but should not be used a monotherapy. PMID:24781751

  16. Acute coronary ischemia during alcohol withdrawal: a case report

    Directory of Open Access Journals (Sweden)

    Sriram Ganeshalingam

    2011-08-01

    Full Text Available Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literature on precipitation of myocardial ischemia during alcohol withdrawal and propose possible mechanisms. Conclusions Alcohol withdrawal is a commonly observed phenomenon in hospitals. However, the number of cases reported in the literature of acute coronary events occurring during withdrawal is few. Many cases of acute ischemia or sudden cardiac deaths may be attributed to other well known complications of delirium tremens. This is an area needing the urgent attention of clinicians and epidemiologists.

  17. Alcohol Withdrawal Syndrome in Critically Ill Patients: Identification, Assessment, and Management.

    Science.gov (United States)

    Sutton, Lynsey J; Jutel, Annemarie

    2016-02-01

    Management of alcohol withdrawal in critically ill patients is a challenge. The alcohol consumption histories of intensive care patients are often incomplete, limiting identification of patients with alcohol use disorders. Abrupt cessation of alcohol places these patients at risk for alcohol withdrawal syndrome. Typically benzodiazepines are used as first-line therapy to manage alcohol withdrawal. However, if patients progress to more severe withdrawal or delirium tremens, extra adjunctive medications in addition to benzodiazepines may be required. Sedation and mechanical ventilation may also be necessary. Withdrawal assessment scales such as the Clinical Institute of Withdrawal Assessment are of limited use in these patients. Instead, general sedation-agitation scales and delirium detection tools have been used. The important facets of care are the rapid identification of at-risk patients through histories of alcohol consumption, management with combination therapies, and ongoing diligent assessment and evaluation. (Critical Care Nurse. 2016;36[1]:28-39). PMID:26830178

  18. Identification and management of alcohol withdrawal syndrome.

    Science.gov (United States)

    Mirijello, Antonio; D'Angelo, Cristina; Ferrulli, Anna; Vassallo, Gabriele; Antonelli, Mariangela; Caputo, Fabio; Leggio, Lorenzo; Gasbarrini, Antonio; Addolorato, Giovanni

    2015-03-01

    Symptoms of alcohol withdrawal syndrome (AWS) may develop within 6-24 h after the abrupt discontinuation or decrease of alcohol consumption. Symptoms can vary from autonomic hyperactivity and agitation to delirium tremens. The gold-standard treatment for AWS is with benzodiazepines (BZDs). Among the BZDs, different agents (i.e., long-acting or short-acting) and different regimens (front-loading, fixed-dose or symptom-triggered) may be chosen on the basis of patient characteristics. Severe withdrawal could require ICU admission and the use of barbiturates or propofol. Other drugs, such as α2-agonists (clonidine and dexmetedomidine) and β-blockers can be used as adjunctive treatments to control neuroautonomic hyperactivity. Furthermore, neuroleptic agents can help control hallucinations. Finally, other medications for the treatment for AWS have been investigated with promising results. These include carbamazepine, valproate, sodium oxybate, baclofen, gabapentin and topiramate. The usefulness of these agents are discussed. PMID:25666543

  19. Clinical management of alcohol withdrawal: A systematic review

    Directory of Open Access Journals (Sweden)

    Shivanand Kattimani

    2013-01-01

    Full Text Available Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed.

  20. Clinical management of alcohol withdrawal: A systematic review.

    Science.gov (United States)

    Kattimani, Shivanand; Bharadwaj, Balaji

    2013-07-01

    Alcohol withdrawal is commonly encountered in general hospital settings. It forms a major part of referrals received by a consultation-liaison psychiatrist. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on pharmacological management of alcohol withdrawal in humans with no limit on the date of publication. Articles not relevant to clinical management were excluded based on the titles and abstract available. Full-text articles were obtained from this list and the cross-references. There were four meta-analyses, 9 systematic reviews, 26 review articles and other type of publications like textbooks. Alcohol withdrawal syndrome is a clinical diagnosis. It may vary in severity. Complicated alcohol withdrawal presents with hallucinations, seizures or delirium tremens. Benzodiazepines have the best evidence base in the treatment of alcohol withdrawal, followed by anticonvulsants. Clinical institutes withdrawal assessment-alcohol revised is useful with pitfalls in patients with medical comorbidities. Evidence favors an approach of symptom-monitored loading for severe withdrawals where an initial dose is guided by risk factors for complicated withdrawals and further dosing may be guided by withdrawal severity. Supportive care and use of vitamins is also discussed. PMID:25013309

  1. Alcohol Dependence, Withdrawal, and Relapse

    OpenAIRE

    Howard C Becker

    2008-01-01

    Continued excessive alcohol consumption can lead to the development of dependence that is associated with a withdrawal syndrome when alcohol consumption is ceased or substantially reduced. This syndrome comprises physical signs as well as psychological symptoms that contribute to distress and psychological discomfort. For some people the fear of withdrawal symptoms may help perpetuate alcohol abuse; moreover, the presence of withdrawal symptoms may contribute to relapse after periods of absti...

  2. Delirium

    Science.gov (United States)

    ... tract infection, influenza, or deficiency of thiamin or vitamin B 12 Retention of urine or feces Sensory deprivation, ... Dementia Overview of Delirium and Dementia Delirium Dementia Alzheimer Disease Vascular Dementia Lewy Body Dementia and Parkinson ...

  3. [Delirium].

    Science.gov (United States)

    Laurila, Jouko

    2012-01-01

    The pathophysiology of delirium is poorly known and scientific evidence of effective forms of treatment is scarce. Detection of triggering factors and their appropriate treatment still constitute the cornerstone of the treatment. If drug therapy is required, an antipsychotic drug is the first-line treatment. Only in the case of the delirium tremens syndrome benzodiazepine is chosen as the first-line treatment. The use of restraint systems should be avoided. The delirium experience is often gravely traumatizing for the patient, and the psychological aftercare of delirium must therefore not be ignored. PMID:22506327

  4. Emergency management of acute alcohol problems. Part 2: Alcohol-related seizures, delirium tremens, and toxic alcohol ingestion.

    OpenAIRE

    Etherington, J. M.

    1996-01-01

    Alcohol-related problems are common in patients frequenting emergency departments. Primary care physicians have to recognize and treat a variety of alcohol-related conditions. This paper outlines one approach to recognizing and managing alcohol-related seizures, delirium tremens, and toxic alcohol ingestion.

  5. A 'symptom-triggered' approach to alcohol withdrawal management.

    Science.gov (United States)

    Murdoch, Jay; Marsden, Janet

    In acute hospital settings, alcohol withdrawal often causes significant management problems and complicates a wide variety of concurrent conditions, placing a huge burden on the NHS. A significant number of critical incidents around patients who were undergoing detoxification in a general hospital setting led to the need for a project to implement and evaluate an evidence-based approach to the management of alcohol detoxification-a project that included a pre-intervention case note audit, the implementation of an evidence-based symptom-triggered detoxification protocol, and a post-intervention case note audit. This change in practice resulted in an average reduction of almost 60% in length of hospital stay and a 66% reduction in the amount of chlordiazepoxide used in detoxification, as well as highlighting that 10% of the sample group did not display any signs of withdrawal and did not require any medication. Even with these reductions, no patient post-intervention developed any severe signs of withdrawal phenomena, such as seizures or delirium tremens. The savings to the trust (The Pennine Acute Hospital Trust) are obvious,but the development of a consistent, quality service will lead to fewer long-term negative effects for patients that can be caused by detoxification. This work is a project evaluation of a locally implemented strategy, which, it was hypothesised,would improve care by providing an individualised treatment plan for the management of alcohol withdrawal symptoms. PMID:24809146

  6. Alcohol Withdrawal and Cerebellar Mitochondria.

    Science.gov (United States)

    Jung, Marianna E

    2015-08-01

    Cerebellar disorders trigger the symptoms of movement problems, imbalance, incoordination, and frequent fall. Cerebellar disorders are shown in various CNS illnesses including a drinking disorder called alcoholism. Alcoholism is manifested as an inability to control drinking in spite of adverse consequences. Human and animal studies have shown that cerebellar symptoms persist even after complete abstinence from drinking. In particular, the abrupt termination (ethanol withdrawal) of long-term excessive ethanol consumption has shown to provoke a variety of neuronal and mitochondrial damage to the cerebellum. Upon ethanol withdrawal, excitatory neurotransmitter molecules such as glutamate are overly released in brain areas including cerebellum. This is particularly relevant to the cerebellar neuronal network as glutamate signals are projected to Purkinje neurons through granular cells that are the most populated neuronal type in CNS. This excitatory neuronal signal may be elevated by ethanol withdrawal stress, which promotes an increase in intracellular Ca(2+) level and a decrease in a Ca(2+)-binding protein, both of which result in the excessive entry of Ca(2+) to the mitochondria. Subsequently, mitochondria undergo a prolonged opening of mitochondrial permeability transition pore and the overproduction of harmful free radicals, impeding adenosine triphosphate (ATP)-generating function. This in turn provokes the leakage of mitochondrial molecule cytochrome c to the cytosol, which triggers a cascade of adverse cytosol reactions. Upstream to this pathway, cerebellum under the condition of ethanol withdrawal has shown aberrant gene modifications through altered DNA methylation, histone acetylation, or microRNA expression. Interplay between these events and molecules may result in functional damage to cerebellar mitochondria and consequent neuronal degeneration, thereby contributing to motoric deficit. Mitochondria-targeting research may help develop a powerful new

  7. Sindrome confusional agudo por abstinencia aguda de nicotina Delirium due to acute nicotine withdrawal

    Directory of Open Access Journals (Sweden)

    Manuel Klein

    2002-08-01

    Full Text Available El síndrome confusional agudo (SCA o delirium en pacientes hospitalizados es un problema frecuente y grave. Se caracteriza por síntomas de comienzo agudo y curso fluctuante con inatención, pensamiento desorganizado, y con distintos niveles de alteración de la conciencia.En la bibliografía consultada, el SCA como manifestación de un síndrome de abstinencia aguda nicotínica fue descripto en solo ocho casos. Presentamos el caso de un tabaquista grave que, internado por una reagudización de su enfermedad pulmonar obstructiva crónica (EPOC, presentó un cuadro de SCA al tercer día de abstinencia tabacal, cediendo los síntomas tras la administración de un parche de nicotina. Lo descripto sugiere que en pacientes internados que presentan SCA y agitación, con fuertes antecedentes de tabaquismo, un simple ensayo con un parche de nicotina puede ofrecer en pocas horas una notable respuesta terapéutica y a su vez un test confirmatorio. El reconocimiento del SCA como forma de presentación de la abstinencia nicotínica permitirá identificar casos habitualmente complejos en los que se podrá implementar una sencilla y eficaz alternativa terapéutica.Delirium or acute confusional state among hospitalized patients is a frequent and serious problem. It is characterized by acute onset symptoms, fluctuating course, impaired attention, unorganized thinking, and altered level of conciousness. Delirium, as a manifestation of acute nicotine withdrawal syndrome has been reported in the reviewed literature only in eight cases. We report the case of a heavy smoker admitted because of a reagudization of his chronic obstructive pulmonary disease. At the third day of nicotine abstinence, he developed delirium with a rapid improvement of his symptoms after treatment with a transdermal nicotine patch. This description suggests that in hospitalized heavy smokers who develop delirium with agitation, a simple trial with a nicotine patch can offer a dramatic

  8. Repetitive myocardial infarctions secondary to delirium tremens.

    Science.gov (United States)

    Schwartzberg, David; Shiroff, Adam

    2014-01-01

    Delirium tremens develops in a minority of patients undergoing acute alcohol withdrawal; however, that minority is vulnerable to significant morbidity and mortality. Historically, benzodiazepines are given intravenously to control withdrawal symptoms, although occasionally a more substantial medication is needed to prevent the devastating effects of delirium tremens, that is, propofol. We report a trauma patient who required propofol sedation for delirium tremens that was refractory to benzodiazepine treatment. Extubed prematurely, he suffered a non-ST segment myocardial infarction followed by an ST segment myocardial infarction requiring multiple interventions by cardiology. We hypothesize that his myocardial ischemia was secondary to an increased myocardial oxygen demand that occurred during his stress-induced catecholamine surge during the time he was undertreated for delirium tremens. This advocates for the use of propofol for refractory benzodiazepine treatment of delirium tremens and adds to the literature on the instability patients experience during withdrawal. PMID:25197580

  9. Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography

    International Nuclear Information System (INIS)

    The regional cerebral blood flow of 12 patients with severe alcohol withdrawal reactions (delirium tremens or impending delirium tremens) was measured during the acute state before treatment and after recovery. Greater cerebral blood flow was significantly correlated with visual hallucinations and agitation during the acute withdrawal reaction. The results suggest that delirium tremens and related clinical states represent a type of acute brain syndrome mainly characterized by CNS hyperexcitability

  10. Cerebral blood flow during delirium tremens and related clinical states studied with xenon-133 inhalation tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hemmingsen, R.; Vorstrup, S.; Clemmesen, L.; Holm, S.; Tfelt-Hansen, P.; Sorensen, A.S.; Hansen, C.; Sommer, W.; Bolwig, T.G.

    1988-11-01

    The regional cerebral blood flow of 12 patients with severe alcohol withdrawal reactions (delirium tremens or impending delirium tremens) was measured during the acute state before treatment and after recovery. Greater cerebral blood flow was significantly correlated with visual hallucinations and agitation during the acute withdrawal reaction. The results suggest that delirium tremens and related clinical states represent a type of acute brain syndrome mainly characterized by CNS hyperexcitability.

  11. Use of propofol as adjuvant therapy in refractory delirium tremens

    Directory of Open Access Journals (Sweden)

    Rajiv Mahajan

    2010-01-01

    Full Text Available Delirium tremens is recognized as a potentially fatal and debilitating complication of alcohol withdrawal. Use of sedatives, particularly benzodiazepines, is the cornerstone of therapy for delirium tremens. But sometimes, very heavy doses of benzodiazepines are required to control delirious symptoms. We are reporting one such case of delirium tremens, which required very heavy doses of benzodiazepines and was ultimately controlled by using infusion of propofol. Thus propofol should always be considered as an option to treat patients with resistant delirium tremens.

  12. [Plasma ACTH, STH and other hormone levels in various groups under chlormethiazole, haloperidol or reserpine load in alchohol delirium, alcoholic hallucinations, and chronic alcoholism].

    Science.gov (United States)

    Dobrzański, T; Pieschl, D

    1976-01-01

    Studies of 135 men with safely diagnosed alcohol delirium mostly revealed increased ACTH blood values when sober and increased T4 values in about 1/3 of these patients. There is a correlation between the psychiatric clinical picture of the alcohol delirium and the ACTH content of the plasma. Under load with chloromethiazole, halperidole or with reserpine, there is a significant drop in the increased ACTH and T4 values. In an acute alcoholic hallucinosis (n=16) similar endocrinological changes as in most cases of safely diagnosed alcohol delirium were observed. In a chronic alcoholic hallucinosis (n=11) and in chronic alcoholics (n=31) the endocrinological values were similar to those of patients after alcohol delirium. PMID:181772

  13. 27 CFR 19.997 - Withdrawal of fuel alcohol.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Withdrawal of fuel alcohol. 19.997 Section 19.997 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU... and Transfers § 19.997 Withdrawal of fuel alcohol. For each shipment or other removal of fuel...

  14. Add on dexmedetomidine in the treatment of severe alcohol withdrawal in a patient of emergency laparotomy

    Directory of Open Access Journals (Sweden)

    Roshan Madan Shende

    2015-09-01

    Full Text Available According to American statistics 90% of people drink alcohol at some time in life. The estimated prevalence of alcohol abuse among hospitalized in patients is 20 % and 10- 33 % in patients admitted to the ICU. Approximately 18% of these patients will develop alcohol withdrawal syndrome (AWS whose symptoms can include physical and psychological manifestations that range from mild to life threatening. Although AWS has been reported in literature in post-operative periods and in intensive care unit, there is less information on treatment and preparing of a patient with AWS, coming for emergency surgical procedure. The surgical stress and deranged liver functions possess an additional challenge to the anesthesiologist. Here we are reporting the successful management of a case of delirium tremens by using Dexmedetomidine in pre, intra and post-operative period in a patient with hollow viscous perforation for emergency laparotomy. [Int J Res Med Sci 2015; 3(9.000: 2446-2449

  15. Oxidative stress during alcohol withdrawal and its relationship with withdrawal severity

    Directory of Open Access Journals (Sweden)

    Ramamourty Parthasarathy

    2015-01-01

    Full Text Available Background: Oxidative parameters are altered during alcohol withdrawal and are said to contribute towards withdrawal symptoms in alcoholic patients. Aims: To study levels of five selected oxidative parameters during alcohol withdrawal state and after treatment of the withdrawal state and to assess the association of the oxidative parameters with the severity of alcohol withdrawal. Materials and Methods: This was a case-control study done in a De-addiction clinic of a tertiary teaching centre, Southern India. 50 persons having alcohol withdrawal symptoms were included. The oxidative stress parameters malondialdehyde, protein carbonyl, glutathione peroxidase, superoxide dismutase and catalase were assessed in during the withdrawal phase and again after the withdrawal had subsided. The same oxidative stress parameters were measured in the control group. Statistical analysis: Statistical analysis was done using SPSS version 17.0. One way ANOVA and Pearson correlation test were used for finding the association between the oxidative stress parameters levels and the severity of alcohol withdrawal. Multiple linear regression analysis done to predict variables associated with level of oxidative parameters. Results: During alcohol withdrawal the pro-oxidant malondialdehyde was elevated compared to that in the control group. Among the antioxidant enzymes the superoxide dismutase was higher and catalase was lower than the control group levels. After remission of the alcohol withdrawal both malondialdehyde remained higher and superoxide dismutase lower than in the control group. The levels of oxidative stress parameters not correlated with the severity of alcohol withdrawal. Conclusions: oxidative stress parameters show changes during alcohol withdrawal and during the remission of withdrawal. However, levels of oxidative stress parameters not correlated with the severity of withdrawal.

  16. Phenobarbital versus diazepam for delirium tremens--a retrospective study

    DEFF Research Database (Denmark)

    Hjermø, Ida; Anderson, John Erik; Fink-Jensen, Anders; Allerup, Peter N.; Ulrichsen, Jakob

    2010-01-01

    Delirium tremens (DT) is a severe and potentially fatal condition that may occur during withdrawal from chronic alcohol intoxication. The purpose of the present study was to compare the effects and the rates of complications of phenobarbital and diazepam treatment in DT.......Delirium tremens (DT) is a severe and potentially fatal condition that may occur during withdrawal from chronic alcohol intoxication. The purpose of the present study was to compare the effects and the rates of complications of phenobarbital and diazepam treatment in DT....

  17. Radiohippuran renography in chronic alcoholics with acute alcohol withdrawal syndromes

    International Nuclear Information System (INIS)

    Functional changes found in radiohippuran renography in chronic alcoholics with acute alcohol withdrawal syndromes (n=82; AAWS) regressed to normal values with recovery from AAWS (during 4 days on the average) with the exception of the secretory value which increased to a maximum on the 7th day of observation, remaining approximately unchanged for the following 3 days and decreasing more gradually to a normal value on the 23rd day of observation. In various forms of AAWS the same functional changes in the radiohippuran renogram were observed. (author)

  18. Assessment of characteristics of patient with delirium tremens.

    Science.gov (United States)

    Singh, P M; Shrestha, D M; Gautam, S C; Swar, S B; Joshi, N

    2012-09-01

    Delirium tremens is the severe form of alcohol withdrawal. It carries a certain degree of mortality and there has been and advancement in the understanding of pathophysiology and risk factors for the development of the condition. This prospective study is carried out to study the characteristic of the patient of delirium tremens in our setting using ICD-10 diagnostic criteria. Thirty seven cases of delirium tremens with majority of males and of all hill origin people were identified. Patients with delirium tremens has been using alcohol for average of 24.8 years with an average intake of around 2.2 litres per day. Most of the patient has seizure and similar episodes in past and using alcohol from morning time. PMID:24047019

  19. A case of mistaken identity: alcohol withdrawal, schizophrenia, or central pontine myelinolysis?

    Directory of Open Access Journals (Sweden)

    Schneider P

    2012-02-01

    Full Text Available Paul Schneider1, Vicki A Nejtek2,3, Cheryl Hurd2,31Green Oaks Behavioral Health Care Services, Dallas, 2University of North Texas Health Science Center, Fort Worth, 3John Peter Smith Health Network, Fort Worth, Texas, USAAbstract: Demyelination is a hallmark of central pontine myelinolysis (CPM. Neuropsychiatric manifestations of this condition include weakness, quadriplegia, pseudobulbar palsy, mood changes, psychosis, and cognitive disturbances. These psychiatric symptoms are also associated with schizophrenia and alcohol withdrawal. Thus, it is clinically relevant to differentiate between CPM, schizophrenia, and alcohol withdrawal as the treatment and prognostic outcomes for each diagnosis are distinct. We present a series of events that led to a misdiagnosis of a patient admitted to the medical emergency center presenting with confusion, psychomotor agitation, and delirium who was first diagnosed with schizophrenia and alcohol withdrawal by emergency medical physicians and later discovered by the psychiatric consult team to have CPM. With a thorough psychiatric evaluation, a review of the laboratory results first showing mild hyponatremia (127 mmol/L, subsequent hypernatremia (154 mmol/L, and magnetic resonance brain imaging, psychiatrists concluded that CPM was the primary diagnosis underlying the observed neuropsychopathology. This patient has mild impairments in mood, cognition, and motor skills that remain 12 months after her emergency-center admission. This case report reminds emergency clinicians that abnormal sodium metabolism can have long-term and devastating psychopathological and neurological consequences. Differentiating between CPM, schizophrenia, and alcohol withdrawal using neuroimaging techniques and preventing the risks for CPM using slow sodium correction are paramount.Keywords: MRI, alcohol, schizophrenia, central pontine myelinolysis, hyponatremia

  20. Takotsubo cardiomyopathy precipitated by delirium tremens.

    Science.gov (United States)

    Agu, Chidozie Charles; Bakhit, Ahmed; Basunia, Md; Bhattarai, Bikash; Oke, Vikram; Salhan, Divya; Schmidt, Frances

    2015-01-01

    A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG) showed diffuse ST elevation with elevated cardiac enzymes. Echocardiogram showed estimated ejection fraction of 20-25% with characteristic apical ballooning. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Coronary angiogram revealed no coronary abnormalities. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, only a few cases have been described with delirium tremens in the medical literature. PMID:26653700

  1. Takotsubo cardiomyopathy precipitated by delirium tremens

    Directory of Open Access Journals (Sweden)

    Chidozie Charles Agu

    2015-12-01

    Full Text Available A 57-year-old woman presented with alcohol withdrawal symptoms, which later progressed to delirium tremens. During hospitalization, she developed respiratory distress with acute pulmonary edema. Electrocardiogram (ECG showed diffuse ST elevation with elevated cardiac enzymes. Echocardiogram showed estimated ejection fraction of 20–25% with characteristic apical ballooning. After several days of supportive care, the patient showed significant clinical improvement with normalization of ECG, cardiac enzymes, and echocardiographic findings. Coronary angiogram revealed no coronary abnormalities. Although Takotsubo cardiomyopathy has been associated with diverse forms of physical or emotional stress, only a few cases have been described with delirium tremens in the medical literature.

  2. Acute coronary ischemia during alcohol withdrawal: a case report

    OpenAIRE

    Sriram Ganeshalingam; Epa Dhanesha; Rodrigo Chaturaka; Jayasinghe Saroj

    2011-01-01

    Abstract Introduction The potential of alcohol withdrawal to cause acute coronary events is an area that needs the urgent attention of clinicians and researchers. Case presentation We report the case of a 52-year-old heavy-alcohol-using Sri Lankan man who developed electocardiogram changes suggestive of an acute coronary event during alcohol withdrawal. Despite the patient being asymptomatic, subsequent echocardiogram showed evidence of ischemic myocardial dysfunction. We review the literatur...

  3. Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?

    OpenAIRE

    Asish Subedi; Balkrishna Bhattarai

    2013-01-01

    As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS) is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal ...

  4. Phenobarbital compared to benzodiazepines in alcohol withdrawal treatment

    DEFF Research Database (Denmark)

    Askgaard, Gro; Hallas, Jesper; Fink-Jensen, Anders; Molander, Anna Camilla; Madsen, Kenneth Grønkjær; Pottegård, Anton

    2016-01-01

    BACKGROUND: Long-acting benzodiazepines such as chlordiazepoxide are recommended as first-line treatment for alcohol withdrawal. These drugs are known for their abuse liability and might increase alcohol consumption among problem drinkers. Phenobarbital could be an alternative treatment option......, possibly with the drawback of a more pronounced acute toxicity. We evaluated if phenobarbital compared to chlordiazepoxide decreased the risk of subsequent use of benzodiazepines, alcohol recidivism and mortality. METHODS: The study was a register-based cohort study of patients admitted for alcohol...... withdrawal 1998-2013 and treated with either phenobarbital or chlordiazepoxide. Patients were followed for one year. We calculated hazard ratios (HR) for benzodiazepine use, alcohol recidivism and mortality associated with alcohol withdrawal treatment, while adjusting for confounders. RESULTS: A total of...

  5. Factor Structure of CIWA-Ar in Alcohol Withdrawal

    OpenAIRE

    Ajay Kumar Bakhla; Khess, Christoday R.J.; Vijay Verma; Mahesh Hembram; Samir Kumar Praharaj; Subhas Soren

    2014-01-01

    Objective. To identify the underlying factor structure of alcohol withdrawal syndrome, as measured with CIWA-Ar. Methods. Exploratory factor analysis was conducted on the items of CIWA-Ar. On 201 alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Results. A three-factor solution was obtained that accounted for 68.74% of total variance. First factor had loading from four items (34.34% variance), second factor also had four items (24.25% variance...

  6. Factor Structure of CIWA-Ar in Alcohol Withdrawal.

    Science.gov (United States)

    Bakhla, Ajay Kumar; Khess, Christoday R J; Verma, Vijay; Hembram, Mahesh; Praharaj, Samir Kumar; Soren, Subhas

    2014-01-01

    Objective. To identify the underlying factor structure of alcohol withdrawal syndrome, as measured with CIWA-Ar. Methods. Exploratory factor analysis was conducted on the items of CIWA-Ar. On 201 alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Results. A three-factor solution was obtained that accounted for 68.74% of total variance. First factor had loading from four items (34.34% variance), second factor also had four items (24.25% variance), and the third had two items (10.04% variance). Conclusions. Factor analysis reveals the existence of multidimensionality of alcohol withdrawal as measured with CIWA-Ar and we found three factors that can be named as delirious, autonomic and nonspecific factors. PMID:24826372

  7. Factor Structure of CIWA-Ar in Alcohol Withdrawal

    Directory of Open Access Journals (Sweden)

    Ajay Kumar Bakhla

    2014-01-01

    Full Text Available Objective. To identify the underlying factor structure of alcohol withdrawal syndrome, as measured with CIWA-Ar. Methods. Exploratory factor analysis was conducted on the items of CIWA-Ar. On 201 alcohol-dependent male patients seeking treatment for alcohol withdrawal at 36 hours of abstinence. Results. A three-factor solution was obtained that accounted for 68.74% of total variance. First factor had loading from four items (34.34% variance, second factor also had four items (24.25% variance, and the third had two items (10.04% variance. Conclusions. Factor analysis reveals the existence of multidimensionality of alcohol withdrawal as measured with CIWA-Ar and we found three factors that can be named as delirious, autonomic and nonspecific factors.

  8. Excited delirium: Consideration of selected medical and psychiatric issues

    Directory of Open Access Journals (Sweden)

    Edith Samuel

    2009-01-01

    Full Text Available Edith Samuel1, Robert B Williams1, Richard B Ferrell21Department of Psychology, Atlantic Baptist University, Moncton, New Brunswick Canada; 2Department of Psychiatry, Dartmouth Medical School, Lebanon, New Hampshire, USAAbstract: Excited delirium, sometimes referred to as agitated or excited delirium, is the label assigned to the state of acute behavioral disinhibition manifested in a cluster of behaviors that may include bizarreness, aggressiveness, agitation, ranting, hyperactivity, paranoia, panic, violence, public disturbance, surprising physical strength, profuse sweating due to hyperthermia, respiratory arrest, and death. Excited delirium is reported to result from substance intoxication, psychiatric illness, alcohol withdrawal, head trauma, or a combination of these. This communication reviews the history of the origins of excited delirium, selected research related to its causes, symptoms, management, and the links noted between it and selected medical and psychiatric conditions. Excited delirium involves behavioral and physical symptoms that are also observed in medical and psychiatric conditions such as rhabdomyolysis, neuroleptic malignant syndrome, and catatonia. A useful contribution of this communication is that it links the state of excited delirium to conditions for which there are known and effective medical and psychiatric interventions.Keywords: excited delirium, excited states, cocaine misuse, restraint or in custody deaths

  9. [Delirium: Concepts, Etiology, and Clinical Management].

    Science.gov (United States)

    Hübscher, A; Isenmann, S

    2016-04-01

    Delirium is a common condition: up to 35 percent of non-ICU- and 80 percent of ICU-patients experience delirium - particularly the elderly suffering from cerebral dysfunction accompanied by acute infection, surgery, or change of medication. Medical staff should be alert for decrease (within hours) of concentration, memory, orientation, and consciousness - especially when agitation appears and symptoms are fluctuating. Vegetative lapses and seizures may complicate the course, in particular in delirium in withdrawal (of alcohol or drugs). Treatment comprises neuroleptic and sedative medication (be careful with benzodiazepines because of their delirogenic potential) as well as alpha-2-agonists for vegetative derangements and anti-epileptics in case of seizures. As usual: start with low doses, and keep the medical treatment as short as possible. Additionally, take care in the · search and solution of delir-causes,. · termination of unnecessary medication (in particular, anticholinergic agents),. · comfort, intimacy and orientation,. · cognitive training and mobilization.. Avoiding a delirium is the best medicine. For that reason, identification of patients at risk, early detection of signs of delirium and prevention are most important. Beside factors 2 to 4, personalized treatment has been proved to be very helpful. PMID:27100850

  10. Delirium (Beyond the Basics)

    Science.gov (United States)

    ... is addressed promptly. Delirium also differs from the psychosis of psychiatric disease, in which orientation, concentration and ... read the same materials their doctors are reading. Acute toxic-metabolic encephalopathy in adults Medically supervised alcohol ...

  11. Propofol for Treatment of Refractory Alcohol Withdrawal Syndrome: A Review of the Literature.

    Science.gov (United States)

    Brotherton, Amy L; Hamilton, Eric P; Kloss, H Grace; Hammond, Drayton A

    2016-04-01

    The authors evaluated all available evidence on the use of propofol as an adjuvant for the treatment of resistant alcohol withdrawal syndrome (AWS) in comparison to other therapies. A comprehensive PubMed search (1966-December 2015) was conducted using the search terms propofol, alcohol withdrawal, and drug therapy. Articles were cross-referenced for other citations. Clinical studies, case series, and case reports published in the English language assessing the use of propofol in adult patients for treatment of AWS were reviewed for inclusion. Propofol is a sedative-hypnotic that exerts its actions through agonism of GABAA receptors at a different binding site than benzodiazepines and reduces glutamatergic activity through N-methyl-d-aspartase (NMDA) receptor blockade. Dosages from 5 to 100 μg/kg/minute reduced AWS symptoms with frequent development of hypotension and requirement for mechanical ventilation. Patients on propofol often experienced longer durations of mechanical ventilation and length of stay, which may be attributed to more-resistant cases of AWS. When propofol was compared with dexmedetomidine as adjuncts in AWS, both agents showed similar benzodiazepine- and haloperidol-sparing effects. Dexmedetomidine was associated with more numerical rates of bradycardia, while propofol was associated with more numerical instances of hypotension. Dexmedetomidine was used more frequently in nonintubated patients. The available data assessing the utility of propofol for AWS exhibited significant heterogeneity. Propofol may be useful in a specific population of patients with AWS, limited to those who are not clinically responding to first-line therapy with benzodiazepines. Specifically, propofol should be considered in patients who are refractory to or not candidates for other adjuvant therapies, patients already requiring mechanical ventilation, or those with seizure activity or refractory delirium tremens. In severe, refractory AWS, adjuvant therapy with

  12. Effects of Alcohol Dependence and Withdrawal on Stress Responsiveness and Alcohol Consumption

    OpenAIRE

    Howard C Becker

    2012-01-01

    A complex relationship exists between alcohol-drinking behavior and stress. Alcohol has anxiety-reducing properties and can relieve stress, while at the same time acting as a stressor and activating the body’s stress response systems. In particular, chronic alcohol exposure and withdrawal can profoundly disturb the function of the body’s neuroendocrine stress response system, the hypothalamic–pituitary–adrenocortical (HPA) axis. A hormone, corticotropin-releasing factor (CRF), which is produc...

  13. [Risk factors for delirium tremens: a literature review].

    Science.gov (United States)

    Thiercelin, N; Rabiah Lechevallier, Z; Rusch, E; Plat, A

    2012-01-01

    Delirium tremens (DT) is the most severe complication from alcohol withdrawal. Risk factors for DT (before the withdrawal begins) and early predictive factors for the development of the withdrawal syndrome towards DT (once withdrawal has started) are not clearly established. We reviewed the literature from PubMed/Medline database to identify risk factors for DT. Twenty-one studies were been selected. Three only were prospective. The most commonly identified risk factors included personal history of DT, seizures, presence of acute somatic comorbidity especially infectious, presence of early withdrawal symptoms, and genetic predisposition. Most of these risk factors are still debated and prospective studies might appear useful considering the DT prevalence and the absence of consensual both diagnostic and therapeutic protocols. PMID:21920639

  14. Pacient s diagnózou delirium tremens v intenzivní péči

    OpenAIRE

    ŽÁKOVÁ, Magdaléna

    2016-01-01

    This bachelor thesis concerns with problematics of nursing care with patients in the Intensive Care Units. Delirium tremens is the most serious stadium of alcoholic withdrawal syndrome and it starts when alcoholics stop drinking alcohol. This state is life endangering and it is necessary to hospitalize the patients in the Intensive Care Units or in the Anesthesiology Resuscitational. Nurses are supposed to know their competence, specific activities and interventions, which leads to the preven...

  15. Study on Alcoholic Withdrawal Score, with Questionnaire Based Session Conducted on Acute and Chronic Alcoholic Liver Disease Patients

    Directory of Open Access Journals (Sweden)

    Bandi Navyatha

    2016-07-01

    Full Text Available Alcohol liver disease is damage to the Liver and its function due to alcohol abuse. It occurs after years of heavy drinking and by through which cirrhosis can occur and which leads to the final phase of Alcoholic liver disease. It not only occurs in heavy drinkers but also there is a chance of getting liver disease go up the longer of been drinking and more alcohol consumption. A study was observational, prospective and descriptive; and was carried out one hundred and nine patients [n=109] who were with suffering from an Alcoholic liver disease, to determine the alcohol withdrawal score and there symptoms involved after they were kept on alcohol withdrawal therapy. An observational, prospective and randomized study was conducted in the hospital from March 2014-March 2016. Questionnaire based session with 10 scaled questions were framed according to CIWA (assessment and management of alcohol withdrawal and the score was noted with their symptoms occurrence after the alcohol cessation plan. CIWA score with moderate severity were found to be highest. 7 patients out of 33 patients in severe category of CIWA score were admitted in the hospital with alcohol withdrawal syndrome and psychological disturbances. Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA helps clinicians assess and treat potential alcohol withdrawal.

  16. Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?

    Directory of Open Access Journals (Sweden)

    Asish Subedi

    2013-01-01

    Full Text Available As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal anesthesia, fascia iliaca compartmental block with 0.25% bupivacaine (30 mL was administered 30 min prior to spinal block. Later, in the intraoperative period the patient developed AWS; however, the features were similar to that of local anesthetic toxicity. The case was successfully managed with intravenous midazolam, esmolol, and propofol infusion. Due to similarity of clinical features of AWS and mild local anesthetic toxicity, an anesthetist should be in a position to differentiate the condition promptly and manage it aggressively.

  17. Intraoperative Alcohol Withdrawal Syndrome: A Coincidence or Precipitation?

    Science.gov (United States)

    Subedi, Asish

    2013-01-01

    As the prevalence of alcohol dependence is approximately half in surgical patients with an alcohol use disorder, anesthetist often encounters such patients in the perioperative settings. Alcohol withdrawal syndrome (AWS) is one of the most feared complications of alcohol dependence and can be fatal if not managed actively. A 61-year-old man, alcoholic with 50 h of abstinence before surgery, received spinal anesthesia for surgery for femoral neck fracture. To facilitate positioning for spinal anesthesia, fascia iliaca compartmental block with 0.25% bupivacaine (30 mL) was administered 30 min prior to spinal block. Later, in the intraoperative period the patient developed AWS; however, the features were similar to that of local anesthetic toxicity. The case was successfully managed with intravenous midazolam, esmolol, and propofol infusion. Due to similarity of clinical features of AWS and mild local anesthetic toxicity, an anesthetist should be in a position to differentiate the condition promptly and manage it aggressively. PMID:23936683

  18. The importance of depression and alcohol use in coronary artery bypass graft surgery patients:risk factors for delirium and poorer quality of life

    Institute of Scientific and Technical Information of China (English)

    Joanne M Humphreys; Linley A Denson; Robert A Baker; Phillip J Tully

    2016-01-01

    ObjectiveToinvestigate whether depression, anxiety and stress increase the risk for delirium and poor quality of life (QOL) after co-ronary artery bypass (CABG) surgery.MethodsA total of 180 CABG patients (mean age of 63.5 ± 10.1 years, 82.2% males) completed baseline and postoperative self-report questionnaires to assess distress and QOL. Incident delirium was diagnosed postoperatively with a structured clinical interview and patients were monitored every day post-operatively for confusion and disturbance in consciousness.Results Delirium developed in 63 persons (35% of sample). After adjustment for covariates, delirium was significantly associated with depression [odds ratio (OR): 1.08; 95% confidence interval (CI): 1.03–1.13,P = 0.003], anxiety (OR: 1.07; 95% CI: 1.02–1.13,P= 0.01) and stress (OR: 1.05; 95% CI: 1.00–1.09,P= 0.03). Preoperative depression scores were associated with poorer QOL including bodily pain (β =-0.39,P = 0.013), vitality (β=-0.32,P = 0.020), social functioning (β=-0.51,P£0.001), emotional role function (β=-0.44,P = 0.003) and general health (β=-0.33,P = 0.038). Among the covariates, harmful levels of alcohol use was consistently associated with poorer QOL.Conclusions Depression and harmful levels of alcohol use were consistently associated with poorer QOL whereas depression, anxiety and stress were associated with delirium risk. These findings point to further research examining depression and harmful levels of alcohol use in coronary heart disease populations undergoing coronary revascularization.

  19. Attenuation of alcohol withdrawal syndrome and blood cortisol level with forced exercise in comparison with diazepam.

    OpenAIRE

    Majid Motaghinejad; Mohammad Yasan Bangash; Ozra Motaghinejad

    2015-01-01

    Relieving withdrawal and post-abstinence syndrome of alcoholism is one of the major strategies in the treatment of alcohol addicted patients. Diazepam, chlordiazepoxide, and topiramate are the approved medications that were used for this object. To assess the role of non-pharmacologic therapy in the management of alcohol withdrawal syndrome, we analyzed effects of forced exercise by treadmill on alcohol dependent mice as an animal model. A total of 60 adult male mice were divided into 5 group...

  20. What to Ask: Delirium

    Science.gov (United States)

    ... Delirium Join our e-newsletter! Resources What to Ask: Delirium Tools and Tips Under recognition of delirium ... care for. The following are questions you can ask your healthcare professional about delirium. What is delirium? ...

  1. Alcohol withdrawal – therapeutical management in surgical patients with upper intestinal bleeding

    OpenAIRE

    Bălălău Cristian; Cobani Oana Denisa; Trambitasu Gloria; Popescu Bogdan; Carolina Negrei; Scăunașu Răzvan Valentin

    2015-01-01

    Psychological dependence involves a desire to use a drug to avoid the unpleasant withdrawal syndrome that results from cessation of exposure to it. Alcohol withdrawal syndrome is one of the most feared complications of alcohol addiction and sometimes can be fatal if not treated properly. Withdrawal syndrome is characterized by neurological hyperexcitability, which can lead to severe psychological and neurological symptoms. A survey was conceived in order to monitor the efficiency of several d...

  2. Alcohol Withdrawal and Brain Injuries: Beyond Classical Mechanisms

    Directory of Open Access Journals (Sweden)

    Marianna E. Jung

    2010-07-01

    Full Text Available Unmanaged sudden withdrawal from the excessive consumption of alcohol (ethanol adversely alters neuronal integrity in vulnerable brain regions such as the cerebellum, hippocampus, or cortex. In addition to well known hyperexcitatory neurotransmissions, ethanol withdrawal (EW provokes the intense generation of reactive oxygen species (ROS and the activation of stress-responding protein kinases, which are the focus of this review article. EW also inflicts mitochondrial membranes/membrane potential, perturbs redox balance, and suppresses mitochondrial enzymes, all of which impair a fundamental function of mitochondria. Moreover, EW acts as an age-provoking stressor. The vulnerable age to EW stress is not necessarily the oldest age and varies depending upon the target molecule of EW. A major female sex steroid, 17β-estradiol (E2, interferes with the EW-induced alteration of oxidative signaling pathways and thereby protects neurons, mitochondria, and behaviors. The current review attempts to provide integrated information at the levels of oxidative signaling mechanisms by which EW provokes brain injuries and E2 protects against it. Unmanaged sudden withdrawal from the excessive consumption of alcohol (ethanol adversely alters neuronal integrity in vulnerable brain regions such as the cerebellum, hippocampus, or cortex. In addition to well known hyperexcitatory neurotransmissions, ethanol withdrawal (EW provokes the intense generation of reactive oxygen species (ROS and the activation of stress-responding protein kinases, which are the focus of this review article. EW also inflicts mitochondrial membranes/membrane potential, perturbs redox balance, and suppresses mitochondrial enzymes, all of which impair a fundamental function of mitochondria. Moreover, EW acts as an age-provoking stressor. The vulnerable age to EW stress is not necessarily the oldest age and varies depending upon the target molecule of EW. A major female sex steroid, 17

  3. Withdrawal symptoms in a long-term model of voluntary alcohol drinking in Wistar rats.

    Science.gov (United States)

    Hölter, S M; Linthorst, A C; Reul, J M; Spanagel, R

    2000-05-01

    Long-term voluntary alcohol drinking with repeated alcohol deprivation episodes has been suggested as animal model for some aspects of alcoholism. Using a radiotelemetric system, the present study investigated the occurrence of withdrawal symptoms in long-term voluntarily alcohol drinking Wistar rats with (repeated alcohol deprivation group) and without (first alcohol deprivation group) prior alcohol deprivation experience. Six days after transmitter implantation, alcohol bottles were removed, and returned 4 days later. Alcohol deprivation induced hyperlocomotion in both groups. In the repeated alcohol deprivation group, hyperlocomotion was increased at the beginning of the alcohol deprivation phase and decreased during the following dark phase, suggesting that removal of the alcohol bottles might have become a conditioned withdrawal stimulus for this group. Both groups showed an enhanced alcohol intake after representation of alcohol bottles compared to preabstinence intakes (alcohol deprivation effect). However, alcohol intake of the repeated alcohol deprivation group was significantly increased compared to the first alcohol deprivation group at the end of the experiment. It is concluded that repeated alcohol deprivation experience might promote the development of alcohol addiction because of its latent stimulating effect on alcohol drinking that can be unveiled by (presumably mildly stressful) experimental situations. PMID:10837854

  4. LEVELS OF BRAIN-SPECIFIC S-100B PROTEIN, SPECIFIC ANTIBODIES AND CYTOKINE PROFILE IN THE PATIENTS WITH ALCOHOL-INDUCED DELIRIUM STATES

    Directory of Open Access Journals (Sweden)

    N. N. Tsybikov

    2008-01-01

    Full Text Available Abstract. Present article deals with our results concerning brain-specific S-100B protein levels, anti-S-100B autoantibodies of IgM and IgG classes, like as cytokine profiles of blood serum and cerebrospinal fluid in the patients with alcohol-induced delirium state. The results obtained provide an evidence of association between alcoholic psychosis and destruction of brain tissue, development of autoimmune reactions and altered cytokine status, thus, probably, resulting into disintegration of immune and neuroendocrine systems.

  5. Similar withdrawal severity in adolescents and adults in a rat model of alcohol dependence

    OpenAIRE

    Morris, S.A.; Kelso, M.L.; Liput, D.J.; Marshall, S A; Nixon, K.

    2010-01-01

    Alcohol use during adolescence leads to increased risk of developing an alcohol use disorder (AUD) during adulthood. Converging evidence suggests that this period of enhanced vulnerability for developing an AUD may be due to the adolescent’s unique sensitivity and response to alcohol. Adolescent rats have been shown to be less sensitive to alcohol intoxication and withdrawal susceptibility; however age differences in ethanol pharmacokinetics may underlie these effects. Therefore, this study i...

  6. [Alcohol and psychiatric disorders].

    Science.gov (United States)

    Bouzyk-Szutkiewicz, Joanna; Waszkiewicz, Napoleon; Szulc, Agata

    2012-09-01

    Alcohol dependence and abuse is one of the most costly health problems in the world from both a social and an economic point of view. It is a widespread problem, focusing attention not only psychiatrists but also doctors of other specialties. Patterns of drinking appear to be changing throughout the world, with more women and young people drinking heavily. Even risky drinking is a potential health risk, while chronic alcohol abuse contribute to the serious physical and mental complications. Alcohol used disorders associated with alcohol-induced brain damage include: withdrawal state, delirium tremens, alcoholic hallucinosis, alcoholic paranoia, Korsakoffs psychosis, alcoholic dementia, alcoholic depression. On the other hand, mental disorders as panic disorder, social anxiety disorder, agoraphobia, depression, bipolar disorder, schizophrenia, personality disorder most frequently comorbid with alcohol abuse or they trigger alcohol. PMID:23157139

  7. The impacts of nitrous oxide gas on sleep quality during alcohol withdrawal

    Directory of Open Access Journals (Sweden)

    Sinclair David

    2011-04-01

    Full Text Available Abstract Background Poor quality of sleep among alcoholics and persons undergoing alcohol withdrawal has been described as a possible cause of alcohol relapse. It has been suggested earlier that nitrous oxide gas has a significant effect on the signs of alcohol withdrawal syndrome (AWS and thus might be expected to reduce sleep disturbance during withdrawal. The aim of the present study was to investigate sleep quality during alcohol withdrawal, to evaluate the correlation between sleep quality and the severity of AWS and alcohol craving, and to determine if nitrous oxide treatment does counteract withdrawal's effects on the quality of sleep. Voluntary patients (n = 105 admitted to the A-Clinic detoxification center with AWS were included in the study. The AWS patients were randomly assigned to one of the following 45-minute gas treatments: (1 nitrous oxide/oxygen; (2 normal air/O2; and (3 medical (normal air. The study was single-blind by design. Sleep quality was assessed after these treatments during the inpatient period; sleep time, sleep efficiency and the fragmentation of sleep were recorded by wrist-worn actigraphs. Severity of AWS was evaluated by the Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar and that of alcohol dependence and craving by the Obsessive Compulsive Drinking Scale [OCDS] and the Severity of Alcohol Dependence Data (SADD questionnaire. Results The fragmentation index and the time awake while in bed were both much above the reference values for the Finnish population. These values reflect the restless and disturbed night sleep of the subjects. The only statistically significant effects between the treatment groups were found in the correlations of CIWA-Ar (severity of AWS scores, OCDS-scores (alcohol craving and coffee consumption, all of which were positively associated with movement time and negatively with total sleep time and sleep efficiency. The sleep quality of patients treated with nitrous

  8. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

    OpenAIRE

    Reddy, Vikram K.; Girish, K.; Pandit Lakshmi; R Vijendra; Ajay Kumar; Harsha, R.

    2014-01-01

    Objectives: Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acid B (GABA B ) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods : This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness an...

  9. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

    OpenAIRE

    Reddy, Vikram K.; Girish, K.; Lakshmi, Pandit; R Vijendra; Kumar, Ajay; Harsha, R.

    2014-01-01

    Objectives: Benzodiazepines (BZDs) are the first-line drugs in alcohol-withdrawal syndrome (AWS). Baclofen, a gamma-aminobutyric acidB (GABAB) agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods: This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (...

  10. Alcohol Withdrawal Syndrome: Symptom-Triggered versus Fixed-Schedule Treatment in an Outpatient Setting

    DEFF Research Database (Denmark)

    Elholm, B.; Larsen, Klaus; Hornnes, N.;

    2011-01-01

    Aims: To investigate whether, in the treatment with chlordiazepoxide for outpatient alcohol withdrawal, there are advantages of symptom-triggered self-medication over a fixed-schedule regimen. Methods: A randomized controlled trial in outpatient clinics for people suffering from alcohol dependence...... (AD) and alcohol-related problems; 165 adult patients in an outpatient setting in a specialized alcohol treatment unit were randomized 1:1 to either a symptom-triggered self-medication or tapered dose, using chlordiazepoxide. Alcohol withdrawal symptoms, amount of medication, duration of symptoms...... the 1-year follow-up. Results: We found no differences in the quantity of medication consumed, time to relapse, well being or treatment satisfaction. Conclusion: Symptom-triggered self-medication was as safe as fixed-schedule medication in treating outpatients with AD and mild to moderate symptoms of...

  11. Emergence delirium

    DEFF Research Database (Denmark)

    Munk, Louise; Andersen, Lars Peter Holst; Gögenur, Ismail

    2013-01-01

    Emergence delirium (ED) is a well-known phenomenon in the postoperative period. However, the literature concerning this clinical problem is limited. This review evaluates the literature with respect to epidemiology and risk factors. Treatment strategies are discussed. The review concludes that...

  12. Gender Differences in Associations between Lifetime Alcohol, Depression, Panic Disorder, and Posttraumatic Stress Disorder and Tobacco Withdrawal

    OpenAIRE

    Weinberger, Andrea H.; Maciejewski, Paul K.; McKee, Sherry A.; Reutenauer, Erin L.; Mazure, Carolyn M.

    2009-01-01

    This study examined the interaction of gender and lifetime psychiatric status on the experience of nicotine withdrawal using retrospective data from the National Comorbidity Survey (NCS; N = 816). Multiple regression analyses were performed to examine the main and interactive effects of gender and major depression, alcohol abuse/dependence, panic disorder, and PTSD on indices of withdrawal. Major depression and alcohol abuse/dependence were associated with longer duration of withdrawal sympto...

  13. Excited Delirium

    Directory of Open Access Journals (Sweden)

    Takeuchi, Asia

    2011-02-01

    Full Text Available Excited (or agitated delirium is characterized by agitation, aggression, acute distress and sudden death, often in the pre-hospital care setting. It is typically associated with the use of drugs that alter dopamine processing, hyperthermia, and, most notably, sometimes with death of the affected person in the custody of law enforcement. Subjects typically die from cardiopulmonary arrest, although the cause is debated. Unfortunately an adequate treatment plan has yet to be established, in part due to the fact that most patients die before hospital arrival. While there is still much to be discovered about the pathophysiology and treatment, it is hoped that this extensive review will provide both police and medical personnel with the information necessary to recognize and respond appropriately to excited delirium. [West J Emerg Med. 2011;12(1:77-83.

  14. Parameters of ante-mortem delirium

    Directory of Open Access Journals (Sweden)

    Deksnyte, Aušra

    2014-02-01

    Full Text Available Objectives. The aim of this study was to investigate the parameters of ante-mortem delirium of the patients in a closed psychiatric institution and to compare them with the ante-mortem psychopathology of the medical patients. Methods. There were 139 medical records of the patients analyzed, who died during the period of 1997-2003 at the in-patient psychiatric institution. The diagnoses were recorded according to the International Classification of Diseases, 10th Revision (ICD-10 criteria. Patients’ data included age, gender, previous psychiatric disorders, current somatic and psychiatric morbidity, and comorbidity. Results. The incidence of delirium was 83,7%. The delirium group included more elder, male persons who were more likely to have dementia and less inclined to depression. Surprisingly the incidence of delirium among non-dementia men was quite high – 76,9%, as compared to non-dementia women – 23,1% (P=0,008. The duration of delirium differed from 1 to 1335 days. Longer delirium was observed among elder than 75 years (87,7, SD 183,9 vs52,6, SD 121,4 days; P=0,019 and dementia (83,6, SD 173,6 vs 13,5, SD 11,6 days; P<0,001 patients, but did not differ in gender groups. Conclusions. Ante-mortem delirium occurred more commonly in more elder and demented patients The duration of ante-mortem delirium was shorter in younger and non-dementia patients. Patients of the psychiatric institution tend to have longer deliriums than medical patients. The patients with depression and the history of alcohol abuse were not likely to get ante-mortem delirium. Before death in many persons hyperactive and mixed delirium transformed into hypoactive.

  15. Prevalence and Correlates of Withdrawal-Related Insomnia among Adults with Alcohol Dependence: Results from a National Survey

    OpenAIRE

    Brower, Kirk J.; Perron, Brian E.

    2010-01-01

    Insomnia during acute alcohol withdrawal (AWD) as well as persisting insomnia during post-acute withdrawal is associated with relapse. Rates of insomnia in clinical samples of alcohol-dependent patients range from 36 to 91%, but the prevalence of AWD-related insomnia in the general population is unknown. The purpose of this study was to describe the prevalence of insomnia as a symptom of acute AWD and its correlates in a general population of alcohol-dependent individuals. Data were analyzed ...

  16. Central pontine myelinolysis in a case of alcohol dependence syndrome.

    Science.gov (United States)

    Chatterjee, Kaushik; Fernandes, Austin B; Goyal, Sunil; Shanker, Sunitha

    2015-01-01

    Osmotic Demyelination Syndrome includes Central Pontine Myelinolysis and Extrapontine Myelinolysis. This condition has been described in cases of chronic Alcohol Dependence Syndrome and in rapid correction of hyponatremia. Though we frequently see patients with Alcohol Dependence Syndrome presenting with complicated withdrawal, Central Pontine Myelinolysis remains largely undetected and under-reported in literature. We present here a case of protracted Delirium Tremens where MRI brain revealed Central Pontine Myelinolysis. Subsequently cognitive assessment revealed significant dysfunction and brain SPECT showed hypo-perfusion of the frontal lobes. Osmotic Demyelination Syndrome should be suspected in protracted Delirium Tremens. PMID:27212829

  17. Central pontine myelinolysis in a case of alcohol dependence syndrome

    Directory of Open Access Journals (Sweden)

    Kaushik Chatterjee

    2015-01-01

    Full Text Available Osmotic Demyelination Syndrome includes Central Pontine Myelinolysis and Extrapontine Myelinolysis. This condition has been described in cases of chronic Alcohol Dependence Syndrome and in rapid correction of hyponatremia. Though we frequently see patients with Alcohol Dependence Syndrome presenting with complicated withdrawal, Central Pontine Myelinolysis remains largely undetected and under-reported in literature. We present here a case of protracted Delirium Tremens where MRI brain revealed Central Pontine Myelinolysis. Subsequently cognitive assessment revealed significant dysfunction and brain SPECT showed hypo-perfusion of the frontal lobes. Osmotic Demyelination Syndrome should be suspected in protracted Delirium Tremens.

  18. Downregulation of Gabra4 expression during alcohol withdrawal is mediated by specific microRNAs in cultured mouse cortical neurons

    OpenAIRE

    Bekdash, Rola A.; Harrison, Neil L.

    2015-01-01

    Background Alcohol abuse and dependence are a serious public health problem. A large number of alcohol-regulated genes, (ARGs) are known to be influenced by alcohol use and withdrawal (AW), and recent evidence suggests that neuroadaptation to alcohol may be due in part to epigenetic changes in the expression of ARGs. Gabra4, which encodes the α4 subunit of GABAA receptors (GABAARs), is one of a number of ARGs that show remarkable plasticity in response to alcohol, being rapidly upregulated by...

  19. Delirium: a key challenge for perioperative care.

    Science.gov (United States)

    O'Regan, N A; Fitzgerald, J; Timmons, S; O'Connell, H; Meagher, D

    2013-01-01

    Delirium is highly prevalent, occurring in 20% of acute hospital inpatients and up to 62% of surgical patients. It is a significant predictor of poor outcomes including mortality and institutionalisation, however it is often viewed as simply a marker of underlying illness and is frequently overlooked in older adults. Although delirium is commonly comorbid with dementia, it represents a more urgent diagnosis, requiring prompt intervention. Delirium presents most commonly with hypoactive features (e.g. withdrawal and reduced spontaneous movement and speech). The common stereotype of hyperactive delirium tremens (e.g. agitation, hallucinations), although more visible, is less common. All presentations share acute disimprovement of cognitive function. Delirium is a highly predictable and preventable occurrence, however a major barrier to improving delirium care and impacting upon outcomes is that it remains poorly detected, particularly in surgical populations and especially in patients with hypoactive presentations. Routine ward-based screening for delirium, particularly in high-risk populations, and improved staff awareness of the significance of the problem can improve detection rates. Preventative strategies, particularly multicomponent approaches, have been most efficacious in improving patient outcomes. Optimising perioperative risk factors can lead to reduced incidence. Appropriate treatment of delirium requires thorough investigation, management of the underlying illness, avoidance of complications and simplification of the care environment. Studies suggest a role for pharmacological prophylaxis, particularly in relation to anaesthetic and sedative agents used intra- and post-operatively. Furthermore, gathering evidence suggests that judicious use of antipsychotic medications may be helpful in delirium prevention and treatment. PMID:23277227

  20. How Imaging Glutamate, γ-Aminobutyric Acid, and Dopamine Can Inform the Clinical Treatment of Alcohol Dependence and Withdrawal.

    Science.gov (United States)

    Hillmer, Ansel T; Mason, Graeme F; Fucito, Lisa M; O'Malley, Stephanie S; Cosgrove, Kelly P

    2015-12-01

    Neuroimaging studies have dramatically advanced our understanding of the neurochemical basis of alcohol dependence, a major public health issue. In this paper, we review the research generated from neurochemical specific imaging modalities including magnetic resonance spectroscopy, positron emission tomography, and single-photon emission computed tomography in studies of alcohol dependence and withdrawal. We focus on studies interrogating γ-aminobutyric acid (GABA), glutamate, and dopamine, as these are prominent neurotransmitter systems implicated in alcohol dependence. Highlighted findings include diminished dopaminergic functioning and modulation of the GABA system by tobacco smoking during alcohol withdrawal. Then, we consider how these findings impact the clinical treatment of alcohol dependence and discuss directions for future experiments to address existing gaps in the literature, for example, sex differences and smoking comorbidity. These and other considerations provide opportunities to build upon the current neurochemistry imaging literature of alcohol dependence and withdrawal, which may usher in improved therapeutic and relapse prevention strategies. PMID:26510169

  1. The kappa opioid receptor antagonist JDTic attenuates alcohol seeking and withdrawal anxiety.

    Science.gov (United States)

    Schank, Jesse R; Goldstein, Andrea L; Rowe, Kelly E; King, Courtney E; Marusich, Julie A; Wiley, Jenny L; Carroll, F Ivy; Thorsell, Annika; Heilig, Markus

    2012-05-01

    The role of kappa-opioid receptors (KOR) in the regulation of alcohol-related behaviors is not completely understood. For example, alcohol consumption has been reported to increase following treatment with KOR antagonists in rats, but was decreased in mice with genetic deletion of KOR. Recent studies have further suggested that KOR antagonists may selectively decrease alcohol self-administration in rats following a history of dependence. We assessed the effects of the KOR antagonist JDTic on alcohol self-administration, reinstatement of alcohol seeking induced by alcohol-associated cues or stress, and acute alcohol withdrawal-induced anxiety ('hangover anxiety'). JDTic dose-dependently reversed hangover anxiety when given 48 hours prior to testing, a time interval corresponding to the previously demonstrated anxiolytic efficacy of this drug. In contrast, JDTic decreased alcohol self-administration and cue-induced reinstatement of alcohol seeking when administered 2 hours prior to testing, but not at longer pre-treatment times. For comparison, we determined that the prototypical KOR antagonist nor-binaltorphimine can suppress self-administration of alcohol at 2 hours pre-treatment time, mimicking our observations with JDTic. The effects of JDTic were behaviorally specific, as it had no effect on stress-induced reinstatement of alcohol seeking, self-administration of sucrose, or locomotor activity. Further, we demonstrate that at a 2 hours pre-treatment time JDTic antagonized the antinociceptive effects of the KOR agonist U50,488H but had no effect on morphine-induced behaviors. Our results provide additional evidence for the involvement of KOR in regulation of alcohol-related behaviors and provide support for KOR antagonists, including JDTic, to be evaluated as medications for alcoholism. PMID:22515275

  2. Temporal changes in innate immune signals in a rat model of alcohol withdrawal in emotional and cardiorespiratory homeostatic nuclei

    OpenAIRE

    Freeman Kate; Brureau Anthony; Vadigepalli Rajanikanth; Staehle Mary M; Brureau Melanie M; Gonye Gregory E; Hoek Jan B; Hooper D; Schwaber James S

    2012-01-01

    Abstract Background Chronic alcohol use changes the brain’s inflammatory state. However, there is little work examining the progression of the cytokine response during alcohol withdrawal, a period of profound autonomic and emotional upset. This study examines the inflammatory response in the central nucleus of the amygdala (CeA) and dorsal vagal complex (DVC), brain regions neuroanatomically associated with affective and cardiorespiratory regulation in an in vivo rat model of withdrawal follo...

  3. From Antiquity to the N-Methyl-D-Aspartate Receptor: A History of Delirium Tremens.

    Science.gov (United States)

    Porcel, F J Rodriguez; Schutta, H S

    2015-01-01

    Delirium associated with excessive alcohol consumption has been known since antiquity. This condition became more common as the supply of distilled fermented liquors increased. Delirium, including delirium associated with excessive alcohol consumption, was for many centuries regarded as a form of brain inflammation - "phrenitis" - and was treated with depletion. At the end of the eighteenth century treatment by depletion of alcohol-related delirium began to be replaced by sedation and led to significantly better outcomes. Thomas Sutton established that alcohol-related delirium was a disease sui generis, distinct from phrenitis, and he named it delirium tremens. Because historical accounts of this disease are rare, brief, and not easily accessible, we offer this account of events that culminated in the discovery of the molecular basis of delirium tremens. PMID:26444921

  4. Alcohol withdrawal – therapeutical management in surgical patients with upper intestinal bleeding

    Directory of Open Access Journals (Sweden)

    Bălălău Cristian

    2015-04-01

    Full Text Available Psychological dependence involves a desire to use a drug to avoid the unpleasant withdrawal syndrome that results from cessation of exposure to it. Alcohol withdrawal syndrome is one of the most feared complications of alcohol addiction and sometimes can be fatal if not treated properly. Withdrawal syndrome is characterized by neurological hyperexcitability, which can lead to severe psychological and neurological symptoms. A survey was conceived in order to monitor the efficiency of several drug associations (Clonidine, Midazolam, IV ethanol, which were administered at the beginning of intensive therapy admission of achohol addicts. By comparing the postoperative evolution parameters and complications incidences for these patients (such as the hospitalization duration in AIT department, the tracheobronchitis incidence, complications as sepsis, pneumonia and cardiac complications, we managed to determine which treatment is the most beneficial for these cases. Benzodiazepines are frequently used for pharmacological therapy of alcohol addicted patients. In our study Midazolam was very efficient, compared to other therapies. When administered for a maximum of 7 days, the inccidence of side effects remains minimal.

  5. Cost-effectiveness analysis of baclofen and chlordiazepoxide in uncomplicated alcohol-withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Vikram K Reddy

    2014-01-01

    Full Text Available Objectives: Benzodiazepines (BZDs are the first-line drugs in alcohol-withdrawal syndrome (AWS. Baclofen, a gamma-aminobutyric acid B (GABA B agonist, controls withdrawal symptoms without causing significant adverse effects. The objective of this study was to compare the cost-effectiveness of baclofen and chlordiazepoxide in the management of uncomplicated AWS. Materials and Methods : This was a randomized, open label, standard controlled, parallel group study of cost-effectiveness analysis (CEA of baclofen and chlordiazepoxide in 60 participants with uncomplicated AWS. Clinical efficacy was measured by the Clinical Institute Withdrawal Assessment for alcohol (CIWA-Ar scores. Lorazepam was used as supplement medication if withdrawal symptoms could not be controlled effectively by the study drugs alone. Both direct and indirect medical costs were considered and the CEA was analyzed in both patient′s perspective and third-party perspective. Results : The average cost-effectiveness ratio (ACER in patient′s perspective of baclofen and chlordiazepoxide was Rs. 5,308.61 and Rs. 2,951.95 per symptom-free day, respectively. The ACER in third-party perspective of baclofen and chlordiazepoxide was Rs. 895.01 and Rs. 476.29 per symptom-free day, respectively. Participants on chlordiazepoxide had more number of symptom-free days when compared with the baclofen group on analysis by Mann-Whitney test (U = 253.50, P = 0.03. Conclusion : Both study drugs provided relief of withdrawal symptoms. Chlordiazepoxide was more cost-effective than baclofen. Baclofen was relatively less effective and more expensive than chlordiazepoxide.

  6. Cocaine withdrawal

    Science.gov (United States)

    ... may not be as unstable as withdrawal from alcohol. However, the withdrawal from any chronic substance abuse is very serious. There is a risk of suicide or overdose. Symptoms usually disappear over time. People who have cocaine ...

  7. Adrenergic Inhibition with Dexmedetomidine to Treat Stress Cardiomyopathy during Alcohol Withdrawal: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Zachary M. Harris

    2016-01-01

    Full Text Available Stress (Takotsubo cardiomyopathy is a form of reversible left ventricular dysfunction with a heightened risk of ventricular arrhythmia thought to be caused by high circulating catecholamines. We report a case of stress cardiomyopathy that developed during severe alcohol withdrawal successfully treated with dexmedetomidine. The case involves a 53-year-old man with a significant history of alcohol abuse who presented to a teaching hospital with new-onset seizures. His symptoms of acute alcohol withdrawal were initially treated with benzodiazepines, but the patient later developed hypotension, and stress cardiomyopathy was suspected based on ECG and echocardiographic findings. Adjunctive treatment with the alpha-2-adrenergic agonist, dexmedetomidine, was initiated to curtail excessive sympathetic outflow of the withdrawal syndrome, thereby targeting the presumed pathophysiology of the cardiomyopathy. Significant clinical improvement was observed within one day of initiation of dexmedetomidine. These findings are consistent with other reports suggesting that sympathetic dysregulation during alcohol withdrawal produces ideal pathobiology for stress cardiomyopathy and leads to ventricular arrhythmogenicity. Stress cardiomyopathy should be recognized as a complication of alcohol withdrawal that significantly increases cardiac-related mortality. By helping to correct autonomic dysregulation of the withdrawal syndrome, dexmedetomidine may be useful in the treatment of stress-induced cardiomyopathy.

  8. Radiotracer transit measurements as an index of regional cerebral blood flow. Pt. 2. Results in acute alcohol withdrawal syndromes

    International Nuclear Information System (INIS)

    The data obtained in 72 male chronic alcoholics with acute alcohol withdrawal syndroms give evidence that there is a significant correlation between the numerical value of the cerebral radiorheographic index and the severity of the psychopathological syndrome (especially of the clouding of sensorium) in these patients. (author)

  9. Morphine for Intravenous Patient-Controlled Analgesia May Inhibit Delirium Tremens: A Case Report and Literature Review.

    Science.gov (United States)

    Chan, Chia-Ta; Liao, Wen-Wei; Huang, William

    2015-10-01

    Alcoholism is common among trauma patients and often lacks the appropriate monitoring. Alcohol withdrawal syndrome (AWS), including delirium tremens (DT), can be associated with significant postoperative morbidity and mortality. However, appropriate acute pain management may protect against delirium; the administration of intravenous patient-controlled analgesia (IV - PCA) may not only alleviate pain, but also reduce the incidence of post-operative delirium. IV-PCA is widely used today; however, little attention has been paid to its influence on the development of AWS or DT post-surgery. Here we present a case in which the administration of IV-PCA may have delayed the onset of DT that interfered with postoperative care and the initiation of psychiatric consultation. The literature was reviewed to determine the potential mechanisms behind the effects of IV-PCA on the onset of AWS or DT.IV-PCA may delay the onset of DT. It is imperative to take into consideration trauma patients' psychiatric history including answers to questions on alcoholism, so that when an IV-PCA is administered and then discontinued, adequate interventions to prevent further morbidity associated with AWS and DT can be initiated in sufficient time. PMID:26512587

  10. Alcohol withdrawal

    Science.gov (United States)

    ... may include: Clammy skin Enlarged (dilated) pupils Headache Insomnia (sleeping difficulty) Loss of appetite Nausea and vomiting ... areas have housing options that provide a supportive environment for those trying to stay sober. Permanent and ...

  11. Diagnosing Delirium by Telephone

    OpenAIRE

    Marcantonio, Edward R.; Sm,; Michaels, Mary; Resnick, Neil M.

    1998-01-01

    To determine whether delirium can be diagnosed by telephone, we interviewed 41 subjects aged 65 years or older 1 month after repair of hip fracture, first by telephone and then face-to-face. Interviews included the modified telephone Mini-Mental State Examination and the Delirium Symptom Interview. Delirium was diagnosed using the Confusion Assessment Method diagnostic algorithm, and the telephone results were compared with the face-to-face results (the “gold standard”). Of 41 subjects, 6 wer...

  12. A case of prolonged delirium tremens.

    Science.gov (United States)

    Nicholas, Jerome; Jacob, Rajesh; Kinson, Rochelle

    2013-08-01

    We present a case of delirium tremens lasting for five weeks in an alcohol-dependent individual. The patient required high-dose benzodiazepines, which is atypical and rare. The clinical presentation and management of this patient is discussed. PMID:24005461

  13. Temporal changes in innate immune signals in a rat model of alcohol withdrawal in emotional and cardiorespiratory homeostatic nuclei

    Directory of Open Access Journals (Sweden)

    Freeman Kate

    2012-05-01

    Full Text Available Abstract Background Chronic alcohol use changes the brain’s inflammatory state. However, there is little work examining the progression of the cytokine response during alcohol withdrawal, a period of profound autonomic and emotional upset. This study examines the inflammatory response in the central nucleus of the amygdala (CeA and dorsal vagal complex (DVC, brain regions neuroanatomically associated with affective and cardiorespiratory regulation in an in vivo rat model of withdrawal following a single chronic exposure. Methods For qRT-PCR studies, we measured the expression of TNF-α, NOS-2, Ccl2 (MCP-1, MHC II invariant chain CD74, and the TNF receptor Tnfrsf1a in CeA and DVC samples from adult male rats exposed to a liquid alcohol diet for thirty-five days and in similarly treated animals at four hours and forty-eight hours following alcohol withdrawal. ANOVA was used to identify statistically significant treatment effects. Immunohistochemistry (IHC and confocal microscopy were performed in a second set of animals during chronic alcohol exposure and subsequent 48-hour withdrawal. Results Following a chronic alcohol exposure, withdrawal resulted in a statistically significant increase in the expression of mRNAs specific for innate immune markers Ccl2, TNF-α, NOS-2, Tnfrsf1a, and CD74. This response was present in both the CeA and DVC and most prominent at 48 hours. Confocal IHC of samples taken 48 hours into withdrawal demonstrate the presence of TNF-α staining surrounding cells expressing the neural marker NeuN and endothelial cells colabeled with ICAM-1 (CD54 and RECA-1, markers associated with an inflammatory response. Again, findings were consistent in both brain regions. Conclusions This study demonstrates the rapid induction of Ccl2, TNF-α, NOS-2, Tnfrsf1a and CD74 expression during alcohol withdrawal in both the CeA and DVC. IHC dual labeling showed an increase in TNF-α surrounding neurons and ICAM-1 on vascular endothelial cells

  14. Delirium in Intensive Care Unit. Factors that affect the appearance of delirium and its importance to the patients’ final outcome

    Directory of Open Access Journals (Sweden)

    Olga Kadda

    2012-10-01

    Full Text Available Delirium is a common cause of acute brain dysfunction in patients treated in the Intensive Care Unit (ICU. Aim: The aim of the present study was to investigate the incidence of delirium in the ICU, to establish risk factors for its development and to determine the effect of delirium on patient’s length of the stay and mortality in the ICU.Material and Methods: The sample studied consisted of 122 patients hospitalized in the ICU of a General Hospital in Attica, having completed 48 hours of stay. In order to diagnose delirium the CAM-ICU delirium scale was used. There were recorded the demographic characteristics of the sample studied, the medical history, the type of sedation, the severity of their illness during admission, the complications, the environment and psychological factors. Moreover, the length of stay, morbidity and mortality of patients were recorded. Data analysis was performed with the statistical package SPSS-ver.17.Results: 62% (n=76 of the sample studied were male. The mean age of the sample was 57±18 years. Intubation and mechanical ventilation was applied in 90% (n=110 of the studied population and seductive drugs in 90% (n=110 of the sample. Delirium frequency was 43%. Risk factors, according to the results, seems to be arterial hypertension (p= 0.009, smoking history (p=0.023, alcohol abuse (p=0.005, severity of illness in admission Apache II (p=0.033. The age and length of stay in ICU doesn’t seem to affect delirium development in ICU. Finally, mortality was clearly increased (p=0.001.Conclusions: The increased frequency of delirium in ICU patients requires measures to prevent it. Factors that seem to be related to delirium development are: arterial hypertension, alcohol abuse, smoking, hyperpyrexia and the usage of sedative drugs., Delirium, also, increases mortality in ICU patients.

  15. Complicações psiquiátricas do uso crônico do álcool: síndrome de abstinência e outras doenças psiquiátricas Psychiatric complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders

    Directory of Open Access Journals (Sweden)

    Cláudia Maciel

    2004-05-01

    Full Text Available A síndrome de abstinência alcoólica é um quadro agudo, caracterizado por um conjunto de sinais e sintomas autolimitados, com gravidade variada, secundário à interrupção total ou parcial do consumo de álcool, podendo ser associado a inúmeros problemas clínicos e/ou outros transtornos psiquiátricos. O objetivo deste artigo é rever as principais complicações psiquiátricas secundárias à síndrome de abstinência alcoólica, como convulsões e delirium tremens, bem como algumas outras condições psiquiátricas associadas à dependência de álcool, como as síndromes de Wernicke Korsakoff e de Marchiava Bignami. Pretende-se, com isso, auxiliar no diagnóstico precoce e tratamento adequado, minimizando assim a morbidade e a mortalidade associadas a tais complicações.Alcohol withdrawal syndrome is an acute condition secondary to total or partial reduction of alcohol consumption, characterized by self limited signs and symptoms and different degrees of severity. It can be complicated by several clinical and/or other psychiatric related problems. The objective of this article is to review the most important psychiatric complications to alcohol withdrawal syndrome as well as other psychiatric disorders associated with alcohol dependence as Wernicke Korsakoff and Marchiava Bignami syndromes. We aim to promote early diagnosis and treatment of these conditions, minimizing morbidity and mortality associated with them.

  16. Alcohol abuse and related disorders treatment of alcohol dependence

    Directory of Open Access Journals (Sweden)

    Yu. P. Sivolap

    2014-01-01

    Full Text Available Alcohol abuse and alcoholism are the leading causes of worse health and increased mortality rates. Excessive alcohol consumption is the third leading cause of the global burden of diseases and a leading factor for lower lifespan and higher mortality. Alcohol abuse decreases working capacity and efficiency and requires the increased cost of the treatment of alcohol-induced disorders, which entails serious economic losses. The unfavorable medical and social consequences of excessive alcohol use determine the importance of effective treatment for alcoholism. The goals of rational pharmacotherapy of alcohol dependence are to enhance GABA neurotransmission, to suppress glutamate neurotransmission, to act on serotonin neurotransmission, to correct water-electrolyte balance, and to compensate for thiamine deficiency. Alcoholism treatment consists of two steps: 1 the prevention and treatment of alcohol withdrawal syndrome and its complications (withdrawal convulsions and delirium alcoholicum; 2 antirecurrent (maintenance therapy. Benzodiazepines are the drugs of choice in alleviating alcohol withdrawal and preventing its convulsive attacks and delirium alcoholicum. Diazepam and chlordiazepoxide are most commonly used for this purpose; the safer drugs oxazepam and lorazepam are given to the elderly and patients with severe liver lesions. Anticonvulsants having normothymic properties, such as carbamazepine, valproic acid, topiramate, and lamotrigine, are a definite alternative to benzodiazepines. The traditional Russian clinical practice (clearance detoxification has not a scientific base or significant impact on alcohol withdrawal-related states in addicts. Relapse prevention and maintenance therapy for alcohol dependence are performed using disulfiram, acamprosate, and naltrexone; since 2013 the European Union member countries have been using, besides these agents, nalmefene that is being registered in Russia. Memantine and a number of other

  17. Thiamine deficiency and delirium.

    Science.gov (United States)

    Osiezagha, Kenneth; Ali, Shahid; Freeman, C; Barker, Narviar C; Jabeen, Shagufta; Maitra, Sarbani; Olagbemiro, Yetunde; Richie, William; Bailey, Rahn K

    2013-04-01

    Thiamine is an essential vitamin that plays an important role in cellular production of energy from ingested food and enhances normal neuronal actives. Deficiency of this vitamin leads to a very serious clinical condition known as delirium. Studies performed in the United States and other parts of the world have established the link between thiamine deficiency and delirium. This literature review examines the physiology, pathophysiology, predisposing factors, clinical manifestations (e.g., Wernicke's encephalopathy, Wernicke-Korsakoff syndrome, structural and functional brain injuries) and diagnosis of thiamine deficiency and delirium. Current treatment practices are also discussed that may improve patient outcome, which ultimately may result in a reduction in healthcare costs. PMID:23696956

  18. Brief review: delirium

    OpenAIRE

    Schmitz ED; Vu JB

    2014-01-01

    No abstract available. Article truncated after 150 words. A significant number of patients develop a decline in cognitive function while hospitalized. Delirium in the intensive care increases mortality and healthcare costs and should be recognized and treated promptly (1,2). This is a brief review of delirium and important treatment options such as early percutaneous tracheostomy, neuroleptics, propofol, daily awakenings and reorientation by all team members. We recommend neither neuroimaging...

  19. Acute withdrawal: diagnosis and treatment.

    Science.gov (United States)

    Brust, John C M

    2014-01-01

    Symptoms of alcohol withdrawal range in severity from mild "hangover" to fatal delirium tremens (DTs). Tremor, hallucinosis, and seizures usually occur within 48 hours of abstinence. Seizures tend to be generalized without focality, occurring singly or in a brief cluster, but status epilepticus is not unusual. DTs usually appears after 48 hours of abstinence and consists of marked inattentiveness, agitation, hallucinations, fluctuating level of alertness, marked tremulousness, and sympathetic overactivity. The mainstay of treatment for alcohol withdrawal is benzodiazepine pharmacotherapy, which can be used to control mild early symptoms, to prevent progression to DTs, or to treat DTs itself. Alternative less evidence-based pharmacotherapies include phenobarbital, anticonvulsants, baclofen, gamma-hydroxybutyric acid, beta-blockers, alpha-2-agonists, and N-methyl-d-aspartate receptor blockers. Treatment of DTs is a medical emergency requiring heavy sedation in an intensive care unit, with close attention to autonomic instability, fever, fluid loss, and electrolyte imbalance. Frequent comorbid disorders include hypoglycemia, liver failure, pancreatitis, sepsis, meningitis, intracranial hemorrhage, and Wernicke-Korsakoff syndrome. PMID:25307572

  20. [Causes of the people death from drunkenness and alcoholism].

    Science.gov (United States)

    Erokhin, Iu A; Paukov, V S; Kirillov, Iu A

    2012-01-01

    We analyzed causes of 1008 people death, who abused by alcohol. Among them 2 groups were separated out: people died due to drunkenness and due to alcoholism. The structure of the death was similar in the both groups, however depended on alcoholism stages. The major cause of the death in group of drunkenness people was acute heart insufficiency, less commonly--lung pathology, and very rarely--brain vessels pathology and liver cirrhosis. In group of people, who died due to alcoholism, lung pathology was the major cause of these deaths, acute heart insufficiency was occurred less commonly, and very rare brain pathology because of delirium tremens or alcohol withdrawal syndrome, as so liver cirrhosis with complications. Hemorrhagic pancreonecrosis after alcoholic excess was found out in both groups, but it was more often in people, who died due to drunkenness. Obtained results show importance of chronic alcoholism identification as a disease with several stages including drunkenness and alcoholism. PMID:22937578

  1. Effect of topiramate on partial excitatory amino acids in hippocampal dentate gyrus of rats after alcohol withdrawal

    Institute of Scientific and Technical Information of China (English)

    Qinghua Yang; Guang Wu; Haiying Jiang; Yuanzhe Jin; Songbiao Cui

    2006-01-01

    BACKGROUND: Many researches have indicated that the imbalances of various amino acid transmitters and neurotransmitters in brain are involved in the formation of alcohol withdrawal, especially that glutamic acid is one of the important transmitters for alcohol tolerance in central nervous system.OBJECTIVE: To observe the changes of excitatory amino acids in hippocampal dentate gyrus in rats with long-term alcohol drinking after withdrawal under consciousness, and investigate the therapeutic effect of topiramate on alcohol withdrawal.DESIGN: A randomized control animal experiment.SETTING: Department of Neurology, Affiliated Hospital of Yanbian University.MATERIALS: Thirty male Wistar rats of 4 months old, weighing 300-350 g, were purchased from the Experimental Animal Department, Medical College of Yanbian University. Topiramate was produced by Swish Cilag Company, and the batch number was 02CS063.METHODS: The experiments were carried out in the Department of Physiology, Medical College of Yanbian University from August 2005 to February 2006. ① The rats were divided randomly into three groups: control group (n=10), alcohol group (n=10) and topiramate-treated group (n=10). Rats in the alcohol group and topiramate-treated group were given intragastric perfusion of 500 g/L alcohol (10 mL/kg), once a day for 4 weeks successively, and then those in the topiramate-treated group were treated with 80 mg/kg topiramate at 24 hours after the last perfusion of alcohol, once a day for 3 days successively. Rats in the control group were intragastricly given isovolume saline. ② The withdrawal symptoms were assessed at 6, 30, 48 and 72 hours after the last perfusion of alcohol by using the withdrawal rating scale set by Erden et al,which had four observational indexes of stereotyped behaviors, agitation, tail stiffness and abnormal posture,each index was scored by 5 points, the higher the score, the more obvious the symptoms. ③ The contents of aspartic acid and glutamic acid

  2. Pharmacological Activation/Inhibition of the Cannabinoid System Affects Alcohol Withdrawal-Induced Neuronal Hypersensitivity to Excitotoxic Insults

    OpenAIRE

    Rubio, Marina; Villain, Hélène; Docagne, Fabian; Roussel, Benoit D.; Ramos, José Antonio; Vivien, Denis; Fernandez-Ruiz, Javier; Ali, Carine

    2011-01-01

    Cessation of chronic ethanol consumption can increase the sensitivity of the brain to excitotoxic damages. Cannabinoids have been proposed as neuroprotectants in different models of neuronal injury, but their effect have never been investigated in a context of excitotoxicity after alcohol cessation. Here we examined the effects of the pharmacological activation/inhibition of the endocannabinoid system in an in vitro model of chronic ethanol exposure and withdrawal followed by an excitotoxic c...

  3. [Respiratory depression in delirium tremens patients treated with phenobarbital. A retrospective study

    DEFF Research Database (Denmark)

    Lutzen, L.; Poulsen, L.M.; Ulrichsen, J.

    2008-01-01

    INTRODUCTION: Delirium tremens (DT) is the most severe manifestation of alcohol withdrawal which--if untreated--has a high rate of mortality. Barbiturates are the most effective drug but respiratory depression may occur. In the present study we investigated the frequency of respiratory problems......-DT and full blown DT were included in the study. RESULTS: While we did not detect any respiratory problems among patients with pre-DT, we found 9 cases among 73 patients with full blown DT, 5 of which were considered serious. In two of these the frequency of respiration (FR) was decreased (5-6 per min). Both...... to ketoacidosis. The death could not be attributed to the phenobarbital treatment. CONCLUSION: In conclusion, we found that the frequency of phenobarbital-induced respiratory depression was low. However, if the DT was complicated with pneumonia, life-threatening respiratory insufficiency could be the outcome...

  4. Delirium hos kritisk syge patienter

    DEFF Research Database (Denmark)

    Strøm, Thomas; Pande-Rolfsen, Guri; Hagen, Christine;

    2009-01-01

    Interest in and the quantity of publications on delirium in critically ill patients have grown increasingly over the last decade. Critically ill patients have traditionally been sedated to facilitate mechanical ventilation. This practice impeded the recognition of delirium in the critically ill...... patients, and consequently the disorder was underdiagnosed. Delirium in the critically ill patients is associated with increased morbidity and mortality. Less sedation, guided by protocols with daily wake up trials, and validated delirium scoring systems, have improved the opportunities to diagnose and...... monitor delirium in the critically ill patients. Udgivelsesdato: 2009-Oct-19...

  5. Study on Alcoholic Withdrawal Score, with Questionnaire Based Session Conducted on Acute and Chronic Alcoholic Liver Disease Patients

    OpenAIRE

    Bandi Navyatha; Pragada Sneha Pallavi; S. Purna Divya

    2016-01-01

    Alcohol liver disease is damage to the Liver and its function due to alcohol abuse. It occurs after years of heavy drinking and by through which cirrhosis can occur and which leads to the final phase of Alcoholic liver disease. It not only occurs in heavy drinkers but also there is a chance of getting liver disease go up the longer of been drinking and more alcohol consumption. A study was observational, prospective and descriptive; and was carried out one hundred and nine patients [n=109] wh...

  6. Computerized tomographic study on the brain of patients with alcohol dependence

    International Nuclear Information System (INIS)

    One hundred ten patients with alcohol dependence and 56 psychiatric patients with either senile dementia, amphetamine psychosis, epilepsy or chronic schizophrenia were investigated with a CT scan of the brain. The maximum width of the 3rd ventricle was measured, and the presence/absence of enlargement of the lateral ventricle and of atrophy of the frontal lobe was determined independently by 3 physicians. The width of the 3rd ventricle in alcoholic and the other patients examined was gradually enlarged with aging, and the width in these patients was significantly larger than that in the age-matched control patients who were selected from the patients with amphetamine psychosis, epilepsy or schizophrenia. The enlargement of the lateral ventricles observed in the alcoholic patients always accompanied the enlargement of the 3rd ventricle, but not vice versa. The alcoholic patients with frontal lobe atrophy showed a higher incidence of withdrawal delirium than the patients without atrophy. These findings suggest that the chronic intake of alcohol might affect primarily the area around the 3rd ventricle, resulting in enlargement of this ventricle and consequential enlargement of the lateral ventricles and also that the alcoholic patients with frontal lobe atrophy could have a high risk for a manifestation of alcoholic withdrawal delirium. (author)

  7. DELIRIUM: IS SLEEP IMPORTANT?

    OpenAIRE

    Watson, Paula L.; Ceriana, Piero; Fanfulla, Francesco

    2012-01-01

    Delirium and poor sleep quality are common and often co-exist in hospitalized patients. A link between these disorders has been hypothesized but whether this link is a cause and effect relationship or simply an association resulting from shared mechanisms is yet to be determined. Potential shared mechanisms include: abnormalities of neurotransmitters, tissue ischemia, inflammation, and sedative exposure. Sedatives, while decreasing sleep latency, often cause a decrease in slow wave sleep and ...

  8. Brief review: delirium

    Directory of Open Access Journals (Sweden)

    Schmitz ED

    2014-12-01

    Full Text Available No abstract available. Article truncated after 150 words. A significant number of patients develop a decline in cognitive function while hospitalized. Delirium in the intensive care increases mortality and healthcare costs and should be recognized and treated promptly (1,2. This is a brief review of delirium and important treatment options such as early percutaneous tracheostomy, neuroleptics, propofol, daily awakenings and reorientation by all team members. We recommend neither neuroimaging nor neurology consultation unless physical exam suggests an acute cerebral vascular accident or status epilepticus as the majority of these patients require no neurologic intervention and may be harmed by transportation to obtain additional testing. The DSM-5 defines delirium as a disturbance in attention (reduced ability to direct, focus, sustain, and shift attention and awareness (reduced orientation to the environment. The disturbance develops over a short period of time (usually hours to a few days, represents a change from baseline attention and awareness, and tends to fluctuate in severity ...

  9. [Delirium and delirium management in critically ill patients].

    Science.gov (United States)

    Kersten, A; Reith, S

    2016-02-01

    Delirium in critically ill patients is a common entity in the intensive care unit (ICU) and is an expression of the cerebral organ dysfunction of the patient. The hallmark signs are disturbed consciousness and cognition in combination with inattentiveness and alterations in perception, which are manifested within a time interval of hours to days during treatment on the ICU. Delirium has been shown to have negative effects on patient short-term and long-term outcome parameters and increases morbidity and mortality. Despite its significance in many cases delirium remains inadequately diagnosed during routine treatment by ICU personnel. There are two validated and easily applicable scales for the standardized diagnosis of delirium: the confusion assessment method for the ICU (CAM-ICU) and the intensive care delirium screening checklist (ICDSC). These are simple to apply by medical as well as non-medical personnel. The therapy of delirium is mostly determined by non-pharmacological measures aiming at early identification, reorientation and mobilization of the patient, improving cerebral activity and establishing adequate wake-sleep cycles. There is only sparse evidence for pharmacological treatment of delirium; however, the choice of sedative agent has a proven effect on the incidence and duration of delirium in the ICU. PMID:26795215

  10. Comparative Evaluation of Partial α2 -Adrenoceptor Agonist and Pure α2 -Adrenoceptor Antagonist on the Behavioural Symptoms of Withdrawal after Chronic Alcohol Administration in Mice.

    Science.gov (United States)

    Arora, Shivani; Vohora, Divya

    2016-08-01

    As an addictive drug, alcohol produces withdrawal symptoms if discontinued abruptly after chronic use. Clonidine (CLN), a partial α2 -adrenergic agonist, and mirtazapine (MRT), an antagonist of α2 -adrenoceptor, both clinically aid alcohol withdrawal. Considering different mechanisms of action of the two drugs, this study was designed to see how far these two mechanistically different drugs differ in their ability to decrease the severity of ethanol withdrawal syndrome. The effect of CLN and MRT on ethanol withdrawal-induced anxiety, depression and memory impairment was analysed using EPM, FST and PAR tests, respectively. Animals received distilled water, ethanol and/or either of the drugs (CLN and MRT) in different doses. Relapse to alcohol use was analysed by CPP test. Animals received ethanol as a conditioning drug and distilled water, CLN or MRT as test drug. CLN and MRT both alleviated anxiety in a dose-dependent manner. MRT (4 mg/kg) was more effective than CLN (0.1 mg/kg) in ameliorating the anxiogenic effect of alcohol withdrawal. However, CLN treatment increased depression. It significantly decreased swimming time and increased immobility time, whereas MRT treatment decreased immobility time and increased climbing and swimming time during abstinence. The effect was dose dependent for both drugs. The results of PAR test show that CLN treatment worsens working memory. Significant increase in SDE and TSZ and decrease in SDL were observed in CLN-treated animals. MRT treatment, on the other hand, improved working memory at both doses. Further, both CLN and MRT alleviated craving. A significant decrease in time spent in the ethanol-paired chamber was seen. MRT treatment at both doses showed better effect than CLN in preventing the development of preference in CPP test. These findings indicate a potential therapeutic use and better profile of mirtazapine over clonidine in improving memory, as well as in alleviating depression, anxiety and craving associated

  11. The kappa opioid receptor antagonist JDTic attenuates alcohol seeking and withdrawal anxiety

    OpenAIRE

    Schank, Jesse R.; Goldstein, Andrea L.; Rowe, Kelly E.; King, Courtney E.; Marusich, Julie A.; Wiley, Jenny L; Carroll, F. Ivy; Thorsell, Annika; Heilig, Markus

    2012-01-01

    The role of kappa-opioid receptors (KOR) in regulation of alcohol-related behaviors is not completely understood. For example, alcohol consumption has been reported to increase following treatment with KOR antagonists in rats, but was decreased in mice with genetic deletion of KOR. Recent studies have further suggested that KOR antagonists may selectively decrease alcohol self-administration in rats following a history of dependence. We assessed the effects of the KOR antagonist JDTic on alco...

  12. Symptom-triggered benzodiazepine therapy for alcohol withdrawal syndrome in the emergency department: a comparison with the standard fixed dose benzodiazepine regimen.

    LENUS (Irish Health Repository)

    Cassidy, Eugene M

    2012-10-01

    The aim of the study was to compare symptom-triggered and standard benzodiazepine regimens for the treatment of alcohol withdrawal syndrome in an emergency department clinical decision unit. The authors found that the symptom-triggered approach reduced cumulative benzodiazepine dose and length of stay.

  13. Alcoholic hallucinosis.

    Science.gov (United States)

    Bhat, Pookala S; Ryali, Vssr; Srivastava, Kalpana; Kumar, Shashi R; Prakash, Jyoti; Singal, Ankit

    2012-07-01

    Alcoholic hallucinosis is a rare complication of chronic alcohol abuse characterized by predominantly auditory hallucinations that occur either during or after a period of heavy alcohol consumption. Bleuler (1916) termed the condition as alcohol hallucinosis and differentiated it from Delirium Tremens. Usually it presents with acoustic verbal hallucinations, delusions and mood disturbances arising in clear consciousness and sometimes may progress to a chronic form mimicking schizophrenia. One such case with multimodal hallucinations in a Defence Service Corps soldier is presented here. PMID:24250051

  14. DELIRIUM FROM THE GLIOCENTRIC PERSPECTIVE

    Directory of Open Access Journals (Sweden)

    Adonis eSfera

    2015-05-01

    Full Text Available Delirium is an acute state marked by disturbances in cognition, attention, memory, perception, and sleep-wake cycle which is common in elderly. Others have shown an association between delirium and increased mortality, length of hospitalization, cost, and discharge to extended stay facilities (1. Until recently it was not known that after an episode of delirium in elderly, there is a 63% probability of developing dementia at 48 months compared to 8% in patients without delirium (2(3. Currently there are no preventive therapies for delirium, thus elucidation of cellular and molecular underpinnings of this condition may lead to the development of early interventions and thus prevent permanent cognitive damage.In this article we make the case for the role of glia in the pathophysiology of delirium and describe an astrocyte-dependent central and peripheral cholinergic anti-inflammatory shield which may be disabled by astrocytic pathology, leading to neuroinflammation and delirium. We also touch on the role of glia in information processing and neuroimaging.

  15. Determinants of improvement in quality of life of alcohol-dependent patients during an inpatient withdrawal programme

    Directory of Open Access Journals (Sweden)

    Pierre Lahmek, Ivan Berlin, Laurent Michel, Chafia Berghout, Nadine Meunier, Henri-Jean Aubin

    2009-01-01

    Full Text Available Background: To investigate the improvement in quality of life (QoL of alcohol-dependent patients during a 3-week inpatient withdrawal programme, and to identify the sociodemographic, clinical and alcohol-related variables associated with baseline QoL on admission and with improvement of QoL during residential treatment. Methods: This prospective, observational study included 414 alcohol-dependent patients, hospitalised for a period of 3 weeks. QoL was measured on admission and at discharge using the French version of the Medical Outcome Study SF-36. The mean scores for each dimension and for the Physical and Mental Component Summary scores were calculated. Results: The mean scores per dimension and the mean Physical and Mental Component Summary scores were significantly lower on admission than at discharge; the lowest scores being observed for social functioning and role limitations due to emotional problems. At discharge, the mean scores per dimension were similar to those observed in the French general population. Female gender, age >45 years, living alone, working as a labourer or employee, somatic comorbidity, and the existence of at least five criteria for alcohol dependence according to the DSM-IV classification were associated with a low Physical Component Summary score on admission; psychiatric comorbidity, the presence of at least five DSM-IV dependence criteria, smoking and suicidality were associated with a low Mental Component Summary score on admission. The increase in Physical and Mental Component Summary scores during hospitalisation was more marked when the initial scores were low. Apart from the initial score, the greatest improvement in Physical Component Summary score was seen in patients with a high alcohol intake and in those without a somatic comorbidity; the increase in Mental Component Summary score was greatest in patients without psychotic symptoms and in those who abused or were dependent on illegal drugs. Conclusion

  16. Alcohol Withdrawal-Induced Seizure Susceptibility is Associated with an Upregulation of CaV1.3 Channels in the Rat Inferior Colliculus

    Science.gov (United States)

    Akinfiresoye, Luli R.; Allard, Joanne S.; Lovinger, David M.

    2015-01-01

    Background: We previously reported increased current density through L-type voltage-gated Ca2+ (CaV1) channels in inferior colliculus (IC) neurons during alcohol withdrawal. However, the molecular correlate of this increased CaV1 current is currently unknown. Methods: Rats received three daily doses of ethanol every 8 hours for 4 consecutive days; control rats received vehicle. The IC was dissected at various time intervals following alcohol withdrawal, and the mRNA and protein levels of the CaV1.3 and CaV1.2 α1 subunits were measured. In separate experiments, rats were tested for their susceptibility to alcohol withdrawal–induced seizures (AWS) 3, 24, and 48 hours after alcohol withdrawal. Results: In the alcohol-treated group, AWS were observed 24 hours after withdrawal; no seizures were observed at 3 or 48 hours. No seizures were observed at any time in the control-treated rats. Compared to control-treated rats, the mRNA level of the CaV1.3 α1 subunit was increased 1.4-fold, 1.9-fold, and 1.3-fold at 3, 24, and 48 hours, respectively. In contrast, the mRNA level of the CaV1.2 α1 subunit increased 1.5-fold and 1.4-fold at 24 and 48 hours, respectively. At 24 hours, Western blot analyses revealed that the levels of the CaV1.3 and CaV1.2 α1 subunits increased by 52% and 32%, respectively, 24 hours after alcohol withdrawal. In contrast, the CaV1.2 and CaV1.3 α1 subunits were not altered at either 3 or 48 hours during alcohol withdrawal. Conclusions: Expression of the CaV1.3 α1 subunit increased in parallel with AWS development, suggesting that altered L-type CaV1.3 channel expression is an important feature of AWS pathogenesis. PMID:25556199

  17. Alcoholism and Alcohol Abuse

    Science.gov (United States)

    ... drinking once you've started Physical dependence - withdrawal symptoms Tolerance - the need to drink more alcohol to feel the same effect With alcohol abuse, you are not physically dependent, but you still ...

  18. Genome-wide association study identifies 5q21 and 9p24.1 (KDM4C) loci associated with alcohol withdrawal symptoms.

    Science.gov (United States)

    Wang, Ke-Sheng; Liu, Xuefeng; Zhang, Qunyuan; Wu, Long-Yang; Zeng, Min

    2012-04-01

    Several genome-wide association (GWA) studies of alcohol dependence (AD) and alcohol-related phenotypes have been conducted; however, little is known about genetic variants influencing alcohol withdrawal symptoms (AWS). We conducted the first GWA study of AWS using 461 cases of AD with AWS and 408 controls in Caucasian population in the Collaborative Study on the Genetics of Alcoholism (COGA) sample. Logistic regression analysis of AWS as a binary trait, adjusted for age and sex, was performed using PLINK. We identified 51 SNPs associated with AWS with p GABRA1, GABRG1, and GABRG3 were associated with AWS (p < 10(-2)) in the COGA sample. In conclusion, we identified several loci associated with AWS. These findings offer the potential for new insights into the pathogenesis of AD and AWS. PMID:22072270

  19. Moxifloxacin Induced Acute Delirium with Visual Hallucinations

    OpenAIRE

    Karagoz, Ergenekon; Ulcay, Asim; Budakli, Asil; Tutuncu, Recep

    2015-01-01

    AbstractA few reports accuse and implicate moxifloxacin as a contributor to delirium state.Here, we report the A 60-year-old female patient, who developed acute delirium with visual hallucinations following treatment with moxifloxacin for atypical pneumonia.   Key Words: Moxifloxacin, delirium, hallucination 

  20. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care

    OpenAIRE

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of s...

  1. Val158Met COMT polymorphism and risk of aggression in alcohol dependence.

    Science.gov (United States)

    Soyka, Michael; Zill, Peter; Koller, Gabi; Samochowiec, Agnieszka; Grzywacz, Anna; Preuss, Ulrich W

    2015-01-01

    Aggression, violence and antisocial behavior are common in alcoholism, but their biological basis is poorly understood. Several studies and recent meta-analyses indicate that in schizophrenia the catecholamine-O-methyltransferase (COMT) Val158Met genotype may be associated with aggression, most often in methionine allele carriers. We tested this hypothesis in a sample of treatment-seeking alcohol-dependent in-patients (293 German patients and 499 controls, and additional 190 Polish patients as replication sample). As expected, patients with a history of violent or non-violent crime were more often male, had an earlier onset of alcoholism and more withdrawal seizures and delirium tremens, and were more likely to have a history of suicide attempts. COMT genotype was not associated with a history of violent or non-violent crime. More studies are needed on the neurobiological basis of aggression and violence in alcoholism. PMID:24118473

  2. Excited delirium: A psychiatric review.

    Science.gov (United States)

    Lipsedge, Maurice

    2016-04-01

    The term 'excited delirium' (ED) is used to explain sudden and unexpected restraint-related deaths. Since the 1990s, ED has often been identified as the principal cause of death in restrained individuals, rather than the restraint procedure itself. Forensic pathologists and psychiatrists attach different meanings to the term delirium. For psychiatrists, delirium is a specific technical term, which implies a grave and potentially life-threatening underlying physical illness. If a patient dies during a bout of delirium, psychiatrists assume that there will be autopsy evidence to demonstrate the primary underlying organic cause. Conversely, pathologists appear to be using the term ED to refer to restraint-related deaths in either highly disturbed cocaine users or psychiatric patients in a state of extreme agitation. In these cases, there is no underlying physical disorder other than a terminal cardiac arrhythmia. As the term ED has different meanings for psychiatrists and for pathologists, it would be helpful for these two professional groups to develop a mutually agreed terminology. PMID:26055153

  3. Alcoholic hallucinosis

    Directory of Open Access Journals (Sweden)

    Pookala S Bhat

    2012-01-01

    Full Text Available Alcoholic hallucinosis is a rare complication of chronic alcohol abuse characterized by predominantly auditory hallucinations that occur either during or after a period of heavy alcohol consumption. Bleuler (1916 termed the condition as alcohol hallucinosis and differentiated it from Delirium Tremens. Usually it presents with acoustic verbal hallucinations, delusions and mood disturbances arising in clear consciousness and sometimes may progress to a chronic form mimicking schizophrenia. One such case with multimodal hallucinations in a Defence Service Corps soldier is presented here.

  4. Postoperative Delirium after elective and emergency surgery: analysis and checking of risk factors. A study protocol

    Directory of Open Access Journals (Sweden)

    Gagliardi Stefano

    2005-05-01

    Full Text Available Abstract Background Delirum is common in hospitalized elderly patients and may be associated with increased morbidity, length of stay and patient care costs. Delirium (acute confusional state is defined as an acute disorder of attention and cognition. In elderly patients, delirium is often an early indicator of patho-physiological disturbances. Despite landmark studies dating back to the 1940s, the pathogenesis of Delirium remains poorly understood. Early investigators noted that Delirium was characterized by global cortical dysfunction that was associated predominantly with specific electroencephalographic changes. It's important to understand the risk factors and incidence of Delirium. Some of the risk factors are already identified in literature and can be summarized in the word "VINDICATE" which stands for: Vascular, Infections, Nutrition, Drugs, Injury, Cardiac, Autoimmune, Tumors, Endocrine. Aims of this study are: to re-evaluate the above mentioned clinical risk factors, adding some others selected from literature, and to test, as risk factors, a pattern of some genes associated to cognitive dysfunction and inflammation possibly related to postoperative Delirium. Design All patients admitted to our Emergency Unit who are meet our inclusion/exclusion criteria will be recruited. The arising of postoperative Delirium will select incidentally two groups (Delirium/non Delirium and the forward analysis of correlate risk factors will be performed. As in a typical observational case/control study we will consider all the exposure factors to which our population are submitted towards the outcome (presence of Delirium. Our exposures are the following: ASA, Pain (SVS; VAS, Blood gas analysis (pH; Hb; pO2; pCO2, Residence pharmacological therapy (BDZ; hypnotics; narcotic drugs; alcohol; nitrous derivates, Body temperature, Arterial pressure, Heart frequency, Breath frequency, Na, K, Creatinin, Glicemia, Albumin, Hct, White blood cells, Glasgow Coma

  5. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care

    Science.gov (United States)

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5.5 days in 2012/2013. Acceptability of screening tools was tested: Common screening tools (CEWA, AUDIT) were rejected by junior doctors due to the high number of questions as too cumbersome for routine practice. Compliance with usage in random samples over a three month period was persistently (n=10%. Testing of an abbreviated AUDIT questionnaire with only two questions and a specified threshold showed a AUROC of 1 (p<0.001 for correct identification). The screening tool was implemented in several PDSAs cycles. After the final cycle a random sample of 100 patients was reviewed for pathway compliance over a three months period. Eighty-six patients were screened with the two-question tool of these 18 were identified as possible risk. Of these 16 patients had the full AUDIT questionnaire, only eight with elevated values were started on DT. Overall compliance with the pathway increased to 84%. PMID:26734413

  6. Alcohol detoxification in Ysbyty Gwynedd: Two small sips or one big gulp? Two-step screening more reliable for identification of alcohol dependency syndrome at risk of delirium tremens for routine care.

    Science.gov (United States)

    Salman, Muhammad; Subbe, Christian

    2015-01-01

    Compliance with pathways for hospitalised patients with alcohol dependency syndrome is often poor. A pathway for recognition and treatment of alcohol dependency was redesigned as part of a 12 month service improvement project in the acute medical unit using plan, do, study, act (PDSA) cycles. A needs assessment was undertaken: Audit data from 2013 showed over-prescription of chlordiazepoxide for detoxification treatment (DT) leading to prolonged hospital admissions with an average length of stay of 5.5 days in 2012/2013. Acceptability of screening tools was tested: Common screening tools (CEWA, AUDIT) were rejected by junior doctors due to the high number of questions as too cumbersome for routine practice. Compliance with usage in random samples over a three month period was persistently (n=10%. Testing of an abbreviated AUDIT questionnaire with only two questions and a specified threshold showed a AUROC of 1 (ptool was implemented in several PDSAs cycles. After the final cycle a random sample of 100 patients was reviewed for pathway compliance over a three months period. Eighty-six patients were screened with the two-question tool of these 18 were identified as possible risk. Of these 16 patients had the full AUDIT questionnaire, only eight with elevated values were started on DT. Overall compliance with the pathway increased to 84%. PMID:26734413

  7. Alcohol consumption increases locomotion in an open field and induces Fos-immunoreactivity in reward and approach/withdrawal-related neurocircuitries.

    Science.gov (United States)

    Wscieklica, Tatiana; de Barros Viana, Milena; Le Sueur Maluf, Luciana; Pouza, Kathlein Cristiny Peres; Spadari, Regina Célia; Céspedes, Isabel Cristina

    2016-02-01

    Drug addiction is a chronically relapsing disorder characterized by compulsion to seek and take the drug, loss of control in limiting intake and, eventually, the emergence of a negative emotional state when access to the drug is prevented. Both dopamine and corticotropin-releasing factor (CRF)-mediated systems seem to play important roles in the modulation of alcohol abuse and dependence. The present study investigated the effects of alcohol consumption on anxiety and locomotor parameters and on the activation of dopamine and CRF-innervated brain regions. Male Wistar rats were given a choice of two bottles for 31 days, one containing water and the other a solution of saccharin + alcohol. Control animals only received water and a solution of 0.2% saccharin. On the 31st day, animals were tested in the elevated plus-maze and open field, and euthanized immediately after the behavioral tests. An independent group of animals was treated with ethanol and used to measure blood ethanol concentration. Results showed that alcohol intake did not alter behavioral measurements in the plus-maze, but increased the number of crossings in the open field, an index of locomotor activity. Additionally, alcohol intake increased Fos-immunoreactivity (Fos-ir) in the prefrontal cortex, in the shell region of the nucleus accumbens, in the medial and central amygdala, in the bed nucleus of the stria terminalis, in the septal region, and in the paraventricular and dorsomedial hypothalamus, structures that have been linked to reward and to approach/withdrawal behavior. These observations might be relevant to a better understanding of the behavioral and physiological alterations that follow alcohol consumption. PMID:26786746

  8. Delirium and cardiac surgery: progress - and more questions

    OpenAIRE

    Martin, Billie-Jean; Rakesh C Arora

    2013-01-01

    Post-operative delirium is a common and dangerous complication of cardiac surgery. Many risk factors for delirium have been identified, but its pathogenesis remains largely elusive. A study by Kazmierski and colleagues investigates a more recently considered risk factor for delirium: perturbations in the hypothalamic pituitary axis and depression. This and further work may help define novel prevention and treatment strategies for delirium.

  9. Motor impairment: a new ethanol withdrawal phenotype in mice

    OpenAIRE

    Philibin, Scott D.; Cameron, Andy J.; Metten, Pamela; Crabbe, John C.

    2008-01-01

    Alcoholism is a complex disorder with genetic and environmental risk factors. The presence of withdrawal symptoms is one criterion for alcohol dependence. Genetic animal models have followed a reductionist approach by quantifying various effects of ethanol withdrawal separately. Different ethanol withdrawal symptoms may have distinct genetic etiologies, and therefore differentiating distinct neurobiological mechanisms related to separate signs of withdrawal would increase our understanding of...

  10. Refractory delirium tremens: a case report and brief review.

    Science.gov (United States)

    Mattoo, Surendra Kumar; Kate, Natasha; Verma, Anant Kumar

    2012-03-01

    Delirium tremens is a common presentation in tertiary care hospitals. Severe and/or refractory delirium tremens is not as common, is potentially lethal, and requires intensive management. Usually delirium tremens responds to management with standard doses of benzodiazepines. Limited literature is available, however, for the management of refractory delirium tremens. We describe a case of refractory delirium tremens in which the patient was successfully managed with a combination of high doses of lorazapam, midazolam, and phenytoin. PMID:22567606

  11. Withdrawal-Associated Increases and Decreases in Functional Neural Connectivity Associated with Altered Emotional Regulation in Alcoholism

    OpenAIRE

    O'Daly, Owen G; Trick, Leanne; Scaife, Jess; Marshall, Jane; Ball, David; Phillips, Mary L.; Williams, Stephen SC; Stephens, David N.; Duka, Theodora

    2012-01-01

    Alcoholic patients who have undergone multiple detoxifications/relapses show altered processing of emotional signals. We performed functional magnetic resonance imaging during performance of implicit and explicit versions of a task in which subjects were presented with morphs of fearful facial emotional expressions. Participants were abstaining, multiply detoxified (MDTx; n=12) or singly detoxified patients (SDTx; n=17), and social drinker controls (n=31). Alcoholic patients were less able th...

  12. Alcohol

    Science.gov (United States)

    If you are like many Americans, you drink alcohol at least occasionally. For many people, moderate drinking ... risky. Heavy drinking can lead to alcoholism and alcohol abuse, as well as injuries, liver disease, heart ...

  13. Mecanismos fisiopatológicos do delirium Pathophysiological mechanisms of delirium

    Directory of Open Access Journals (Sweden)

    Franklin Santana Santos

    2005-06-01

    Full Text Available O delirium é uma das síndromes mais fascinantes na medicina, apesar de pobremente compreendida. Apesar de sua ocorrência freqüente e de haver crescente informação sobre o diagnóstico, fenomenologia, epidemiologia e etiologias, estudos sobre os mecanismos que mediam a fisiopatologia são, freqüentemente, ausentes. O desenvolvimento de sofisticadas metodologias de imagem cerebral tem permitido ir além das considerações diagnósticas e investigar a neurobiologia dos sintomas específicos observados no delirium. Esses avanços na neuropsiquiatria e na neuroimagem têm revelado diferenças entre as regiões cerebrais, incluindo os hemisférios. O delirium é uma síndrome que pode ocorrer como o resultado de múltipla e complexa interação entre sistemas de neurotransmissores e processos patológicos. Os neurotransmissores, acetilcolina e serotonina, podem ter participação importante no delirium devido a condições clínicas comuns, bem como no delirium pós-cirúrgico. Outros neurotransmissores (dopamina e GABA e fatores neurobiológicos tais como citocinas, hormônios e radicais livres precisarão de mais estudos para definir as suas participações na gênese do delirium. Futuros estudos, centralizados na fisiopatologia do delirium, poderão levar a melhores estratégias de prevenção e tratamento.Delirium is one of the most fascinating and poorly understood syndromes in medicine. Despite its frequent occurrence and growing information on diagnosis, phenomenology, epidemiology, and aetiologies, studies on mediating pathophysiological mechanisms in delirium are largely lacking. The emergence of sophisticated brain imaging methodologies has made it possible to move beyond diagnostic consideration and investigate the neurobiology of specific symptom clusters observed in delirium. Advances in neuropsychiatry and neuroimaging have revealed differences between brain regions, including the hemispheres. Delirium is a syndrome that may

  14. Hematoma epidurale in patients with delirium tremens

    Directory of Open Access Journals (Sweden)

    S. Kasper

    2005-08-01

    Full Text Available In this report we presented a case of diagnostic and therapeutic treatment of the patient with delirium tremens in the Psychiatric Ward of the Cantonal Hospital in Zenica. Neuroradiologic diagnostics had shown existance of epiduralhematoma. The patient was transfered to the Neurosurgery Ward for observation and treatment. Difficultieswith differential diagnostics were caused by already present state of delirium as well as an old neurological deficitrelated to right side hemiparesis.

  15. Delirium detection and improved delirium management in older patients hospitalized for hip fracture.

    Science.gov (United States)

    Todd, Kristine S; Barry, Jean; Hoppough, Susan; McConnell, Eleanor

    2015-11-01

    Delirium is a common and potentially devastating problem for older patients following hip fracture. Although early detection is recommended, description and evaluation of standardized approaches are scarce. The aims of this quality improvement project were to: (1) implement a clinical algorithm for improving delirium detection and management and (2) assess the impact of the clinical algorithm on length of stay, discharge disposition and patient satisfaction. The pilot study was implemented on an orthopedic unit to evaluate the effectiveness of a clinical protocol for delirium detection and management to improve outcomes. Outcomes of 33 elderly post-operative hip fracture patients were compared to historical controls from the same unit. Delirium was detected in 18% of patients. Length of stay was reduced by 22% (P post-intervention. Implementation of a clinical algorithm to promote early detection and treatment of delirium in post-operative hip fracture patients is feasible and associated with improved outcomes. PMID:26547684

  16. Delirium

    Science.gov (United States)

    ... alert at night) Changes in feeling (sensation) and perception Changes in level of consciousness or awareness Changes in movement (for example, may be slow moving or hyperactive) Changes in sleep patterns, drowsiness Confusion (disorientation) about time or place ...

  17. Delirium Superimposed on Dementia: Accuracy of Nurse Documentation

    OpenAIRE

    Steis, Melinda R.; Fick, Donna M.

    2011-01-01

    Delirium is an acute, fluctuating confusional state that results in poor outcomes for older adults. Dementia causes a more convoluted course when coexisting with delirium. This study examined 128 days of documentation to describe what nurses document when caring for patients with dementia who experience delirium. Nurses did not document that they recognized delirium. Common descriptive terms included words and phrases indicating fluctuating mental status, lethargy, confusion, negative behavio...

  18. Delirium in elderly people: a review

    Directory of Open Access Journals (Sweden)

    Sónia Martins

    2012-06-01

    Full Text Available The present review aims to highlight this intricate syndrome, regarding diagnosis, pathophysiology, etiology, prevention and management in elderly people. The diagnosis of delirium is based on clinical observations, cognitive assessment, detailed family history, physical and neurological examination. Clinically, delirium occurs in hyperactive, hypoactive or mixed forms, based on psychomotor behaviour. As an acute confusional state, it is characterized by a rapid onset of symptoms, fluctuating course and an altered level of consciousness, global disturbance of cognition or perceptual abnormalities and evidence of a physical cause.In spite of pathophysiological mechanisms of delirium remaining unclear, current evidence suggests that disruption of neurotransmission, inflammation or acute stress responses might all contribute to the development of this ailment.It usually occurs as a result of a complex interaction of multiple risk factors, such as cognitive impairment/dementia, current hip fracture and presence of severe illness.Despite all of the above, delirium is frequently under-recognized and often misdiagnosed by health professionals. In particular, this happens due to its fluctuating nature, its overlap with dementia and the scarcity of routine formal cognitive assessment in general hospitals.It is also associated with multiple adverse outcomes that have been well documented, such as increased hospital stay, function/cognitive decline, institutionalization and mortality.In this context, early identification of delirium will be essential. Timely and optimal management of people with delirium, should be performed with identification of possible underlying causes, dealing with a suitable care environment and improving education of health professionals. All these can be important factors, which contribute to a decrease in adverse outcomes associated with delirium.

  19. Studies on circadian rhythm disturbances and melatonin in delirium

    NARCIS (Netherlands)

    A.-M. de Jonghe

    2014-01-01

    The circadian sleep/wake rhythm disturbances that are seen in delirium and the role of melatonin supplementation provide a new angle in delirium research. More research is needed to determine the role of melatonin in the pathophysiological mechanisms of delirium and to determine whether the restorat

  20. Tools to Detect Delirium Superimposed on Dementia: A Systematic Review

    OpenAIRE

    Morandi, A.; McCurley, J; Vasilevskis, E; Fick, D.; Bellelli, G; Lee, P.; Jackson, J.; Shenkin, S; Trabucchi, M; Schnelle, J; Inouye, S; Ely, W; MacLullich, A

    2012-01-01

    OBJECTIVES: To identify valid tools to diagnose delirium superimposed on dementia. DESIGN: Systematic review of studies of delirium tools that explicitly included individuals with dementia. SETTING: Hospital. PARTICIPANTS: Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments. MEASUREMENTS: PubMed, Embase, and Web of Sc...

  1. Inter-professional delirium education and care: a qualitative feasibility study of implementing a delirium Smartphone application

    OpenAIRE

    Zhang, Melvyn; Bingham, Kathleen; Kantarovich, Karin; Laidlaw, Jennifer; Urbach, David; Sockalingam, Sanjeev; Ho, Roger

    2016-01-01

    Background Delirium is a common medical condition with a high prevalence in hospital settings. Effective delirium management requires a multi-component intervention, including the use of Interprofessional teams and evidence-based interventions at the point of care. One vehicle for increasing access of delirium practice tools at the point of care is E-health. There has been a paucity of studies describing the implementation of delirium related clinical application. The purpose of this current ...

  2. Alcohol

    OpenAIRE

    World Bank

    2003-01-01

    Alcohol abuse is one of the leading causes of death and disability worldwide. Alcohol abuse is responsible for 4 percent of global deaths and disability, nearly as much as tobacco and five times the burden of illicit drugs (WHO). In developing countries with low mortality, alcohol is the leading risk factor for males, causing 9.8 percent of years lost to death and disability. Alcohol abuse...

  3. Brain-derived neurotrophic factor Val66Met polymorphism and alcohol-related phenotypes.

    Science.gov (United States)

    Nedic, Gordana; Perkovic, Matea Nikolac; Sviglin, Korona Nenadic; Muck-Seler, Dorotea; Borovecki, Fran; Pivac, Nela

    2013-01-10

    Alcoholism is a chronic psychiatric disorder affecting neural pathways that regulate motivation, stress, reward and arousal. Brain-derived neurotrophic factor (BDNF) regulates mood, response to stress and interacts with neurotransmitters and stress systems involved in reward pathways and addiction. Aim of the study was to evaluate the association between a single nucleotide polymorphism (BDNF Val66Met or rs6265) and alcohol related phenotypes in Caucasian patients. In ethnically homogenous Caucasian subjects of the Croatian origin, the BDNF Val66Met genotype distribution was determined in 549 male and 126 female patients with alcohol dependence and in 655 male and 259 female healthy non-alcoholic control subjects. Based on the structured clinical interview, additional detailed clinical interview, the Brown-Goodwin Scale, the Hamilton Rating Scale for Depression and the Clinical Global Impression scores, alcoholic patients were subdivided into those with or without comorbid depression, aggression, delirium tremens, withdrawal syndrome, early/late onset of alcohol abuse, prior suicidal attempt during lifetime, current suicidal behavior, and severity of alcohol dependence. The results showed no significant association between BDNF Val66Met variants and alcohol dependence and/or any of the alcohol related phenotypes in either Caucasian women, or men, with alcohol dependence. There are few limitations of the study. The overall study sample size was large (N=1589) but not well-powered to detect differences in BDNF Val66Met genotype distribution between studied groups. Healthy control women were older than female alcoholic patients. Only one BDNF polymorphism (rs6265) was studied. In conclusion, these data do not support the view that BDNF Val66Met polymorphism correlates with the specific alcohol related phenotypes in ethnically homogenous medication-free Caucasian subjects with alcohol dependence. PMID:23023098

  4. Emergency Department Management of Delirium in the Elderly

    Directory of Open Access Journals (Sweden)

    Lynn E.J. Gower, DO

    2012-05-01

    Full Text Available An increasing number of elderly patients are presenting to the emergency department. Numerousstudies have observed that emergency physicians often fail to identify and diagnose delirium in theelderly. These studies also suggest that even when emergency physicians recognized delirium, theystill may not have fully appreciated the import of the diagnosis. Delirium is not a normal manifestation ofaging and, often, is the only sign of a serious underlying medical condition. This article will review thesignificance, definition, and principal features of delirium so that emergency physicians may betterappreciate, recognize, evaluate, and manage delirium in the elderly.

  5. Multicomponent delirium prevention: not as effective as NICE suggest?

    Science.gov (United States)

    Teale, Elizabeth; Young, John

    2015-11-01

    Multicomponent delirium prevention strategies have been shown in intervention studies consistently to reduce the occurrence of delirium. Based on this convincing evidence base, the National Institute for Health and Care Excellence has advocated the widespread adoption of multicomponent delirium prevention interventions into the routine inpatient care of older people. However, despite successful reductions in incident delirium of about a third, anticipated reductions in mortality or admissions to long-term care--both clinically important endpoints statistically correlated with the occurrence of delirium--have not been conclusively observed. We hypothesise that the reasons for this disconnection are partly methodological, due to difficulties in delirium detection and blinding of study personnel to the intervention, but predominantly due to the underlying relationship between delirium and the abnormal health state of frailty; the interaction between these two geriatric syndromes is currently poorly understood. PMID:26316509

  6. Association of gene polymorphisms encoding dopaminergic system components and platelet MAO-B activity with alcohol dependence and alcohol dependence-related phenotypes.

    Science.gov (United States)

    Nedic Erjavec, Gordana; Nenadic Sviglin, Korona; Nikolac Perkovic, Matea; Muck-Seler, Dorotea; Jovanovic, Tanja; Pivac, Nela

    2014-10-01

    The present study aimed to evaluate the association of alcohol dependence and alcohol dependence-related phenotypes with platelet monoamine oxidase type B (MAO-B) activity, Val108/158Met of catechol-o-methyltransferase (COMT), variable number of tandem repeats (VNTR) in the third exon of dopamine receptor D4 (DRD4) gene, VNTR in the 3'-untranslated region of dopamine transporter (DAT) gene, -1021C/T of dopamine beta-hydroxylase (DBH) and MAO-B intron 13 polymorphisms. The study included 1270 Caucasian men and women of Croatian origin: 690 patients with alcohol dependence and 580 healthy controls. Patients with alcohol dependence were subdivided according to the presence or absence of withdrawal symptoms, aggressive behavior, severity of alcohol dependence, delirium tremens, comorbid depression, suicidal behavior, lifetime suicide attempt and early/late onset of alcohol abuse. The results, corrected for multiple testing, revealed increased platelet MAO-B activity in patients with alcohol dependence, subdivided into those with or without alcohol-related liver diseases, compared to control subjects (P<0.001). In addition, we found an increased frequency of the COMT Met/Met genotype among suicidal (P=0.002) and patients who attempted suicide (P<0.001) and an increased frequency of COMT Val/Val genotype in patients with an early onset of alcohol dependence (P=0.004). This study provides data from a sample of ethnically homogeneous unrelated Caucasian subjects for future meta-analyses and suggests that the increased platelet MAO-B activity might be used as independent peripheral indicator of alcohol dependence, while COMT Val108/158Met polymorphism is associated with increased suicidality and early onset of alcohol dependence. PMID:25035107

  7. Alcoholic leukopenic pneumococcal sepsis.

    Science.gov (United States)

    Alraiyes, Abdul Hamid; Shaheen, Khaldoon; Alraies, M Chadi

    2013-04-01

    Alcohol abuse has been associated with an increased mortality and morbidity due to increased aspiration, delirium tremens, and seizures. The association of pneumococcal lung infections and leukopenia in the setting of alcohol abuse are rarely reported; however, when present, severe lung infections can happen with severe lung injury and poor response to conventional therapy and ultimately, death. We are reporting a case of 55-year-old-man presented with shortness of breath, cough and altered mental status and eventually found with severe pneumococcal lung infection in the setting of leukopenia and long-term alcohol abuse representing alcoholic leukopenic pneumococcal sepsis syndrome. PMID:23930244

  8. Alcohol

    Science.gov (United States)

    ... Date reviewed: January 2014 previous 1 • 2 For Teens For Kids For Parents MORE ON THIS TOPIC Word! Alcoholism What You Need to Know About Drugs What You Need to Know About Drugs: Depressants What Kids Say About: Drinking Alcohol Dealing With Peer Pressure Contact Us Print Resources Send to a friend ...

  9. Delirium em pacientes críticos Delirium in the critically ill patient

    Directory of Open Access Journals (Sweden)

    Renata Fittipaldi Pessoa

    2006-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O delirium é um achado freqüente em pacientes críticos. Apesar de estar associado a um aumento da morbidade e mortalidade, ainda é pouco reconhecido pelos intensivistas. Esta revisão teve como objetivo revisar os principais aspectos relacionados ao delirium no paciente critico. CONTEÚDO: Definição, incidência, mortalidade, fatores de risco, fisiopatologia, diagnóstico e tratamento do delirium no paciente crítico. CONCLUSÕES: O delirium é um distúrbio da consciência, cognição e percepção que pode acometer até 80% dos pacientes em ventilação mecânica. Os fatores de risco incluem doenças sistêmicas agudas, idade avançada, distúrbios cognitivos preexistentes, privação do sono e certas medicações, como os fármacos com atividade anticolinérgica. Embora novas ferramentas estejam disponíveis para o seu rápido diagnóstico em pacientes críticos, os profissionais de saúde ainda não costumam monitorizar esta condição. Nos últimos anos a prevenção e o diagnóstico têm sido priorizados. O haloperidol continua sendo a medicação de escolha embora exista alguma evidência da eficácia da risperidona.BACKGROUND AND OBJECTIVES: Delirium is a frequent finding in the critically ill patient. Although it is associated with increased morbidity and mortality, it is often not recognized by intensive care doctors. This review will address the main issues regarding delirium in critically ill patients. CONTENTS: Definition, incidence, mortality, risk factors, diagnosis, and treatment of delirium in the critically ill. CONCLUSIONS: Deliriumis defined as a disturbance of consciousness, attention, cognition and perception that occurs frequently in critically ill patients. It occurs in as many as 80% of mechanically ventilated ICU patients. Risk factors for delirium include acute systemic illnesses, older age, pre-existing cognitive impairment, sleep deprivation, and medications with anticholinergic

  10. Thyroid Storm in Postoperative Delirium Etiology: Case Report

    OpenAIRE

    Nermin Kelebek Girgin; Remzi İşçimen; İrem Aydoğmuş; Sinan Bora; Ayşen Akkurt Kocaeli; Ferda Kahveci

    2016-01-01

    Delirium is an acute organic brain syndrome of different physical and pathophysiological etiologies characterized by a disturbance in consciousness with accompanying change in cognition. Delirium causes prolonged length of stay in hospital and intensive care unit, also increased morbidity and mortality. Thyroid storm is a severe, life-threatening type of thyrotoxicosis and is one of a few endocrine disorders that cause delirium. It is mostly occured suddenly after acute infection, surgical...

  11. Pharmacological and Nonpharmacological Management of Delirium in Critically Ill Patients

    OpenAIRE

    Hipp, Dustin M.; Ely, E. Wesley

    2012-01-01

    Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tool...

  12. Prevalence of delirium among patients at a cancer ward

    DEFF Research Database (Denmark)

    Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex;

    2016-01-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the...... Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient...

  13. Association between leptin and delirium in elderly inpatients

    Science.gov (United States)

    Sánchez, Julio C; Ospina, Jenny P; González, Martha I

    2013-01-01

    Leptin is a hormone with significant effects on the brain, both at the cellular level and cognitive level. This study aimed to establish the association between leptin levels and delirium in a Colombian elderly population. 115 patients older than 60 years were included. Leptin was measured by enzyme-linked immunosorbent assay after overnight fasting and Mini-Mental State Examination and Confusion Assessment Method (CAM) tests were employed. Delirium was diagnosed using CAM in 23.48% of patients, being most frequent in men. There were no significant differences in hematology and renal test values between patients with delirium and those without delirium, but cerebrovascular diagnoses were more frequent in patients with delirium. No correlation with any specific medication was found, but patients with delirium had a higher number of comorbidities and medications. Leptin levels were significantly lower in patients with delirium and correlated negatively with the number of diagnoses and medications, but not with age, gender, body mass index, or hematology and renal test results. Leptin levels may have a role in the pathophysiological process of delirium and low leptin could be a useful clinical biomarker to establish risk in elderly patients given the association with delirium. PMID:23717044

  14. Melatonin based therapies for delirium and dementia.

    Science.gov (United States)

    Alagiakrishnan, Kannayiram

    2016-05-01

    Melatonin levels have been shown to decline with aging. Melatonin and its analogs in addition to their effect on sleep promotion, has been shown to have multiple pleiotropic effects. It can also help with neuroprotection through different mechanisms. Evidence in animal and human studies suggests that low levels of melatonin have been linked to delirium, mild cognitive impairment, dementia, and with certain behavioral problems. Recent clinical trials have showed that both melatonin and its analogs may be useful in the prevention, treatment of delirium, and the management of dementia. These medications seem to have the advantage of less side effects and better safety profile when compared to antipsychotics and sedatives like benzodiazepines. These medications are available over the counter in North America, Europe, and Asia, and some of these medications are approved by FDA. This manuscript will discuss the promising role of these melatonergic medications alone or in combination with other medications for the management of Geriatric Psychiatric diseases like delirium and dementia. PMID:27355332

  15. Review of Postoperative Delirium in Geriatric Patients Undergoing Hip Surgery.

    Science.gov (United States)

    Rizk, Paul; Morris, William; Oladeji, Philip; Huo, Michael

    2016-06-01

    Postoperative delirium is a serious complication following hip surgery in elderly patients that can adversely affect outcomes in both hip fracture and arthroplasty surgery. Recently, the incidence of hip fracture in the Medicare population was estimated at approximately 500 000 patients per year, with the majority treated surgically. The annual volume of total hip arthroplasty is nearly 450 000 patients and is projected to increase over the next 15 to 20 years. Subsequently, the incidence of postoperative delirium will rise. The incidence of postoperative delirium after hip surgery in the elderly patients ranges between 4% and 53%, and it is identified as the most common surgical complication of older patients. The most common risk factors include advanced age, hip fracture surgery (vs elective hip surgery), and preoperative delirium/cognitive impairment. Exact pathophysiology has not been fully defined. It is hypothesized that imbalances in cortical neurotransmitters or inflammatory cytokine pathway mechanisms contribute to delirium. Development of postoperative delirium is associated with longer hospital stay, increased medical complications, and poorer short-term functional outcome. Patients who develop postoperative delirium are also at increased risk for cognitive decline beyond the acute phase. Following acute care, postoperative delirium is associated with the need for a higher level of care, an additional cost. Management of postoperative delirium centers on prevention and early recognition. Medical prophylaxis has been demonstrated to have limited utility. Utilization of delirium detection methods contributed to early recognition. The most effective means of prevention involved a multidisciplinary team focused on adequate hydration, optimization of analgesia, reduction in polypharmacy, aggressive physiotherapy, and early recognition of the delirium symptoms. PMID:27239384

  16. Cocaine withdrawal

    Science.gov (United States)

    Cocaine withdrawal occurs when someone who has used a lot of cocaine cuts down or quits taking the drug. Symptoms ... even if the user is not completely off cocaine and still has some of the drug in ...

  17. Aspectos neurofarmacológicos do uso crônico e da Síndrome de Abstinência do Alcool Neuropharmacological aspects of chronic alcohol use and withdrawal syndrome

    Directory of Open Access Journals (Sweden)

    Marcos Zaleski

    2004-05-01

    Full Text Available O objetivo deste artigo é o de revisar e descrever as principais alterações neurofarmacológicas causadas pela exposição crônica ao álcool, assim como os fenômenos ocorridos durante o período de abstinência. São apresentados dados referentes às alterações neuroadaptativas e de tolerância ocorridas nos principais sistemas de monoaminas, aminoácidos neurotransmissores e canais de cálcio, o que está relacionado a uma piora no prognóstico de portadores de comorbidades psiquiátricas com o consumo de álcool. São também descritos alguns estudos relevantes que demonstram o envolvimento de outros mecanismos de ação do álcool no sistema nervoso central, como o envolvimento de opióides, entre outras substâncias. O artigo reafirma a importância, para clínicos e pesquisadores, de um sempre maior entendimento do mecanismo de ação central do álcool, pois dele depende a busca por novas opções farmacológicas, tanto para a redução dos danos provocados pelo seu uso crônico, como para o tratamento da síndrome de abstinência a esta substância.The objective of this paper is to review and describe the main neuropharmacological changes caused by the chronic use of alcohol and those observed during its withdrawal period. The results show international data referring to the involvement of monoamine systems, neurotransmitters and calcium channels in both neuroadaptation and tolerance to alcohol effects and withdrawal. Relevant studies showing the participation of other systems in those mechanisms, as opioids and other substances, are also shown. The article reinforces the importance, for both physicians and researchers, of an always growing understanding of alcohol central mechanisms of action. This understanding is necessary to new pharmacological options to alcohol harm reduction as well as to alcohol withdrawal treatment.

  18. Delirium Associated with Olanzapine Therapy in an Elderly Male with Bipolar Affective Disorder

    OpenAIRE

    Sharma, Ravi C.; Aggarwal, Ashish

    2010-01-01

    Atypical antipsychotic medications are commonly used to treat symptoms of delirium. Olanzapine has been successfully used in the treatment of delirium. However, there have been few case reports of delirium associated with olanzapine. We hereby report a case of delirium associated with olanzapine therapy. Possible risk factors and underlying pathogenesis is discussed.

  19. Delirium in the hospitalized elder and recommendations for practice.

    Science.gov (United States)

    Rigney, Ted S

    2006-01-01

    Delirium is a mental disorder of acute onset and fluctuating course, characterized by disturbances in consciousness, orientation, memory, thought, perception, and behavior. It occurs in up to 50% of elderly hospital inpatients, many with preexisting dementia, and is associated with significant increases in functional disability, length of hospital stay, rates of death, and health care costs. Despite its clinical importance, delirium often remains undetected or misdiagnosed as dementia or other psychiatric illness. Awareness of the etiologies and risk factors of delirium should enable nurses to focus on patients at risk and to recognize delirium symptoms early. Knowledge of pharmacological and nonpharmacological treatments for delirium will provide the nurse with an arsenal of potential interventions in the care of the delirious hospitalized elder. PMID:16757386

  20. Pharmacological and nonpharmacological management of delirium in critically ill patients.

    Science.gov (United States)

    Hipp, Dustin M; Ely, E Wesley

    2012-01-01

    Delirium is a common yet under-diagnosed syndrome of acute brain dysfunction, which is characterized by inattention, fluctuating mental status, altered level of consciousness, or disorganized thinking. Although our recognition of risk factors for delirium has progressed, our understanding of the underlying pathophysiologic mechanisms remains limited. Improvements in monitoring and assessment for delirium (particularly in the intensive care setting) have resulted in validated and reliable tools such as arousal scales and bedside delirium monitoring instruments. Once delirium is recognized and the modifiable risk factors are addressed, the next step in management (if delirium persists) is often pharmacological intervention. The sedatives, analgesics, and hypnotics most often used in the intensive care unit (ICU) to achieve patient comfort are all too frequently deliriogenic, resulting in a longer duration of ICU and hospital stay, and increased costs. Therefore, identification of safe and efficacious agents to reduce the incidence, duration, and severity of ICU delirium is a hot topic in critical care. Recognizing that there are no medications approved by the Food and Drug Administration (FDA) for the prevention or treatment of delirium, we chose anti-psychotics and alpha-2 agonists as the general pharmacological focus of this article because both were subjects of relatively recent data and ongoing clinical trials. Emerging pharmacological strategies for addressing delirium must be combined with nonpharmacological approaches (such as daily spontaneous awakening trials and spontaneous breathing trials) and early mobility (combined with the increasingly popular approach called: Awakening and Breathing Coordination, Delirium Monitoring, Early Mobility, and Exercise [ABCDE] of critical care) to develop evidence-based approaches that will ensure safer and faster recovery of the sickest patients in our healthcare system. PMID:22270810

  1. Delirium: uma perspectiva histórica Delirium a historical perspective

    Directory of Open Access Journals (Sweden)

    Priscilla Wacker

    2005-06-01

    Full Text Available O delirium corresponde a uma das primeiras doenças mentais descritas na literatura médica, há mais de 2.500 anos. Nas classificações psiquiátricas, permaneceu como categoria nosológica independente até o final do século XIX, quando foi redefinida com base nos seus aspectos fenomenológicos e etiológicos, precipitando a reclassificação das insanidades funcionais em psicoses. os estados confusionais passaram a se referir a uma síndrome mais ampla que incluía o delirium, enfatizando a desorganização dos processos cognitivos e do pensamento, e tendo no turvamento da consciência e na desorientação temporoespacial a condição de base. Com o objetivo de descrever a evolução histórica do conceito de delirium, foram realizados levantamentos da literatura médica através do sistema Medline, além da pesquisa em publicações literárias específicas sobre os temas história da medicina e história da psiquiatria. Partiu-se de algumas observações dogmáticas praticadas na Antigüidade e Idade Média, para atingir as definições e práticas atuais, oferecendo uma análise crítica dos critérios diagnósticos vigentes (DSM-III, DSM-IIIR, DSM-IV e CID-10. Não obstante a evolução conceitual, o delirium continua sendo mal compreendido, do ponto de vista fisiopatológico e são poucas as opções terapêuticas. o diagnóstico de delirium é ato eminentemente clínico: baseia-se na observação cautelosa das manifestações psíquicas e comportamentais dos pacientes acometidos, além da análise dos fatores predisponentes e precipitantes. É freqüente o seu subdiagnóstico em contextos clínicos e cirúrgicos. o diagnóstico do delirium é estabelecido em apenas 30% a 50% dos pacientes, sendo a omissão diagnóstica menos freqüente em serviços que contam com a interconsulta psiquiátrica. o delirium é uma das complicações mais comuns entre pacientes idosos hospitalizados e está associado a maior morbimortalidade. Isso

  2. Incidence and risk factors of postoperative delirium in elderly patients undergoing transurethral resection of prostate: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Xue P

    2016-01-01

    Full Text Available Peng Xue,1 Ziyu Wu,2 Kunpeng Wang,1 Chuanquan Tu,1 Xiangbo Wang1 1Department of Urology, First People’s Hospital of Lianyungang, Lianyungang, 2Department of Urology, No 2 Hospital of Huaian, Huaian, Jiangsu Province, People’s Republic of China Aim: The aim of the present study was to investigate the occurrence of postoperative delirium (POD in elderly patients undergoing transurethral resection of prostate (TURP and to identify those factors associated with delirium.Methods: From July 2010 to February 2015, 358 patients, aged ≥65 years and undergoing TURP were prospectively enrolled. Personal, medical and cognitive data, laboratory assessments, pain intensity, preoperative medications, and details of hemodynamic control were collected as predictors of delirium. POD was assessed using the Confusion Assessment Method.Results: In the present study, POD occurred in 28 out of 358 cases (7.8% after TURP, with duration of 1–4 days. The multivariate analysis showed that old age and visual analog scale pain scores were associated with POD. Marital status, body mass index, education, alcohol consumption, smoking history, preoperative psychotropic medication usage, activities of daily living scores, preoperative Mini-Mental Status Examination score, anesthesia type, American Society of Anesthesiologists classification, or hypotensive episodes during surgery did not significantly correlate with the occurrence of POD.Conclusion: Old age and pain intensity after surgery were found as the risk factors for the development of delirium in elderly patients undergoing TURP. These findings might help develop preventive strategies to decrease POD through targeted evaluation. Keywords: elderly, postoperative delirium, risk factors, transurethral resection of prostate

  3. Validation of a Consensus Method for Identifying Delirium from Hospital Records

    OpenAIRE

    Elvira Kuhn; Xinyi Du; Keith McGrath; Sarah Coveney; Niamh O'Regan; Sarah Richardson; Andrew Teodorczuk; Louise Allan; Dan Wilson; Inouye, Sharon K.; MacLullich, Alasdair M.J.; David Meagher; Carol Brayne; Suzanne Timmons; Daniel Davis

    2014-01-01

    BACKGROUND: Delirium is increasingly considered to be an important determinant of trajectories of cognitive decline. Therefore, analyses of existing cohort studies measuring cognitive outcomes could benefit from methods to ascertain a retrospective delirium diagnosis. This study aimed to develop and validate such a method for delirium detection using routine medical records in UK and Ireland.METHODS: A point prevalence study of delirium provided the reference-standard ratings for delirium dia...

  4. Delirium in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Kurbegovic, Sorel; Andersen, Jens; Krenk, Lene; Kehlet, Henrik

    2015-01-01

    BACKGROUND: Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously...... demonstrated to enhance recovery and reduce morbidity. METHODS: Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. RESULTS: Total median length of hospital stay was...

  5. 27 CFR 19.532 - Withdrawals of spirits for use in wine production.

    Science.gov (United States)

    2010-04-01

    ... use in wine production. 19.532 Section 19.532 Alcohol, Tobacco Products and Firearms ALCOHOL AND... Withdrawals Withdrawal of Spirits Without Payment of Tax § 19.532 Withdrawals of spirits for use in wine production. Wine spirits may be withdrawn to a bonded wine cellar without payment of tax for use in...

  6. [Current peculiarities of alcoholic psychosis].

    Science.gov (United States)

    Aleksin, D S; Egorov, A Iu

    2011-01-01

    The follow-up study of alcoholic psychoses in male patients admitted to a clinical department of a psychiatric hospital in 2005-2007 was carried out. Patients with alcoholic psychoses made up from 15 to 30% of all patients. The number of psychosis had seasonal variations with the elevations in spring and autumn, peaks in January, lune and October. Alcoholic delirium morbidity made up from 69 to 82% of the total number of alcoholic psychoses, alcoholic hallucinosis varied from 14 to 27%. Other forms were presented by single cases. In alcoholic delirium hallucinations had brighter, sated character. The most specific were visual hallucinations in the form of zoohallucinations, hallucinations of an oral cavity ("sensation of threads, hair etc"). The most often observable characters were "extraneous people, animal, demons". In alcoholic hallucinosis, verbal contrast hallucinations, making comment hallucinations, visual illusions were most frequent. The family history of mental disorders and alcoholism was noted in 30% of patients with alcoholic psychosis. The probability of occurrence of alcoholic psychoses depended on the quality of consumed drinks. The presence of a cranial-brain injury in the anamnesis considerably aggravated the disease forecast and increased the risk of seizure syndrome. PMID:22611692

  7. Educational interventions to improve recognition of delirium: a systematic review.

    Science.gov (United States)

    Yanamadala, Mamata; Wieland, Darryl; Heflin, Mitchell T

    2013-11-01

    Delirium is a common and serious condition that is underrecognized in older adults in a variety of healthcare settings. It is poorly recognized because of deficiencies in provider knowledge and its atypical presentation. Early recognition of delirium is warranted to better manage the disease and prevent the adverse outcomes associated with it. The purpose of this article is to review the literature concerning educational interventions focusing on recognition of delirium. The Medline and Cumulative Index to Nursing and Allied Health Literature (CINHAL) databases were searched for studies with specific educational focus in the recognition of delirium, and 26 studies with various designs were identified. The types of interventions used were classified according to the Predisposing, Reinforcing and Enabling Constructs in Educational Diagnosis and Evaluation (PRECEDE) model, and outcomes were sorted according to Kirkpatrick's hierarchy. Educational strategies combining predisposing, enabling, and reinforcing factors achieved better results than strategies that included one or two of these components. Studies using predisposing, enabling, and reinforcing strategies together were more often effective in producing changes in staff behavior and participant outcomes. Based on this review, improvements in knowledge and skill alone seem insufficient to favorably influence recognition of delirium. Educational interventions to recognize delirium are most effective when formal teaching is interactive and is combined with strategies including engaging leadership and using clinical pathways and assessment tools. The goal of the current study was to systematically review the published literature to determine the effect of educational interventions on recognition of delirium. PMID:24219200

  8. A case of Sheehan's syndrome with delirium.

    Science.gov (United States)

    Umekawa, T; Yoshida, T; Sakane, N; Kondo, M

    1996-12-01

    A 53 year old woman was brought to a psychiatric clinic because of delirium. Upon immediate examination, severe hyponatremia (105 mEq/L) was detected. She was suspected of having internal diseases and referred to our university hospital. When she reached our hospital she was delirious and showed excitement and agitation. Her electroencephalogram showed low voltage theta waves (20 microV) in all leads. She was hospitalized and diagnosed with acute tonsillar abscess and panhypopituitarism based on various endocrine tests. Her past history suggested that Sheehan's syndrome had developed after child-bearing at age 31, resulting in panhypopituitarism. After administration of antibiotics, the fever and tonsillar abscess gradually recovered, and the correction of electrolytes improved the level of consciousness, suggesting that the hyponatremia had been closely related to the clouding of consciousness. As the subsequent administration of cortisol kept the patient's serum sodium levels within the normal range, a decrease in plasma cortisol seemed to be the major cause of the hyponatremia. Psychological symptoms of panhypopituitarism often included abulia, apathy and occasionally coma. However, it is rare for a patient with panhypopituitarism to be misdiagnosed as having a psychiatric disease with delirium. This rare case is presented. PMID:9014231

  9. Impact of alcohol intoxication and withdrawal syndrome on social phobia and panic disorder in alcoholic inpatients Impacto das fases de intoxicação e de abstinência de álcool sobre a fobia social e o transtorno de pânico em pacientes alcoolistas hospitalizados

    Directory of Open Access Journals (Sweden)

    Mauro Barbosa Terra

    2004-01-01

    Full Text Available PURPOSE: To investigate the impact of alcohol intoxication and withdrawal on the course of social phobia and panic disorder. METHOD: A group of 41 alcoholic inpatients undergoing detoxification therapy were interviewed using the SCID-I (DSM-IV and questions to detect fluctuations in the course of social phobia and panic disorder as a function of the different phases in alcohol dependence (intoxication, withdrawal, and lucid interval. RESULTS: Only 1 (2.4% patient presented panic disorder throughout life, and 9 (21.9% had panic attacks during alcohol intoxication or during the withdrawal syndrome. Sixteen (39% alcoholic patients showed social phobia with onset prior to drug use. However, drinking eventually became unable to alleviate social phobia symptoms or worsened such symptoms in 31.2% of social-phobic patients. While patients with social phobia reported a significant improvement in psychiatric symptoms during alcohol intoxication, patients experiencing panic attacks worsened significantly during intoxication. In the withdrawal phase, patients with social phobia tended to have more and more intense phobic symptoms. CONCLUSION: Our findings indicate that the impact of alcohol intoxication is different for social phobia as compared to panic disorder, at first decreasing the social-phobic symptoms but later aggravating them. In panic disorder, the impact of intoxication by alcohol is more harmful, at least in the short term.OBJETIVO: Estudar o impacto das fases de intoxicação e de abstinência do uso de álcool sobre o curso da fobia social e do transtorno de pânico. MÉTODO: Um grupo de 41 pacientes hospitalizados por dependência de álcool foi entrevistado com o SCID-I (DSM-IV, adicionado de perguntas para detectar as flutuações no curso da fobia social e do transtorno do pânico em função das diferentes fases do uso da droga (intoxicação, abstinência e intervalo lúcido. RESULTADOS: Apenas um (2,4% paciente, apresentou transtorno

  10. No association between the TaqI A1 RFLP of the D2 receptor gene and alcoholism in a Mexican population

    Energy Technology Data Exchange (ETDEWEB)

    Cruz-Fuentes, C.; Carmarena, B.; Eroza, V. [and others

    1994-09-01

    The suggested association of the A1 allele of the D2 dopamine receptor (DRD2) human gene with alcoholism was studied by comparing the DRD2/TaqI genotypes of 36 healthy controls and 38 individuals who met the DSM-III-R diagnostic criteria for alcohol dependence. All subjects were unrelated, with parents and grandparents of Mexican origin. The alcoholics in our sample suffered one of the following conditions: delirium tremens (16.6%), alcohol hallucinosis (56.6%) or uncomplicated alcohol withdrawal (26.4%). Eight-eight percent of the controls carried the A1 allele. The frequency of the DRD2 A1 allele in the Mexican urban sample (pA1 = 0.61) was 2 to 3-fold higher than reported in Caucasian populations from the USA and Europe, but similar to the allele frequencies found in defined Amerindian populations. There were not significant differences in the prevalence or allele frequency between alcoholics (pA1 = 0.64) and controls, regardless if the alcoholics were subtyped accordingly to severity, age of onset or positive family history. Alcoholics had higher scores than controls in the neuroticism (N) and psychoticism (P) subscales on the Eysenck personality test: alcoholics P = 6.2 {+-} 2.9, N = 16.0 {+-} 4.2 vs. controls P = 2.5 {+-} 2.3, N = 5.7 {+-} 5.1; p<0.001 and p<0.001, respectively. However, no relationship between personality traits and genotypes was found. Our results do not support a consistent association between the TaqI A1 RFLP for the DRD2 gene and alcoholism.

  11. The complex interplay between delirium, sepsis and sedation

    OpenAIRE

    Kress, John P

    2010-01-01

    Critically ill patients requiring mechanical ventilation frequently suffer from intensive care unit delirium, a syndrome associated with numerous poor measured outcomes. The relationship between delirium, sepsis, and sedation is complex. A discussion of the recent study ('Effect of dexmedetomidine versus lorazepam on outcome in patients with sepsis: an a priori-designed analysis of the MENDS [maximizing efficacy of targeted sedation and reducing neurological dysfunction] randomized controlled...

  12. Hypovitaminosis D in Delirium: a Retrospective Cross-sectional Study

    Science.gov (United States)

    Ford, Jennifer; Hategan, Ana; Bourgeois, James A.; Tisi, Daniel K.; Xiong, Glen L.

    2013-01-01

    Background As vitamin D may have a neuroprotective effect, the authors studied the association of biomarkers of vitamin D status and delirium to see if low vitamin D status was common in delirium cases. Methods Biochemical measures of vitamin D (25-hydroxyvitamin D [25-OHD]) and calcium metabolism were used in this retrospective cross-sectional analysis of adult in-patients with delirium, admitted at three Canadian academic hospitals from January 2011 to July 2012. Primary outcome was to determine estimates of the prevalence of hypovitaminosis D in this group in whom vitamin D was checked. Results Seventy-one (5.8%) out of 1,232 delirium inpatients had their vitamin D measured. Thirty-nine (55%) showed vitamin D insufficiency (25-OHD of 25-75 nmol/L) and 8 (11%) showed vitamin D deficiency (25-OHD < 25 nmol/L). Mean serum 25-OHD levels were lower in males (57.1±7.7 nmol/L) than in females (78.2±6.1 nmol/L), p = .01, even when controlled for age and season. Men were younger than the women (74.4±2.3 vs. 82.4±1.7, p = .005). Mean age was 78.7±1.5 years, and 33 (47%) were male. Conclusions Although vitamin D is rarely checked during delirium workup and/or management, high rates of hypovitaminosis D were found to be common in the delirium in-patients in whom it was checked. Larger studies would be needed to estimate the prevalence of hypovitaminosis D in delirium and whether hypovitaminosis D plays a role in the pathogenesis of delirium. PMID:24278095

  13. Biomarkers of postoperative delirium and cognitive dysfunction

    Directory of Open Access Journals (Sweden)

    Ganna Androsova

    2015-06-01

    Full Text Available Elderly surgical patients frequently experience postoperative delirium (POD and the subsequent development of postoperative cognitive dysfunction (POCD. Clinical features include deterioration in cognition, disturbance in attention and reduced awareness of the environment and result in higher morbidity, mortality and greater utilization of social financial assistance. The aging Western societies can expect an increase in the incidence of POD and POCD. The underlying pathophysiological mechanisms have been studied on the molecular level albeit with unsatisfying small research efforts given their societal burden. Here, we review the known physiological and immunological changes and genetic risk factors, identify candidates for further studies and integrate the information into a draft network for exploration on a systems level. The pathogenesis of these postoperative cognitive impairments is multifactorial; application of integrated systems biology has the potential to reconstruct the underlying network of molecular mechanisms and help in the identification of prognostic and diagnostic biomarkers.

  14. A new delirium phenotype with rapid high amplitude onset and nearly as rapid reversal: Central Coast Australia Delirium Intervention Study

    Directory of Open Access Journals (Sweden)

    Regal PJ

    2015-02-01

    Full Text Available Paul J RegalGeriatric Medicine, University of Newcastle, Callaghan, AustraliaBackground: Traditional models for delirium based on the Diagnostic and Statistical Manual for Mental Disorders and its 1990 offspring, the Confusion Assessment Method (CAM, were not designed to distinguish behavioral and psychological symptoms of dementia from rapid cognitive decline. We examined a new diagnostic criterion for delirium plus exclusion of behavioral and psychological symptoms of dementia and recent inattention with a 25% decline in digit span forward (DSF.Methods: This was a prospective, randomized controlled trial comparing management of prevalent delirium in general medical with that in geriatric medical wards in a 370-bed hospital north of Sydney. Inclusion criteria were age ≥65 years and prevalent delirium in the emergency department based on: CAM; proof that CAM elements were not better explained by behavioral and psychological symptoms of dementia; proof of recent inattention on DSF; evidence of cognitive decline not due to sedatives or antipsychotics in the emergency department. Measurements included the Instrumental Activities of Daily Living (IADL, 22-item, Selective IADL (8-item, Mini-Mental State Examination, DSF daily, Delirium Index daily, and Apathy Evaluation Scale. Pre-delirium scores from past cognitive tests and best scores were imputed after admission. Relative change (RC was calculated as absolute change/test range and RC/MPC ratio was calculated as RC after admission/maximal possible change.Results: A total of 130 subjects were recruited but 14 with subsyndromal delirium were excluded, leaving 116 subjects (mean age 83.6 years. Forty-eight percent had prior dementia. RC from pre-delirium to admission was 42% for the Mini-Mental State Examination, 41% for Selective IADL, 34% for 5-DSF, 54% for 6-DSF, and 37% for the Apathy Evaluation Scale. Improvements after admission (RC and RC/MPC ratios were 32%/98% for 5-DSF, 54%/82% for 6-DSF

  15. In-hospital delirium risk assessment, diagnosis and management; medications to avoid

    Directory of Open Access Journals (Sweden)

    Andrew Clegg

    2013-03-01

    Full Text Available Background: Delirium is a common, but potentially preventable complication of acute illness that is associated with important adverse outcomes including increased length of hospital admission, risk of dementia and admission to long-term care. In-hospital risk assessment and diagnosis: Age over 65, severe illness, current hip fracture and presence of cognitive impairment or dementia are important risk factors for delirium. Assess people with any of these risk factors for recent changes or fluctuations in behaviour that might indicate delirium. If any indicators are present, complete a full cognitive assessment to confirm the diagnosis of delirium. In-hospital risk management: Multicomponent delirium prevention interventions can reduce the incidence of delirium in hospital by around one third and should be provided to people with any of the important risk factors that do not have delirium at admission. A medication review that considers both the number and type of prescribed medications is an important part of the multicomponent delirium prevention intervention. Which medications to avoid in people at risk of delirium: For people at risk of delirium, avoid new prescriptions of benzodiazepines or consider reducing or stopping these medications where possible. Opioids should be prescribed with caution in people at risk of delirium but this should be tempered by the observation that untreated severe pain can itself trigger delirium. Caution is also required when prescribing dihydropyridines and antihistamine H1 antagonists for people at risk of delirium and considered individual patient assessment is advocated. Conclusion: Delirium is common, distressing to patients, relatives and carers and is associated with important adverse outcomes. Multicomponent delirium prevention interventions can reduce the incidence of delirium by approximately one third and usually incorporate a medication review. Identification of which medications to avoid in people at

  16. Investigations into the behavioural and neurobiological effects of repeated ethanol withdrawal

    OpenAIRE

    Hoang, Leigh

    2011-01-01

    This thesis presents a rat model, by which the effects of repeated ethanol withdrawal on withdrawal severity was investigated, in relation to the cognitive and behavioural deficits associated with repeated episodes of withdrawal. Repeated ethanol withdrawal in the rat has been well established to model the effects of repeated episodes of human alcohol detoxification. This model has enabled the study of withdrawal severity and the role of the prefrontal cortex in the form of rat behaviour. ...

  17. Effects of a screening and treatment protocol with haloperidol on post-cardiotomy delirium

    DEFF Research Database (Denmark)

    Schrøder Pedersen, Sofie; Kirkegaard, Thomas; Balslev Jørgensen, Martin;

    2014-01-01

    delirium, and 123 patients were included after. Nurses screened patients using validated tools (the Delirium Observation Screening (DOS) scale and confusion assessment method for the intensive care unit (CAM-ICU)). In case of delirium, a checklist to eliminate precipitating/ inducing factors and a protocol...

  18. Prediction of delirium after cardiac surgery and the use of a risk checklist

    NARCIS (Netherlands)

    Koster, S.; Hensens, A.G.; Schuurmans, M.J.; Palen, van der J.A.M.

    2013-01-01

    Background: Delirium is a temporary mental disorder, which occurs frequently among patients who undergo cardiac surgery. Delirium prediction and its associated prevention is essential. In a previous study, a risk checklist for delirium was developed. Aims: The present study validated this checkli

  19. Mecanismos fisiopatológicos do delirium Pathophysiological mechanisms of delirium

    OpenAIRE

    Franklin Santana Santos

    2005-01-01

    O delirium é uma das síndromes mais fascinantes na medicina, apesar de pobremente compreendida. Apesar de sua ocorrência freqüente e de haver crescente informação sobre o diagnóstico, fenomenologia, epidemiologia e etiologias, estudos sobre os mecanismos que mediam a fisiopatologia são, freqüentemente, ausentes. O desenvolvimento de sofisticadas metodologias de imagem cerebral tem permitido ir além das considerações diagnósticas e investigar a neurobiologia dos sintomas específicos observados...

  20. A clinical perspective of sepsis-associated delirium.

    Science.gov (United States)

    Tsuruta, Ryosuke; Oda, Yasutaka

    2016-01-01

    The term sepsis-associated encephalopathy (SAE) has been applied to animal models, postmortem studies in patients, and severe cases of sepsis. SAE is considered to include all types of brain dysfunction, including delirium, coma, seizure, and focal neurological signs. Clinical data for sepsis-associated delirium (SAD) have been accumulating since the establishment of definitions of coma or delirium and the introduction of validated screening tools. Some preliminary studies have examined the etiology of SAD. Neuroinflammation, abnormal cerebral perfusion, and neurotransmitter imbalances are the main mechanisms underlying the development of SAD. However, there are still no specific diagnostic blood, electrophysiological, or imaging tests or treatments specific for SAD. The duration of delirium in intensive care patients is associated with long-term functional disability and cognitive impairment, although this syndrome usually reverses after the successful treatment of sepsis. Once the respiratory and hemodynamic states are stabilized, patients with severe sepsis or septic shock should receive rehabilitation as soon as possible because early initiation of rehabilitation can reduce the duration of delirium. We expect to see further pathophysiological data and the development of novel treatments for SAD now that reliable and consistent definitions of SAD have been established. PMID:27011789

  1. Delirium in the elderly: current problems with increasing geriatric age

    Science.gov (United States)

    Kukreja, Deepti; Günther, Ulf; Popp, Julius

    2015-01-01

    Delirium is an acute disorder of attention and cognition seen relatively commonly in people aged 65 yr or older. The prevalence is estimated to be between 11 and 42 per cent for elderly patients on medical wards. The prevalence is also high in nursing homes and long term care (LTC) facilities. The consequences of delirium could be significant such as an increase in mortality in the hospital, long-term cognitive decline, loss of autonomy and increased risk to be institutionalized. Despite being a common condition, it remains under-recognised, poorly understood and not adequately managed. Advanced age and dementia are the most important risk factors. Pain, dehydration, infections, stroke and metabolic disturbances, and surgery are the most common triggering factors. Delirium is preventable in a large proportion of cases and therefore, it is also important from a public health perspective for interventions to reduce further complications and the substantial costs associated with these. Since the aetiology is, in most cases, multfactorial, it is important to consider a multi-component approach to management, both pharmacological and non-pharmacological. Detection and treatment of triggering causes must have high priority in case of delirium. The aim of this review is to highlight the importance of delirium in the elderly population, given the increasing numbers of ageing people as well as increasing geriatric age. PMID:26831414

  2. Delirium and concomitant use of lithium+electroconvulsive therapy (ECT

    Directory of Open Access Journals (Sweden)

    Sadeghi M

    2001-09-01

    Full Text Available Concomitant use of lithium and E.C.T has always been accused to cause delirium in patients receiving such a combination. In this study incidence of delirium in patients who receive lithium+E.C.T. concurrently has been compared with those who have been treated with E.C.T. only. Of 49 patients who had Bipolar Mood Disorder (B.M.D. 1 disorder (manic episode 24 were given E.C.T.+lithium and 25 were treated with E.C.T. Only, 3 patients of the first group and 2 patients of the second group developed delirium. The difference between two groups was not statistically significant. Another finding was that all cases of delirium developed in patients who were above 35 years old (P value=0.001. These findings show that combination of E.C.T. and Lithium may not be so harmful as it was once considered. On the other hand it could be concluded that increased age may be a risk factor for delirium in such a combination.

  3. Discovering Genes Involved in Alcohol Dependence and Other Alcohol Responses

    OpenAIRE

    Buck, Kari J.; Milner, Lauren C.; Denmark, Deaunne L.; Grant, Seth G.N.; Kozell, Laura B.

    2012-01-01

    The genetic determinants of alcoholism still are largely unknown, hindering effective treatment and prevention. Systematic approaches to gene discovery are critical if novel genes and mechanisms involved in alcohol dependence are to be identified. Although no animal model can duplicate all aspects of alcoholism in humans, robust animal models for specific alcohol-related traits, including physiological alcohol dependence and associated withdrawal, have been invaluable resources. Using a varie...

  4. 29 CFR 4219.11 - Withdrawal liability upon mass withdrawal.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Withdrawal liability upon mass withdrawal. 4219.11 Section... Redetermination of Withdrawal Liability Upon Mass Withdrawal § 4219.11 Withdrawal liability upon mass withdrawal. (a) Initial withdrawal liability. The plan sponsor of a multiemployer plan that experiences a...

  5. A pilot study of rivastigmine in the treatment of delirium after stroke: A safe alternative

    Directory of Open Access Journals (Sweden)

    Jansen Ben PW

    2008-09-01

    Full Text Available Abstract Background Delirium is a common disorder in the early phase of stroke. Given the presumed cholinergic deficiency in delirium, we tested treatment with the acetylcholinesterase inhibitor rivastigmine. Methods This pilot study was performed within an epidemiological study. In 527 consecutive stroke patients presence of delirium was assessed during the first week with the confusion assessment method. Severity was scored with the delirium rating scale (DRS. Sixty-two patients developed a delirium in the acute phase of stroke. Only patients with a severe and persistent delirium (defined as a DRS of 12 or more for more than 24 hours were enrolled in the present study. In total 26 fulfilled these criteria of whom 17 were treated with orally administered rivastigmine with a total dose between 3 and 12 mg a day. Eight patients could not be treated because of dysphagia and one because of early discharge. Results No major side effects were recorded. In 16 patients there was a considerable decrease in severity of delirium. The mean DRS declined from 14.8 on day one to 8.5 after therapy and 5.6 after tapering. The mean duration of delirium was 6.7 days (range; 2–17. Conclusion Rivastigmine is safe in stroke patients with delirium even after rapid titration. In the majority of patients the delirium improved after treatment. A randomized controlled trial is needed to establish the usefulness of rivastigmine in delirium after stroke. Trial registration Nederlands Trial Register NTR1395

  6. Alterações clínicas e laboratoriais anteriores ao desenvolvimento do delirium tremens Clinical and laboratorial alterations previous at the delirium tremens

    Directory of Open Access Journals (Sweden)

    Paulo Borini

    1997-01-01

    Full Text Available Duzentos e trinta pacientes alcoolistas crônicos do sexo masculino internados em hospital psiquiátrico para tratamento do alcoolismo foram examinados clínica e laboratorialmente dentro das primeiras 24 horas da internação. Treze pacientes que desenvolveram delirium tremens (DT após a internação (grupo I constituem a casuística deste estudo que visa avaliar a ocorrência de alterações clínicas, hematológicas, bioquímicas hepáticas e eletrolíticas que antecedem ao aparecimento das manifestações do DT. Para análises comparativas foram estudados dois grupos de 26 pacientes cada um, constituídos de pacientes que não entraram em DT na internação atual mas com história pregressa de DT (grupo II e pacientes aleatoriamente arrolados - amostra aleatória simples obtida empregando tabela de números aleatórios fornecida por computador - que nunca entraram em DT (grupo III. Os pacientes do grupo I apresentavam média de idade significativamente mais baixa e fisicamente encontravam-se em pior estado geral que os do grupo III. As frequências de taxas elevadas de aminotransferases e de hipomagnesemia foram significativamente maiores nos grupos I e II que no grupo III. Os valores plasmáticos médios das aminotransferases, especialmente da aspartato-aminotransferase, estavam significativamente mais elevados nos grupos I e II que no grupo III.Thirteen alcoholic male patients that developed delirium tremens (DT after admission in a psychiatric hospital for treatment of alcoholism (group I had their clinical and laboratorial records examined. The laboratory samples were taken during the phase previous at the DT. Data on this group were compared to those of two other groups of alcoholics - 26 patients each - that did not develop DT in the present admission, with (group II or without (group III previous history of DT. The patients of group I had significantly lower average age and worse general conditions than the patients of group III. The

  7. Sepsis associated delirium mimicking postoperative delirium as the initial presenting symptom of urosepsis in a patient who underwent nephrolithotomy

    Science.gov (United States)

    Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Singh, Harprit

    2016-01-01

    We report a case of 70 years old male who underwent percutaneous nephrolithotomy for renal calculi. After an uneventful recovery from anaesthesia, the patient developed delirium which manifested as restlessness, agitation, irritability and combative behavior. All other clinical parameters including arterial blood gas, chest X-ray and core temperature were normal and the patient remained haemodynamically stable. But 45 min later the patient developed florid manifestations of septic shock. He was aggressively managed in a protocolized manner as per the Surviving Sepsis Guidelines in the Critical Care Unit and recovered completely. There are no case reports showing postoperative delirium as the only initial presentation of severe sepsis, with other clinical parameters remaining normal. Both urosepsis and sepsis associated delirium have very high mortality. High index of suspicion and a protocolized approach in the management of sepsis can save lives. PMID:27182528

  8. Delirium en ancianos hospitalizados: Seguimiento de 18 meses Delirium in elderly inpatients: An 18 month follow-up

    Directory of Open Access Journals (Sweden)

    Fernando J. Vázquez

    2010-02-01

    Full Text Available El objetivo de este trabajo fue describir la prevalencia de síndrome confusional agudo en ancianos hospitalizados, la evolución durante la internación y a los 18 meses. Se evaluó en forma prospectiva a pacientes de 70 años de edad o mayores, internados en el Servicio de Clínica Médica de nuestro hospital, entre septiembre de 2005 y mayo de 2006. Se utilizó una versión validada en español del Confussion Assessment Method para diagnosticar delirium. A los 18 meses se evaluó el estado vital, lugar de residencia, actividades de la vida diaria, dependencia de cuidadores y reinternaciones. Se evaluaron 194 pacientes y 74 fueron excluidos. De los 120 casos incluidos, 52 (43.3% presentaron delirium. La edad media fue de 82.6 años (DS: 7.4 en el grupo de pacientes con síndrome confusional agudo y de 80.4 años (DS: 5.6 en el grupo de pacientes sin delirium. Al comparar estos dos grupos encontramos diferencias significativas en las características, siendo más frecuentes en el grupo con delirium la residencia previa en un centro de tercer nivel (17.3% vs. 1.5%; p Delirium usually hardens care during hospitalization and increases morbidity during hospital stay and after discharge. The objective of this study was to describe the prevalence of delirium in elderly inpatients in a Buenos Aires hospital, its morbidity and mortality during hospital stay and the next 18 month follow-up. Patients aged 70 or older admitted to internal medicine unit between September 2005 and May 2006 were enrolled. Delirium was assessed with the Spanish version of Confusion Assessment Method. Demographic data, cause of admition and length of stay, destination after discharge and mortality were registered. A new evaluation was made 18 months after discharge. We evaluated 194 patients and 74 were excluded. Of the 120 included, 52 (43.3% presented delirium. We found significant differences between patients with and without delirium in previous placement in nursing home

  9. Risk of Pre-and Post-Operative Delirium and the Delirium Elderly At Risk (DEAR) Tool in Hip Fracture Patients

    Science.gov (United States)

    Freter, Susan; Dunbar, Michael; Koller, Katalin; MacKnight, Chris; Rockwood, Kenneth

    2015-01-01

    Background and Purpose Delirium is common after hip fracture. Previous work has shown that a simple delirium risk factor tool, the Delirium Elderly At Risk instrument (DEAR), has a high inter-rater reliability in this population. Little research has looked at the ability of risk factor screening tools to identify patients at high risk of pre-operative delirium. This study investigates the ability of the DEAR to identify patients at high risk of pre-operative delirium, as well as reporting its performance in a post-operative validation sample. Associations between delirium risk factors and pre-operative delirium are explored. Methods This prospective cohort study took place on an orthopedic in-patient service at a University-affiliated tertiary care hospital. Patients aged 65 and older who were admitted for surgical repair of hip fracture (N = 283) were assessed pre-operatively for 5 delirium risk factors (cognitive impairment, sensory impairment, functional dependence, substance use, age) using the DEAR. Patients were assessed for delirium using the Mini-Mental State Examination and the Confusion Assessment Method pre-operatively and on post-operative days 1, 3 and 5. Characteristics of patients who developed delirium were compared with the characteristics of those who did not. Results Delirium was present in 58% (95% CI = 52–63%) of patients pre-operatively and 42% (95% CI = 36–48%) post-operatively. Individually, sensory impairment (χ2 = 21.7, p = .0001), functional dependence (χ2 = 24.1, p = .0001), cognitive impairment (χ2 = 55.5, p = .0001) and substance use (χ2 = 7.5, p = .007) were significantly associated with pre-operative delirium, as was wait-time for surgery (t = 3.1, p = .003) and length of stay (t = 2.8, p =.03). In multivariate modeling, the strongest association with pre-operative delirium was cognitive impairment. Conclusions The DEAR, a simple, delirium risk factor screening tool, can be used to identify hip fracture patients at risk of

  10. 酒精戒断综合征:机制、评估及药物治疗进展%Alcohol Withdrawal Syndrome:Updates on Mechanism, Assessment and Pharmacotherapy

    Institute of Scientific and Technical Information of China (English)

    杨雪; 盛利霞; 郝伟; 汤宜朗

    2014-01-01

    Objective:To review the updates on mechanism of,and assessment and pharmacotherapy for alcohol Withdrawal syn-drome(AWS). Methods:Literature review and hand-picked literature. Results:We reviewed the time-course,mechanism(espe-cially mechanism related to GABA and NMDA systems),assessment and medications for AWS. Detailed discussions are provided re-garding fixed-dosed and symptom-triggered methods when using benzodiazepines for AWS. Role of other medications is also discussed. Conclusion:AWS is common and of diagnostic value in alcohol dependence. Alterations in GABA/ NMDA system after prolonged ex-posure to alcohol is believed to be the primary mechanism for AWS and long-acting benzodiazepines are the first-line pharmacotherapy, though other medications have been tried. Either fixed-dose or symptom-triggered method can be used,depending on the setting,clini-cians’preference and staff training.%目的:介绍酒精戒断综合征(AWS)的机制、评估及药物治疗方面的进展。方法:对近年相关文献进行复习。结果:本文对 AWS 的时程、机制(尤其是涉及 GABA 及 NMDA 递质系统)、评估及药物治疗进行了介绍。详细讨论了固定剂量法及对症给药法的具体细节。对其他药物的使用也略有介绍。结论:AWS 比较常见且对酒精将具有诊断意义。长期饮酒导致的GABA/ NMDA 系统的改变是 AWS 的主要机制,长效苯二氮□类药是控制 AWS 的一线药物,不过其他药物也有使用。具体是使用固定剂量法还是对症给药法则以治疗环境、医生的偏好以及员工的培训情况而定。

  11. PROTEOMIC AND EPIGENOMIC MARKERS OF SEPSIS-INDUCED DELIRIUM (SID

    Directory of Open Access Journals (Sweden)

    Adonis eSfera

    2015-10-01

    Full Text Available In elderly population sepsis is one of the leading causes of intensive care unit (ICU admissions in the United States. Sepsis-induced delirium (SID is the most frequent cause of delirium in ICU (1. Together delirium and SID represent under recognized public health problems which place an increasing financial burden on the US health care system, currently estimated at 143 to 152 billion dollars per year (2. The interest in SID was recently reignited as it was demonstrated that, contrary to prior beliefs, cognitive deficits induced by this condition may be irreversible and lead to dementia (3-4. Conversely, it is construed that diagnosing SID early or mitigating its full blown manifestations may preempt geriatric cognitive disorders. Biological markers specific for sepsis and SID would facilitate the development of potential therapies, monitor the disease process and at the same time enable elderly individuals to make better informed decisions regarding surgeries which may pose the risk of complications, including sepsis and delirium.This article proposes a battery of peripheral blood markers to be used for diagnostic and prognostic purposes in sepsis and SID. Though each individual marker may not be specific enough, we believe that together as a battery they may achieve the necessary accuracy to answer two important questions: who may be vulnerable to the development of sepsis, and who may develop SID and irreversible cognitive deficits following sepsis?

  12. Symptoms of posttraumatic stress after intensive care delirium

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Egerod, Ingrid; Christensen, Doris;

    2015-01-01

    and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months. Remaining...

  13. Symptoms of Posttraumatic Stress after Intensive Care Delirium

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Egerod, Ingrid; Christensen, Doris;

    2015-01-01

    in the ICU and symptoms of PTSD in 8% (2 months) and 6% (6 months) after ICU-discharge. Recall of ICU stay was present in 93%. Associations between ICU-delirium and post-discharge PTSD-symptoms were weak and insignificant. Memories of delusions were significantly associated with anxiety after two months...

  14. 27 CFR 19.502 - Withdrawal of spirits on production or filling gauge.

    Science.gov (United States)

    2010-04-01

    ... production or filling gauge. 19.502 Section 19.502 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Transfer and Withdrawals General § 19.502 Withdrawal of spirits on production or filling gauge. When the production...

  15. Survey of attitudes and behaviors of healthcare professionals on delirium in ICU

    Institute of Scientific and Technical Information of China (English)

    GONG Zhi-ping; LIU Xi-wang; ZHUANG Yi-yu; CHEN Xiang-ping; XIE Guo-hao; CHENG Bao-li; JIN Yue; FANG Xiang-ming

    2009-01-01

    Objective: To assess the medical community's awareness and practice regarding delirium in the intensive care unit (ICU). Methods: One hundred and ten predesigned questionnaires were distributed to ICU practitioners in the affiliated hospitals of Zhejiang University. Results: A total of 105 valid questionnaires were collected. Totally, 55.3% of the clinicians considered that delirium was common in the ICU. Delirium was believed to be a significant or serious problem by 70.5% of respondents, and under-diagnosis was acknowledged by 56.2% of the respondents. The incidence of ICU delirium is even more under-estimated by the pediatric doctors compared with their counterparts in adult ICU (P<0.05). Primary disease of the brain (agreed by 82.1% of the respondents) was believed to be the most common risk factor for delirium. None of the ICU professionals screened delirium or used a specific tool for delirium assessment routinely. The vast majority (92.4%) of respondents had little knowledge on the diagnosis and the standard treatment of delirium.Conclusions: Although delirium is considered as a serious problem by a majority of the surveyed ICU professionals, it is still under-recognized in routine critical care practice. Data from this survey show a disconnection between the perceived significance of delirium and the current practices of monitoring and treatment in ICU in China.

  16. A Family-Focused Delirium Educational Initiative With Practice and Research Implications.

    Science.gov (United States)

    Paulson, Christina May; Monroe, Todd; McDougall, Graham J; Fick, Donna M

    2016-01-01

    Delirium is burdensome and psychologically distressing for formal and informal caregivers, yet family caregivers often have very little understanding or knowledge about delirium. As part of a large multisite intervention study, the Early Nurse Detection of Delirium Superimposed on Dementia (END-DSD), the authors identified a need for family educational materials. This educational initiative's purpose was to develop a delirium admission brochure for family members to aid in the prevention and earlier identification of delirium during hospitalization. A brochure was developed using an iterative approach with an expert panel. Following three iterations, a final brochure was approved. The authors found that an iterative expert consensus approach can be used to develop a brochure for families. Major content areas were helping families understand the difference between delirium and dementia, signs and symptoms of delirium, causes of delirium, and strategies family members can use to prevent delirium. A caregiver-focused educational brochure is one intervention to use in targeting older adults hospitalized with delirium. PMID:26165565

  17. Alcoholism and Alcohol Abuse

    Science.gov (United States)

    ... their drinking causes distress and harm. It includes alcoholism and alcohol abuse. Alcoholism, or alcohol dependence, is a disease that causes ... groups. NIH: National Institute on Alcohol Abuse and Alcoholism

  18. [Emergence delirium in children - prophylaxis and treatment].

    Science.gov (United States)

    Wermelt, Julius Z; Ellerkmann, Richard K

    2016-07-01

    Emergence Delirium in children after general anesthesia is a common and self limitating event. Although it might be seen as being harmless it can cause other serious complications and might leave both parents and other caregivers with a negative impression behind. Although the cause may still not be clear, potential predictors can be named: preschool age, the use of fast acting volatile anesthestics, higher preoperative anxiety levels and postoperative pain.A child-focused approach to reduce preoperative anxiety focusing on distraction methods rather than pharmacological sedation may be the key as well as sufficient postoperative pain control and the use of total intravenous anesthesia. Parenteal presence during induction of anaesthesia (PPIA) may be beneficial to reduce preoperative anxiety levels, but has failed to prove a better outcome regarding ED.The use of age adopted scores/scales to diagnose ED and Pain are mandatory.In the case of an ED event it is most important to protect the child from self injury and the loss of the iv-line. Postoperative pian needs to be ruled out before treating ED. Most cases can be treated by interrupting the situation and putting the child "back to sleep". Short acting drugs as Propofol have been used successfully due to its pharmacodynamics and short acting profile. Alternatively alpha-agonists or ketamin may be preferred by other authors. If potential predictors and a positive history are present, prophylactic treatment should be considered. A TIVA or the use of alpha-2-agonists have proven to be successful in reducing the risk of an ED. Midazolam may reduce preoperative anxiety but not the incidence of ED and should therefore be used carefully and is not a good choice in PACU for the treatment of ED.Parents who witnessed ED in their children should be guided and followed up. Explaining this phenomenon to parents beforehand should be part of the pre anaesthesia clinic talk and written consent.Standard protocols should be in

  19. Relationship between cobalamin deficiency and delirium in elderly patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Sevuk U

    2015-08-01

    Full Text Available Utkan Sevuk,1 Erkan Baysal,2 Nurettin Ay,3 Yakup Altas,2 Rojhat Altindag,2 Baris Yaylak,2 Vahhac Alp,3 Ertan Demirtas4 1Department of Cardiovascular Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 2Department of Cardiology, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 3Department of General Surgery, Diyarbakir Gazi Yasargil Education and Research Hospital, Diyarbakir, 4Department of Cardiovascular Surgery, Liv Hospital, Ankara, Turkey Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12 deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG surgery.Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98.Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017 and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034 than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004. Delirium severity score showed a moderate correlation with cobalamin levels (Ρ=-0.27; P=0.024. Logistic regression analysis demonstrated that

  20. Delirium in a 74-year-old man: correct imaging revealed the truth.

    Science.gov (United States)

    Wani, Abdul Majid; Manjaly, Mussa; Hussain, Waleed Mohd; Fatani, Mohamad Ibrahim; Turkistani, Ahmad; Showkat, Khalid; Maimani, Gassan Al; Qadmani, Ahmad; Akhtar, Mubeena

    2009-01-01

    Delirium is a cognitive disorder. DSM-IV criteria for delirium must include both acute onset and fluctuating symptoms; disturbance of consciousness (including inattention); at least one of the following: disorganised thinking, disorientation, memory impairment or perceptual disturbance; and evidence of a putative causal medical condition. Traditionally, the course has been described as transient in which recovery is likely to be complete if the underlying aetiological factor is promptly corrected or is self-limited. The most common precipitating causes in elderly include sepsis, dehydration and drugs. Work-up for delirium is limited to septic screening, baseline investigations and imaging. Patients with delirium without focal signs and with either evidence for a medical aetiology of delirium or pre-diagnosed dementia are at a very low risk of having focal lesions in their contrast-enhanced CT or MRI. We are presenting an interesting case of delirium with urosepsis whose imaging revealed milliary brain tuberculomas on contrast-enhanced MRI. PMID:21847424

  1. Study protocol—investigation of the Delirium Observation Screening Scale (DOSS) for the routine detection of delirium in the care home setting: a prospective cohort study

    Science.gov (United States)

    Teale, Elizabeth; Young, John; Siddiqi, Najma; Munyombwe, Theresa; Harrison, Jennifer; Schuurmanns, Marieke

    2016-01-01

    Introduction Delirium is a common and distressing condition associated with frailty, dementia and comorbidity. These are common in long-term care settings. Residents in care homes are therefore at particular risk of delirium. Despite this, methods to detect delirium in care homes are lacking, with existing diagnostic tools taking too long, or requiring specific training to deliver. This limits their feasibility for use for the routine detection of delirium by care home staff. Routine screening for delirium in care homes would allow timely attention to exacerbating factors to attenuate the episode, and facilitate future research into delirium in the care home environment. Methods Residents from 4 large care homes will be asked to consent (or their consultees asked to provide a declaration of agreement) to participate in the study. Care home staff will administer the 25-item Delirium Observation Screening Scale (DOSS)—a delirium screening tool based on observed behaviours—and this will be tested against the research standard Confusion Assessment Method (CAM) administered by trained research assistants performed two times per week for all participating residents. Analysis Sensitivity, specificity, positive and negative predictive values, likelihood ratios and a diagnostic OR will be calculated for the detection of delirium with the 25-item DOSS. The feasibility of routine delirium screening and the scaling properties of the 25-item DOSS will also be explored. Ethics and Dissemination For residents lacking capacity to participate, a consultee will be approached for a declaration of agreement for inclusion in the study. Results will be published in peer-reviewed journals and disseminated in written format to clinical commissioning groups, general practitioners and relevant third parties. Trial registration number ISRCTN14608554. PMID:27324706

  2. At the extreme end of the psychoneuroimmunological spectrum: delirium as a maladaptive sickness behaviour response

    OpenAIRE

    CUNNINGHAM, COLM

    2013-01-01

    PUBLISHED Delirium is a common and severe neuropsychiatric syndrome characterised by acute deterioration and fluctuations in mental status. It is precipitated mainly by acute illness, trauma, surgery, or drugs. Delirium affects around 1 in 8 hospital inpatients and is associated with multiple adverse consequences, including new institutionalisation, worsening of existing dementia, and death. Patients with delirium show attentional and other cognitive deficits, altered alertness (mostly red...

  3. At the extreme end of the psychoneuroimmunological spectrum: Delirium as a maladaptive sickness behaviour response

    OpenAIRE

    CUNNINGHAM, COLM; MacLullich, Alasdair MJ

    2012-01-01

    Delirium is a common and severe neuropsychiatric syndrome characterised by acute deterioration and fluctuations in mental status. It is precipitated mainly by acute illness, trauma, surgery, or drugs. Delirium affects around 1 in 8 hospital inpatients and is associated with multiple adverse consequences, including new institutionalisation, worsening of existing dementia, and death. Patients with delirium show attentional and other cognitive deficits, altered alertness (mostly reduced, but som...

  4. Tools to Detect Delirium Superimposed on Dementia:A Systematic Review

    OpenAIRE

    Morandi, Alessandro; McCurley, Jessica; Vasilevskis, Eduard E.; Fick, Donna M.; Bellelli, Giuseppe; Lee, Patricia; Jackson, James C.; Shenkin, Susan D.; MarcoTrabucchi, [No Value; Schnelle, John; Inouye, Sharon K; Ely, Wesley E.; MacLullich, Alasdair

    2012-01-01

    Objectives To identify valid tools to diagnose delirium superimposed on dementia. Design Systematic review of studies of delirium tools that explicitly included individuals with dementia. Setting Hospital. Participants Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments. Measurements PubMed, Embase, and Web of Science databases were searched for art...

  5. Dexmedetomidine infusion to facilitate opioid detoxification and withdrawal in a patient with chronic opioid abuse

    Directory of Open Access Journals (Sweden)

    Surjya Prasad Upadhyay

    2011-01-01

    Full Text Available Many patients are admitted to the intensive care unit (ICU for acute intoxication, serious complication of overdose, or withdrawal symptoms of illicit drugs. An acute withdrawal of drugs with addiction potential is associated with a sympathetic overactivity leading to marked psychomimetic disturbances. Acute intoxication or withdrawal of such drugs is often associated with life-threatening complications which require ICU admission and necessitate prolonged sedative analgesic medications, weaning from which is often complicated by withdrawal and other psychomimetic symptoms. Dexmedetomidine, an alpha-2 (α2 agonist, has been used successfully to facilitate withdrawal and detoxification of various drugs and also to control delirium in ICU patients. Herein, we report a case of a chronic opioid abuse (heroin patient admitted with acute overdose complications leading to a prolonged ICU course requiring sedative-analgesic medication; the drug withdrawal-related symptoms further complicated the weaning process. Dexmedetomidine infusion was successfully used as a sedative-analgesic to control the withdrawal-related psychomimetic symptoms and to facilitate smooth detoxification and weaning from opioid and other sedatives.

  6. Change of depression-like behavior in chronic alcoholism and withdrawal model, and co-mechanism of depression and chronic alcoholism in mice%小鼠慢性酒精中毒及戒断过程中抑郁样行为的改变及其共病机制

    Institute of Scientific and Technical Information of China (English)

    蒋曦; 田福荣; 赵应征

    2016-01-01

    目的:研究小鼠慢性酒精中毒及戒断过程中抑郁样行为的改变,进一步探讨酒精中毒与抑郁症的共病机制。方法:构建新型慢性酒精中毒小鼠模型;实验分为正常对照组及慢性酒精7 d、14 d、21 d和28 d组。在第6、13、20和27天分别进行酒精偏好度测试,测试后戒断酒精1 d,随后次日进行抑郁行为学测试,测试结束后处死小鼠取海马与额叶皮层,采用高效液相色谱法测定5-羟色胺(5-HT)及去甲肾上腺素(NE)含量,采用免疫印迹法测定cAMP反应元件结合蛋白( CREB)和脑源性神经营养因子( BDNF)的含量。结果:随着酒精饮酒天数及戒断次数的增加,小鼠表现出明显嗜酒现象,并且在强迫游泳和悬尾测试中,表现出明显的不动时间增加。7d组小鼠额叶皮层内5-HT水平升高(P<0.05),海马与额叶5-HT水平在21 d与28 d组降低(P<0.01);7 d和14 d组小鼠海马与额叶NE水平无明显变化,21 d和28 d组NE水平降低( P<0.05)。21 d和28 d组小鼠海马与额叶内p-CREB/CREB比值及BDNF表达水平明显下降( P<0.05),7 d与14 d组无明显变化。结论:酒精中毒、戒断阶段与抑郁的共病机制涉及5-HT。5-HT-cAMP-CREB-BDNF信号转导通路可能为酒精中毒与抑郁症的共病机制。%AIM: To investigate the behavior of depression in chronic alcoholism and withdrawal model of mice, and to explore the co-mechanism of alcoholism and depression.METHODS: A novel model of chronic alcoholism was constructed in this study.The animals were divided into normal control group, and alcohol 7 d, 14 d, 21 d and 28 d groups.The mice were given alcohol preference test on the 6th, 13th, 20th and 27th days.After the test, alcohol were withdrawn for 1 d, then the next day the mice were given behavior test of depression.After the test, the mice were sacri-ficed.The contents of 5-hydroxytryptamine (5-HT) and norepinephrine

  7. Serial Administration of a Modified Richmond Agitation and Sedation Scale for Delirium Screening

    Science.gov (United States)

    Chester, Jennifer Gonik; Harrington, Mary Beth; Rudolph, James

    2016-01-01

    Objectives Because delirium is common and frequently unrecognized, this study sought to design a brief screening tool for a core feature of mental status and to validate the instrument as a serial assessment for delirium. Design Prospective cohort Setting Tertiary VA Hospital in New England Participants 100 Veterans admitted to the medical service Methods A consensus panel developed a modified version of the Richmond Agitation and Sedation Scale (RASS) to capture alterations in consciousness. Upon admission and daily thereafter, patients were screened with the modified RASS and independently, underwent a comprehensive mental status interview by a geriatric expert, who determined if the criteria for delirium were met. The sensitivity, specificity, and positive likelihood ratio (LR) of the modified RASS for delirium are reported. Results As a single assessment, the modified RASS had a sensitivity of 64% and a specificity of 93% for delirium (LR=9.4). When used to detect change, serial modified RASS assessments had a sensitivity of 74% and a specificity of 92% (LR=8.9) in both prevalent and incident delirium. When prevalent cases were excluded, any change in the modified RASS had a sensitivity of 85% and a specificity of 92% for incident delirium (LR=10.2) Conclusion When administered daily, the modified RASS has good sensitivity and specificity for incident delirium. Given the brevity of the instrument (approximately 15 seconds), consideration should be given to incorporating the modified RASS as a daily screening measure for consciousness and delirium. PMID:22173963

  8. Concordance between DSM-IV and DSM-5 criteria for delirium diagnosis in a pooled database of 768 prospectively evaluated patients using the delirium rating scale-revised-98

    OpenAIRE

    Meagher, David; Morandi, Alessandro; Inouye, Sharon K.; Ely, Wes; Adamis, Dimitrios; Maclullich, Alasdair J; Rudolph, James L; Neufeld, Karin; Leonard, Maeve; Bellelli, Giuseppe; Davis, Daniel; Teodorczuk, Andrew; Kreisel, Stefan; Thomas, Christine; Hasemann, Wolfgang

    2014-01-01

    Background: The Diagnostic and Statistical Manual fifth edition (DSM-5) provides new criteria for delirium diagnosis. We examined delirium diagnosis using these new criteria compared with the Diagnostic and Statistical Manual fourth edition (DSM-IV) in a large dataset of patients assessed for delirium and related presentations. Methods: Patient data (n = 768) from six prospectively collected cohorts, clinically assessed using DSM-IV and the Delirium Rating Scale-Revised-98 (DRS-R98), were poo...

  9. Excited delirium following use of synthetic cathinones (bath salts).

    Science.gov (United States)

    Penders, Thomas M; Gestring, Richard E; Vilensky, Dmitry A

    2012-01-01

    Synthetic analogs of the cathinone molecule have seen increasing recreational use as substitutes for cocaine, 3,4-methylenedioxymethamphetamine (ecstasy) and methamphetamine. Repeated use of these drugs is associated with a paranoid hallucinatory delirium. A subset of patients using these substances develops a syndrome of extreme agitation and violent behavior that has been reported following the use of other stimulant drugs that also produce rapid changes in brain monoamines. This syndrome, characterized as "excited delirium," presents to the acute care setting with a challenging combination of paranoia, severe agitation and violent behavior. These patients frequently suffer from dehydration, skeletal muscle damage and renal failure that may lead to multiorgan failure and death. Management of these individuals requires careful consideration of the consequences of interventions commonly implemented in medical settings to control dangerous aggressive behavior. PMID:22898445

  10. Cocaine-induced agitated delirium: a case report and review.

    Science.gov (United States)

    Plush, Theodore; Shakespeare, Walter; Jacobs, Dorian; Ladi, Larry; Sethi, Sheeba; Gasperino, James

    2015-01-01

    Cocaine use continues to be a major public health problem in the United States. Although many of the initial signs and symptoms of cocaine intoxication result from increased stimulation of the sympathetic nervous system, this condition can present as a spectrum of acuity from hypertension and tachycardia to multiorgan system failure. Classic features of acute intoxication include tachycardia, arterial vasoconstriction, enhanced thrombus formation, mydriasis, psychomotor agitation, and altered level of consciousness. At the extreme end of this toxidrome is a rare condition known as cocaine-induced agitated delirium. This syndrome is characterized by severe cardiopulmonary dysfunction, hyperthermia, and acute neurologic changes frequently leading to death. We report a case of cocaine-induced agitated delirium in a man who presented to our institution in a paradoxical form of circulatory shock. Rapid evaluation, recognition, and proper management enabled our patient not only to survive but also to leave the hospital without neurologic sequelae. PMID:24212597

  11. Psychometric Properties of the Family Caregiver Delirium Knowledge Questionnaire.

    Science.gov (United States)

    Bull, Margaret J; Avery, Jennifer Sjostedt; Boaz, Lesley; Oswald, Debra

    2015-01-01

    A valid, reliable measure of family caregivers' knowledge about delirium was not located in the literature; such an instrument is essential to assess learning needs and outcomes of education provided. The purpose of the current study was to (a) develop a family Caregiver Delirium Knowledge Questionnaire (CDKQ) based on the Symptom Interpretation Model; and (b) establish validity and reliability of the measure. The 19-item CDKQ was developed and administered to 164 family caregivers for community-dwelling older adults. Descriptive statistics were examined for all variables. Psychometric testing included confirmatory factor analysis, item-to-total correlations, and internal consistency reliability. A three-factor model provided the best fit for the data. The findings support initial validity and reliability of the CDKQ with family caregivers. Although the CDKQ was developed for use with family caregivers, it has potential for use with other caregivers, such as home health aides. PMID:25893726

  12. Pharmacological management of anticholinergic delirium - theory, evidence and practice.

    Science.gov (United States)

    Dawson, Andrew H; Buckley, Nicholas A

    2016-03-01

    The spectrum of anticholinergic delirium is a common complication following drug overdose. Patients with severe toxicity can have significant distress and behavioural problems that often require pharmacological management. Cholinesterase inhibitors, such as physostigmine, are effective but widespread use has been limited by concerns about safety, optimal dosing and variable supply. Case series support efficacy in reversal of anticholinergic delirium. However doses vary widely and higher doses commonly lead to cholinergic toxicity. Seizures are reported in up to 2.5% of patients and occasional cardiotoxic effects are also recorded. This article reviews the serendipitous path whereby physostigmine evolved into the preferred anticholinesterase antidote largely without any research to indicate the optimal dosing strategy. Adverse events observed in case series should be considered in the context of pharmacokinetic/pharmacodynamic studies of physostigmine which suggest a much longer latency before the maximal increase in brain acetylcholine than had been previously assumed. This would favour protocols that use lower doses and longer re-dosing intervals. We propose based on the evidence reviewed that the use of cholinesterase inhibitors should be considered in anticholinergic delirium that has not responded to non-pharmacological delirium management. The optimal risk/benefit would be with a titrated dose of 0.5 to 1 mg physostigmine (0.01-0.02 mg kg(-1) in children) with a minimum delay of 10-15 min before re-dosing. Slower onset and longer acting agents such as rivastigmine would also be logical but more research is needed to guide the appropriate dose in this setting. PMID:26589572

  13. Early Assessment of Delirium in Elderly Patients after Hip Surgery

    OpenAIRE

    Lee, Hyo Jin; Hwang, Deuk Soo; Wang, Seong Keun; Chee, Ik Seung; Baeg, Sengmi; Kim, Jeong Lan

    2011-01-01

    Objective This study is intended to identify predictive factors of delirium, including risk factors and prodromal symptoms. Methods This study included sixty-five patients aged 65 years or older who had undergone hip surgery. Baseline assessments included age; gender; admission type (acute/elective); reason for surgery (fracture/replacement); C-reactive protein (CRP); Acute Physiology, Age, Chronic Health Evaluation (APACHE III); and the Mini-Mental State Examination (MMSE). The Korean versio...

  14. Acute delirium in an elderly woman following zoledronate administration

    Directory of Open Access Journals (Sweden)

    Mohammad Nasiruddin

    2014-01-01

    Full Text Available Zoledronate is a third-generation bisphosphonate having distinctive profile of high potency as well as prolonged duration of action. Intravenous zoledronate is the recently approved bisphosphonate for the treatment of osteoporosis and has an attractive once-yearly regimen for the treatment of osteoporosis. Here we report, for the first time, a case of acute delirium following zoledronate administration for osteoporosis. An 86-year-old female patient presented to orthopedics out-patient department (OPD with complaints of pain and unable to bear weight on left thigh with history of fall from bed 2 months back. She was diagnosed as fracture neck of femur with severe osteoporosis and treated conservatively. She was given zoledronate IV 5 mg infusion over 30 min. After 10-12 h of zoledronate infusion, patient became confused, disorientated, and agitated. A septic work-up was negative. Electrolyte disturbances were excluded with normal sodium, potassium, calcium, and magnesium levels. Computed tomography of the brain was unremarkable. A metabolic cause could not be found for the change in her mental state. Patient was referred to medicine department where she was diagnosed as drug-induced acute delirium probably due to zoledronate. Patient was advised injections haloperidol and torsemide. In the following 48 h, her confusion got cleared and mental status was improved. According to the Naranjo′s scale, the effect of zoledronate in our patient was scored 6 indicating a probable likelihood of causing delirium. It was a probable cause of acute delirium according to World Health Organization (WHO causality scale.

  15. A New Model of Delirium Care in the Acute Geriatric Setting: Geriatric Monitoring Unit

    Directory of Open Access Journals (Sweden)

    Chong Mei

    2011-08-01

    Full Text Available Abstract Background Delirium is a common and serious condition, which affects many of our older hospitalised patients. It is an indicator of severe underlying illness and requires early diagnosis and prompt treatment, associated with poor survival, functional outcomes with increased risk of institutionalisation following the delirium episode in the acute care setting. We describe a new model of delirium care in the acute care setting, titled Geriatric Monitoring Unit (GMU where the important concepts of delirium prevention and management are integrated. We hypothesize that patients with delirium admitted to the GMU would have better clinical outcomes with less need for physical and psychotropic restraints compared to usual care. Methods/Design GMU models after the Delirium Room with adoption of core interventions from Hospital Elder Life Program and use of evening bright light therapy to consolidate circadian rhythm and improve sleep in the elderly patients. The novelty of this approach lies in the amalgamation of these interventions in a multi-faceted approach in acute delirium management. GMU development thus consists of key considerations for room design and resource planning, program specific interventions and daily core interventions. Assessments undertaken include baseline demographics, comorbidity scoring, duration and severity of delirium, cognitive, functional measures at baseline, 6 months and 12 months later. Additionally we also analysed the pre and post-GMU implementation knowledge and attitude on delirium care among staff members in the geriatric wards (nurses, doctors and undertook satisfaction surveys for caregivers of patients treated in GMU. Discussion This study protocol describes the conceptualization and implementation of a specialized unit for delirium management. We hypothesize that such a model of care will not only result in better clinical outcomes for the elderly patient with delirium compared to usual geriatric care

  16. Importância da monitorização do delirium na unidade de terapia intensiva The importance of delirium monitoring in the intensive care unit

    OpenAIRE

    Melissa Tassano Pitrowsky; Cássia Righy Shinotsuka; Marcio Soares; Marco Antonio Sales Dantas Lima; Jorge Ibrain Figueira Salluh

    2010-01-01

    O delirium é um estado confusional agudo associado a maior mortalidade na unidade de terapia intensiva e comprometimento da recuperação funcional em longo prazo. Apesar de sua elevada incidência e relevante impacto nos desfechos de pacientes criticamente enfermos, o delirium continua sendo sub-diagnosticado. Atualmente existem instrumentos validados para diagnosticar e monitorar o delirium, permitindo a detecção precoce dessa disfunção orgânica e início precoce do tratamento. Além dos fatores...

  17. Importância da monitorização do delirium na unidade de terapia intensiva The importance of delirium monitoring in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Melissa Tassano Pitrowsky

    2010-09-01

    Full Text Available O delirium é um estado confusional agudo associado a maior mortalidade na unidade de terapia intensiva e comprometimento da recuperação funcional em longo prazo. Apesar de sua elevada incidência e relevante impacto nos desfechos de pacientes criticamente enfermos, o delirium continua sendo sub-diagnosticado. Atualmente existem instrumentos validados para diagnosticar e monitorar o delirium, permitindo a detecção precoce dessa disfunção orgânica e início precoce do tratamento. Além dos fatores de risco não modificáveis do paciente, existem aspectos clínicos e ambientais modificáveis que devem ser avaliados para reduzir a ocorrência e gravidade do delirium. Conforme demonstrado por estudos recentes, intervenções para reduzir a exposição a sedatição excessiva e melhorar a orientação do paciente podem estar associadas a redução da incidência de delirium. Baixa incidência de delirium deve ser almejada e considerada como uma medida da qualidade nas unidades de terapia intensiva.Delirium is an acute confusional state associated with increased mortality in the intensive care unit and long-term impaired functional recovery. Despite its elevated incidence and major impact in the outcomes of critically ill patients, delirium remains under-diagnosed. Presently, there are validated instruments to diagnose and monitor delirium, allowing the detection of early organ dysfunction and treatment initiation. Beyond patient's non-modifiable risk factors, there are modifiable clinical and environmental aspects that should be accessed to reduce the occurrence and severity of delirium. As recent studies demonstrate that interventions aiming to reduce sedative exposure and to improve patients' orientation associated with early mobility have proved to reduce delirium, a low incidence of delirium should be targeted and considered as a measure of quality of care in the intensive care unit (ICU.

  18. Excited delirium syndrome (ExDS): treatment options and considerations.

    Science.gov (United States)

    Vilke, Gary M; Bozeman, William P; Dawes, Donald M; Demers, Gerard; Wilson, Michael P

    2012-04-01

    The term Excited Delirium Syndrome (ExDS) has traditionally been used in the forensic literature to describe findings in a subgroup of patients with delirium who suffered lethal consequences from their untreated severe agitation.(1-5) Excited delirium syndrome, also known as agitated delirium, is generally defined as altered mental status and combativeness or aggressiveness. Although the exact signs and symptoms are difficult to define precisely, clinical findings often include many of the following: tolerance to significant pain, rapid breathing, sweating, severe agitation, elevated temperature, delirium, non-compliance or poor awareness to direction from police or medical personnel, lack of fatiguing, unusual or superhuman strength, and inappropriate clothing for the current environment. It has become increasingly recognized that individuals displaying ExDS are at high risk for sudden death, and ExDS therefore represents a true medical emergency. Recently the American College of Emergency Physicians (ACEP) published the findings of a white paper on the topic of ExDS to better find consensus on the issues of definition, diagnosis, and treatment.(6) In so doing, ACEP joined the National Association of Medical Examiners (NAME) in recognizing ExDS as a medical condition. For both paramedics and physicians, the difficulty in diagnosing the underlying cause of ExDS in an individual patient is that the presenting clinical signs and symptoms of ExDS can be produced by a wide variety of clinical disease processes. For example, agitation, combativeness, and altered mental status can be produced by hypoglycemia, thyroid storm, certain kinds of seizures, and these conditions can be difficult to distinguish from those produced by cocaine or methamphetamine intoxication.(7) Prehospital personnel are generally not expected to differentiate between the multiple possible causes of the patient's presentation, but rather simply to recognize that the patient has a medical emergency

  19. Polymorphisms in the melatonin receptor 1B gene and the risk of delirium

    NARCIS (Netherlands)

    de Jonghe, A; de Rooij, S; Tanck, M W T; Sijbrands, E J G; van Munster, B C V

    2012-01-01

    BACKGROUND/AIMS: A disturbed sleep-wake rhythm cycle can be seen in delirium and as melatonin regulates this cycle via melatonin receptors, genetic variations in these receptors may contribute to susceptibility to delirium. The purpose of this study was to investigate whether genetic variants in the

  20. Udvikling og behandling af delirium hos kritisk syge børn

    DEFF Research Database (Denmark)

    Winther-Olesen, Marie; Afshari, Arash

    2012-01-01

    Delirium is a common and often under-recognised neuropsychiatric disorder in paediatric critical care, secondary to a general medical condition. Paediatric delirium (PD) is associated with high morbidity and mortality and prolonged stay at the intensive care unit. This review introduces the reade...

  1. Cortisol, interleukins and S100B in delirium in the elderly.

    NARCIS (Netherlands)

    Munster, B.C. van; Bisschop, P.H.; Zwinderman, A.H.; Korevaar, J.C.; Endert, E.; Wiersinga, W.J.; Oosten, H.E. van; Goslings, J.C.; Rooij, S.E. de

    2010-01-01

    In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65 years and older admitted for hip fracture surgery with and without delirium. Cort

  2. Cortisol, interleukins and S100B in delirium in the elderly

    NARCIS (Netherlands)

    B.C. Munster; P.H. Bisschop; A.H. Zwinderman; J.C. Korevaar; E. Endert; W.J. Wiersinga; H.E. van Oosten; J.C. Goslings; S.E.J.A. de Rooij

    2010-01-01

    In independent studies delirium was associated with higher levels of cortisol, interleukin(IL)s, and S100B. The aim of this study was to simultaneously compare cortisol, IL-6, IL-8, and S100B levels in patients aged 65years and older admitted for hip fracture surgery with and without delirium. Corti

  3. Incomplete functional recovery after delirium in elderly people: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Freter Susan H

    2005-03-01

    Full Text Available Abstract Background Delirium often has a poor outcome, but why some people have incomplete recovery is not well understood. Our objective was to identify factors associated with short-term (by discharge and long-term (by 6 month incomplete recovery of function following delirium. Methods In a prospective cohort study of elderly patients with delirium seen by geriatric medicine services, function was assessed at baseline, at hospital discharge and at six months. Results Of 77 patients, vital and functional status at 6 months was known for 71, of whom 21 (30% had died. Incomplete functional recovery, defined as ≥10 point decline in the Barthel Index, compared to pre-morbid status, was present in 27 (54% of the 50 survivors. Factors associated with death or loss of function at hospital discharge were frailty, absence of agitation (hypoactive delirium, a cardiac cause and poor recognition of delirium by the treating service. Frailty, causes other than medications, and poor recognition of delirium by the treating service were associated with death or poor functional recovery at 6 months. Conclusion Pre-existing frailty, cardiac cause of delirium, and poor early recognition by treating physicians are associated with worse outcomes. Many physicians view the adverse outcomes of delirium as intractable. While in some measure this might be true, more skilled care is a potential remedy within their grasp.

  4. A systematic review of risk factors for delirium in the ICU

    NARCIS (Netherlands)

    Zaal, Irene J.; Devlin, John W.; Peelen, Linda M.; Slooter, Arjen J C

    2015-01-01

    Objective: Although numerous risk factors for delirium in the ICU have been proposed, the strength of evidence supporting each risk factor remains unclear. This study systematically identifies risk factors for delirium in critically ill adults where current evidence is strongest. Data Sources: CINAH

  5. Drosophila larvae as a model to study physiological alcohol dependence

    OpenAIRE

    Robinson, Brooks G.; Khurana, Sukant; Atkinson, Nigel S.

    2013-01-01

    Alcohol addiction is a disease that includes a diverse set of phenotypes. Functional alcohol tolerance is an adaptation to the effects of alcohol that restores neuronal homeostatic balance while the drug is present. When the drug is suddenly withheld, these adaptations unbalance the nervous system and are thought to be the origin of some withdrawal symptoms. Withdrawal symptoms, which can be a motivating factor for alcoholics to relapse, are taken as evidence of physiological ethanol dependen...

  6. Phenomenological and neuropsychological profile across motor variants of delirium in a palliative care unit

    LENUS (Irish Health Repository)

    Leonard, Maeve

    2011-01-01

    Studies using composite measurement of cognition suggest that cognitive performance is similar across motor variants of delirium. The authors assessed neuropsychological and symptom profiles in 100 consecutive cases of DSM-IV delirium allocated to motor subtypes in a palliative-care unit: Hypoactive (N=33), Hyperactive (N=18), Mixed (N=26), and No-Alteration motor groups (N=23). The Mixed group had more severe delirium, with highest scores for DRS-R-98 sleep-wake cycle disturbance, hallucinations, delusions, and language abnormalities. Neither the total Cognitive Test for Delirium nor its five neuropsychological domains differed across Hyperactive, Mixed, and Hypoactive motor groups. Most patients (70%) with no motor alteration had DRS-R-98 scores in the mild or subsyndromal range even though they met DSM-IV criteria. Motor variants in delirium have similar cognitive profiles, but mixed cases differ in expression of several noncognitive features.

  7. Children of Alcoholics

    Science.gov (United States)

    ... at home: Failure in school; truancy Lack of friends; withdrawal from classmates Delinquent behavior, such as stealing or violence Frequent physical complaints, such as headaches or stomachaches Abuse of drugs or alcohol; or Aggression towards other children Risk taking behaviors Depression or ...

  8. [A case of traveller who showed heroin withdrawal after returning from abroad].

    Science.gov (United States)

    Tohhara, S; Kato, A; Tsuji, M; Nakajima, T; Kato, N

    1991-10-01

    A 28-year old Japanese man with heroin abuse was reported. He is an ex-beautician and has abused a variety of substances such as toluene, marihuana, methamphetamine, LSD, and so on since he was in a junior high school in Japan. He experienced an intravenous injection of heroin for five days on his first trip to Thailand in 1989. Soon after he returned home, he went back there to use heroin again. He also experienced tearing and running nose as withdrawal at the end of his ten-day trip. During his third stay there he got a job as a wholesale dealer of heroin under a illegal drug organization in the northern part of Thailand. Before he returned home in Japan, he managed to withdraw from heroin by reducing the dose and replacing it with opium smoking. On his fourth trip he failed to withdraw from heroin and injected the drug intravenously at Chiang Mai Airport before leaving Thailand. He began to show acute heroin withdrawal just after he arrived in Osaka, Japan and sought treatment without telling heroin abuse. He was hospitalized next day and soon showed more severe withdrawal and delirium for next ten days. The delirium was thought to be due to not only heroin but the other drugs which he used. Recently heroin abuse, once prevalent during the latter half of 1950s in Japan, has been hardly seen owing to changing the law to severe punishment in 1963. To avoid strict regulations in home some of young Japanese seem to travel abroad and abuse drugs in Asian countries where the drugs are easily available.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1772378

  9. Melatonin treatment in the prevention of postoperative delirium in cardiac surgery patients

    Science.gov (United States)

    Artemiou, Panagiotis; Bilecova-Rabajdova, Miroslava; Sabol, Frantisek; Torok, Pavol; Kolarcik, Peter; Kolesar, Adrian

    2015-01-01

    Introduction Post-cardiac surgery delirium is a severe complication. The circadian rhythm of melatonin secretion has been shown to be altered postoperatively. Aim of the study It was hypothesized that restoring normal sleeping patterns with a substance that is capable of resynchronizing circadian rhythm such as exogenous administration of melatonin may possibly reduce the incidence of postoperative delirium. Material and methods This paper represents a prospective clinical observational study. Two consecutive groups of 250 consecutive patients took part in the study. Group A was the control group and group B was the melatonin group. In group B, the patients received prophylactic melatonin treatment. The main objectives were to observe the incidence of delirium, to identify any predictors of delirium, and to compare the two groups based on the delirium incidence. Results The incidence of delirium was 8.4% in the melatonin group vs. 20.8% in the control group (p = 0.001). Predictors of delirium in the melatonin group were age (p = 0.001) and higher EuroSCORE II value (p = 0.001). In multivariate analysis, age and EuroSCORE II value (p = 0.014) were predictors of postoperative delirium. Comparing the groups, the main predictors of delirium were age (p = 0.001), EuroSCORE II value (p = 0.001), cardio-pulmonary bypass (CPB) time (p = 0.001), aortic cross-clamping (ACC) time (p = 0.008), sufentanil dose (p = 0.001) and mechanical ventilation (p = 0.033). Conclusions Administration of melatonin significantly decreases the incidence of postoperative delirium after cardiac surgery. Prophylactic treatment with melatonin should be considered in every patient scheduled for cardiac surgery. PMID:26336494

  10. Incidence and Cause of Delirium in Hospitalized Patients between the Ages of 18 and 56: A Retrospective Chart Review

    Directory of Open Access Journals (Sweden)

    Michelle T. Weckmann

    2014-01-01

    Full Text Available Background. Delirium is a common and devastating condition which has been well characterized in elderly cancer patients, but little is known about delirium in cancer patients under the age of 65. Aim. A pilot study to explore the incidence and potential causes of delirium in hospitalized advanced cancer patients at the age of 18–56 years. Design. A retrospective chart review using validated instruments was used to examine the charts of hematology-oncology admissions in a large academic institution. Data was collected as to the likelihood of delirium and potential precipitants. Results. Delirium incidence was 29% among advanced cancer patients. The associated precipitants of delirium were multifactorial, the most common being medications and infection. Delirium was more common in patients admitted for either acute symptom management or the presence of a lung malignancy. Patients with delirium demonstrated significantly increased total hospital cost and a borderline significant result for increased mortality compared to those without delirium. Conclusions. Delirium is common in hospitalized advanced cancer patients (age 18–56 years and the cause is typically multifactorial. Delirium results in a more complicated hospital course and likely increased mortality. Further research is needed to define strategies to prevent and treat this common and distressing condition.

  11. Evaluating Alcoholism and Drug Abuse Knowledge in Medical Education: A Collaborative Project.

    Science.gov (United States)

    Griffin, John B., Jr.

    1983-01-01

    Medical students performed less well on examinations about drug abuse problems and patient management than on traditional medical board examinations. The best knowledge was of pharmacology of drug abuse, Alcoholics Anonymous, and treatment of delirium tremens. Students knew less about metabolic and biochemical areas, emergency-room treatment, and…

  12. Application of Clinical Practice Guidelines for Pain, Agitation, and Delirium.

    Science.gov (United States)

    Krupp, Anna; Balas, Michele C

    2016-06-01

    Critically ill patients experience several severe, distressing, and often life-altering symptoms during their intensive care unit stay. A clinical practice guideline released by the American College of Critical Care Medicine provides a template for improving the care and outcomes of the critically ill through evidence-based pain, agitation, and delirium assessment, prevention, and management. Key strategies include the use of valid and reliable assessment tools, setting a desired sedation level target, a focus on light sedation, choosing appropriate sedative medications, the use of nonpharmacologic symptom management strategies, and engaging and empowering patients and their family to play an active role in their intensive care unit care. PMID:27215361

  13. CHRONIC ALCOHOL NEUROADAPTATION AND STRESS CONTRIBUTE TO SUSCEPTIBILITY FOR ALCOHOL CRAVING AND RELAPSE

    OpenAIRE

    Breese, George R.; Sinha, Rajita; Heilig, Markus

    2010-01-01

    Alcoholism is a chronic relapsing disorder. Major characteristics observed in alcoholics during an initial period of alcohol abstinence are altered physiological functions and a negative emotional state. Evidence suggests that a persistent, cumulative adaptation involving a kindling/allostasis-like process occurs during the course of repeated chronic alcohol exposures that is critical for the negative symptoms observed during alcohol withdrawal. Basic studies have provided evidence for specif...

  14. Identifying pediatric emergence delirium by using the PAED Scale: a quality improvement project.

    Science.gov (United States)

    Stamper, Matthew J; Hawks, Sharon J; Taicher, Brad M; Bonta, Juliet; Brandon, Debra H

    2014-04-01

    Pediatric emergence delirium is a postoperative phenomenon characterized by aberrant cognitive and psychomotor behavior, which can place the patient and health care personnel at risk for injury. A common tool for identifying emergence delirium is the Level of Consciousness-Richmond Agitation and Sedation Scale (LOC-RASS), although it has not been validated for use in the pediatric population. The Pediatric Anesthesia Emergence Delirium Scale (PAED) is a newly validated tool to measure emergence delirium in children. We chose to implement and evaluate the effectiveness and fidelity of using the PAED Scale to identify pediatric emergence delirium in one eight-bed postanesthesia care unit in comparison with the traditional LOC-RASS. The overall incidence of pediatric emergence delirium found by using the LOC-RASS with a retrospective chart review (3%) was significantly lower than the incidence found by using the LOC-RASS (7.5%) and PAED Scale (11.5%) during the implementation period. Our findings suggest that the PAED Scale may be a more sensitive measure of pediatric emergence delirium, and, in the future, we recommend that health care personnel at our facility use the PAED Scale rather than the LOC-RASS. PMID:24674794

  15. CONSUMER'S RIGHT TO WITHDRAW

    OpenAIRE

    ANCA NICOLETA GHEORGHE; CAMELIA SPASICI

    2013-01-01

    The right of withdrawal (of a contract) belongs to the consumer, and is an essential means for the improvement of regulations that protect the consumer.. Right of withdrawal is not a recent creation and is not even specific to the consumer field. He was previously recognized in civil and commercial law (without special regulation). The right to withdraw may even have as ground the parties will. Thus, based on the contractual freedom, the parties may agree that one of them has the right to ter...

  16. New aspects of delirium in elderly patients with critical limb ischemia

    Directory of Open Access Journals (Sweden)

    van Eijsden WA

    2015-09-01

    Full Text Available Willem A van Eijsden,1 Jelle W Raats,1 Paul GH Mulder,2 Lijckle van der Laan1 1Department of Surgery, 2Amphia Academy, Amphia Hospital, Breda, the Netherlands Objective: The primary objective was to identify possible risk factors for delirium in patients with critical limb ischemia undergoing surgery. The secondary objective was to study the effect of delirium on complications, the length of hospital stay, health care costs, and mortality. Methods: All patients 65 years or older with critical limb ischemia undergoing surgery from February 2013 to July 2014 at Amphia Hospital, were included and followed up until December 31, 2014. Delirium was scored using the Delirium Observation Screening Scale (DOSS. Perioperative risk factors (age, comorbidity, factors of frailty, operation type, hemoglobulin, and transfusion were collected and analyzed using logistic regression. Secondary outcomes were the number of complications, total hospital stay, extra health care costs per delirium, and mortality within 3 months and 6 months of surgery Results: We included 92 patients with critical limb ischemia undergoing surgery. Twenty-nine (32% patients developed a delirium during admission, of whom 17 (59% developed delirium preoperatively. After multivariable analysis, only diabetes mellitus (odds ratio [OR] =6.23; 95% confidence interval [CI]: 1.11–52.2; P=0.035 and Short Nutritional Assessment Questionnaire for Residential Care (SNAQ-RC ≥3 (OR =5.55; 95% CI: 1.07–42.0; P=0.039 was significantly associated with the onset of delirium. Delirium was associated with longer hospital stay (P=0.001, increased health care costs, and higher mortality after 6 months (P<0.001. Conclusion: Delirium is a common adverse event in patients with critical limb ischemia undergoing surgery with devastating outcome in the long term. Most patients developed delirium preoperatively, which indicates the need for early recognition and preventive strategies in the preoperative

  17. Delirium in the geriatric unit: proton-pump inhibitors and other risk factors

    Directory of Open Access Journals (Sweden)

    Otremba I

    2016-04-01

    Full Text Available Iwona Otremba, Krzysztof Wilczyński, Jan SzewieczekDepartment of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, PolandBackground: Delirium remains a major nosocomial complication of hospitalized elderly. Predictive models for delirium may be useful for identification of high-risk patients for implementation of preventive strategies.Objective: Evaluate specific factors for development of delirium in a geriatric ward setting.Methods: Prospective cross-sectional study comprised 675 consecutive patients aged 79.2±7.7 years (66% women and 34% men, admitted to the subacute geriatric ward of a multiprofile university hospital after exclusion of 113 patients treated with antipsychotic medication because of behavioral disorders before admission. Comprehensive geriatric assessments including a structured interview, physical examination, geriatric functional assessment, blood sampling, ECG, abdominal ultrasound, chest X-ray, Confusion Assessment Method for diagnosis of delirium, Delirium-O-Meter to assess delirium severity, Richmond Agitation-Sedation Scale to assess sedation or agitation, visual analog scale and Doloplus-2 scale to assess pain level were performed.Results: Multivariate logistic regression analysis revealed five independent factors associated with development of delirium in geriatric inpatients: transfer between hospital wards (odds ratio [OR] =2.78; confidence interval [CI] =1.54–5.01; P=0.001, preexisting dementia (OR =2.29; CI =1.44–3.65; P<0.001, previous delirium incidents (OR =2.23; CI =1.47–3.38; P<0.001, previous fall incidents (OR =1.76; CI =1.17–2.64; P=0.006, and use of proton-pump inhibitors (OR =1.67; CI =1.11–2.53; P=0.014.Conclusion: Transfer between hospital wards, preexisting dementia, previous delirium incidents, previous fall incidents, and use of proton-pump inhibitors are predictive of development of delirium in the geriatric inpatient setting.Keywords: delirium

  18. Emergence delirium with transient associative agnosia and expressive aphasia reversed by flumazenil in a pediatric patient.

    Science.gov (United States)

    Drobish, Julie K; Kelz, Max B; DiPuppo, Patricia M; Cook-Sather, Scott D

    2015-06-01

    Multiple factors may contribute to the development of emergence delirium in a child. We present the case of a healthy 12-year-old girl who received preoperative midazolam with the desired anxiolytic effect, underwent a brief general anesthetic, and then exhibited postoperative delirium, consisting of a transient associative agnosia and expressive aphasia. Administration of flumazenil led to immediate and lasting resolution of her symptoms. We hypothesize that γ-aminobutyric acid type A receptor-mediated effects, most likely related to an atypical offset of midazolam, are an important subset of emergence delirium that is amenable to pharmacologic therapy with flumazenil. PMID:26035220

  19. Incidence and risk factors of delirium in critically ill patients after non-cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    SHI Cheng-mei; WANG Dong-xin; CHEN Kai-sheng; GU Xiu-e

    2010-01-01

    Background Delirium is a common and deleterious complication in critically ill patients after surgery. The purpose of this study was to determine the incidence and risk factors of delirium in critically ill patients after non-cardiac surgery, and to investigate the relationship between the serum cortisol level and the occurrence of postoperative delirium. Methods In a prospective cohort study, 164 consecutive patients who were admitted to the surgical intensive care unit after non-cardiac surgery were enrolled. Baseline characteristics and perioperative variables were collected. Blood samples were obtained on the first postoperative day and serum cortisol concentrations were measured. Delirium was assessed using the Nursing Delirium Screening Scale until the seventh postoperative day or the disappearance of delirious symptoms.Results Postoperative delirium occurred in 44.5% of patients (73 of 164). The median time to first onset of delirium is 0 (range 0 to 5 days) and the median duration of delirium is 3 (1 to 13) days. Independent risk factors of postoperative delirium included increasing age (odds ratio (OR) 2.646, 95% confidence interval (CI) 1.431 to 4.890, P=0.002), a history of previous stroke (OR 4.499, 95%CI 1.228 to 16.481, P=0.023), high Acute Physiology and Chronic Health Evaluation Ⅱ score on surgical intensive care unite admission (OR 1.391, 95%CI 1.201 to 1.612, P<0.001), and high serum cortisol level on the 1 st postoperative day (OR 3.381, 95%CI 1.690 to 6.765, P=0.001). The development of delirium was linked to higher incidence of postoperative complications (28.8% vs. 7.7%, P<0.001), and longer duration of hospitalization (18 (7 to 74) days vs. 13 (3 to 48) days, P <0.001).Conclusions Delirium was a frequent complication in critically ill patients after non-cardiac surgery. High serum cortisol level was associated with increased incidence of postoperative delirium.

  20. Preventing intensive care unit delirium: a patient-centered approach to reducing sleep disruption.

    Science.gov (United States)

    Stuck, Amy; Clark, Mary Jo; Connelly, Cynthia D

    2011-01-01

    Delirium in the intensive care unit is a disorder with multifactorial causes and is associated with poor outcomes. Sleep-wake disturbance is a common experience for patients with delirium. Care processes that disrupt sleep can lead to sleep deprivation, contributing to delirium. Patient-centered care is a concept that considers what is best for each individual. How can clinicians use a patient-centered approach to alter processes to decrease patient disruptions and improve sleep and rest? Could timing of blood draws and soothing music work to promote sleep? PMID:21983504

  1. Battery of behavioral tests in mice to study postoperative delirium.

    Science.gov (United States)

    Peng, Mian; Zhang, Ce; Dong, Yuanlin; Zhang, Yiying; Nakazawa, Harumasa; Kaneki, Masao; Zheng, Hui; Shen, Yuan; Marcantonio, Edward R; Xie, Zhongcong

    2016-01-01

    Postoperative delirium is associated with increased morbidity, mortality and cost. However, its neuropathogenesis remains largely unknown, partially owing to lack of animal model(s). We therefore set out to employ a battery of behavior tests, including natural and learned behavior, in mice to determine the effects of laparotomy under isoflurane anesthesia (Anesthesia/Surgery) on these behaviors. The mice were tested at 24 hours before and at 6, 9 and 24 hours after the Anesthesia/Surgery. Composite Z scores were calculated. Cyclosporine A, an inhibitor of mitochondria permeability transient pore, was used to determine potential mitochondria-associated mechanisms of these behavioral changes. Anesthesia/Surgery selectively impaired behaviors, including latency to eat food in buried food test, freezing time and time spent in the center in open field test, and entries and duration in the novel arm of Y maze test, with acute onset and various timecourse. The composite Z scores quantitatively demonstrated the Anesthesia/Surgery-induced behavior impairment in mice. Cyclosporine A selectively ameliorated the Anesthesia/Surgery-induced reduction in ATP levels, the increases in latency to eat food, and the decreases in entries in the novel arm. These findings suggest that we could use a battery of behavior tests to establish a mouse model to study postoperative delirium. PMID:27435513

  2. The 3 D's of geriatric psychiatry: depression, delirium, and dementia.

    Science.gov (United States)

    Dharia, Sheetal; Verilla, Kailen; Breden, Ericka L

    2011-08-01

    A Caucasian female octogenarian with multiple medical problems was admitted to the inpatient geriatric psychiatry unit with intermittent altered mental status and decline in memory. She had been hospitalized four times in the previous three months. She was admitted on more than 10 medications and received more than 20 different medications in this time period. It was determined that she had delirium concurrent with dementia and/or depression. During her hospital stay a urinary tract infection (UTI) was treated, her anticholinergic medications were minimized, and her digoxin dose was adjusted. As her mental status cleared, a workup was completed to differentiate between dementia and depression. She was initially treated with memantine, but as time progressed it became more evident she was experiencing depression and a "pseudodementia," which was treated with sertraline. Her Mini-Mental State Examination returned to 29/30 (her score previously was 26/29). This case demonstrates the complexity of treating an elder individual and the importance of differentiating among delirium, depression, and dementia. The pharmacy team played an active role in medication reconciliation. Additionally, they worked with the medical team to minimize her potentially harmful medications and optimize the treatment of her UTI and depression. PMID:21840820

  3. Withdrawing Nutrition, Hydration

    Science.gov (United States)

    Module eleven of the EPEC-O Self-Study Original Version discusses the general aspects of withholding or withdrawing of life-sustaining therapies, and presents a specific application to artificial nutrition and hydration.

  4. Comparison and Analysis of Delirium Induced by Histamine H2 Receptor Antagonists and Proton Pump Inhibitors in Cancer Patients

    Directory of Open Access Journals (Sweden)

    Shiro Fujii

    2012-07-01

    Full Text Available Objective: H2 blockers have been reported to be responsible for drug-induced delirium. We compared the incidence of delirium between two groups of patients who were treated with H2 blockers (H2 group or proton pump inhibitors (PPI group for anastomotic ulcer prevention following surgical treatment of esophageal cancer. Method: The incidence and severity of delirium were retrospectively compared in patients of the H2 group (30 cases; age, 65.2 ± 8.1 years and the PPI group (30 cases; 65.2 ± 6.5 years. The diagnosis of delirium was based on the Diagnostic and Statistical Manual of Mental Disorders-IV-Text Revision. Delirium severity was rated on the Delirium Rating Scale (DRS. Results: The incidence of delirium was significantly lower in the PPI group than in the H2 group (p = 0.047. In the 11 patients from the H2 group who developed delirium, discontinuation of H2 blockers resulted in a significant reduction in the DRS score (p = 0.009. In three patients for whom H2 blockers were discontinued, DRS scores decreased by 50% or more three days after discontinuation compared to the prediscontinuation score. Conclusions: These results suggested that switching antiulcer drugs from H2 blockers to PPIs reduced delirium and thus provided an appropriate coping method for drug-induced delirium from antiulcer drugs.

  5. Effect of Magnesium Level to the Development of Delirium in Patients Under Sedation in Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Zümrüt Ela Aslan

    2015-04-01

    Full Text Available Objective: Delirium is a state not to be neglected which can cause severe consequences that is related to critical illness in intensive care unit with acute cerebral dysfunction. Magnesium (Mg plays an important role in many physiological events affecting the brain. In this study, we retrospectively investigated the incidence of delirium development and its relationship with the serum Mg levels. Material and Method: Patients who admitted to intensive care unit (ICU were divided in to two groups according to their serum Mg levels (0.7 normomagnesemia. Delirium was assessed using Richmond Agitation Sedation Scale and Confusion Assessment Method for ICU. We identified the duration of mechanical ventilation, applied sedation, age, gender, sepsis, shock, malignancy, ICU requirement after operation, admission SOFA score, admission APACHE II score, admission of Mg and mean Mg levels as secondary outcome measures whether they affected delirium incidence. Results: A total of 178 patients were assessed, 72 of them were found delirium positive. The incidence of delirium was found 45% in patients with hypomagnesaemia; this was found 25% in patients with normomagnesaemia. Duration of mechanical ventilation, ICU stay, and mortality rate were found higher in patients with delirium than those in individuals without delirium. Conclusion: We retrospectively investigated delirium incidence in critically ill patients and the percentage was found remarkably high. Our findings were parallel with the other studies that, delirium has a negative impact on morbidity and mortality rates.

  6. Prevalence of delirium among patients at a cancer ward: Clinical risk factors and prediction by bedside cognitive tests.

    Science.gov (United States)

    Grandahl, Mia Gall; Nielsen, Svend Erik; Koerner, Ejnar Alex; Schultz, Helga Holm; Arnfred, Sidse Marie

    2016-08-01

    Background Delirium is a frequent psychiatric complication to cancer, but rarely recognized by oncologists. Aims 1. To estimate the prevalence of delirium among inpatients admitted at an oncological cancer ward 2. To investigate whether simple clinical factors predict delirium 3. To examine the value of cognitive testing in the assessment of delirium. Methods On five different days, we interviewed and assessed patients admitted to a Danish cancer ward. The World Health Organization International Classification of Diseases Version 10, WHO ICD-10 Diagnostic System and the Confusion Assessment Method (CAM) were used for diagnostic categorization. Clinical information was gathered from medical records and all patients were tested with Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test. Results 81 cancer patients were assessed and 33% were diagnosed with delirium. All delirious participants were CAM positive. Poor performance on the cognitive tests was associated with delirium. Medical records describing CNS metastases, benzodiazepine or morphine treatment were associated with delirium. Conclusions Delirium is prevalent among cancer inpatients. The Mini Cognitive Test, The Clock Drawing Test, and the Digit Span Test can be used as screening tools for delirium among inpatients with cancer, but even in synergy, they lack specificity. Combining cognitive testing and attention to nurses' records might improve detection, yet further studies are needed to create a more detailed patient profile for the detection of delirium. PMID:26882016

  7. The confusion assessment method for the intensive care unit (CAM-ICU) and intensive care delirium screening checklist (ICDSC) for the diagnosis of delirium: a systematic review and meta-analysis of clinical studies

    OpenAIRE

    Gusmao-Flores, Dimitri; Salluh, Jorge Ibrain Figueira; Chalhub, Ricardo Ávila; Lucas C Quarantini

    2012-01-01

    Introduction Delirium is a frequent form of acute brain dysfunction in critically ill patients, and several detection tools for it have been developed for use in the Intensive Care Unit (ICU). The objective of this study is to evaluate the current evidence on the accuracy of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) and the Intensive Care Delirium Screening Checklist (ICDSC) for the diagnosis of delirium in critically ill patients. Methods A systematic review was condu...

  8. 27 CFR 22.113 - Receipt of tax-free alcohol.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Receipt of tax-free alcohol. 22.113 Section 22.113 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTRIBUTION AND USE OF TAX-FREE ALCOHOL Withdrawal...

  9. Cognitive-style characteristics as criteria for differential diagnosis of delirium

    OpenAIRE

    I.V. Kuznetsov; Morozova, M. V.

    2014-01-01

    We present a psychological study of the relationship of cognitive styles with the development of delusional formations, overvalued ideas and simulative products in order to develop criteria of delirium differential diagnosis. We examined 118 men, ordered at forensic psychological and psychiatric examination, among them delusional symptoms were found in 68 people, and overvalued ideas in 26 people, 24 people simulated delirium. As a method of research, we used pathopsychological experiment and...

  10. Exogenous Melatonin for Delirium Prevention: a Meta-analysis of Randomized Controlled Trials.

    Science.gov (United States)

    Chen, Sheng; Shi, LiGen; Liang, Feng; Xu, Liang; Desislava, Doycheva; Wu, Qun; Zhang, Jianmin

    2016-08-01

    Recently, two high-quality clinical randomized controlled trials (RCTs) regarding the preventive effect of exogenous melatonin on delirium drew inconsistent conclusions. We therefore performed a systemic review to explore whether melatonin had a benefit on delirium prevention. MEDLINE, EMBASE, and Cochrane Library were searched from January 1980 to April 2015 for English language studies. After strict selection and evaluation, the data were extracted from the included four RCTs. The primary outcome of this meta-analysis was the incidence of delirium. The secondary outcome was the improvement of sleep-wake rhythm. A total of four RCTs with 669 elderly patients were included in the present study. Melatonin group showed a tendency to decrease the incidence of delirium (relative risk [RR] 0.41, 95 % confidence interval [CI] 0.15 to 1.13; P = 0.08) compared with control group. In subgroup analysis of the elderly patients in medical wards, melatonin supplementation decreased the incidence of delirium by 75 % (RR 0.25, 95 % CI 0.07 to 0.88; P = 0.03), but not in sleep-wake disturbance (RR 1.24, 95 % CI 0.51 to 3.00; P = 0.64). No differences were found in the incidence of delirium between the two groups in the elderly patients that were presented to surgical wards. In conclusion, melatonin supplementation had a significant preventive effect in decreasing the incidence of delirium in elderly patients that were presented to medical wards. Further studies should provide sufficient evidence about the effect of melatonin on delirium in a large sample size. PMID:26189834

  11. Factors Associated with Post-Surgical Delirium in Patients Undergoing Open Heart Surgery

    Directory of Open Access Journals (Sweden)

    Yadollah Jannati

    2014-09-01

    Full Text Available Objective: The objective of the present study is to determine the incidence of delirium and the associated factors in patients undergoing open heart surgery. Methods: This is an Analytic-descriptive study conducted on 404 patients undergoing elective open heart surgery in Fatemeh Zahra Heart Center, Sari, over the period of 6 months from July to December 2011. Sampling was achieved in a nonrandomized targeted manner and delirium was assessed using NeeCham questionnaire. A trained nurse evaluated the patients for delirium and completed the risk factor checklist on days 1 to 5 after surgery. Data analyses were accomplished using survival analysis (Kaplan-Meier and Cox regression on SPSS software version 15. Results: We found that variables, including ventilation time, increased drainage during the first 24 hours, the need for re-operation in the first 24 hours, dysrhythmias, use of inotropic agents, increased use of analgesics, increased arterial carbon dioxide, lack of visitors, and use of physical restrainers were associated with the development of delirium. In addition, we found a delirium incidence of 29%. Conclusion: Diagnosis of cognitive disorders is of utmost value; therefore, further studies are required to clarify the risk factors because controlling them will help prevent delirium.

  12. Angka Kejadian Delirium dan Faktor Risiko di Intensive Care Unit Rumah Sakit Dr. Hasan Sadikin Bandung

    Directory of Open Access Journals (Sweden)

    Rakhman Adiwinata

    2016-04-01

    Full Text Available Delirium ditandai dengan perubahan status mental, tingkat kesadaran, serta perhatian yang akut dan fluktuatif. Keadaan ini merupakan kelainan yang serius berhubungan dengan pemanjangan lama perawatan di Intensive Care Unit (ICU, biaya yang lebih tinggi, memperlambat pemulihan fungsional, serta peningkatan morbiditas dan mortalitas. Tujuan penelitian adalah mengetahui angka kejadian delirium dan faktor risiko terjadinya delirium di ICU Rumah Sakit Dr. Hasan Sadikin (RSHS Bandung. Pengambilan sampel dilakukan selama tiga bulan (Januari–Maret 2015 di ICU RSHS Bandung. Metode penelitian ini deskriptif observasional secara kohort prospektif, menggunakan alat ukur Confusion Assessment Method-Intensive Care Unit (CAM-ICU, sebelumnya dilakukan penilaian dengan Richmond agitation-sedation scale (RASS pada pasien yang tersedasi. Hasil penelitian ini dari 105 pasien, 22 pasien dieksklusikan, dari 83 pasien didapatkan 31 pasien positif delirium, angka kejadian 37%. Faktor-faktor risiko pada pasien positif delirium terdiri atas geriatri 15 dari 31, pemakaian ventilator 12 dari 31, pemberian analgesik morfin 9 dari 31, sepsis atau infeksi 9 dari 31, kelainan jantung 8 dari 31, acute physiology and chronic health evaluation (APACHE II skor tinggi 8 dari 31, kelainan ginjal 7 dari 31 laboratorium abnormal 7 dari 31, pemberian sedasi midazolam 6 dari 31 kelainan endokrin 5 dari 31, pemberian analgesik fentanil 2 dari 31, dan strok 1 dari 31. Simpulan, angka kejadian delirium di ICU RSHS Bandung cukup tinggi sebesar 37% dengan faktor risiko terbesar adalah pasien geriatrik.

  13. Improved awareness, better screening needed to identify delirium patients who present to the ED.

    Science.gov (United States)

    2014-10-01

    While many older patients experience symptoms of delirium while in the emergency setting, the condition often is not recognized by emergency providers. Further, a missed diagnosis can lead to enhanced caregiver stress as well as a higher risk of institutionalization, readmission, and death. Experts suggest that providers need to be better educated on the subtle clues that a patient may be delirious so that steps can be taken to find and address the inciting cause. Research shows that delirium is present in 7% to 10% of older patients who present to the ED, but it is unrecognized about 75% of the time. Most cases of delirium involve what is called the hypoactive subtype in which patients appear to be sedate or depressed, and they have difficulty paying attention. Many patients with hypoactive delirium are mistaken as being depressed, and as a result, this is a subtype that is frequently missed by clinicians. While no screening tool is 100% effective, researchers have had the best success with a two-step process that involves use of a rapid Delirium Triage Screen (DTS) to rule out delirium. Patients who are not ruled out by the DTS then undergo a more formal Brief Confusion Assessment Method or B-CAM, a tool that is a modified form of the CAM-ICU. PMID:25291836

  14. Unexpected death related to restraint for excited delirium: a retrospective study of deaths in police custody and in the community

    OpenAIRE

    Pollanen, M. S.; Chiasson, D A; Cairns, J T; Young, J G

    1998-01-01

    BACKGROUND: Some people in states of excited delirium die while in police custody. Emerging evidence suggests that physical restraint in certain positions may contribute to such deaths. In this study the authors determined the frequency of physical restraint among people in a state of excited delirium who died unexpectedly. METHODS: The authors reviewed the records of 21 cases of unexpected death in people with excited delirium, which were investigated by the Office of the Chief Coroner for O...

  15. The PiTSTOP study:a feasibility cluster randomized trial of delirium prevention in care homes for older people

    OpenAIRE

    Siddiqi, Najma; Cheater, Francine; Collinson, Michelle; Farrin, Amanda; Forster, Anne; George, Deepa; Godfrey, Mary; Graham, Elizabeth; Harrison, Jennifer; Heaven, Anne; Heudtlass, Peter; Hulme, Claire; Meads, David; North, Chris; Sturrock, Angus

    2016-01-01

    BACKGROUND AND OBJECTIVES: delirium is a distressing but potentially preventable condition common in older people in long-term care. It is associated with increased morbidity, mortality, functional decline, hospitalization and significant healthcare costs. Multicomponent interventions, addressing delirium risk factors, have been shown to reduce delirium by one-third in hospitals. It is not known whether this approach is also effective in long-term care. In previous work, we designed a bespoke...

  16. Delirium, a ‘confusing’ condition in general hospitals: The experience of a Consultation–Liaison Psychiatry Unit in Greece

    OpenAIRE

    Goulia, Panagiota; Mantas, Christos; Hyphantis, Thomas

    2009-01-01

    Background/aims: A plethora of studies showed that delirium is common in hospitalized populations. We aimed to examine the characteristics of delirium patients referred to our Consultation–Liaison Psychiatry Unit (CLPU). Methods: Our CLPU database was used to obtain data of all referred patients admitted to our hospital and diagnosed with delirium. All referred nondelirious patients served as controls. Results: During one year, 483 patients were referred to the CLPU. Ninety-three (19.3%) were...

  17. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study

    OpenAIRE

    Davis, Daniel H. J.; Terrera, Graciela Muniz; Keage, Hannah; Rahkonen, Terhi; Oinas, Minna; Matthews, Fiona E; CUNNINGHAM, COLM; Polvikoski, Tuomo; Sulkava, Raimo; MacLullich, Alasdair M.J.; Brayne, Carol

    2012-01-01

    Recent studies suggest that delirium is associated with risk of dementia and also acceleration of decline in existing dementia. However, previous studies may have been confounded by incomplete ascertainment of cognitive status at baseline. Herein, we used a true population sample to determine if delirium is a risk factor for incident dementia and cognitive decline. We also examined the effect of delirium at the pathological level by determining associations between dementia and neuropathologi...

  18. Delirium is a strong risk factor for dementia in the oldest-old: a population-based cohort study.

    OpenAIRE

    CUNNINGHAM, COLM

    2012-01-01

    Recent studies suggest that delirium is associated with risk of dementia and also acceleration of decline in existing dementia. However, previous studies may have been confounded by incomplete ascertainment of cognitive status at baseline. Herein, we used a true population sample to determine if delirium is a risk factor for incident dementia and cognitive decline. We also examined the effect of delirium at the pathological level by determining associations between dementia and neuropathologi...

  19. Acute confusional state/delirium: An etiological and prognostic evaluation

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    Dheeraj Rai

    2014-01-01

    Full Text Available Introduction: Acute confusional state/delirium is a frequent cause of hospital admission, in the elderly. It is characterized by an acute fluctuating impairment of cognitive functions and inattention. Recognition and prompt treatment is crucial to decrease the morbidity and mortality associated with it. Materials and Methods: In this retrospective study, we determined the etiology and prognostic factors of an acute confusional state. A total of 52 patients of acute confusional state were clinically evaluated. All patients were also subjected to a battery blood biochemical examination, cerebrospinal fluid analysis and neuroimaging. Disability was assessed by using modified Barthel index (MBI. Patients were followed-up for 3 months. Results: The mean age of our cohort was 65.04 ± 10.6 years. 32 (61.5% patients were male. In 33 patients, we were able to identify possible precipitating cause of an acute confusional state. In the rest of the patients results of all the tests were normal. Leukocytosis and hyponatremia were frequent factors associated with delirium. The mean duration of the hospital stay was 10.73 ± 3.6 days (range 5-21 days. Patients with an abnormal work-up (possible precipitating cause had significantly lower mortality, less duration of hospital stay and less severe disability after 3 months. Age, underlying illness, serum creatinine, abnormal neuroimaging and MBI were identified as a significant prognostic indicator. 18 (34.6% of our patients died, of these in 10 patients we could not find a precipitating cause. Conclusion: Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay.

  20. Incidence and Risk Factors for Delirium among Mechanically Ventilated Patients in an African Intensive Care Setting: An Observational Multicenter Study

    Directory of Open Access Journals (Sweden)

    Arthur Kwizera

    2015-01-01

    Full Text Available Aim. Delirium is common among mechanically ventilated patients in the intensive care unit (ICU. There are little data regarding delirium among mechanically ventilated patients in Africa. We sought to determine the burden of delirium and associated factors in Uganda. Methods. We conducted a multicenter prospective study among mechanically ventilated patients in Uganda. Eligible patients were screened daily for delirium using the confusional assessment method (CAM-ICU. Comparisons were made using t-test, chi-squares, and Fisher’s exact test. Predictors were assessed using logistic regression. The level of statistical significance was set at P<0.05. Results. Of 160 patients, 81 (51% had delirium. Median time to onset of delirium was 3.7 days. At bivariate analysis, history of mental illness, sedation, multiorgan dysfunction, neurosurgery, tachypnea, low mean arterial pressure, oliguria, fevers, metabolic acidosis, respiratory acidosis, anaemia, physical restraints, marital status, and endotracheal tube use were significant predictors. At multivariable analysis, having a history of mental illness, sedation, respiratory acidosis, higher PEEP, endotracheal tubes, and anaemia predicted delirium. Conclusion. The prevalence of delirium in a young African population is lower than expected considering the high mortality. A history of mental illness, anaemia, sedation, endotracheal tube use, and respiratory acidosis were factors associated with delirium.

  1. Alcoholism between Fiction and Reality.

    Science.gov (United States)

    Carota, Antonio; Calabrese, Pasquale

    2013-01-01

    Alcoholism has always been emphasized in literature, narratives, and theater as its prevalence and related disability are very high, is found throughout the world, and affects women and men of all ages and social classes. There is a tragic or romantic fascination in the deep sense of personal failure that drinking is able to relieve and in the uncontrollable inability to stop drinking. These aspects have been portrayed well by fictional alcoholics in movies and novels. It has become evident that biological traits together with a complex series of psychosocial factors (e.g. negative life events, depression, anxiety, and other psychiatric or personality disorders), which are also well represented in novels and movies, can lead to alcohol addiction. Behavioral (euphoria, disinhibiting behaviors, aggressiveness) and neurological changes (confusion, bradypsychism, slurred speech, ataxia, blackouts) related to alcohol intoxication are also well portrayed by fictional characters. Delirium tremens, epilepsy, alcohol dementia, and Wernicke-Korsakoff disease, however, find less representation in literature and on the stage and screen. The treatment of alcoholic dependence is very difficult (as often reported by fictional and real stories), but should never be considered hopeless. It should be initiated at any stage of the disease. The support offered by Alcoholics Anonymous has always had great appeal for the public. Fictional works can portray alcohol addiction superbly and show some dark sides of human nature (negative emotions and autodestructive thoughts and behaviors), and, at the same time, the severity and pervasiveness of mental illnesses. The psychiatric and psychosocial aspects of alcohol addiction in movies and novels could be an inspiring source for new psychological studies and rehabilitation programs. PMID:23485899

  2. 27 CFR 19.534 - Withdrawals of spirits for use in production of nonbeverage wine and nonbeverage wine products.

    Science.gov (United States)

    2010-04-01

    ... 27 Alcohol, Tobacco Products and Firearms 1 2010-04-01 2010-04-01 false Withdrawals of spirits for use in production of nonbeverage wine and nonbeverage wine products. 19.534 Section 19.534 Alcohol, Tobacco Products and Firearms ALCOHOL AND TOBACCO TAX AND TRADE BUREAU, DEPARTMENT OF THE TREASURY LIQUORS DISTILLED SPIRITS PLANTS Transfer...

  3. A genome-wide association study of alcohol dependence

    OpenAIRE

    Laura J Bierut; Agrawal, Arpana; Bucholz, Kathleen K.; Doheny, Kimberly F.; Laurie, Cathy; Pugh, Elizabeth; Fisher, Sherri; Fox, Louis; Howells, William; Bertelsen, Sarah; Hinrichs, Anthony L.; Almasy, Laura; Breslau, Naomi; Culverhouse, Robert C; Dick, Danielle M

    2010-01-01

    Excessive alcohol consumption is one of the leading causes of preventable death in the United States. Approximately 14% of those who use alcohol meet criteria during their lifetime for alcohol dependence, which is characterized by tolerance, withdrawal, inability to stop drinking, and continued drinking despite serious psychological or physiological problems. We explored genetic influences on alcohol dependence among 1,897 European-American and African-American subjects with alcohol dependenc...

  4. The effect of an e-learning course on nursing staff’s knowledge of delirium: a before-and-after study

    OpenAIRE

    Van de Steeg, Lotte; IJkema, Roelie; Wagner, Cordula; Langelaan, Maaike

    2015-01-01

    Background Delirium is a common condition in hospitalized patients, associated with adverse outcomes such as longer hospital stay, functional decline and higher mortality, as well as higher rates of nursing home placement. Nurses often fail to recognize delirium in hospitalized patients, which might be due to a lack of knowledge of delirium diagnosis and treatment. The objective of the study was to test the effectiveness of an e-learning course on nurses’ delirium knowledge, describe nursing ...

  5. Interrelationship of Postoperative Delirium and Cognitive Impairment and Their Impact on the Functional Status in Older Patients Undergoing Orthopaedic Surgery: A Prospective Cohort Study

    OpenAIRE

    Chih-Kuang Liang; Chin-Liang Chu; Ming-Yueh Chou; Yu-Te Lin; Ti Lu; Chien-Jen Hsu; Liang-Kung Chen

    2014-01-01

    BACKGROUND: The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. METHOD: This prospectiv...

  6. [Use of tiapride in the anxious alcoholic].

    Science.gov (United States)

    Lion, A

    1983-02-24

    The alcoholic patient is usually anxious. Anxiety is increased by withdrawal. The anxiety-relieving effect of tiapride was studied in 20 alcoholics, with a mean age of 44 years. 18 patients were male. Alcoholism was chronic in 18 cases and paroxystic in two. At the time of withdrawal each patient was given 3 intramuscular injections daily for 7 days, then 3 tablets per day. Results, which were evaluated according to the Hamilton score, were excellent in 9 cases, good in 10 and poor in 1: no failure was recorded. The symptoms which responded best were fear, somatic and psychic manifestations of anxiety, depressive feelings and sleep disturbances. Concomitantly, digestive disorders, anorexia, tremor and pain were alleviated. Tolerance was excellent: no neurologic, digestive, cardiovascular or biologic manifestations were recorded. In caring for alcoholic patients, the critical time of withdrawal is undeniably facilitated by the use of tiapride. PMID:6302898

  7. The effect of an e-learning course on nursing staff's knowledge of delirium: A before-and-after study

    NARCIS (Netherlands)

    L. Van De Steeg (Lotte); R.I. Jkema (Roelie I); C. Wagner (Cordula); M. Langelaan (Maaike)

    2015-01-01

    textabstractBackground: Delirium is a common condition in hospitalized patients, associated with adverse outcomes such as longer hospital stay, functional decline and higher mortality, as well as higher rates of nursing home placement. Nurses often fail to recognize delirium in hospitalized patients

  8. Sleep disorders and acute nocturnal delirium in the elderly: a comorbidity not to be overlooked.

    Science.gov (United States)

    Terzaghi, Michele; Sartori, Ivana; Rustioni, Valter; Manni, Raffaele

    2014-04-01

    Delirium is a disturbance of consciousness and cognition that results in a confusional state. It tends to fluctuate in intensity and is often observed in older patients. Sleep is a window of vulnerability for the occurrence of delirium and sleep disorders can play a role in its appearance. In particular, delirious episodes have been associated with obstructive sleep apnoea syndrome, which is reported to be frequent in the elderly. Hereby, we present a case-report documenting the sudden onset of a confusional state triggered by obstructive sleep apnoea-induced arousal, together with a review of the literature on the topic. We emphasise that, among the many pathogenic factors implicated in delirium, it is worth considering the possible link between nocturnal delirium and the occurrence of impaired arousals. Indeed, the complex confusional manifestations of delirium could be due, in part, to persistence of dysfunctional sleep activity resulting in an inability to sustain full arousal during behavioural wakefulness. Arousals can be triggered by sleep disturbances or other medical conditions. Clinicians should be aware that older patients may present disordered sleep patterns, and make investigation of sleep patterns and disorders potentially affecting sleep continuity a key part of their clinical workup, especially in the presence of cognitive comorbidities. Correct diagnosis and optimal treatment of sleep disorders and disrupted sleep can have a significant impact in the elderly, improving sleep quality and reducing the occurrence of abnormal sleep-related behaviours. PMID:24636782

  9. Sigma-1 receptor agonist fluvoxamine for postoperative delirium in older adults: report of three cases

    Directory of Open Access Journals (Sweden)

    Hashimoto Kenji

    2010-06-01

    Full Text Available Abstract Background Postoperative delirium is a topic of great importance in the geriatric surgical specialty. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Drug treatment for postoperative delirium requires careful consideration of the balance between the effective management of symptoms and potential adverse effects. Methods We report on a Japanese woman (an 86-year-old (open reduction and internal fixation of the right femoral neck fracture, and two Japanese men (an 86-year-old (abdominal aortic aneurysm stent grafting, and a 77-year-old (right upper lobectomy due to lung tumour in which the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the postoperative delirium of these patients. Results Delirium Rating Scale scores in these patients dramatically decreased after treatment with fluvoxamine. Conclusions Doctors should consider fluvoxamine as an alternative approach to treating postoperative delirium in older patients in order to avoid the risk of side effects and increased mortality by antipsychotic drugs.

  10. Dos miradas diferentes frente al delirium en el hospital: cuidadora familiar e inmigrante

    Directory of Open Access Journals (Sweden)

    Ana María Moreno Rodríguez

    2013-09-01

    Full Text Available El Síndrome confusional agudo o delirium es un problema grave en pacientes hospitalizados, mayores de 65 años. Altera la relación y comunicación con sus cuidadores. Objetivo: conocer las vivencias de las cuidadoras familiares e inmigrantes ante el delirium del paciente ingresado, las diferencias entre ambas y sus demandas a la enfermera. Metodología: Investigación Cualitativa de trayectoria fenomenológica, siguiendo la propuesta de Taylor-Bogdan. Se realizaron entrevistas semi-estructuradas a ocho cuidadoras, españolas e inmigrantes. Resultados: se interpretó que el estrés de las cuidadoras aumenta con la agresividad de los enfermos en delirium y disminuye su resistencia física. Demandan información sobre el delirium. Las cuidadoras inmigrantes solicitan más la sujeción mecánica del enfermo alterado. Discusión: para conseguir la implicación de la cuidadora familiar en el cuidado de enfermos con delirium y minimizar sus efectos, es importante disminuir su estrés e informar sobre el proceso.

  11. Sigma-1 receptor agonist fluvoxamine for delirium in intensive care units: report of five cases

    Directory of Open Access Journals (Sweden)

    Hashimoto Kenji

    2010-04-01

    Full Text Available Abstract Background Delirium is a highly prevalent disorder among older patients in intensive care units (ICUs. Although antipsychotic drugs are the medications most frequently used to treat this syndrome, these drugs are associated with a variety of adverse events, including sedation, extrapyramidal side effects, and cardiac arrhythmias. Drug treatment for delirium requires careful consideration of the balance between the effective management of symptoms and potential adverse effects. Methods We report on five Japanese men (an 84 year old (acute aortic dissociation: Stanford type A, a 55 year old (traumatic subarachnoid hemorrhage and brain contusion, a 76 year old (sepsis by pyelonephritis, an 85 year old (cerebral infarction, and an 86 year old (pulmonary emphysema and severe pneumonia in which the selective serotonin reuptake inhibitor and sigma-1 receptor agonist fluvoxamine was effective in ameliorating the delirium of the patients. Results Delirium Rating Scale (DRS scores in these five patients dramatically decreased after treatment with fluvoxamine. Conclusion Doctors should consider fluvoxamine as an alternative approach to treating delirium in ICU patients in order to avoid the risk of side effects and increased mortality from antipsychotic drugs.

  12. Huntington′s disease and alcohol abuse.

    Directory of Open Access Journals (Sweden)

    Mattoo S

    1999-01-01

    Full Text Available The dopamine, glutamate and GABA systems are known to mediate the effects of alcohol on the movement disorders, though their exact roles are not clear. Thus, use of alcohol has implications for pathogenesis as well as management of the movement disorders. These implications are discussed citing a patient who had a strong family history of Huntington′s disease and in whom movement disorder and behavioral problems were manifest under alcohol use and withdrawal, but not while being abstinent.

  13. Treatment Of Alcoholism In Family Practice

    OpenAIRE

    Bulmer, David R.

    1980-01-01

    Treatment goals and treatment methods for alcoholism are discussed with particular emphasis on the role of the family physician in the management of this extremely common problem. The office treatment of alcoholism of moderate severity is discussed, starting with the treatment of alcohol withdrawal, followed by making a treatment contract with the patient in order to help him remain sober, and to fit the patient to the optimal treatment methods on an individual basis. Office treatment methods...

  14. Comparison of cognitive and neuropsychiatric profiles in hospitalised elderly medical patients with delirium, dementia and comorbid delirium–dementia

    Science.gov (United States)

    Leonard, Maeve; McInerney, Shane; McFarland, John; Condon, Candice; Awan, Fahad; O'Connor, Margaret; Reynolds, Paul; Meaney, Anna Maria; Adamis, Dimitrios; Dunne, Colum; Cullen, Walter; Trzepacz, Paula T; Meagher, David J

    2016-01-01

    Objectives Differentiation of delirium and dementia is a key diagnostic challenge but there has been limited study of features that distinguish these conditions. We examined neuropsychiatric and neuropsychological symptoms in elderly medical inpatients to identify features that distinguish major neurocognitive disorders. Setting University teaching hospital in Ireland. Participants and measures 176 consecutive elderly medical inpatients (mean age 80.6±7.0 years (range 60–96); 85 males (48%)) referred to a psychiatry for later life consultation-liaison service with Diagnostic and Statistical Manual of Mental Disorders (DSM) IV delirium, dementia, comorbid delirium–dementia and cognitively intact controls. Participants were assessed cross-sectionally with comparison of scores (including individual items) for the Revised Delirium Rating Scale (DRS-R98), Cognitive Test for Delirium (CTD) and Neuropsychiatric Inventory (NPI-Q). Results The frequency of neurocognitive diagnoses was delirium (n=50), dementia (n=32), comorbid delirium–dementia (n=62) and cognitively intact patients (n=32). Both delirium and comorbid delirium–dementia groups scored higher than the dementia group for DRS-R98 and CTD total scores, but all three neurocognitively impaired groups scored similarly in respect of total NPI-Q scores. For individual DRS-R98 items, delirium groups were distinguished from dementia groups by a range of non-cognitive symptoms, but only for impaired attention of the cognitive items. For the CTD, attention (p=0.002) and vigilance (p=0.01) distinguished between delirium and dementia. No individual CTD item distinguished between comorbid delirium–dementia and delirium. For the NPI-Q, there were no differences between the three neurocognitively impaired groups for any individual item severity. Conclusions The neurocognitive profile of delirium is similar with or without comorbid dementia and differs from dementia without delirium. Simple tests of attention and

  15. Managing verbal agitation in people with dementia and delirium.

    Science.gov (United States)

    Inkley, Francesca; Goldberg, Sarah

    2016-03-01

    Patients with dementia and delirium in acute hospitals can exhibit verbal agitation, but there is no research on rate of occurrence or how ward staff manage such behaviour. This service evaluation aimed to measure rate of occurrence of verbal agitation in confused older inpatients and understand the management strategies used by staff. An agitation inventory was completed daily by the nursing team for all verbally agitated patients on eight older person wards over two weeks. Six semi-structured interviews were conducted with staff and three hours of non-participant observations were undertaken. A mean 6% (13/223) of patients were verbally agitated each day. Management strategies included trial and error, distraction and engagement, reassurance, communication and familiarity. Staff did not adopt a systematic approach to care planning due to lack of training and support on the ward, as well as scarce resources in terms of staff, space and activities. Research is needed to develop and evaluate interventions that support staff to care for these patients. PMID:26917188

  16. The incidence of emergence delirium and risk factors following sevoflurane use in pediatric patients for day case surgery, Kingston, Jamaica

    Directory of Open Access Journals (Sweden)

    Rachel Gooden

    2014-12-01

    Full Text Available Background and objectives: Emergence delirium is a distressing complication of the use of sevoflurane for general anesthesia. This study sought to determine the incidence of emergence delirium and risk factors in patients at a specialist pediatric hospital in Kingston, Jamaica. Methods: This was a cross-sectional, observational study including pediatric patients aged 3-10 years, ASA I and II, undergoing general anesthesia with sevoflurane for elective day-case procedures. Data collected included patients' level of anxiety pre-operatively using the modified Yale Preoperative Anxiety Scale, surgery performed, anesthetic duration and analgesics administered. Postoperatively, patients were assessed for emergence delirium, defined as agitation with non-purposeful movement, restlessness or thrashing; inconsolability and unresponsiveness to nursing and/or parental presence. The need for pharmacological treatment and post-operative complications related to emergence delirium episodes were also noted. Results: One hundred and forty-five (145 children were included, with emergence delirium occurring in 28 (19.3%. Emergence delirium episodes had a mean duration of 6.9±7.8 min, required pharmacologic intervention in 19 (67.8% children and were associated with a prolonged recovery time (49.4±11.9 versus 29.7± 10.8 min for non-agitated children; p<0.001. Factors positively associated with emergence delirium included younger age (p = 0.01, OR 3.3, 95% CI 1.2-8.6 and moderate and severe anxiety prior to induction (p <0.001, OR 5.6, 95% CI 2.3-13.0. Complications of emergence delirium included intravenous line removal (n = 1, and surgical site bleeding (n = 3. Conclusion: Children of younger age with greater preoperative anxiety are at increased risk of developing emergence delirium following general anesthesia with sevoflurane. The overall incidence of emergence delirium was 19%.

  17. CONSUMER'S RIGHT TO WITHDRAW

    Directory of Open Access Journals (Sweden)

    ANCA NICOLETA GHEORGHE

    2013-05-01

    Full Text Available The right of withdrawal (of a contract belongs to the consumer, and is an essential means for the improvement of regulations that protect the consumer.. Right of withdrawal is not a recent creation and is not even specific to the consumer field. He was previously recognized in civil and commercial law (without special regulation. The right to withdraw may even have as ground the parties will. Thus, based on the contractual freedom, the parties may agree that one of them has the right to terminate the contract unilaterally The possibility of unilateral denunciation of the contract, gives the consumer, added protection by being able to reflect the decision and to check how the trader fulfil its obligations. In this context, through its effects, the right of denunciation, forces the professional parties to conduct themselves as fair as possible to the consumer and to execute the contract properly. In the study of the consumer protection, the time of conclusion is essential because in this stage is manifested, the inequality between the consumer and professional. Thus, the lack of information, the major of products and activities, commercial practices, influence the formation of consumer will, preventing the expression of a freely and knowingly consent.

  18. [A 80-year-old woman with delirium after intertrochanteric fracture of femur].

    Science.gov (United States)

    Piotrowicz, Karolina; Klich-Raczka, Alicja

    2010-01-01

    The aim of this study is to present a case of delirium -the state occurring frequently in elderly patients. A 80-year-old woman was hospitalized in the department of internal diseases for internal medical examinations before scheduled operation of femoral osteosynthesis. In ward, she was given analgesic medicines from the group of non-steroidal anti-inflammatory drugs (NSAID), paracetamole and opioids influencing central nervous system. On the second day after modifying the painkilling treatment (single doses of paracetamole were increased and oral opioid medication was introduced) a quickly progressing (within a few hours) delirium was observed. Its occurrence was ascribed to the application of strong medicines influencing central nervous system. Treatment was modified then; the opioid medicine was replaced with NSAID, which had already been used before, applied intravenously. Subsidence of delirium clinical symptoms and cognitive functions' improvement was observed. PMID:21387774

  19. Alcohol fuels

    Energy Technology Data Exchange (ETDEWEB)

    1980-01-01

    This issue is devoted almost entirely to alcohol fuels, the following topics being presented: A History of Alcohol Fuels; In the Midwest - Focus on Alcohol Fuels; Gasohol - A DOE Priority; Alcohol Fuels Potential; Gasohol - The Nutritious Fuel; Energy from Agriculture; Alcohol and the Price of Food; A New Look at Economics and Energy Balance in Alcohol Production; Economics of small-scale alcohol producers; Get the Lead Out with Alcohol; Biomass and the Carbon Dioxide Buildup; Federal Agency Activity in Alcohol Fuels; Congressional Activity in Alchol Fuels; Licensing a Small Still; Funding Sources for Alcohol Facilities; Safety in Alcohol Production; Alcohol Fuels Information; State-by-State Guide to Alcohol Activity; Alcohol Fuels Glossary; Alcohol Fuels and Your Car; Alcohol Fuels Training Grants Progam; Citizen Action Plan for Gasohol; and Alcohol Fuels - a Path to Reconciliation.

  20. Alcohol Alert

    Science.gov (United States)

    ... Us You are here Home » Alcohol Alert Alcohol Alert The NIAAA Alcohol Alert is a quarterly bulletin that disseminates important research ... text. To order single copies of select Alcohol Alerts, see ordering Information . To view publications in PDF ...

  1. Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery

    Science.gov (United States)

    Sato, Tendo; Okamoto, Teppei; Yamamoto, Hayato; Hosogoe, Shogo; Tobisawa, Yuki; Yoneyama, Tohru; Hashiba, Eiji; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Koie, Takuya; Hirota, Kazuyoshi; Ohyama, Chikara

    2016-01-01

    Objectives The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery. Methods We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium. Results Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium. Conclusions Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809. PMID:27145178

  2. Alcohol Alert: Genetics of Alcoholism

    Science.gov (United States)

    ... and Reports » Alcohol Alert » Alcohol Alert Number 84 Alcohol Alert Number 84 Print Version The Genetics of ... immune defense system. Genes Encoding Enzymes Involved in Alcohol Breakdown Some of the first genes linked to ...

  3. Developing Guidelines on the Assessment and Treatment of Delirium in Older Adults at the End of Life

    OpenAIRE

    Brajtman, Susan; Wright, David; Hogan, David B.; Allard, Pierre; Bruto, Venera; Burne, Deborah; Gage, Laura; Pierre R Gagnon; Sadowski, Cheryl A; Helsdingen, Sherri; Wilson, Kimberley

    2011-01-01

    Background and Purpose Delirium at the end of life is common and can have serious consequences on an older person’s quality of life and death. In spite of the importance of detecting, diagnosing, and managing delirium at the end of life, comprehensive clinical practice guidelines (CPG) are lacking. Our objective was to develop CPG for the assessment and treatment of delirium that would be applicable to seniors receiving end-of-life care in diverse settings. Methods Using as a starting point t...

  4. Pathogenesis of and management strategies for postoperative delirium after hip fracture: a review

    DEFF Research Database (Denmark)

    Bitsch, Martin; Foss, Nicolai; Kristensen, Billy Bjarne; Kehlet, Henrik

    2004-01-01

    summarize current knowledge about the pathogenesis of postoperative delirium with a view to finding strategies for prevention and management. METHOD: We conducted an Internet search through the Medline database (1966-March 2003) and supplemented it with a manual search. We included 12 studies which...

  5. Risk factors for delirium after on-pump cardiac surgery : A systematic review

    NARCIS (Netherlands)

    Gosselt, Alex N C; Slooter, Arjen J C; Boere, Pascal R Q; Zaal, Irene J.

    2015-01-01

    Introduction: As evidence-based effective treatment protocols for delirium after cardiac surgery are lacking, efforts should be made to identify risk factors for preventive interventions. Moreover, knowledge of these risk factors could increase validity of etiological studies in which adjustments ne

  6. Outcomes of an innovative model of acute delirium care: the Geriatric Monitoring Unit (GMU

    Directory of Open Access Journals (Sweden)

    Chong MS

    2014-04-01

    Full Text Available Mei Sian Chong, Mark Chan, Laura Tay, Yew Yoong Ding Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore Objective: Delirium is associated with poor outcomes following acute hospitalization. The Geriatric Monitoring Unit (GMU is a specialized five-bedded unit for acute delirium care. It is modeled after the Delirium Room program, with adoption of core interventions from the Hospital Elder Life Program and use of evening light therapy to consolidate circadian rhythms and improve sleep in older inpatients. This study examined whether the GMU program improved outcomes in delirious patients. Method: A total of 320 patients, including 47 pre-GMU, 234 GMU, and 39 concurrent control subjects, were studied. Clinical characteristics, cognitive status, functional status (Modified Barthel Index [MBI], and chemical restraint-use data were obtained. We also looked at in-hospital complications of falls, pressure ulcers, nosocomial infection rate, and discharge destination. Secondary outcomes of family satisfaction (for the GMU subjects were collected. Results: There were no significant demographic differences between the three groups. Pre-GMU subjects had longer duration of delirium and length of stay. MBI improvement was most evident in the GMU compared with pre-GMU and control subjects (19.2±18.3, 7.5±11.2, 15.1±18.0, respectively (P<0.05. The GMU subjects had a zero restraint rate, and pre-GMU subjects had higher antipsychotic dosages. This translated to lower pressure ulcer and nosocomial infection rate in the GMU (4.1% and 10.7%, respectively and control (1.3% and 7.7%, respectively subjects compared with the pre-GMU (9.1% and 23.4%, respectively subjects (P<0.05. No differences were observed in mortality or discharge destination among the three groups. Caregivers of GMU subjects felt the multicomponent intervention to be useful, with scheduled activities voted the most beneficial in patient

  7. A 3 year case study of alcohol related psychotic disorders at Hospital Seremban.

    Science.gov (United States)

    George, S; Chin, C N

    1998-09-01

    This paper reports the characteristics and psychopathology of alcohol dependents with alcohol induced psychotic disorder admitted to the Seremban Hospital. The method is that of a case study of all alcohol dependents with alcohol induced psychotic disorder admitted to the Psychiatric Ward, Hospital Seremban over 3 years (1993-1995). There were 34 subjects, 30 Indians, 3 Chinese and 1 Malay with a mean age of 43 years. 32 were men and predominantly of Social Class IV and V (91%). They had a mean duration of drinking of 14.2 years and had a mean weekly consumption of 69.5 units of alcohol. There was a family history of alcohol dependence in (44%). The majority (68%) consumed samsu with beer the second choice. Auditory hallucinations (26) and delusions (16) were common while visual hallucinations (3) and depression (2) were less frequent. Speech disorder occurred in 4 subjects. 2 developed delirium tremens and 1 died. Liver function test was normal in 55%. All except the death from delirium tremens responded to treatment with a combination of anxiolytics, thiamine and antipsychotics and were rapidly discharged. The mean stay was 7 days. However, (68%) did not return for follow up and only 4 were abstinent from alcohol at the time of follow up. PMID:10968157

  8. Delirium risk screening and haloperidol prophylaxis program in hip fracture patients is a helpful tool in identifying high-risk patients, but does not reduce the incidence of delirium

    Directory of Open Access Journals (Sweden)

    Tuinebreijer Wim E

    2011-08-01

    Full Text Available Abstract Background Delirium in patients with hip fractures lead to higher morbidity and mortality. Prevention in high-risk patients by prescribing low dose haloperidol is currently under investigation. Methods This prospective cohort surveillance assessed hip fracture patients for risk of developing a delirium with the Risk Model for Delirium (RD score. High-risk patients (score ≥ 5 points were treated with a prophylactic low-dose of haloperidol according to hospital protocol. Primary outcome was delirium incidence. Secondary outcomes were differences between high- and low-risk patients in delirium, length of stay (LOS, return to pre-fracture living situation and mortality. Logistic regression analysis was performed with age, ASA-classification, known dementia, having a partner, type of fracture, institutional residence and psychotropic drug use as possible confounders. Results 445 hip fracture patients aged 65 years and older were admitted from January 2008 to December 2009. The RD-score was completed in 378 patients, 173 (45.8% high-risk patients were treated with prophylactic medication. Sensitivity was 71.6%, specificity 63.8% and the negative predictive value (NPV of a score Delirium incidence (27.0% was not significantly different compared to 2007 (27.8% 2006 (23.9% and 2005 (29.0% prior to implementation of the RD- protocol. Logistic regression analysis showed that high-risk patients did have a significant higher delirium incidence (42.2% vs. 14.1%, OR 4.1, CI 2.43-7.02. They were more likely to be residing at an alternative living situation after 3 months (62.3% vs. 17.0%, OR 6.57, CI 3.23-13.37 and less likely to be discharged from hospital before 10 days (34.9% vs. 55.9%, OR 1.63, CI 1.03-2.59. Significant independent risk factors for a delirium were a RD-score ≥ 5 (OR 4.13, CI 2.43-7.02, male gender (OR 1.93, CI 0.99-1.07 and age (OR 1.03, CI 0.99-1.07. Conclusions Introducing the delirium prevention protocol did not reduce

  9. Intensive care delirium - effect on memories and health-related quality of life - a follow-up study

    DEFF Research Database (Denmark)

    Svenningsen, Helle; Tønnesen, Else K; Videbech, Poul;

    2013-01-01

    after intensive care unit. Interviews were repeated after two and six months and supplemented with Short Form-36 and the Barthel Index. RESULTS: Delirium was detected in 60% of the patients in our study, and delirious patients had significantly fewer factual memories and more memories of delusion than...... nondelirious patients up to six months postintensive care unit discharge. Delirium, memories and intensive care unit diaries with follow-up did not affect health-related quality of life and healthcare dependency. Memories of delusions might have an impact on patients assessed as nondelirious. CONCLUSIONS: More...... than half of the patients in intensive care unit experience delirium, which is associated with fewer factual memories and more memories of delusions. Short Form-36 might not be sensitive to delirium-related outcomes. Future research should include the development of better assessment tools to determine...

  10. The Development and Evaluation of Delirium Assessment and Nursing Care Decision-Making Assistant Mobile Application for Intensive Care Unit.

    Science.gov (United States)

    Yang, Fangyu; Ji, Meihua; Ding, Shu; Wu, Ying; Chang, Polun; Lin, Chiawei; Yang, Xin

    2016-01-01

    Delirium is a common complication among patients in ICU settings. Although it has been repeatedly confirmed that Confusion Assessment Model for Intensive Care Unit (CAM-ICU), one of the most commonly used ICU delirium assessment tool, is highly accurate in validation studies, it's sensitivity and specificity is relatively low during routine practice among bedside nurses. The aim of this study is to develop a mobile application (app) to detect delirium and to test its reliability and validity both by research nurses and among ICU bedside nurses. The app was programmed with Java and installed on a mobile device with Android system. After completion of reliability and validity testing, the app will be integrated into the existing Hospital Information System in order to automatically retrieve essential information for risk factor identification and formulation of care plan accordingly to prevent or manage ICU delirium. PMID:27332299

  11. The effect of range of motion exercises on delirium prevention among patients aged 65 and over in intensive care units.

    Science.gov (United States)

    Karadas, Canan; Ozdemir, Leyla

    2016-01-01

    The purpose of this study was to determine the effect of range of motion exercises on preventing delirium and shortening the duration of delirium among patients in the intensive care unit who are aged 65 and over. The study was conducted in the intensive care unit on patients with non-invasive mechanical ventilation. The sample size included 47 patients from the intervention group and 47 from the control group. The incidence of delirium was 8.5% in the intervention group and 21.3% in the control group. The duration of delirium was 15 h for patients in the intervention group and 38 h for those in the control group. Although delirium incidence and duration decreased by 2.5-fold in the intervention group compared to the control group; there was no significant relationship between the intervention and control groups. In conclusion, as the decreases in delirium occurrence and duration were not statistically significant, the effect of range of motion exercises was limited. PMID:26763172

  12. 5 CFR 1650.11 - Withdrawal elections.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Withdrawal elections. 1650.11 Section 1650.11 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD METHODS OF WITHDRAWING FUNDS FROM THE THRIFT SAVINGS PLAN Post-Employment Withdrawals § 1650.11 Withdrawal elections....

  13. Preoperative regional cerebral oxygen saturation is a predictor of postoperative delirium in on-pump cardiac surgery patients: a prospective observational trial

    OpenAIRE

    Schoen, Julika; Meyerrose, Joscha; Paarmann, Hauke; Heringlake, Matthias; Hueppe, Michael; Berger, Klaus-Ulrich

    2011-01-01

    Introduction Postoperative delirium is an important problem in patients undergoing major surgery. Cerebral oximetry is a non-invasive method to detect imbalances in the cerebral oxygen supply/demand-ratio. Low preoperative cerebral oxygen saturation (ScO2) levels have been associated with postoperative delirium in non-cardiac surgery patients. The present prospective observational study determines the relationship between pre- and intra-operative ScO2 levels and postoperative delirium in pati...

  14. Associations between sedation, delirium and post-traumatic stress disorder and their impact on quality of life and memories following discharge from an intensive care unit

    DEFF Research Database (Denmark)

    Svenningsen, Helle

    2013-01-01

    systematisk for delirium. En mindre del af patienterne er undersøgt i forhold til bl.a. posttraumatisk-stress¬syndrom (PTSD) efterfølgende. Studier om delirium viser at det er lidelsesfuldt for patienten, og at delirium øger risiko for død betydeligt, eller øger sygelighed efterfølgende fx i form af demens...

  15. Neurobiological Basis of Alcohol Addiction

    Directory of Open Access Journals (Sweden)

    Milagros Lisset León Regal

    2014-02-01

    Full Text Available Alcoholism is a serious social problem due to its impact on individual and collective health. In order to provide an update on the latest findings that explain the development and symptoms of alcohol addiction, the short and long term changes that this disorder causes in the central nervous system are shown in this paper. A total of 52 information sources were consulted, including 43 journal articles, 4 books and statistical reports. The main network managers were used. The interaction of ethanol with various structures of the neuronal membrane affects the cytoarchitecture and brain function associated with the reward system, motor processing, learning and memory, resulting in the development of alcohol dependence. In addition, ethanol-induced changes in excitation/inhibition explain the phenomena of alcohol tolerance and withdrawal.

  16. Alcoholic neuropathy

    Science.gov (United States)

    ... objects in the shoes Guarding the extremities to prevent injury from pressure Alcohol must be stopped to prevent the damage from ... The only way to prevent alcoholic neuropathy is not to drink excessive amounts of alcohol.

  17. Role of caloric homeostasis and reward in alcohol intake in Syrian golden hamsters

    OpenAIRE

    Gulick, Danielle; Green, Alan I.

    2010-01-01

    The Syrian golden hamster drinks alcohol readily, but only achieves moderate blood alcohol levels, and does not go through withdrawal from alcohol. Because the hamster is a model of caloric homeostasis, both caloric content and reward value may contribute to the hamster’s alcohol consumption. The current study examines alcohol consumption in the hamster when a caloric or non-caloric sweet solution is concurrently available and caloric intake in the hamster before, during, and after exposure t...

  18. Withdrawal: Expanding a Key Addiction Construct.

    Science.gov (United States)

    Piper, Megan E

    2015-12-01

    Withdrawal is an essential component of classical addiction theory; it is a vital manifestation of dependence and motivates relapse. However, the traditional conceptualization of withdrawal as a cohesive collection of symptoms that emerge during drug deprivation and decline with either the passage of time or reinstatement of drug use, may be inadequate to explain scientific findings or fit with modern theories of addiction. This article expands the current understanding of tobacco withdrawal by examining: (1) withdrawal variability; (2) underlying causes of withdrawal variability, including biological and person factors, environmental influences, and the influence of highly routinized behavioral patterns; (3) new withdrawal symptoms that allow for enhanced characterization of the withdrawal experience; and (4) withdrawal-related cognitive processes. These topics provide guidance regarding the optimal assessment of withdrawal and illustrate the potential impact modern withdrawal conceptualization and assessment could have on identifying treatment targets. PMID:25744958

  19. Effects of a Natural Community Intervention Intensifying Alcohol Law Enforcement Combined With a Restrictive Alcohol Policy on Adolescent Alcohol Use

    NARCIS (Netherlands)

    Schelleman-Offermans, K.; Knibbe, R.A.; Kuntsche, E.N.; Casswell, S.

    2012-01-01

    Purpose Determining whether intensified inspections on alcohol retailers, combined with a policy withdrawing liquor licenses if retailers are fined twice per annum, is effective in reducing adolescents' odds to initiate weekly drinking and drunkenness. Causal pathways by which the intervention was a

  20. La lectura al web 2.0. Estudi de cas: els blogs en el 'Reto Delirium'

    Directory of Open Access Journals (Sweden)

    Sandra Sánchez García

    2013-06-01

    Full Text Available Aquest treball presenta els resultats de l'anàlisi d'un estudi de cas: els blogs que participaren en la campanya Reto Delirium, llançada per l'editorial SM al gener de 2011 amb l'objectiu de promoure i difondre el llibre de Lauren Oliver, Delirium. L'anàlisi del blocs participants, com a fenomen de comunicació social i com a eina de promoció lectora, s’ha realitzat seguint una metodologia exploratòria, analítica i quantitativa. La investigació s'ha centrat en un procés de comunicació virtual localitzat en espais concrets (els blogs i en un període temporal limitat, que ens ha permès determinar les capacitats i possibilitats d’aquest recurs de la web social per a la promoció de la lectura.

  1. MRI findings in patients with multiple lacunar infarcts manifesting hyperactive-type delirium

    Energy Technology Data Exchange (ETDEWEB)

    Arahata, Yutaka; Motegi, Yoshimasa; Furuse, Masahiro (Nakatsugawa Municipal General Hospital, Gifu (Japan)); Watanabe, Masaki; Takahashi, Akira

    1994-04-01

    MRI studies were carried out on 69 patients with multiple lacunar infarcts: 32 had hyperactive-type delirium and the other 37 were non-delirious controls. Between the two groups, there were no statistically significant differences in mean age and sex distribution. In the corona radiata and basal ganglia, the number of infarcts did not differ between the two groups. However, the extent of thalamic infarcts and periventricular hyperintensity (PVH), the maximal width of the third ventricle and Evans' ratio among the delirious patients were significantly larger than those in the controls. In conclusion, thalamic lesions and diffuse advanced PVH may have an intimate correlation in the development of hyperactive-type delirium in patients with multiple lacunar infarcts. (author).

  2. The DSM-5 criteria, level of arousal and delirium diagnosis: Inclusiveness is safer

    OpenAIRE

    CUNNINGHAM, COLM

    2014-01-01

    PUBLISHED Background Delirium is a common and serious problem among acutely unwell persons. Alhough linked to higher rates of mortality, institutionalisation and dementia, it remains underdiagnosed. Careful consideration of its phenomenology is warranted to improve detection and therefore mitigate some of its clinical impact. The publication of the fifth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-5) provides an opportunity to examine t...

  3. Delirium markers in older fallers: a case-control study

    OpenAIRE

    Doherty, Kelly

    2014-01-01

    Kelly Doherty,1 Elizabeth Archambault,1 Brittany Kelly,1,2 James L Rudolph1,3,4 1Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; 2School of Nursing, Science & Health Professions, Regis College, Boston, MA, USA; 3Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA; 4Harvard Medical School, Boston, MA, USA Background: When a hospitalized older patient falls or develops delirium, there are significant con...

  4. Clinical Practice Guideline for the Care of Elderly Patients Hospitalized with Delirium

    OpenAIRE

    Ángel Julio Romero Carbrera; Leocadia Amores Hernández; Ernesto Alonso Cabrera; Francisco Olascoaga Pérez; Eduardo Fernández Casteleiro

    2015-01-01

    Delirium is a frequent disorder found in people of advanced age in the hospital setting. It is characterized by an acute disorder of consciousness and alterations in behavior, posing a diagnostic and therapeutic challenge for the doctors that look after geriatric patients. A clinical practice guideline drawn up by consensus is presented. It highlights the clinical and therapeutic aspects of this complex syndrome. An algorithm that facilitates the management of this condition at Dr. Gustavo Al...

  5. The Low-Frequency Oscillation Model of Hallucinations in Neurodegenerative Disorders and in Delirium

    OpenAIRE

    Juszczak, Grzegorz R

    2011-01-01

    Electroencephalography (EEG) found in dementia with Lewy bodies, Parkinson's disease, Alzheimer's disease and delirium, is characterized by increased power of delta and theta frequencies with the degree of EEG slowing parallel to the frequency of hallucinations occurrence. According to the proposed model of hallucination, pathological low-frequency oscillations may interfere with information processing in two different ways leading to hallucinations. First, pathological low-frequency oscillat...

  6. A Clinical Update on Delirium: From Early Recognition to Effective Management

    OpenAIRE

    Elizabeta B. Mukaetova-Ladinska; Joaquim Cerejeira

    2011-01-01

    Delirium is a neuropsychiatric syndrome characterized by altered consciousness and attention with cognitive, emotional and behavioural symptoms. It is particularly frequent in elderly people with medical or surgical conditions and is associated with adverse outcomes. Predisposing factors render the subject more vulnerable to a congregation of precipitating factors which potentially affect brain function and induce an imbalance in all the major neurotransmitter systems. Early diagnosis of deli...

  7. Sleep Disruption and Proprioceptive Delirium due to Acetaminophen in a Pediatric Patient

    OpenAIRE

    Carla Carnovale; Marco Pozzi; Andrea Angelo Nisic; Elisa Scrofani; Valentina Perrone; Stefania Antoniazzi; Emilio Clementi; Sonia Radice

    2013-01-01

    We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13 mg/kg (260 mg) of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar f...

  8. Detection and documentation of dementia and delirium in acute geriatric wards.

    Science.gov (United States)

    Laurila, Jouko V; Pitkala, Kaisu H; Strandberg, Timo E; Tilvis, Reijo S

    2004-01-01

    Detection of cognitive impairment among hospitalized older individuals has shown to be insufficient. A point prevalence study in two geriatric hospitals in Helsinki, Finland, was performed among 219 acutely ill individuals over 70 years to assess the detection of dementia and delirium. Documentation of dementia and delirium in medical records, and recordings of confusional symptoms in nurses' notes were compared with the researchers' diagnosis made after a detailed assessment of cognitive status. The cognitive decline was mentioned in medical records in 70/88 (79.5%) of the cases. Cognitive testing was performed on 42/88 (47.7%) of the dementia patients, and the diagnosis of dementia was recorded in 47/88 (53.4%) of them. A specific etiological diagnosis was recorded in only 4/88 (4.5%) cases. Cognitive impairment in at least one of these four means was recorded in 80/88 (90.9%) of cases (sensitivity 0.93). Eight patients had a false-positive diagnosis of dementia (specificity 0.94). Delirium was diagnosed in 77 (35.2%) patients by the researchers, but it was recorded in only 31/77 (40.3%) in medical records. In 64/77 (83.1%) cases signs of confusion were recorded in nurses' notes. Poor detection and documentation may lead to undertreatment of both disorders. PMID:14757300

  9. Prevalence and Risk Factors of Postoperative Delirium in Patients Undergoing Open Heart Surgery in Northwest of Iran

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    Ahmadreza Jodati

    2013-09-01

    Full Text Available Introduction: Delirium as a relatively common complication following cardiac surgery remains a contributory factor in postoperative mortality and an obstacle to early discharge of patients.Methods: In the present study 329 patients who underwent open heart surgery between 1st January 2008 to 1st January 2009 in Shahid Madani Heart Center, Tabriz, Iran were enrolled.Results: Overall 4.9% of patients developed delirium after cardiac surgery. We found atrial fibrillation (P = 0.005, lung diseases (P = 0.04 and hypertension (P = 0.02 to be more common in patients who develop delirium postoperatively. Furthermore, the length of intensive care unit (ICU stay, cardiopulmonary bypass (CPB time, and ventilation period were also significantly increased. Also a statistically meaningful relationship between the female gender and development of delirium was also noted (P = 0.02. On the other hand no meaningful relationship was detected between diabetes, history of cerebral vascular diseases, peripheral vascular diseases, myocardial infarction, development of pneumonia following surgery, and laboratory levels of sodium, potassium, glucose, and complete blood cell count (CBC including white blood cells, red blood cells, platelets in the blood-hemoglobin and hematocrits. Also environmental factors like presence of other patients or companion with the patient, and objects like clock, window and calendar in the patient’s room did not affect prevention of delirium.Conclusion: Based on this and other investigations, it can be suggested to use MMPI test to recognize pathologic elements to prevented delirium after surgery and complementary treatment for coping with delirium.

  10. Delirium, sedation and analgesia in the intensive care unit: a multinational, two-part survey among intensivists.

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    Alawi Luetz

    Full Text Available Analgesia, sedation and delirium management are important parts of intensive care treatment as they are relevant for patients' clinical and functional long-term outcome. Previous surveys showed that despite this fact implementation rates are still low. The primary aim of the prospective, observational multicenter study was to investigate the implementation rate of delirium monitoring among intensivists. Secondly, current practice concerning analgesia and sedation monitoring as well as treatment strategies for patients with delirium were assesed. In addition, this study compares perceived and actual practice regarding delirium, sedation and analgesia management. Data were obtained with a two-part, anonymous survey, containing general data from intensive care units in a first part and data referring to individual patients in a second part. Questionnaires from 101 hospitals (part 1 and 868 patients (part 2 were included in data analysis. Fifty-six percent of the intensive care units reported to monitor for delirium in clinical routine. Fourty-four percent reported the use of a validated delirium score. In this respect, the survey suggests an increasing use of delirium assessment tools compared to previous surveys. Nevertheless, part two of the survey revealed that in actual practice 73% of included patients were not monitored with a validated score. Furthermore, we observed a trend towards moderate or deep sedation which is contradicting to guideline-recommendations. Every fifth patient was suffering from pain. The implementation rate of adequate pain-assessment tools for mechanically ventilated and sedated patients was low (30%. In conclusion, further efforts are necessary to implement guideline recommendations into clinical practice. The study was registered (ClinicalTrials.gov identifier: NCT01278524 and approved by the ethical committee.

  11. Binge ethanol withdrawal: Effects on post-withdrawal ethanol intake, glutamate-glutamine cycle and monoamine tissue content in P rat model.

    Science.gov (United States)

    Das, Sujan C; Althobaiti, Yusuf S; Alshehri, Fahad S; Sari, Youssef

    2016-04-15

    Alcohol withdrawal syndrome (AWS) is a medical emergency situation which appears after abrupt cessation of ethanol intake. Decreased GABA-A function and increased glutamate function are known to exist in the AWS. However, the involvement of glutamate transporters in the context of AWS requires further investigation. In this study, we used a model of ethanol withdrawal involving abrupt cessation of binge ethanol administration (4g/kg/gavage three times a day for three days) using male alcohol-preferring (P) rats. After 48h of withdrawal, P rats were re-exposed to voluntary ethanol intake. The amount of ethanol consumed was measured during post-withdrawal phase. In addition, the expression of GLT-1, GLAST and xCT were determined in both medial prefrontal cortex (mPFC) and nucleus accumbens (NAc). We also measured glutamine synthetase (GS) activity, and the tissue content of glutamate, glutamine, dopamine and serotonin in both mPFC and NAc. We found that binge ethanol withdrawal escalated post-withdrawal ethanol intake, which was associated with downregulation of GLT-1 expression in both mPFC and NAc. The expression of GLAST and xCT were unchanged in the ethanol-withdrawal (EW) group compared to control group. Tissue content of glutamate was significantly lower in both mPFC and NAc, whereas tissue content of glutamine was higher in mPFC but unchanged in NAc in the EW group compared to control group. The GS activity was unchanged in both mPFC and NAc. The tissue content of DA was significantly lower in both mPFC and NAc, whereas tissue content of serotonin was unchanged in both mPFC and NAc. These findings provide important information of the critical role of GLT-1 in context of AWS. PMID:26821293

  12. Who withdraws? Psychological individual differences and employee withdrawal behaviors.

    Science.gov (United States)

    Zimmerman, Ryan D; Swider, Brian W; Woo, Sang Eun; Allen, David G

    2016-04-01

    Psychological individual differences, such as personality, affectivity, and general mental ability, have been shown to predict numerous work-related behaviors. Although there is substantial research demonstrating relationships between psychological individual differences and withdrawal behaviors (i.e., lateness, absenteeism, and turnover), there is no integrative framework providing scholars and practitioners a guide for conceptualizing how, why, and under what circumstances we observe such relationships. In this integrative conceptual review we: (a) utilize the Cognitive-Affective Processing System framework (Mischel & Shoda, 1995) to provide an overarching theoretical basis for how psychological individual differences affect withdrawal behaviors; (b) create a theoretical model of the situated person that summarizes the existing empirical literature examining the effect of psychological differences on withdrawal behavior; and (c) identify future research opportunities based on our review and integrative framework. (PsycINFO Database Record PMID:26595754

  13. Suicidal Behavior and Alcohol Abuse

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    Maurizio Pompili

    2010-03-01

    Full Text Available Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.

  14. The incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery

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    Wei WANG

    2011-06-01

    Full Text Available Objective To identify the incidence and risk factors of postoperative delirium in elderly patients in critical condition after non-cardiac surgery.Methods One hundred and twenty-five elderly patients who were admitted to the surgical intensive care unit(SICU after non-cardiac surgery were involved in the present study.Baseline and the perioperative variables of patients were collected.Postoperative delirium was diagnosed using the Confusion Assessment Method for Intensive Care Unit(CAM-ICU.Delirium assessment was performed once daily during the first five days after surgery.Results Postoperative evaluations of delirium were completed in 124 patients.Postoperative delirium occurred in 42 patients(33.87%,among them delirium occurred within the first 2 postoperative days in 92.86%(39/42(4.76% in the operative day,50.00% in the first postoperative day,and 38.10% in the second postoperative day,respectively.When compared with the non-delirious patients,the delirious patients had longer duration of ICU stay [39.75(21.00-65.63h vs 19.63(17.77-22.31h,P=0.000],higher incidence of postoperative complications [(38.1%(16/42 vs 13.4%(11/82,P=0.000],and higher mortality [11.9%(5/42 vs 1.2%(1/82,P=0.000].Multivariate logistic regression analysis demonstrated that the following risk factors predicted the occurrence of postoperative delirium: preoperative history of cerebral accident(OR=3.051,95%CI 1.032-8.370,high APACHE Ⅱ score at admission to the SICU(OR=1.664,95%CI 1.268-2.184,and high pain score at 24 hours after operation(OR=1.043,95%CI 1.021-1.086.Conclusions Delirium is a common complication after surgery.The prognosis is significantly worse in the delirious patients than in the non-delirious patients.Risk factors of postoperative delirium include history of preoperative cerebral accident,high APACHE Ⅱ score at admission to the SICU,and high pain score at 24 hours after operation.

  15. Dependence Induced Increases in Intragastric Alcohol Consumption (IGAC) in Mice

    OpenAIRE

    Fidler, Tara L.; Powers, Matthew S.; Ramirez, Jason J.; Crane, Andrew; Mulgrew, Jennifer; Smitasin, Phoebe; Cunningham, Christopher L.

    2011-01-01

    Three experiments used the Intragastric Alcohol Consumption (IGAC) procedure to examine effects of variations in passive ethanol exposure on withdrawal and voluntary ethanol intake in two inbred mouse strains, C57BL/6J (B6) and DBA/2J (D2). Experimental treatments were selected to induce quantitative differences in ethanol dependence and withdrawal severity by: (a) varying the periodicity of passive ethanol exposure (3, 6 or 9 infusions/day), (b) varying the dose per infusion (Low, Medium or ...

  16. Alcohol Facts

    Science.gov (United States)

    ... alcohol. Alcohol is the ingredient that gets you drunk. Hard liquor—such as whiskey, rum, or gin— ... of malt liquor 12 ounces of beer Being drunk can make a person feel very silly, angry, ...

  17. Alcoholics Anonymous

    Science.gov (United States)

    ... Banners Site Help What's New Welcome to Alcoholics Anonymous ® NEED HELP WITH A DRINKING PROBLEM? If you ... drinking problem, wish to learn more about Alcoholics Anonymous or want to find A.A. near you, ...

  18. The validity and reliability of the portuguese versions of three tools used to diagnose delirium in critically ill patients

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    Dimitri Gusmao-Flores

    2011-01-01

    Full Text Available OBJECTIVES: The objectives of this study are to compare the sensitivity and specificity of three diagnostic tools for delirium (the Intensive Care Delirium Screening Checklist, the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet in a mixed population of critically ill patients, and to validate the Brazilian Portuguese Confusion Assessment Method for Intensive Care Units. METHODS: The study was conducted in four intensive care units in Brazil. Patients were screened for delirium by a psychiatrist or neurologist using the Diagnostic and Statistical Manual of Mental Disorders. Patients were subsequently screened by an intensivist using Portuguese translations of the three tools. RESULTS: One hundred and nineteen patients were evaluated and 38.6% were diagnosed with delirium by the reference rater. The Confusion Assessment Method for Intensive Care Units had a sensitivity of 72.5% and a specificity of 96.2%; the Confusion Assessment Method for Intensive Care Units Flowsheet had a sensitivity of 72.5% and a specificity of 96.2%; the Intensive Care Delirium Screening Checklist had a sensitivity of 96.0% and a specificity of 72.4%. There was strong agreement between the Confusion Assessment Method for Intensive Care Units and the Confusion Assessment Method for Intensive Care Units Flowsheet (kappa coefficient = 0.96 CONCLUSION: All three instruments are effective diagnostic tools in critically ill intensive care unit patients. In addition, the Brazilian Portuguese version of the Confusion Assessment Method for Intensive Care Units is a valid and reliable instrument for the assessment of delirium among critically ill patients.

  19. Discrete Cues Paired with Naloxone-Precipitated Withdrawal from Acute Morphine Dependence Elicit Conditioned Withdrawal Responses

    OpenAIRE

    Amitai, Nurith; Liu, Jian; Schulteis, Gery

    2006-01-01

    Acute bolus doses of morphine induce a state of acute opioid dependence as measured by naloxone-precipitated withdrawal. Repeated morphine and precipitated withdrawal experience further enhances naloxone-induced withdrawal severity, in part due to direct neuroadaptation to repeated morphine, and in part due to conditioned associations of context and withdrawal experience. To determine whether a discrete tone/light conditioned stimulus (CS) could elicit conditioned withdrawal responses in acut...

  20. Alcohol use disorders and current pharmacological therapies: the role of GABAA receptors

    OpenAIRE

    Liang, Jing; Olsen, Richard W.

    2014-01-01

    Alcohol use disorders (AUD) are defined as alcohol abuse and alcohol dependence, which create large problems both for society and for the drinkers themselves. To date, no therapeutic can effectively solve these problems. Understanding the underlying mechanisms leading to AUD is critically important for developing effective and safe pharmacological therapies. Benzodiazepines (BZs) are used to reduce the symptoms of alcohol withdrawal syndrome. However, frequent use of BZs causes cross-toleranc...

  1. Alcohol misuse

    OpenAIRE

    Robson, W

    2009-01-01

    Alcohol use is a leading cause of mortality and morbidity internationally, and is ranked by the WHO as one of the top five risk factors for disease burden. Without treatment, approximately 16% of hazardous or harmful alcohol users will progress to more dependent patterns of alcohol consumption.

  2. Alcohol Test

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    The recent alcohol tax increase poses a challenge to China’s white spirits makers Alcohol, rather than wine, is an in-dispensable component to Chinese table culture. The financial crisis has failed to affect white spirits sales, but an alcohol tax increase might.

  3. The effects of melatonin versus placebo on delirium in hip fracture patients: study protocol of a randomised, placebo-controlled, double blind trial

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    van Velde Romuald

    2011-07-01

    Full Text Available Abstract Background With an ageing population, older persons become a larger part of the hospital population. The incidence of delirium is high in this group, and experiencing delirium has major short- and long-term sequelae, which makes prevention crucial. During delirium, a disruption of the sleep-wake cycle is frequently observed. Melatonin plays an important role in the regulation of the sleep-wake cycle, so this raised the hypothesis that alterations in the metabolism of melatonin might play an important role in the development of delirium. The aim of this article is to describe the design of a randomised, placebo controlled double-blind trial that is currently in progress and that investigates the effects of melatonin versus placebo on delirium in older, postoperative hip fracture patients. Methods/Design Acutely hospitalised patients aged 65 years or older admitted for surgical repair of hip fracture are randomised (n = 452 into a treatment or placebo group. Prophylactic treatment consists of orally administered melatonin (3 mg at 21:00 h on five consecutive days. The primary outcome is the occurrence of delirium, to be diagnosed according to the Confusion Assessment Method, within eight days after start of the study medication. Secondary outcomes are delirium severity, measured by the Delirium Rating Scale; duration of delirium; differences in subtypes of delirium; differences in total length of hospital stay; total dose of antipsychotics and/or benzodiazepine use during delirium; and in-hospital complications. In the twelve-month follow up visit, cognitive function is measured by a Mini-Mental state examination and the Informant Questionnaire on Cognitive Decline in the Elderly. Functional status is assessed with the Katz ADL index score (patient and family version and grip strength measurement. The outcomes of these assessments are compared to the outcomes that were obtained during admission. Discussion The proposed study will

  4. The Effects of Intrathecal Fentanyl on Sedation Depth and Postoperative Recovery Room Delirium

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    Ozgur Bulent Tuzun

    2015-01-01

    Full Text Available Background/Aim. Intrathecal anaesthesia has been shown to increase sedation level. This study aimed to evaluate the effects of intrathecal applied fentanyl with levobupivacaine on intraoperative sedation and recovery room delirium. Materials and Methods. The study included 68 patients, ASA I–III, 55–85 years. One day preoperatively, the Confusion Assessment Method (CAM and the Mini Mental Status Test (MMST were applied and patients were separated into two groups. In Group L 2.5 mL levobupivacaine and in Group LF 2 mL levobupivacaine and 0.5 mL fentanyl were applied intrathecally. In a supine position, following a propofol IV 1 mg kg−1 bolus to obtain Bispectral Index (BIS of 70–85, propofol infusion was started (1 mg kg−1 st−1. With observation of SpO2, BIS, and the Observer Assessment and Alertness/Sedation Scale (OAA/SS with the haemodynamic values, the total propofol amount was calculated. Evaluations were made of pain severity (VAS, analgesic use, transfusion requirement, and recovery room delirium. Results. In the comparison within the groups, a significant decrease was determined in HR and MAP compared to the initial values (p<0.05. A positive correlation was found between the BIS and OAA/SS values. The amounts of propofol used were similar between the groups. Conclusions. Intrathecal fentanyl and levobupivacaine had the same effect on sedation or BIS and fentanyl did not cause delirium.

  5. Analysis of multi-dimensional contemporaneous EHR data to refine delirium assessments.

    Science.gov (United States)

    Corradi, John P; Chhabra, Jyoti; Mather, Jeffrey F; Waszynski, Christine M; Dicks, Robert S

    2016-08-01

    Delirium is a potentially lethal condition of altered mental status, attention, and level of consciousness with an acute onset and fluctuating course. Its causes are multi-factorial, and its pathophysiology is not well understood; therefore clinical focus has been on prevention strategies and early detection. One patient evaluation technique in routine use is the Confusion Assessment Method (CAM): a relatively simple test resulting in 'positive', 'negative' or 'unable-to-assess' (UTA) ratings. Hartford Hospital nursing staff use the CAM regularly on all non-critical care units, and a high frequency of UTA was observed after reviewing several years of records. In addition, patients with UTA ratings displayed poor outcomes such as in-hospital mortality, longer lengths of stay, and discharge to acute and long term care facilities. We sought to better understand the use of UTA, especially outside of critical care environments, in order to improve delirium detection throughout the hospital. An unsupervised clustering approach was used with additional, concurrent assessment data available in the EHR to categorize patient visits with UTA CAMs. The results yielded insights into the most common situations in which the UTA rating was used (e.g. impaired verbal communication, dementia), suggesting potentially inappropriate ratings that could be refined with further evaluation and remedied with updated clinical training. Analysis of the patient clusters also suggested that unrecognized delirium may contribute to the poor outcomes associated with the use of UTA. This method of using temporally related high dimensional EHR data to illuminate a dynamic medical condition could have wider applicability. PMID:27340924

  6. Caudal block and emergence delirium in pediatric patients: Is it analgesia or sedation?

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    Aparna Sinha

    2012-01-01

    Full Text Available Background: Emergence delirium (ED although a short-lived and self-limiting phenomenon, makes a child prone to injury in the immediate postoperative period and hence is a cause of concern not only to the pediatric anesthesiologist, surgeons, and post anesthesia care unit staff but also amongst parents. Additional medication to quieten the child offsets the potential benefits of rapid emergence and delays recovery in day care settings. There is conflicting evidence of influence of analgesia and sedation following anesthesia on emergence agitation. We hypothesized that an anesthetic technique which improves analgesia and prolongs emergence time will reduce the incidence of ED. We selected ketamine as adjuvant to caudal block for this purpose. Methods: This randomized, double blind prospective study was performed in 150 premedicated children ASA I, II, aged 2 to 8 years who were randomly assigned to either group B (caudal with bupivacaine, BK (bupivacaine and ketamine, or NC (no caudal, soon after LMA placement. Recovery characteristics and complications were recorded. Results: Emergence time, duration of pain relief, and Pediatric Anesthesia Emergence Delirium (PAED scores were significantly higher in the NC group (P<0.05. Duration of analgesia and emergence time were significantly more in group BK than groups B and NC. However, the discharge readiness was comparable between all groups. No patient in BK group required to be given any medication to treat ED. Conclusion: Emergence time as well as duration of analgesia have significant influence on incidence of emergence delirium. Ketamine, as caudal adjuvant is a promising agent to protect against ED in children, following sevoflurane anesthesia.

  7. Delirium markers in older fallers: a case-control study

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    Doherty K

    2014-11-01

    Full Text Available Kelly Doherty,1 Elizabeth Archambault,1 Brittany Kelly,1,2 James L Rudolph1,3,4 1Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, MA, USA; 2School of Nursing, Science & Health Professions, Regis College, Boston, MA, USA; 3Division of Aging, Brigham and Women’s Hospital, Boston, MA, USA; 4Harvard Medical School, Boston, MA, USA Background: When a hospitalized older patient falls or develops delirium, there are significant consequences for the patient and the health care system. Assessments of inattention and altered consciousness, markers for delirium, were analyzed to determine if they were also associated with falls. Methods: This retrospective case-control study from a regional tertiary Veterans Affairs referral center identified falls and delirium risk factors from quality databases from 2010 to 2012. Older fallers with complete delirium risk assessments prior to falling were identified. As a control, non-fallers were matched at a 3:1 ratio. Admission risk factors that were compared in fallers and non-fallers included altered consciousness, cognitive performance, attention, sensory deficits, and dehydration. Odds ratio (OR was reported (95% confidence interval [CI]. Results: After identifying 67 fallers, the control population (n=201 was matched on age (74.4±9.8 years and ward (83.6% medical; 16.4% intensive care unit. Inattention as assessed by the Months of the Year Backward test was more common in fallers (67.2% versus 50.8%, OR=2.0; 95% CI: 1.1–3.7. Fallers tended to have altered consciousness prior to falling (28.4% versus 12.4%, OR=2.8; 95% CI: 1.3–5.8. Conclusion: In this case-control study, alterations in consciousness and inattention, assessed prior to falling, were more common in patients who fell. Brief assessments of consciousness and attention should be considered for inclusion in fall prediction. Keywords: geriatrics, patient centered outcomes research, patient safety

  8. Clinical Practice Guideline for the Care of Elderly Patients Hospitalized with Delirium

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    Ángel Julio Romero Carbrera

    2015-06-01

    Full Text Available Delirium is a frequent disorder found in people of advanced age in the hospital setting. It is characterized by an acute disorder of consciousness and alterations in behavior, posing a diagnostic and therapeutic challenge for the doctors that look after geriatric patients. A clinical practice guideline drawn up by consensus is presented. It highlights the clinical and therapeutic aspects of this complex syndrome. An algorithm that facilitates the management of this condition at Dr. Gustavo Aldereguía Lima University General Hospital of Cienfuegos is included.

  9. Alcoholic cardiomyopathy

    Institute of Scientific and Technical Information of China (English)

    Gonzalo; Guzzo-Merello; Marta; Cobo-Marcos; Maria; Gallego-Delgado; Pablo; Garcia-Pavia

    2014-01-01

    Alcohol is the most frequently consumed toxic substance in the world. Low to moderate daily intake of alcohol has been shown to have beneficial effects on the cardiovascular system. In contrast, exposure to high levels of alcohol for a long period could lead to progressive cardiac dysfunction and heart failure. Cardiac dysfunction associated with chronic and excessive alcohol intake is a specific cardiac disease known as alcoholic cardiomyopathy(ACM). In spite of its clinical importance, data on ACM and how alcohol damages the heart are limited. In this review, we evaluate available evidence linking excessive alcohol consumption with heart failure and dilated cardiomyopathy. Additionally, we discuss the clinical presentation, prognosis and treatment of ACM.

  10. Method of withdrawing fuel rods

    International Nuclear Information System (INIS)

    Purpose: To facilitate the withdrawal of fuel rods from a fuel bundle by heating a lower tie plate. Constitution: A lower tie plate for a fuel bundle is disposed within a heating coil. Magnetic fluxes and eddy currents passing through the lower tie plate are induced by applying an alternating current to the heating coil to generate eddy current loss and hysteresis loss in the lower tie plate thereby generating heat to the inside of the lower tie plate per se with no external heating. The lower tie plate is heated in this way. Since the lower tie plate has a greater linear expansion coefficient than that of the lower end plug, a gap is resulted at the engaging portion between the lower tie plate and the lower end plug, by which the fastening of the lower end plug is released to facilitate the withdrawal of the fuel rod. (Yoshino, Y.)

  11. Neonatal withdrawal syndrome: Case report

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    Radunović-Gojković Tatjana

    2009-01-01

    Full Text Available Introduction. Maternal drug abuse has increased over the past decade. It has a multiple negative influence on a pregnant woman, as well as her newborn. Practically, every drug taken during pregnancy crosses the placenta, and the developing fetus may also be affected by the effects of a drug. After delivery, an infant of a drug-abusing mother may potentially develop neonatal withdrawal syndrome. Existing studies on the neonatal effects of drug exposure in utero are subject to many factors. Many studies have relied on the history obtained from the mother, which is innacurate. Urine testing for drug abuse does not reflect exposure to a drug through pregnancy and does not provide quantitative information. Social and economic deprivation is common among drug abusers, and this factor has a major effect on long term studies of infant outcome. The purpose of this article is to underline the problems during management of a neonatal withdrawal syndrom, and growing incidence of it in our society. Case report. A case of an infant of a heroin-abusing mother is reported. Conclusion. It is very important to take care of an infant with neonatal withdrawal syndrome, but it is also of a great importance to supervise these children for a long period of time.

  12. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial - The PINOCCHIO trial

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    Spinelli Allison

    2011-07-01

    Full Text Available Abstract Background Postoperative delirium can result in increased postoperative morbidity and mortality, major demand for postoperative care and higher hospital costs. Hypnotics serve to induce and maintain anaesthesia and to abolish patients' consciousness. Their persisting clinical action can delay postoperative cognitive recovery and favour postoperative delirium. Some evidence suggests that these unwanted effects vary according to each hypnotic's specific pharmacodynamic and pharmacokinetic characteristics and its interaction with the individual patient. We designed this study to evaluate postoperative delirium rate after general anaesthesia with various hypnotics in patients undergoing surgical procedures other than cardiac or brain surgery. We also aimed to test whether delayed postoperative cognitive recovery increases the risk of postoperative delirium. Methods/Design After local ethics committee approval, enrolled patients will be randomly assigned to one of three treatment groups. In all patients anaesthesia will be induced with propofol and fentanyl, and maintained with the anaesthetics desflurane, or sevoflurane, or propofol and the analgesic opioid fentanyl. The onset of postoperative delirium will be monitored with the Nursing Delirium Scale every three hours up to 72 hours post anaesthesia. Cognitive function will be evaluated with two cognitive test batteries (the Short Memory Orientation Memory Concentration Test and the Rancho Los Amigos Scale preoperatively, at baseline, and postoperatively at 20, 40 and 60 min after extubation. Statistical analysis will investigate differences in the hypnotics used to maintain anaesthesia and the odds ratios for postoperative delirium, the relation of early postoperative cognitive recovery and postoperative delirium rate. A subgroup analysis will be used to categorize patients according to demographic variables relevant to the risk of postoperative delirium (age, sex, body weight and to the

  13. Management of levofloxacin induced anaphylaxis and acute delirium in a palliative care setting

    Directory of Open Access Journals (Sweden)

    Arunangshu Ghoshal

    2015-01-01

    Full Text Available Levofloxacin is a commonly prescribed antibiotic for managing chest and urinary tract infections in a palliative care setting. Incidence of Levofloxacin-associated anaphylaxis is rare and delirium secondary to Levofloxacin is a seldom occurrence with only few published case reports. It is an extremely rare occurrence to see this phenomenon in combination. Early identification and prompt intervention reduces both mortality and morbidity. A 17-year-old male with synovial sarcoma of right thigh with chest wall and lung metastasis and with no prior psychiatric morbidity presented to palliative medicine outpatient department with community-acquired pneumonia. He was initiated on intravenous (IV Ceftriaxone and IV Levofloxacin. Post IV Levofloxacin patient developed anaphylaxis and acute delirium necessitating IV Hydrocortisone, IV Chlorpheneramine, Oxygen and IV Haloperidol. Early detection and prompt intervention helped in complete recovery. Patient was discharged to hospice for respite after 2 days of hospitalization and then discharged home. Acute palliative care approach facilitated management of two life-threatening medical complications in a palliative care setting improving both quality and length of life.

  14. Electroconvulsive therapy as a treatment for protracted refractory delirium in the intensive care unit--five cases and a review

    DEFF Research Database (Denmark)

    Nielsen, R M; Olsen, K S; Lauritsen, Anne Øberg;

    2014-01-01

    stress, and able to cooperate with the ventilator but remained in a state of posttraumatic amnesia after a head trauma. CONCLUSION: Although controversial, ECT is nevertheless recognized as an efficient and safe treatment for various psychiatric illnesses including delirium. Considering the significantly...

  15. [Extension of the concept of withdrawal signs].

    Science.gov (United States)

    Kato, Shin

    2015-12-01

    If the conditions including normal-dose dependence in which withdrawal signs are observed in the absence of definite psychic dependence are classified as dependence, this classification should be regarded as inappropriate extension of the concept of drug dependence. These conditions should be diagnosed as 'withdrawal' as specified by the DSM-5 or ICD-10. Advancements of research have clarified that an increased number of drugs cause withdrawal signs. Some Japanese researchers use the concept of 'withdrawal signs of psychic dependence.' Their definition of drug dependence and concept of withdrawal signs, however, are different from the definition established by the WHO and the researchers specializing in this field. Thus, the concept of 'withdrawal signs of psychic dependence' raises a lot of questions. PMID:26964289

  16. Withdrawal history, private information, and bank runs

    OpenAIRE

    Carlos Garriga; Chao Gu

    2012-01-01

    This paper provides a simple two-depositor, two-stage model to understand how a bank’s withdrawal history affects an individual’s decision about withdrawals, which could possibly trigger bank runs. Individual depositors have private information about their personal consumption types and receive noisy private signals about the quality of the bank’s portfolio. Depositors make publicly observable withdrawal decisions in sequence. Computed examples indicate that the optimal contract contingent on...

  17. Cannabis withdrawal in adolescent treatment seekers

    OpenAIRE

    Vandrey, Ryan; Budney, Alan J.; Kamon, Jody L.; Stanger, Catherine

    2004-01-01

    A valid cannabis withdrawal syndrome has been demonstrated in controlled studies with adult marijuana abusers, yet few published reports have examined cannabis withdrawal among adolescents. Adolescents presenting for outpatient substance abuse treatment, whose primary substance of abuse was cannabis, completed a questionnaire reporting the presence and severity of withdrawal symptoms during past periods of cannabis abstinence. Nearly two-thirds of the sample indicated that they had experience...

  18. 29 CFR 4219.12 - Employers liable upon mass withdrawal.

    Science.gov (United States)

    2010-07-01

    ... 29 Labor 9 2010-07-01 2010-07-01 false Employers liable upon mass withdrawal. 4219.12 Section 4219... Redetermination of Withdrawal Liability Upon Mass Withdrawal § 4219.12 Employers liable upon mass withdrawal. (a... experiences successive mass withdrawals, an employer that has been determined to be liable under this...

  19. Delirium with anticholinergic symptoms after a combination of paliperidone and olanzapine pamoate in a patient known to smoke cannabis: an unfortunate coincidence.

    Science.gov (United States)

    Kokalj, Anja; Rijavec, Nikolina; Tavčar, Rok

    2016-01-01

    We report a case of delirium with anticholinergic symptoms in a 19-year-old female patient with schizophrenia. On the day the symptoms emerged, the patient received olanzapine long-acting injection and a higher dose of paliperidone. We observed symptoms ranging from confusion to delirium as well as some anticholinergic symptoms. The delirium lasted 24 hours and was managed by intravenous fluid substitution and oral benzodiazepines. Olanzapine pamoate, paliperidone and cannabis are central nervous system (CNS) depressants, and their combination can increase the risks of CNS depression. In this case report, we review the symptoms of delirium in a case of antipsychotic overdose and provide general guidelines for managing these symptoms. We also review possible complications in combined use of cannabis, olanzapine and paliperidone. PMID:27335358

  20. Time-Course Analysis of Brain Regional Expression Network Responses to Chronic Intermittent Ethanol and Withdrawal: Implications for Mechanisms Underlying Excessive Ethanol Consumption

    OpenAIRE

    Smith, Maren L.; Lopez, Marcelo F; Archer, Kellie J; Wolen, Aaron R.; Howard C Becker; Miles, Michael F.

    2016-01-01

    Long lasting abusive consumption, dependence, and withdrawal are characteristic features of alcohol use disorders (AUD). Mechanistically, persistent changes in gene expression are hypothesized to contribute to brain adaptations leading to ethanol toxicity and AUD. We employed repeated chronic intermittent ethanol (CIE) exposure by vapor chamber as a mouse model to simulate the cycles of ethanol exposure and withdrawal commonly seen with AUD. This model has been shown to induce progressive eth...

  1. Treatment of Decompensated Alcoholic Liver Disease

    Directory of Open Access Journals (Sweden)

    John Menachery

    2011-01-01

    Full Text Available Alcoholic liver disease (ALD is a spectrum ranging from simple hepatic steatosis to alcoholic hepatitis and cirrhosis. Patients with severe alcoholic hepatitis can have clinical presentation almost similar to those with decompensated cirrhosis. Scoring with models like Maddrey discriminant function, a model for end-stage liver disease, Glasgow alcoholic hepatitis score, and Lille model are helpful in prognosticating patients with ALD. One of the first therapeutic goals in ALD is to induce alcohol withdrawal with psychotherapy or drugs. Most studies have shown that nutritional therapy improves liver function and histology in patients with ALD. The rationale for using glucocorticoids is to block cytotoxic and inflammatory pathways in patients with severe alcoholic hepatitis. Pentoxifylline, a tumor necrosis factor alpha (TNFα suppressor, and infliximab, an anti-TNFα mouse/human chimeric antibody, has been extensively studied in patients with alcoholic hepatitis. Liver transplantation remains the definitive therapy for decompensated cirrhosis/alcoholic hepatitis despite the issues of recidivism, poor compliance with postoperative care, and being a self-inflicted disease.

  2. A pragmatic study exploring the prevention of delirium among hospitalized older hip fracture patients: Applying evidence to routine clinical practice using clinical decision support

    Directory of Open Access Journals (Sweden)

    Schmaltz Heidi N

    2010-10-01

    Full Text Available Abstract Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive interventions can lower delirium rates. The objective of this study was to implement and evaluate the effectiveness of an evidence-based electronic care pathway, which incorporates multi-component delirium strategies, among older hip fracture patients. We conducted a pragmatic study using an interrupted time series design in order to evaluate the use and impact of the intervention. The target population was all consenting patients aged 65 years or older admitted with an acute hip fracture to the orthopedic units at two Calgary, Alberta hospitals. The primary outcome was delirium rates. Secondary outcomes included length of hospital stay, in-hospital falls, in-hospital mortality, new discharges to long-term care, and readmissions. A Durbin Watson test was conducted to test for serial correlation and, because no correlation was found, Chi-square statistics, Wilcoxon test and logistic regression analyses were conducted as appropriate. At study completion, focus groups were conducted at each hospital to explore issues around the use of the order set. During the 40-week study period, 134 patients were enrolled. The intervention had no effect on the overall delirium rate (33% pre versus 31% post; p = 0.84. However, there was a significant interaction between study phase and hospital (p = 0.03. Although one hospital did not experience a decline in delirium rate, the delirium rate at the other hospital declined from 42% to 19% (p = 0.08. This difference by hospital was mirrored in focus group feedback. The hospital that experienced a decline in delirium rates was more supportive of the intervention. Overall, post-intervention there were no significant differences in mean length of stay (12 days post versus 14 days pre; p = 0.74, falls (6% post

  3. Delirium, a ‘confusing’ condition in general hospitals: The experience of a Consultation–Liaison Psychiatry Unit in Greece

    OpenAIRE

    Panagiota Goulia; Christos Mantas; Thomas Hyphantis

    2009-01-01

    Panagiota Goulia, Christos Mantas, Thomas HyphantisConsultation-Liaison Psychiatry Unit, Department of Psychiatry, Medical School, University of Ioannina, Ioannina, GreeceBackground/aims: A plethora of studies showed that delirium is common in hospitalized populations. We aimed to examine the characteristics of delirium patients referred to our Consultation–Liaison Psychiatry Unit (CLPU).Methods: Our CLPU database was used to obtain data of all referred patients admitted to our hosp...

  4. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients

    OpenAIRE

    Van Rompaey, Bart; Elseviers, Monique M; Van Drom, Wim; Fromont, Veronique; Jorens, Philippe G.

    2012-01-01

    Introduction This study hypothesised that a reduction of sound during the night using earplugs could be beneficial in the prevention of intensive care delirium. Two research questions were formulated. First, does the use of earplugs during the night reduce the onset of delirium or confusion in the ICU? Second, does the use of earplugs during the night improve the quality of sleep in the ICU? Methods A randomized clinical trial included adult intensive care patients in an intervention group of...

  5. Irish coffee: Effects of alcohol and caffeine on object discrimination in zebrafish.

    Science.gov (United States)

    Santos, Luana C; Ruiz-Oliveira, Julia; Oliveira, Jéssica J; Silva, Priscila F; Luchiari, Ana C

    2016-04-01

    Many studies regarding the effects of drugs investigate the acute and chronic use of alcohol, but only a few address the effects of caffeine and alcohol combined to the performance of the zebrafish in cognitive tasks. The zebrafish is an important model for studying the effects of drugs on learning, because it has large genetic similarities to humans and the non-invasive administration of the substances favors translational bias of research. In this study, we observed the effects of alcohol and caffeine on zebrafish cognition through an object discrimination test. We noticed that animals subjected to acute alcohol dose and those under alcohol or caffeine withdrawal did not show discrimination. When fish were treated with associated alcohol and caffeine, those chronically treated with alcohol and subjected to moderate acute dose of caffeine showed learning of the task. Our results reinforce the harmful effects of the alcohol use on cognitive tasks, and suggest that continued use of high doses of caffeine cause cognitive impairment during withdrawal of the substance. However, the acute use of caffeine appears to reverse the harmful effects of alcohol withdrawal, allowing discriminative performance equivalent to control fish. Finally, we reiterate the use of zebrafish as a model for drug effects screening and search for active compounds that modulate the alcohol and caffeine effects. PMID:26850919

  6. Alcohol Energy Drinks

    Science.gov (United States)

    ... Home / About Addiction / Alcohol / Alcohol Energy Drinks Alcohol Energy Drinks Read 17728 times font size decrease font size increase font size Print Email Alcohol energy drinks (AEDs) or Caffeinated alcoholic beverages (CABs) are ...

  7. Alcohol during Pregnancy

    Science.gov (United States)

    ... Home > Pregnancy > Is it safe? > Alcohol during pregnancy Alcohol during pregnancy E-mail to a friend Please ... and fetal alcohol spectrum disorders. How does drinking alcohol during pregnancy affect your baby's health? Drinking alcohol ...

  8. Alcohol Energy Drinks

    Science.gov (United States)

    ... Home / About Addiction / Alcohol / Alcohol Energy Drinks Alcohol Energy Drinks Read 14466 times font size decrease font size increase font size Print Email Alcohol energy drinks (AEDs) or Caffeinated alcoholic beverages (CABs) are ...

  9. Sleep Disruption and Proprioceptive Delirium due to Acetaminophen in a Pediatric Patient

    Directory of Open Access Journals (Sweden)

    Carla Carnovale

    2013-01-01

    Full Text Available We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13 mg/kg (260 mg of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar features. Potential alternative explanations were excluded, and analysis with the Naranjo algorithm indicated a “probable” relationship between acetaminophen and this adverse reaction. We discuss the potential mechanisms involved, comprising imbalances in prostaglandin levels, alterations of dopamine, and cannabinoid and serotonin signalings.

  10. Sleep Disruption and Proprioceptive Delirium due to Acetaminophen in a Pediatric Patient

    Science.gov (United States)

    Carnovale, Carla; Pozzi, Marco; Nisic, Andrea Angelo; Scrofani, Elisa; Perrone, Valentina; Antoniazzi, Stefania; Radice, Sonia

    2013-01-01

    We present the case of a 7-year-old boy, who received acetaminophen for the treatment of hyperpyrexia, due to an infection of the superior airways. 13 mg/kg (260 mg) of acetaminophen was administered orally before bedtime, and together with the expected antipyretic effect, the boy experienced sleep disruption and proprioceptive delirium. The symptoms disappeared within one hour. In the following six months, acetaminophen was administered again twice, and the reaction reappeared with similar features. Potential alternative explanations were excluded, and analysis with the Naranjo algorithm indicated a “probable” relationship between acetaminophen and this adverse reaction. We discuss the potential mechanisms involved, comprising imbalances in prostaglandin levels, alterations of dopamine, and cannabinoid and serotonin signalings. PMID:23573447

  11. 42 CFR 457.170 - Withdrawal process.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Withdrawal process. 457.170 Section 457.170 Public... Plans for Child Health Insurance Programs and Outreach Strategies § 457.170 Withdrawal process. (a... amendment, or any portion of a proposed State plan or plan amendment, at any time during the review...

  12. 76 FR 14592 - Safety Management System; Withdrawal

    Science.gov (United States)

    2011-03-17

    ..., and 145 RIN 2120-AJ15 Safety Management System; Withdrawal AGENCY: Federal Aviation Administration... (``product/ service providers'') to develop a Safety Management System (SMS). The FAA is withdrawing the... proposed rulemaking (ANPRM) published on July 23, 2009 (74 FR 36414) is withdrawn as of March 17, 2011....

  13. Treatment of acute opioid withdrawal with ibogaine.

    Science.gov (United States)

    Alper, K R; Lotsof, H S; Frenken, G M; Luciano, D J; Bastiaans, J

    1999-01-01

    Ibogaine is an alkaloid with putative effect in acute opioid withdrawal. Thirty-three cases of treatments for the indication of opioid detoxification performed in non-medical settings under open label conditions are summarized involving an average daily use of heroin of .64 +/- .50 grams, primarily by the intravenous route. Resolution of the signs of opioid withdrawal without further drug seeking behavior was observed within 24 hours in 25 patients and was sustained throughout the 72-hour period of posttreatment observation. Other outcomes included drug seeking behavior without withdrawal signs (4 patients), drug abstinence with attenuated withdrawal signs (2 patients), drug seeking behavior with continued withdrawal signs (1 patient), and one fatality possibly involving surreptitious heroin use. The reported effectiveness of ibogaine in this series suggests the need for systematic investigation in a conventional clinical research setting. PMID:10506904

  14. Role of endogenous neuropeptides in the pathomechanism of alcohol addiction

    Directory of Open Access Journals (Sweden)

    Urszula Rudzińska

    2009-12-01

    Full Text Available Recent studies with endogenous neuropeptides have indicated their modulating role in the etiology of alcoholism. The role of endogenous opioids is relatively well known and there is growing evidence for a role of the appetite-regulating peptides leptin, ghrelin, neuropeptide Y, galanin, and orexins. It has been demonstrated that these peptides could also be involved in alcohol intake regulation and the occurrence of alcohol craving. Moreover, important significance is attached to corticotrophin-releasing factor, since an increased level of this peptide during alcohol withdrawal is responsible for the occurrence of anxiety behaviors. Knowledge of the processes tied with neuropeptides is needed in the search for more effective therapy for alcohol addiction as their actions could perhaps facilitate the search for new medicines which would adapt the therapy to the individual patient as well as contribute to increasing the effectiveness of alcohol addiction therapy.

  15. Clonidina como droga adjuvante no tratamento da síndrome de abstinência alcoólica em unidade de terapia intensiva: relato de caso Clonidina como droga coadyuvante en el tratamiento de la síndrome de abstinencia alcohólica en unidad de terapia intensiva: relato de un caso Clonidine as adjuvant therapy for alcohol withdrawal syndrome in intensive care unit: case report

    Directory of Open Access Journals (Sweden)

    Leandro Gobbo Braz

    2003-12-01

    alta de la UTI. CONCLUSIONES: La droga escogida para el tratamiento del síndrome de abstinencia alcohólico es el benzodiazepínico. No obstante, en el presente relato, solamente el uso coadyuvante de clonidina consiguió proporcionar tratamiento adecuado al paciente.BACKGROUND AND OBJECTIVES: Sedation of patients with past history of alcohol and drug abuse in Intensive Care Units (ICU is a challenge due to the high incidence of sedative drugs tolerance and withdrawal syndromes. This report aimed at describing a case of a young patient admitted to the ICU who developed alcohol withdrawal syndrome and tolerance to sedatives, resolved only after clonidine administration. CASE REPORT: Male patient, 18 years old, alcohol, tobacco, cocaine and marijuana abuser, victim of firearm accident, who was admitted to the ICU in the first post-enterectomy day, after gastric content aspiration during tracheal re-intubation. Clinical evolution was: vasoactive drugs up to the 4th day; bilateral bronchopneumonia with pleural effusion and need for artificial ventilation up to the 15th day. Initial sedation scheme was the association of midazolam and fentanyl. As from the 4th day, patient presented with several psychomotor agitation episodes, even after the association of lorazepam in the 6th day. In the 9th day, patient received the largest doses but remained agitated. Dexmedetomidine was associated, which has decreased other drug doses in 35% and has improved agitation. In the 12th day, midazolam and dexmedetomidine were replaced by propofol infusion with worsening of agitation. In the 13th day, clonidine was associated to the sedation scheme with total resolution of agitation. Propofol was withdrawn in the 14th day, fentanyl was maintained and midazolam infusion was restarted, with doses 75% and 65% lower as compared to peak doses of such drugs. Patient was extubated in the 15th day and was discharged from ICU. CONCLUSIONS: Benzodiazepines should remain the drugs of choice for the

  16. Alcoholism (image)

    Science.gov (United States)

    ... that interferes with physical or mental health, and social, family or job responsibilities. This addiction can lead to liver, circulatory and neurological problems. Pregnant women who drink alcohol in any amount ...

  17. Efficacy of Non-Pharmacological Interventions to Prevent and Treat Delirium in Older Patients: A Systematic Overview. The SENATOR project ONTOP Series.

    Directory of Open Access Journals (Sweden)

    Iosief Abraha

    Full Text Available Non-pharmacological intervention (e.g. multidisciplinary interventions, music therapy, bright light therapy, educational interventions etc. are alternative interventions that can be used in older subjects. There are plenty reviews of non-pharmacological interventions for the prevention and treatment of delirium in older patients and clinicians need a synthesized, methodologically sound document for their decision making.We performed a systematic overview of systematic reviews (SRs of comparative studies concerning non-pharmacological intervention to treat or prevent delirium in older patients. The PubMed, Cochrane Database of Systematic Reviews, EMBASE, CINHAL, and PsychINFO (April 28th, 2014 were searched for relevant articles. AMSTAR was used to assess the quality of the SRs. The GRADE approach was used to assess the quality of primary studies. The elements of the multicomponent interventions were identified and compared among different studies to explore the possibility of performing a meta-analysis. Risk ratios were estimated using a random-effects model. Twenty-four SRs with 31 primary studies satisfied the inclusion criteria. Based on the AMSTAR criteria twelve reviews resulted of moderate quality and three resulted of high quality. Overall, multicomponent non-pharmacological interventions significantly reduced the incidence of delirium in surgical wards [2 randomized trials (RCTs: relative risk (RR 0.71, 95% Confidence Interval (CI 0.59 to 0.86, I2=0%; (GRADE evidence: moderate] and in medical wards [2 CCTs: RR 0.65, 95%CI 0.49 to 0.86, I2=0%; (GRADE evidence: moderate]. There is no evidence supporting the efficacy of non-pharmacological interventions to prevent delirium in low risk populations (i.e. low rate of delirium in the control group[1 RCT: RR 1.75, 95%CI 0.50 to 6.10 (GRADE evidence: very low]. For patients who have developed delirium, the available evidence does not support the efficacy of multicomponent non

  18. Interrelationship of postoperative delirium and cognitive impairment and their impact on the functional status in older patients undergoing orthopaedic surgery: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Chih-Kuang Liang

    Full Text Available BACKGROUND: The impact of postoperative delirium on post-discharge functional status of older patients remains unclear, and little is known regarding the interrelationship between cognitive impairment and post-operative delirium. Therefore, the main purpose was to evaluate the post-discharge functional status of patients who experience delirium after undergoing orthopaedic surgery and the interrelationship of postoperative delirium with underlying cognitive impairment. METHOD: This prospective cohort study, conducted at a tertiary care medical center from April 2011 to March 2012, enrolled all subjects aged over 60 years who were admitted for orthopaedic surgery. The baseline characteristics (age, gender, BMI, and living arrangement, surgery-related factors (ASA class, admission type, type of surgery, and length of hospital stay, results of geriatric assessment (postoperative delirium, cognition, depressive mood, comorbidity, pain, malnutrition, polypharmacy, ADL, and instrumental [I]ADL and 1-12-month postoperative ADL and IADL functional status were collected for analysis. RESULTS: Overall, 9.1% of 232 patients (mean age: 74.7 ± 7.8 years experienced postoperative delirium, which was significantly associated with IADL decline at only 6 and 12 months postoperatively (RR: 6.22, 95% CI: 1.08-35.70 and RR: 12.54, 95% CI: 1.88-83.71, respectively. Delirium superimposed on cognitive impairment was a significant predictor for poor functional status at 6 and 12 months postoperatively (RR: 12.80, 95% CI: 1.65-99.40 for ADL at the 6th month, and RR: 7.96, 95% CI: 1.35-46.99 at the 12th month; RR: 13.68, 95% CI: 1.94-96.55 for IADL at the 6th month, and RR: 30.61, 95% CI: 2.94-318.54 at the 12th month, respectively. CONCLUSION: Postoperative delirium is predictive of IADL decline in older patients undergoing orthopaedic surgery, and delirium superimposed on cognitive impairment is an independent risk factor for deterioration of ADL and IADL functional

  19. Delirium (PDQ)

    Science.gov (United States)

    ... Español 1-800-4-CANCER Live Chat Publications Dictionary Menu Contact Dictionary Search About Cancer Causes and Prevention Risk Factors ... Contacts Other Funding Find NCI funding for small business innovation, technology transfer, and contracts Training Cancer Training ...

  20. Exploring the Utility of Ultra-Brief Delirium Assessments in a Nonintensive Care Geriatric Population: The GEM Study

    OpenAIRE

    Powers, James S.; Doering, Tracey; Gordon, Sharon; Svetlana K Eden; Shintani, Ayumi; Schnelle, John

    2012-01-01

    Objective: To determine how an ultra-brief structured tool that would require usually less than a minute for delirium assessment compares with a clinical assessment based on Diagnostic and Statistical Manual-IV (DSM-IV) in a geriatric postacute care (PAC) rehabilitation unit. Design: Prospective observational cohort study. Setting: Postacute geriatric hospital ward of a Veteran’s Affairs hospital. Participants: Consecutively admitted patients between 50 and 100 years old for inpatient postacu...

  1. Adjunctive valproic acid for delirium and/or agitation on a consultation-liaison service: A report of six cases

    OpenAIRE

    Bourgeois, James A. O.D., M.D.; Koike, A K; Simmons, J.E.; Telles, S; Eggleston, C

    2005-01-01

    The authors present six cases in which valproate was used in patients seen by a consultation-liaison service (CLS) to manage delirium and/or psychotic agitation. The intravenous (IV) preparation (Depacon, Abbott Laboratories) was used in two nothing by mouth (NPO) patients, while the liquid oral preparation (Depakene, Abbott Laboratories) was used via nasogastric tube (NGT) in the other patients. All of these cases had suboptimal responses and/or concerning side effects from conventional ther...

  2. SYSTEMIC INFLAMMATION IMPAIRS ATTENTION AND COGNITIVE FLEXIBILITY BUT NOT ASSOCIATIVE LEARNING IN AGED RATS: Possible Implications for Delirium

    OpenAIRE

    Culley, Deborah J.; Mary eSnayd; Baxter, Mark G.; Zhongcong eXie; In-Ho eLee; James eRudolph; Sharon eInouye; Edward eMarcantonio; Gregory eCrosby

    2014-01-01

    Delirium is a common and morbid condition in elderly hospitalized patients. Its pathophysiology is poorly understood but inflammation has been implicated based on a clinical association with systemic infection and surgery and preclinical data showing that systemic inflammation adversely affects hippocampus-dependent memory. However, clinical manifestations and imaging studies point to abnormalities not in the hippocampus but in cortical circuits. We therefore tested the hypothesis that system...

  3. Systemic Inflammation Impairs Attention and Cognitive Flexibility but Not Associative Learning in Aged Rats: Possible Implications for Delirium

    OpenAIRE

    Culley, Deborah J.; Snayd, Mary; Baxter, Mark G.; Xie, Zhongcong; Lee, In Ho; Rudolph, James; Inouye, Sharon K.; Marcantonio, Edward R.; Crosby, Gregory

    2014-01-01

    Delirium is a common and morbid condition in elderly hospitalized patients. Its pathophysiology is poorly understood but inflammation has been implicated based on a clinical association with systemic infection and surgery and preclinical data showing that systemic inflammation adversely affects hippocampus-dependent memory. However, clinical manifestations and imaging studies point to abnormalities not in the hippocampus but in cortical circuits. We therefore tested the hypothesis that system...

  4. Effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing dental treatment under general anesthesia

    OpenAIRE

    El Batawi, Hisham Yehia

    2015-01-01

    Aim: To investigate the possible effects of preoperative oral Midazolam on parental separation anxiety, emergence delirium, and post-anesthesia care unit time on children undergoing dental rehabilitation under general anesthesia. Methods: Randomized, prospective, double-blind study. Seventy-eight American Society of Anesthesiology (ASA) I children were divided into two groups of 39 each. Children of the first group were premedicated with oral Midazolam 0.5 mg/kg, while children of the control...

  5. Predictors and clinical outcomes of postoperative delirium after administration of dexamethasone in patients undergoing coronary artery bypass surgery

    Directory of Open Access Journals (Sweden)

    Davoud Mardani

    2012-01-01

    Full Text Available Background: Postoperative delirium (POD is one of the important complications of cardiac surgery and it is assumed to provoke inflammatory responses. Theoretically, anti-inflammatory effects of dexamethasone can have an influence on the incidence and outcomes of POD. The aim of our study was to assess POD predictors and outcomes of dexamethasone administration after cardiac surgery. Methods: Patients′ mental status was examined by mini-mental status examination and psychiatric interviewing to diagnose delirium. Subsequently, authors analyzed the patient variables for identification of predictors and outcomes of POD. Results: Between 196 patients who met the inclusion criteria, 34 (17.34% patients were delirious. History of chronic renal failure, obstructive pulmonary disease, smoking, and addiction strongly predicted development of POD. Other predictors were intra-aortic balloon pump insertion, transfusion of packed cells, and atrial fibrillation rhythm. In our study, the administration of dexamethasone significantly reduced the risk for POD. Furthermore, delirium was associated with longer intensive care unit (ICU stay. Conclusion: Our study reports the predictors of POD, which patients commonly facing them in cardiac surgery ICU. Appropriate management and prevention of these predictors, especially modifiable ones, can decrease the incident of POD and improves cognitive outcomes of cardiac surgeries.

  6. Withdrawal from Genetic Counselling for Cancer

    Directory of Open Access Journals (Sweden)

    Bleiker Eveline

    2005-02-01

    Full Text Available Abstract Background A substantial minority of individuals who initially apply for genetic counselling for breast/ovarian cancer withdraw at an early stage from the counselling process. This study investigated the self-reported reasons for early withdrawal and the factors associated significantly with such withdrawal. Methods Self-report questionnaires were mailed to 83 women who had applied for genetic counselling for breast/ovarian cancer but who subsequently withdrew from the counselling process (the "withdrawers". A comparison group of 105 women who had completed the genetic counselling (the "attendees" received a similar questionnaire. The questionnaire assessed sociodemographic characteristics, reasons for applying for genetic counselling, general distress (MHI-5, cancer-specific distress (IES, and cancer worries. For those women who discontinued the counselling, reasons for withdrawal were also assessed. Results The primary reasons given for withdrawing from counselling were difficulties in anticipating the consequences of genetic counselling (28%, and worries about being unable to adequately cope with an unfavourable test result (20%. Compared to the attendees, the withdrawers were significantly younger, more frequently asymptomatic, more often the first and only member of the family to apply for counselling, and less worried about cancer. Current levels of cancer-specific distress and general distress were comparable between the two groups. Conclusion Younger women, those without a history of cancer, and those who are first in their family to apply are more likely to withdraw prematurely from genetic counselling for breast/ovarian cancer. These withdrawers have no elevated levels of distress. However, a substantial percentage of individuals discontinue counselling due to concerns about their (inability to cope with a possible unfavourable test outcome. This suggests that greater attention should be paid to ways of coping with test

  7. Quantifying the clinical significance of cannabis withdrawal.

    Directory of Open Access Journals (Sweden)

    David J Allsop

    Full Text Available BACKGROUND AND AIMS: Questions over the clinical significance of cannabis withdrawal have hindered its inclusion as a discrete cannabis induced psychiatric condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM IV. This study aims to quantify functional impairment to normal daily activities from cannabis withdrawal, and looks at the factors predicting functional impairment. In addition the study tests the influence of functional impairment from cannabis withdrawal on cannabis use during and after an abstinence attempt. METHODS AND RESULTS: A volunteer sample of 49 non-treatment seeking cannabis users who met DSM-IV criteria for dependence provided daily withdrawal-related functional impairment scores during a one-week baseline phase and two weeks of monitored abstinence from cannabis with a one month follow up. Functional impairment from withdrawal symptoms was strongly associated with symptom severity (p=0.0001. Participants with more severe cannabis dependence before the abstinence attempt reported greater functional impairment from cannabis withdrawal (p=0.03. Relapse to cannabis use during the abstinence period was associated with greater functional impairment from a subset of withdrawal symptoms in high dependence users. Higher levels of functional impairment during the abstinence attempt predicted higher levels of cannabis use at one month follow up (p=0.001. CONCLUSIONS: Cannabis withdrawal is clinically significant because it is associated with functional impairment to normal daily activities, as well as relapse to cannabis use. Sample size in the relapse group was small and the use of a non-treatment seeking population requires findings to be replicated in clinical samples. Tailoring treatments to target withdrawal symptoms contributing to functional impairment during a quit attempt may improve treatment outcomes.

  8. 19 CFR 144.27 - Withdrawal from warehouse by transferee.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal from warehouse by transferee. 144.27...; DEPARTMENT OF THE TREASURY (CONTINUED) WAREHOUSE AND REWAREHOUSE ENTRIES AND WITHDRAWALS Transfer of Right To Withdraw Merchandise from Warehouse § 144.27 Withdrawal from warehouse by transferee. At any time...

  9. 2017-2022 Proposed Program - Withdrawal Areas

    Data.gov (United States)

    Bureau of Ocean Energy Management, Department of the Interior — This file represents the areas of the Outer Continental Shelf that have been withdrawn from disposition by leasing. The withdrawal of these areas prevents...

  10. Deconstructing dementia and delirium hospital practice: using cultural historical activity theory to inform education approaches.

    Science.gov (United States)

    Teodorczuk, Andrew; Mukaetova-Ladinska, Elizabeta; Corbett, Sally; Welfare, Mark

    2015-08-01

    Older patients with dementia and delirium receive suboptimal hospital care. Policy calls for more effective education to address this though there is little consensus on what this entails. The purpose of this clarification study is to explore how practice gaps are constructed in relation to managing the confused hospitalised older patient. The intent is to inform educational processes in the work-place beyond traditional approaches such as training. Adopting grounded theory as a research method and working within a social constructionist paradigm we explored the practice gaps of 15 healthcare professionals by interview and conducted five focus groups with patients, carers and Liaison mental health professionals. Data were thematically analysed by constant comparison and theoretical sampling was undertaken until saturation reached. Categories were identified and pragmatic concepts developed grounded within the data. Findings were then further analysed using cultural historical activity theory as a deductive lens. Practice gaps in relation to managing the confused older patient are determined by factors operating at individual (knowledge and skill gaps, personal philosophy, task based practice), team (leadership, time and ward environmental factors) and organisational (power relationships, dominance of medical model, fragmentation of care services) levels. Conceptually, practice appeared to be influenced by socio-cultural ward factors and compounded by a failure to join up existing "patient" knowledge amongst professionals. Applying cultural historical activity theory to further illuminate the findings, the central object is defined as learning about the patient and the mediating artifacts are the care relationships. The overarching medical dominance emerges as an important cultural historical factor at play and staff rules and divisions of labour are exposed. Lastly key contradictions and tensions in the system that work against learning about the patient are

  11. Episodic Withdrawal Promotes Psychomotor Sensitization to Morphine

    OpenAIRE

    Rothwell, Patrick E.; Gewirtz, Jonathan C.; Thomas, Mark J

    2010-01-01

    The relative intermittency or continuity of drug delivery is a major determinant of addictive liability, and also influences the impact of drug exposure on brain function and behavior. Events that occur during the offset of drug action (ie, acute withdrawal) may have an important role in the consequences of intermittent drug exposure. We assessed whether recurrent episodes of acute withdrawal contribute to the development of psychomotor sensitization in rodents during daily morphine exposure....

  12. On Auctions with Withdrawable Winning Bids

    OpenAIRE

    Michael H. Rothkopf

    1991-01-01

    This paper considers sealed bidding in which bidders may submit two or more bids and after the bids are opened may, perhaps at a cost, withdraw bids that are more aggressive than would be necessary to win. Such withdrawal strategies are sometimes followed, but currently are surreptitious. However, legitimization of them would create potentially useful market mechanisms of potential interest to government agencies. These market mechanisms are also of theoretical interest since they are interme...

  13. Delirium Accompanied by Cholinergic Deficiency and Organ Failure in a 73-Year-Old Critically Ill Patient: Physostigmine as a Therapeutic Option

    Directory of Open Access Journals (Sweden)

    Benedikt Zujalovic

    2015-01-01

    Full Text Available Delirium is a common problem in ICU patients, resulting in prolonged ICU stay and increased mortality. A cholinergic deficiency in the central nervous system is supposed to be a relevant pathophysiologic process in delirium. Acetylcholine is a major transmitter of the parasympathetic nervous system influencing several organs (e.g., heart and kidneys and the inflammatory response too. This perception might explain that delirium is not an individual symptom, but rather a part of a symptom complex with various disorders of the whole organism. The cholinergic deficiency could not be quantified up to now. Using the possibility of bedside determination of the acetylcholinesterase activity (AChE activity, we assumed to objectify the cholinergic homeostasis within minutes. As reported here, the postoperative delirium was accompanied by a massive hemodynamic and renal deterioration of unclear genesis. We identified the altered AChE activity as a plausible pathophysiological mechanism. The pharmacological intervention with the indirect parasympathomimetic physostigmine led to a quick and lasting improvement of the patient’s cognitive, hemodynamic, and renal status. In summary, severe delirium is not always an attendant phenomenon of critical illness. It might be causal for multiple organ deterioration if it is based on cholinergic deficiency and has to be treated at his pathophysiological roots whenever possible.

  14. Alcohol and Hepatitis C

    Science.gov (United States)

    ... code here Enter ZIP code here Daily Living: Alcohol for Veterans and the Public Alcohol and Hepatitis: Entire Lesson Overview Alcohol is one ... related to choices you make about your lifestyle . Alcohol and fibrosis Fibrosis is the medical term for ...

  15. Alcohol use disorder

    Science.gov (United States)

    Alcohol dependence; Alcohol abuse; Problem drinking; Drinking problem; Alcohol addiction ... No one knows what causes problems with alcohol. Health experts think that ... Psychology, such as being impulsive or having low self- ...

  16. Alcohol and pregnancy

    Science.gov (United States)

    Drinking alcohol during pregnancy ... When a pregnant woman drinks alcohol, the alcohol travels through her blood and into the baby's blood, tissues, and organs. Alcohol breaks down much more slowly in ...

  17. Fetal Alcohol Syndrome

    Science.gov (United States)

    ... Condiciones Chinese Conditions Fetal Alcohol Syndrome Read in Chinese What is Fetal Alcohol Syndrome (FAS)? Fetal Alcohol Syndrome (FAS) describes changes in a baby born to a mother whose pregnancy was complicated by alcohol consumption. A broader term ...

  18. Alcohol-Specific Coping Styles of Adult Children of Individuals with Alcohol Use Disorders and Associations with Psychosocial Functioning.

    Science.gov (United States)

    Drapkin, Michelle L; Eddie, David; Buffington, Angela J; McCrady, Barbara S

    2015-07-01

    Parental alcohol use disorders (AUDs) have been conceptualized as a chronic stressor that can lead to deleterious long-term outcomes in children of individuals with AUDs. Yet, while many individuals are detrimentally affected by their parents' problematic alcohol use, and go on to manifest psychological problems, others do not. How individuals cope with the stress of having a parent with an AUD is believed to be an important moderator of this differential outcome. This study assessed whether individuals' alcohol-specific coping styles predicted alcohol use, positive or negative life events, and depression, using a sample of 465 college students, of whom 20% were adult children of individuals with alcohol use disorders, colloquially known as adult children of alcoholics (ACOAs), and a battery of well-validated, self-report measures. Participant ACOAs reported less 'engaged' and 'total' alcohol-specific coping strategies and more 'withdrawal' alcohol-specific coping strategies than their non adult children of alcoholics (NACOAs) counterparts. Across participants, women reported more 'engaged', 'tolerant/inactive', and 'total' coping than men. Although ACOAs reported significantly more negative life events, which predicted more passive coping styles, they did not differ significantly from NACOAs on measures of problematic alcohol use or depression, supporting theories of resilience in ACOAs regardless of their alcohol-specific coping styles. For NACOAs, 'tolerant' coping predicted greater depression and alcohol-related problems; 'engaged' coping predicted fewer alcohol problems. Results suggest that ACOAs cope differently with problematic alcohol use among relatives and friends compared with NACOAs and are more likely to experience negative life events. Additionally, alcohol-related coping strategies have more predictive utility in NACOAs than ACOAs. PMID:25802055

  19. Effects of Intraoperative Hemodynamics on Incidence of Postoperative Delirium in Elderly Patients: A Retrospective Study.

    Science.gov (United States)

    Yang, Lin; Sun, De-Feng; Han, Jun; Liu, Ruochuan; Wang, Li-Jie; Zhang, Zhen-Zhen

    2016-01-01

    BACKGROUND Postoperative delirium (POD) is a common complication in the elderly. This retrospective study investigated the effect of intraoperative hemodynamics on the incidence of POD in elderly patients after major surgery to explore ways to reduce the incidence of POD. MATERIAL AND METHODS Based on the incidence of POD, elderly patients (81±6 y) were assigned to a POD (n=137) or non-POD group (n=343) after elective surgery with total intravenous anesthesia. POD was diagnosed based on the guidelines of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), using the confusion assessment method. The hemodynamic parameters, such as mean arterial pressure, were monitored 10 min before anesthesia (baseline) and intraoperatively. The incidence of intraoperative hypertension, hypotension, tachycardia, and bradycardia were calculated. RESULTS At 30 min and 60 min after the initiation of anesthesia and at the conclusion of surgery, the monitored hemodynamic parameter values of the POD group, but not those of the non-POD group, were significantly higher than at baseline. Multivariate logistic regression analysis showed that intraoperative hypertension and tachycardia were significantly associated with POD. CONCLUSIONS Intraoperative hypertension and tachycardia were significantly associated with POD. Maintaining intraoperative stable hemodynamics may reduce the incidence of POD in elderly patients undergoing surgery. PMID:27038856

  20. A neurologist's approach to delirium: diagnosis and management of toxic metabolic encephalopathies.

    Science.gov (United States)

    Krishnan, Vaishnav; Leung, Lester Y; Caplan, Louis R

    2014-02-01

    Toxic metabolic encephalopathies (TMEs) present as an acute derangement in consciousness, cognition and behavior, and can be brought about by various triggers, including endocrine and metabolic disturbances, exogenous toxins, pain and infection. Also referred to as "delirium" or "acute confusional states," TMEs are characterized by (1) an altered level of consciousness and activity, (2) global changes in cognition with inattention, (3) a fluctuating course with disturbances in the sleep-wake cycle, and (4) asterixis and myoclonus. The pathophysiology of this syndrome is poorly understood. Imbalanced neurotransmitter signaling and pathologically heightened brain inflammatory cytokine signaling have been proposed as candidate mechanisms. Focal brain lesions can also occasionally mimic TMEs. A neurological examination is required to identify the presence of focal findings, which when present, identify a new focal lesion or the recrudescence of prior ischemic, inflammatory or neoplastic insults. Diagnostic testing must include a search for metabolic and infectious derangements. Offending medications should be withdrawn. Magnetic resonance imaging, cerebrospinal fluid analysis and electroencephalography should be considered in select clinical situations. In addition to being an unpleasant experience for the patient and family, this condition is associated with extended hospital stays, increased mortality and high costs. In individuals with diminished cognitive reserve, episodes of TME lead to an accelerated decline in cognitive functioning. Starting with an illustrative case, this paper provides a neurologist's approach to the diagnosis, differential diagnosis and management of toxic metabolic encephalopathies. PMID:24332366

  1. Carisoprodol: abuse potential and withdrawal syndrome.

    Science.gov (United States)

    Reeves, Roy R; Burke, Randy S

    2010-03-01

    Carisoprodol (N-isopropyl-2 methyl-2-propyl-1,3-propanediol dicarbamate; N-isopropylmeprobamate) is a centrally acting skeletal muscle relaxant whose primary active metabolite is meprobamate, a substance with well established abuse potential similar to that of benzodiazepines. A number of reports show that carisoprodol has been abused for its sedative and relaxant effects, to augment or alter the effects of other drugs, and by the intentional combination of carisoprodol and other noncontrolled medications because of the relative ease (as compared to controlled substances) of obtaining prescriptions. The diversion and abuse of carisoprodol and its adverse health effects appear to have dramatically increased over the last several years. Clinicians have begun to see a withdrawal syndrome consisting of insomnia, vomiting, tremors, muscle twitching, anxiety, and ataxia in patients who abruptly cease intake of large doses of carisoprodol. Hallucinations and delusions may also occur. The withdrawal symptoms are very similar to those previously described for meprobamate withdrawal, suggesting that what may actually be occurring is withdrawal from meprobamate accumulated as a result of intake of excessive amounts of carisoprodol. However carisoprodol itself is capable of modulating GABA(A) function, and this may contribute both to the drugs abuse potential and to the occurrence of a withdrawal syndrome with abrupt cessation of intake. Carisoprodol has been classified as a controlled substance in several states in the US and restrictions on the use of the drug have been imposed in some European countries. Carisoprodol is metabolized to a controlled substance, has clear evidence of abuse potential and increasing incidence of abuse, and has shown evidence of a withdrawal syndrome with abrupt cessation from intake. This article will discuss the abuse potential of carisoprodol and the associated withdrawal syndrome, and consider implications for future use of the drug. PMID

  2. Intra-administration associations and withdrawal symptoms: morphine-elicited morphine withdrawal.

    Science.gov (United States)

    McDonald, Robert V; Siegel, Shepard

    2004-02-01

    On the basis of a conditioning analysis, some drug "withdrawal symptoms" are conditional responses elicited by stimuli paired with the drug effect. Prior demonstrations of conditional elicitation of withdrawal symptoms evaluated the role of environmental cues; however, pharmacological cues also typically signal a drug effect. Within each administration, early drug onset cues (DOCs) may become associated with the later, larger drug effect (intra-administration associations). This experiment evaluated the contribution of intra-administration associations to withdrawal symptoms. The results indicated that (a). 5 mg/kg morphine elicited behavioral and thermic withdrawal symptoms in rats previously injected on a number of occasions with 50 mg/kg morphine and that (b). DOC-elicited withdrawal symptoms are not a sensitized response to the opiate but rather an associative phenomenon. PMID:14769091

  3. Rol de enfermería en la prevención del delirium en ancianos hospitalizados con fractura de cadera. Recomendaciones generales.

    OpenAIRE

    Carrera Castro, Carmen

    2012-01-01

    Se realiza una revisión bibliográfica de la literatura en las principales bases biomédicas para identificar cuáles son los factores de riesgo modificables o controlables en ancianos hospitalizados con fractura de cadera, susceptible de padecer delirium, y crear un Plan de Actuación de Recomendaciones de Enfermería desde el ingreso hasta el alta en la unidad, basándonos en la prevención, con el propósito de fomentar el descenso en la frecuencia y consecuencias desfavorables del delirium. So...

  4. Atividade basal de acetilcolinesterase e níveis plasmáticos de serotonina não se associam ao delirium em pacientes gravemente enfermos

    Directory of Open Access Journals (Sweden)

    Cristiane Damiani Tomasi

    2015-06-01

    Full Text Available RESUMO Objetivo: Investigar se os níveis plasmáticos de serotonina e atividade de acetilcolinesterase determinados por ocasião da admissão à unidade de terapia intensiva preveem a ocorrência de disfunção cerebral aguda em pacientes internados em unidade de terapia intensiva. Métodos: Foi conduzido no período entre maio de 2009 e setembro de 2010 um estudo prospectivo de coorte em uma amostra com 77 pacientes não consecutivos. A ocorrência de delirium foi determinada utilizando a ferramenta Confusion Assessment Method for the Intensive Care Unit, tendo sido determinadas as avaliações de acetilcolinesterase e serotonina em amostras de sangue coletadas até um máximo de 24 horas após admissão do paciente à unidade de terapia intensiva. Resultados: No presente estudo, 38 pacientes (49,6% desenvolveram delirium durante sua permanência na unidade de terapia intensiva. Nem os níveis de atividade de acetilcolinesterase nem os de serotonina tiveram associação independente com delirium. Não se observaram correlações significantes entre atividade de acetilcolinesterase e níveis de serotonina com o número de dias livres de delirium/coma, porém, em pacientes que desenvolveram delirium, ocorreu uma forte correlação negativa entre níveis de acetilcolinesterase e número de dias livres de delirium/coma, demonstrando que níveis mais elevados de acetilcolinesterase se associaram com menos dias de vida sem delirium e coma. Nenhuma associação foi identificada entre os biomarcadores e mortalidade. Conclusão: Nem a atividade de acetilcolinesterase nem os níveis séricos de serotonina se associaram com delirium ou disfunção cerebral aguda em pacientes gravemente enfermos. A ocorrência de sepse não modificou esse relacionamento.

  5. Study protocol for the recreational stimulation for elders as a vehicle to resolve delirium superimposed on dementia (Reserve For DSD trial

    Directory of Open Access Journals (Sweden)

    Leslie Doug

    2011-05-01

    Full Text Available Abstract Background Delirium is a state of confusion characterized by an acute and fluctuating decline in cognitive functioning. Delirium is common and deadly in older adults with dementia, and is often referred to as delirium superimposed on dementia, or DSD. Interventions that treat DSD are not well-developed because the mechanisms involved in its etiology are not completely understood. We have developed a theory-based intervention for DSD that is derived from the literature on cognitive reserve and based on our prior interdisciplinary work on delirium, recreational activities, and cognitive stimulation in people with dementia. Our preliminary work indicate that use of simple, cognitively stimulating activities may help resolve delirium by helping to focus inattention, the primary neuropsychological deficit in delirium. Our primary aim in this trial is to test the efficacy of Recreational Stimulation for Elders as a Vehicle to resolve DSD (RESERVE- DSD. Methods/Design This randomized repeated measures clinical trial will involve participants being recruited and enrolled at the time of admission to post acute care. We will randomize 256 subjects to intervention (RESERVE-DSD or control (usual care. Intervention subjects will receive 30-minute sessions of tailored cognitively stimulating recreational activities for up to 30 days. We hypothesize that subjects who receive RESERVE-DSD will have: decreased severity and duration of delirium; greater gains in attention, orientation, memory, abstract thinking, and executive functioning; and greater gains in physical function compared to subjects with DSD who receive usual care. We will also evaluate potential moderators of intervention efficacy (lifetime of complex mental activities and APOE status. Our secondary aim is to describe the costs associated with RESERVE-DSD. Discussion Our theory-based intervention, which uses simple, inexpensive recreational activities for delivering cognitive stimulation

  6. Characterization of an alcohol addiction-prone phenotype in mice.

    Science.gov (United States)

    Radwanska, Kasia; Kaczmarek, Leszek

    2012-05-01

    Human studies indicate that high impulsivity, novelty seeking and anxiety predispose individuals to alcohol abuse. Unclear, however, is whether the same phenotypes can be observed in laboratory animals prone to uncontrolled alcohol drinking. To characterize a novelty-seeking trait, anxiety, impulsivity, compulsivity and the motivation for natural rewards in mice, numerous tests were performed in the automated IntelliCage learning system. The same mice then had extended access to alcohol for 70 days, followed by the evaluation of addiction-like behaviors, including (1) the motivation for alcohol in a progressive-ratio schedule of reinforcement; (2) persistent and compulsive alcohol seeking and taking during signaled 'no alcohol' periods and (3) when subjected to punishment; and (4) the intensity of relapse after alcohol withdrawal. Our data suggest that high levels of anxiety-related traits (i.e. low novelty seeking, low resistance to punishment and a high level of compulsive behaviors) and high impulsivity predict addiction-like alcohol drinking in mice. Future studies are, however, warranted to create a valid model of alcohol addiction in mice in the IntelliCage system. PMID:22017485

  7. Alcohol Consumption and Alcohol Advertising Bans

    OpenAIRE

    Henry Saffer

    2000-01-01

    The purpose of this paper is to empirically examine the relationship between alcohol advertising bans and alcohol consumption. Most prior studies have found no effect of advertising on total alcohol consumption. A simple economic model is provided which explains these prior results. The data set used in this study is a pooled time series of data from 20 countries over 26 years. The empirical model is a simultaneous equations system which treats both alcohol consumption and alcohol advertising...

  8. Cyclosporine alters opiate withdrawal in rodents.

    Science.gov (United States)

    Dafny, N; Wagle, V G; Drath, D B

    1985-05-01

    Opiates exert numerous effects on all levels of the central nervous system with tolerance, physical dependence and withdrawal being characteristics of this drug class. The degree of dependence is directly correlated to the intensity of withdrawal. Therefore, success in modifying the withdrawal syndrome may shed light on the dynamics of opiate addiction. The present study demonstrates that cyclosporine, a widely used immunosuppressive drug, considerably modified the behavioral signs of a naloxone-induced abstinence syndrome in morphine-addicted rats. In previous experiments, alpha-interferon has shown similar results. The similarity in actions of these two immunomodulator drugs is discussed and we suggest that opiate addiction may involve the immune system. PMID:4039025

  9. Children's judgements of social withdrawal behaviours.

    Science.gov (United States)

    Watling, Dawn

    2015-06-01

    Ding et al. (Brit. J. Dev. Psychol., 2015; 33, 159-173) demonstrated that Chinese children discriminate between the three subtypes of social withdrawal: Shyness, unsociability, and social avoidance. This commentary on the Ding et al.'s paper highlights the need to further explore the following: (1) children's understanding of the implications of being shy, unsociable, or socially avoidant, including assessing these which we know are associated with outcomes for socially withdrawn children; (2) what additional subtypes might exist naturally within the Chinese culture; and (3) consider the implications of social withdrawal on children's developing social skills. PMID:25853224

  10. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    Directory of Open Access Journals (Sweden)

    Chin Yee Cheong

    2016-06-01

    Full Text Available Background/Aims: The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT programme on mood and engagement in older patients with delirium and/or dementia (PtDD in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods: Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4 were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy on 3 consecutive days: day 1 (control condition without music and days 2 and 3 (with CMT. Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES and Observed Emotion Rating Scale (OERS. Results: Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01 in MPES and pleasure and general alertness (Z = 3.188,p = 0.01 in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014. Negative engagement (Z = 2.582, p = 0.01 and affect (Z = 2.004, p = 0.045 were both lower during CMT compared to no music. Conclusion: These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation.

  11. Restraint related deaths and excited delirium syndrome in Ontario (2004-2011).

    Science.gov (United States)

    Michaud, Alain

    2016-07-01

    Restraint related death in individuals in excited delirium syndrome (ExDS) is a rare event that has been the subject of controversies for more than 3 decades. The purpose of this retrospective study was to retrieve data on all restraint related deaths (RRD) that occurred in Ontario during an 8-year period and compare them with an earlier study on RRD in ExDS covering the period 1988-1995 in Ontario. The Office of the Chief Coroner of Ontario website was consulted under verdicts and recommendations. The Canadian Legal Information Institute website was used to consult verdict explanations and coroner's summary of evidence. During the period 2004-2011, RRD occurred in 14 individuals in ExDS, a 33% reduction. Psychiatric illness as a cause of ExDS decreased from 57% to 14%. Cocaine was the cause of ExDS in 11 (79%) individuals. The number of RRD following a violent encounter in cocaine-induced ExDS (8) was identical in the 2 periods. RRD occurred in 6 individuals without ExDS following a violent encounter. Final restraint position preceding cardiorespiratory arrest was available in 36% of individuals with ExDS and 83% of individuals without ExDS. In both groups, cardiorespiratory arrests could be classified as immediate or delayed. All 4 individuals without ExDS who had immediate cardiorespiratory arrests were restrained in the prone position. Delayed cardiorespiratory arrest occurred in the non-prone position in both groups. Although many hypotheses may be put forward to explain changes in the epidemiology of RRD in ExDS in Ontario, multiple warnings and recommendations from coroners' inquests cannot be ignored. There is probably not a unique pathophysiological pathway leading to cardiorespiratory arrest in RRD. The death rate in RRD in ExDS is so low that drawing any conclusions based on statistical studies or on isolated case report could be hazardous. PMID:27126837

  12. Creative Music Therapy in an Acute Care Setting for Older Patients with Delirium and Dementia

    Science.gov (United States)

    Cheong, Chin Yee; Tan, Jane An Qi; Foong, Yi-Lin; Koh, Hui Mien; Chen, Denise Zhen Yue; Tan, Jessie Joon Chen; Ng, Chong Jin; Yap, Philip

    2016-01-01

    Background/Aims The acute hospital ward can be unfamiliar and stressful for older patients with impaired cognition, rendering them prone to agitation and resistive to care. Extant literature shows that music therapy can enhance engagement and mood, thereby ameliorating agitated behaviours. This pilot study evaluates the impact of a creative music therapy (CMT) programme on mood and engagement in older patients with delirium and/or dementia (PtDD) in an acute care setting. We hypothesize that CMT improves engagement and pleasure in these patients. Methods Twenty-five PtDD (age 86.5 ± 5.7 years, MMSE 6/30 ± 5.4) were observed for 90 min (30 min before, 30 min during, and 30 min after music therapy) on 3 consecutive days: day 1 (control condition without music) and days 2 and 3 (with CMT). Music interventions included music improvisation such as spontaneous music making and playing familiar songs of patient's choice. The main outcome measures were mood and engagement assessed with the Menorah Park Engagement Scale (MPES) and Observed Emotion Rating Scale (OERS). Results Wilcoxon signed-rank test showed a statistically significant positive change in constructive and passive engagement (Z = 3.383, p = 0.01) in MPES and pleasure and general alertness (Z = 3.188,p = 0.01) in OERS during CMT. The average pleasure ratings of days 2 and 3 were higher than those of day 1 (Z = 2.466, p = 0.014). Negative engagement (Z = 2.582, p = 0.01) and affect (Z = 2.004, p = 0.045) were both lower during CMT compared to no music. Conclusion These results suggest that CMT holds much promise to improve mood and engagement of PtDD in an acute hospital setting. CMT can also be scheduled into the patients' daily routines or incorporated into other areas of care to increase patient compliance and cooperation. PMID:27489560

  13. The Low-Frequency Oscillation Model of Hallucinations in Neurodegenerative Disorders and in Delirium

    Directory of Open Access Journals (Sweden)

    Grzegorz R. Juszczak

    2011-01-01

    Full Text Available Electroencephalography (EEG found in dementia with Lewy bodies, Parkinson's disease, Alzheimer's disease and delirium, is characterized by increased power of delta and theta frequencies with the degree of EEG slowing parallel to the frequency of hallucinations occurrence. According to the proposed model of hallucination, pathological low-frequency oscillations may interfere with information processing in two different ways leading to hallucinations. First, pathological low-frequency oscillations may be a source of signal noise, which is next transformed into emotionally charged signal. The filtering of the signal noise may depend on differences in synaptic weights between networks storing representations of emotionally charged and neutral objects. Initially filtered signal can be next reinforced by attention leading to hallucinations. Second, there is growing body of evidence that theta oscillations in distributed cortical networks participate in mechanism of working memory. Therefore, pathological low-frequency oscillations may interfere with the mechanisms of working memory leading to excessive activation of memory traces and to the intrusion of memories into consciousness. The assumption that neuronal representations of emotionally relevant and neutral objects differ in synaptic strengths is supported by studies showing enhanced memory for emotional stimuli. The model is also supported by experiments showing that perception of feared object is facilitated by stimulus-driven, involuntary and automatic recruitment of attention. Consistently with the model, hallucinations are most often unpleasant and emotionally irrelevant objects are rarely hallucinated in neurodegenerative disorders. Proposed disturbances of visual working memory are consistent with the high incidence of palinopsia (perseveration of previously viewed objects after a certain time in demented patients. The significance of the model for understanding hallucinations that occur in

  14. 17 CFR 41.47 - Withdrawal of margin.

    Science.gov (United States)

    2010-04-01

    ... PRODUCTS Customer Accounts and Margin Requirements § 41.47 Withdrawal of margin. (a) By the customer... after such withdrawal is sufficient to satisfy the required margin for the security futures and...

  15. 48 CFR 14.303 - Modification or withdrawal of bids.

    Science.gov (United States)

    2010-10-01

    ... CONTRACTING METHODS AND CONTRACT TYPES SEALED BIDDING Submission of Bids 14.303 Modification or withdrawal of... for the bid. (c) Upon withdrawal of an electronically transmitted bid, the data received shall not...

  16. ANALYSIS OF THE RANGE OF MEDICINES FOR THE PHARMACEUTICAL CORRECTION OF THE ALCOHOL TREMOR IN THE STRUCTURE OF ABSTINENT ALCOHOL DEPENDENCE SYNDROME

    Directory of Open Access Journals (Sweden)

    Shapovalov V.V. (Jr.

    2015-05-01

    Full Text Available Established that the use of psychoactive substances may lead to premature death. The most commonly used psychoactive substance is alcohol. The authors had previously been justified and suggested for implementation in the practice of medicine cupping method alcoholic tremor in the structure of withdrawal symptoms in alcohol dependence. The article presents an analysis of drugs for the pharmaceutical correction of the alcoholic tremor in the structure of withdrawal symptoms, which are included in the patent of the pharmaceutical correction for the alcohol dependence. According to the international ATC classification included 5 ATC codes clinical and pharmacological groups: "A", "B", "C», «N», «S». The analysis found that in circulation in the pharmaceutical market of Ukraine for the pharmacotherapy of alcohol dependence are mainly domestic remedies (23 pharmaceutical manufacturer that provide the range of nosology at 88.0%. The next step in the analysis was to determine the types of dosage forms used for the pharmacotherapy of alcohol dependence. Found that the dosage means presented in the form of injection solutions and infusion (36.0%, powders for the preparation of solution (suspension for ingestion (36.0% in the form of tablets or capsules (28.0%. At the last stage analyzed registration certificates and found that the registration for the medicines for pharmacotherapy of alcohol dependence are 2015 four international nonproprietary names (8 drugs until 2019 in 4 international nonproprietary names (11 drugs.

  17. Tobacco Withdrawal Symptoms Mediate Motivation to Reinstate Smoking During Abstinence

    OpenAIRE

    Aguirre, Claudia; Madrid, Jillian; Leventhal, Adam M.

    2015-01-01

    Withdrawal-based theories of addiction hypothesize that motivation to reinstate drug use following acute abstinence is mediated by withdrawal symptoms. Experimental tests of this hypothesis in the tobacco literature are scant and may be subject to methodological limitations. This study utilized a robust within-subject laboratory experimental design to investigate the extent to which composite tobacco withdrawal symptomatology level and three unique withdrawal components (i.e., low positive af...

  18. 19 CFR 144.36 - Withdrawal for transportation.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal for transportation. 144.36 Section 144... § 144.36 Withdrawal for transportation. (a) Time limit. Merchandise may be withdrawn from warehouse for transportation to another port of entry if withdrawal for consumption or exportation can be accomplished at...

  19. Teachers' Withdrawal Behaviors and Their Relationship with Work Ethic

    Science.gov (United States)

    Erdemli, Özge

    2015-01-01

    Problem Situation: People experience ups and downs in their job satisfaction and motivation levels at different points of their work lives for various reasons. One of the outputs of low job satisfaction and motivation is defined as "withdrawal behaviors" in the literature. Withdrawal behaviors are any employee behavior of withdrawal from…

  20. Alcohol Use Disorders

    Science.gov (United States)

    ... this Section Genetics of Alcohol Use Disorder Alcohol Use Disorder Problem drinking that becomes severe is given the medical diagnosis of “alcohol use disorder” or AUD. Approximately 7.2 percent or ...

  1. Breath alcohol test

    Science.gov (United States)

    Alcohol test - breath ... There are various brands of breath alcohol tests. Each one uses a different method to test the level of alcohol in the breath. The machine may be electronic or manual. One ...

  2. Alcoholic liver disease

    Science.gov (United States)

    Liver disease due to alcohol; Cirrhosis or hepatitis - alcoholic; Laennec's cirrhosis ... Alcoholic liver disease occurs after years of heavy drinking. Over time, scarring and cirrhosis can occur. Cirrhosis is the ...

  3. Fetal alcohol syndrome

    Science.gov (United States)

    Alcohol in pregnancy; Alcohol-related birth defects; Fetal alcohol effects; FAS ... the baby is in the womb and after birth Decreased muscle tone and ... Heart defects such as ventricular septal defect (VSD) or atrial ...

  4. Sodium Valproate Withdrawal Correlates with Reduced Aggression

    Science.gov (United States)

    Pritchard, Duncan; Hoerger, Marguerite; Dyer, Tim; Graham, Nicola; Penney, Heather; Mace, F. Charles

    2014-01-01

    People with learning disabilities are sometimes prescribed psychotropic medication to help manage their challenging behaviour. This case study describes how a multicomponent behavioural intervention in conjunction with the systematic withdrawal of sodium valproate was strongly correlated with reduced aggression. No symptoms of bipolar disorder or…

  5. Design of withdrawal-weighted SAW filters.

    Science.gov (United States)

    Lee, Youngjin; Lee, Seunghee; Roh, Yongrae

    2002-03-01

    This paper presents a new design algorithm for a withdrawal-weighted surface acoustic wave (SAW) transversal filter. The proposed algorithm is based on the effective transmission loss theory and a delta function model of a SAW transversal filter. The design process consists of three steps, which eventually determine eight geometrical design parameters for the filter in order to satisfy given performance specifications. First, the number of fingers in the input and output interdigital transducers (IDTs), plus their geometrical sizes is determined using the insertion loss specification. Second, the number and positions of the polarity reverses in the output IDT are determined using the bandwidth and ripple specifications. Third, the number and position for withdrawing and switching specific fingers in the output IDT and attached electrode area are determined to achieve the desired sidelobe level. The efficiency of the technique is illustrated using a sample design of an IF filter consisting of a uniform input IDT and withdrawal-weighted output IDT. The proposed algorithm is distinct from conventional techniques in that it can optimize the structural geometry of a withdrawal-weighted SAW filter in a direct manner by considering all the performance specifications simultaneously. PMID:12322883

  6. 31 CFR 103.84 - Withdrawing requests.

    Science.gov (United States)

    2010-07-01

    ... 31 Money and Finance: Treasury 1 2010-07-01 2010-07-01 false Withdrawing requests. 103.84 Section 103.84 Money and Finance: Treasury Regulations Relating to Money and Finance FINANCIAL RECORDKEEPING AND REPORTING OF CURRENCY AND FOREIGN TRANSACTIONS Administrative Rulings § 103.84...

  7. Genetics and alcoholism

    OpenAIRE

    Edenberg, Howard J.; Foroud, Tatiana

    2013-01-01

    Alcohol is widely consumed, but excessive use creates serious physical, psychological and social problems and contributes to many diseases. Alcoholism (alcohol dependence, alcohol use disorders) is a maladaptive pattern of excessive drinking leading to serious problems. Abundant evidence indicates that alcoholism is a complex genetic disease, with variations in a large number of genes affecting risk. Some of these genes have been identified, including two genes of alcohol me...

  8. ALCOHOL AND ARTERIAL HYPERTENSION

    Directory of Open Access Journals (Sweden)

    O. D. Ostroumova

    2015-09-01

    Full Text Available The article considers the questions of the relationship between the amount of the consumed alcohol, the type of alcoholic beverage, pattern of alcohol consumption and the blood pressure level. The article presents data on the positive effect of alcohol intake restrictions and recommendations for permissible limits of alcohol consumption. New possibilities of drug therapy aimed at limiting alcohol consumption are being reported.

  9. Alcoholism and alcohol drinking habits predicted from alcohol dehydrogenase genes

    DEFF Research Database (Denmark)

    Tolstrup, Janne Schurmann; Nordestgaard, Børge Grønne; Rasmussen, Søren;

    2008-01-01

    Alcohol drinking habits and alcoholism are partly genetically determined. Alcohol is degraded primarily by alcohol dehydrogenase (ADH) wherein genetic variation that affects the rate of alcohol degradation is found in ADH1B and ADH1C. It is biologically plausible that these variations may...... be associated with alcohol drinking habits and alcoholism. By genotyping 9080 white men and women from the general population, we found that men and women with ADH1B slow vs fast alcohol degradation drank more alcohol and had a higher risk of everyday drinking, heavy drinking, excessive drinking...... and of alcoholism. For example, the weekly alcohol intake was 9.8 drinks (95% confidence interval (CI): 9.1-11) among men with the ADH1B.1/1 genotype compared to 7.5 drinks (95% CI: 6.4-8.7) among men with the ADH1B.1/2 genotype, and the odds ratio (OR) for heavy drinking was 3.1 (95% CI: 1.7-5.7) among men...

  10. Delirium em pacientes na unidade de terapia intensiva submetidos à ventilação não invasiva: um inquérito multinacional

    Directory of Open Access Journals (Sweden)

    Lilian Maria Sobreira Tanaka

    2015-12-01

    Full Text Available RESUMO Objetivos: Conduzir um inquérito multinacional com profissionais de unidades de terapia intensiva para determinar as práticas relacionadas à avaliação e ao manejo do delirium, bem como as percepções e as atitudes relacionadas à avaliação e ao impacto do delirium em pacientes submetidos à ventilação não invasiva. Métodos: Foi elaborado um questionário eletrônico para avaliar o perfil dos respondedores e das unidades de terapia intensiva a eles relacionadas; a realização de avaliação sistemática e a forma de manejo do delirium; e as percepções e condutas dos profissionais com relação à presença de delirium em pacientes submetidos à ventilação não invasiva. O questionário foi distribuído por meio da mala direta de correio eletrônico da rede de cooperação em pesquisa clínica da Associação de Medicina Intensiva Brasileira (AMIB-Net e para pesquisadores em diferentes centros da América Latina e Europa. Resultados: Foram analisados 436 questionários que, em sua maioria, eram provenientes do Brasil (61,9%, seguidos por Turquia (8,7% e Itália (4,8%. Aproximadamente 61% dos respondedores relataram não proceder à avaliação de delirium na unidade de terapia intensiva, enquanto 31% a realizavam em pacientes submetidos à ventilação não invasiva. Confusion Assessment Method for the Intensive Care Unit foi a ferramenta diagnóstica validada mais frequentemente citada (66,9%. Com relação à indicação de ventilação não invasiva para pacientes em delirium, 16,3% dos respondedores nunca permitiam o uso de ventilação não invasiva neste contexto clínico. Conclusão: Este inquérito fornece dados que enfatizam a escassez de esforços direcionados à avaliação e ao manejo do delirium no ambiente da terapia intensiva, em especial nos pacientes submetidos à ventilação não invasiva.

  11. National Institute on Alcohol Abuse and Alcoholism

    Science.gov (United States)

    ... begins January 23 Event registration opens today; new teacher resources... New & Noteworthy August 22, 2016 Fact Sheet: ... Events Sep 15 National Advisory Council on Alcohol Abuse and Alcoholism Nov 11 Frontiers in Addiction Research ...

  12. Health risks of alcohol use

    Science.gov (United States)

    Alcoholism - risks; Alcohol abuse - risks; Alcohol dependence - risks; Risky drinking ... Beer, wine, and liquor all contain alcohol. If you are drinking any of these, you are using alcohol. Your drinking patterns may vary, depending on who you are with ...

  13. Health risks of alcohol use

    Science.gov (United States)

    Alcoholism - risks; Alcohol abuse - risks; Alcohol dependence - risks; Risky drinking - risks ... Beer, wine, and liquor all contain alcohol. If you are drinking any of these, you are using alcohol. Your drinking patterns may vary, depending on who you are with ...

  14. Alcoholism and alcohol drinking habits predicted from alcohol dehydrogenase genes

    DEFF Research Database (Denmark)

    Tolstrup, J.S.; Nordestgaard, Børge; Rasmussen, S.;

    2008-01-01

    Alcohol is degraded primarily by alcohol dehydrogenase (ADH) wherein genetic variation that affects the rate of alcohol degradation is found in ADH1B and ADH1C. It is biologically plausible that these variations may be associated with alcohol drinking habits and alcoholism. By genotyping 9080 white...... men and women from the general population, we found that men and women with ADH1B slow vs fast alcohol degradation drank more alcohol and had a higher risk of everyday drinking, heavy drinking, excessive drinking and of alcoholism. For example, the weekly alcohol intake was 9.8 drinks (95% confidence......, individuals with ADH1C slow vs fast alcohol degradation had a higher risk of heavy and excessive drinking. For example, the OR for heavy drinking was 1.4 (95% CI: 1.1-1.8) among men with the ADH1C.1/2 genotype and 1.4 (95% CI: 1.0-1.9) among men with the ADH1B.2/2 genotype, compared with men with the ADH1C.1...

  15. Turning to alcohol?

    International Nuclear Information System (INIS)

    Brazil is examining whether turning to alcohol could solve its problems. The fuel alcohol producers are lobbying hard for the government to increase the use of alcohol to fuel the country's cars. Not only does using alcohol reduce CO2, runs the argument, but the Kyoto agreement might just attract international financing for the project. (author)

  16. Internet Alcohol Marketing and Underage Alcohol Use

    Science.gov (United States)

    McClure, Auden C.; Tanski, Susanne E.; Li, Zhigang; Jackson, Kristina; Morgenstern, Matthis; Li, Zhongze; Sargent, James D.

    2016-01-01

    BACKGROUND AND OBJECTIVE Internet alcohol marketing is not well studied despite its prevalence and potential accessibility and attractiveness to youth. The objective was to examine longitudinal associations between self-reported engagement with Internet alcohol marketing and alcohol use transitions in youth. METHODS A US sample of 2012 youths aged 15 to 20 was surveyed in 2011. An Internet alcohol marketing receptivity score was developed, based on number of positive responses to seeing alcohol advertising on the Internet, visiting alcohol brand Web sites, being an online alcohol brand fan, and cued recall of alcohol brand home page images. We assessed the association between baseline marketing receptivity and both ever drinking and binge drinking (≥6 drinks per occasion) at 1-year follow-up with multiple logistic regression, controlling for baseline drinking status, Internet use, sociodemographics, personality characteristics, and peer or parent drinking. RESULTS At baseline, ever-drinking and binge-drinking prevalence was 55% and 27%, respectively. Many (59%) reported seeing Internet alcohol advertising, but few reported going to an alcohol Web site (6%) or being an online fan (3%). Higher Internet use, sensation seeking, having family or peers who drank, and past alcohol use were associated with Internet alcohol marketing receptivity, and a score of 1 or 2 was independently associated with greater adjusted odds of initiating binge drinking (odds ratio 1.77; 95% confidence interval, 1.13–2.78 and odds ratio 2.15; 95% confidence interval, 1.06–4.37 respectively) but not with initiation of ever drinking. CONCLUSIONS Although high levels of engagement with Internet alcohol marketing were uncommon, most underage youths reported seeing it, and we found a prospective association between receptivity to this type of alcohol marketing and future problem drinking, making additional research and ongoing surveillance important. PMID:26738886

  17. Voluntary alcohol consumption and plasma beta-endorphin levels in alcohol preferring rats chronically treated with lamotrigine.

    Science.gov (United States)

    Zalewska-Kaszubska, Jadwiga; Bajer, Bartosz; Gorska, Dorota; Andrzejczak, Dariusz; Dyr, Wanda; Bieńkowski, Przemysław

    2015-02-01

    Several recent studies have indicated that lamotrigine, similarly to other antiepileptic drugs, may be useful in the therapy of alcohol dependence. The rationale for using lamotrigine in the treatment of alcohol addiction is based on its multiple mechanisms of action which include inhibition of voltage-sensitive sodium channels, modulation voltage-gated calcium currents and transient potassium outward current. However, the known mechanism of lamotrigine does not fully explain its efficacy in alcohol addiction therapy. For this reason we have decided to examine the effect of lamotrigine on the opioid system. Our previous studies showed that topiramate and levetiracetam (antiepileptic drugs) as well as the most effective drugs in alcohol addiction therapy i.e. naltrexone and acamprosate, when given repeatedly, all increased plasma beta endorphin (an endogenous opioid peptide) level, despite operating through different pharmacological mechanisms. It is known that low beta-endorphin level is often associated with alcohol addiction and also that alcohol consumption elevates the level of this peptide. This study aims to assess the effect of repeated treatment with lamotrigine on voluntary alcohol intake and beta-endorphin plasma level in alcohol preferring rats (Warsaw high preferring (WHP) rats). We observed a decrease in alcohol consumption in rats treated with lamotrigine. However we didn't observe significant changes in beta-endorphin level during withdrawal of alcohol, which may indicate that the drug does not affect the opioid system. We suppose that lamotrigine may be useful in alcohol dependence therapy and presents a potential area for further study. PMID:25449391

  18. Clinical profile of patients with nascent alcohol related seizures

    Directory of Open Access Journals (Sweden)

    P Sandeep

    2013-01-01

    Full Text Available Aim: The aim of this study is to characterize the clinical profile of patients with alcohol related seizures (ARS and to identify the prevalence of idiopathic generalized epilepsy (IGE in the same. Materials and Methods: 100 consecutive male patients presenting to a tertiary care center in South India with new onset ARS were analyzed with alcohol use disorders identification test (AUDIT score. All underwent 19 channel digital scalp electroencephalography (EEG and at least computed tomography (CT scan. Results: A total of 27 patients (27% who had cortical atrophy on CT had a mean duration of alcohol intake of 23.62 years compared with 14.55 years in patients with no cortical atrophy (P < 0.001. Twenty-two patients (22% had clustering in the current episode of whom 18 had cortical atrophy. Nearly, 88% patients had generalized tonic clonic seizures while 12% who had partial seizures underwent magnetic resonance imaging (MRI, which identified frontal focal cortical dysplasia in one. Mean lifetime duration of alcohol intake in patients presenting with seizures within 6 hours (6H-gp of intake of alcohol was significantly lower (P = 0.029. One patient in the 6H-gp with no withdrawal symptoms had EEG evidence for IGE and had a lower AUDIT score compared with the rest. Conclusion: CT evidence of cortical atrophy is related to the duration of alcohol intake and portends an increased risk for clustering. Partial seizures can be a presenting feature of ARS and those patients may benefit from MRI to identify underlying symptomatic localization related epilepsy (8.3% of partial seizures. IGE is more likely in patients presenting with ARS within first 6 hours especially if they do not have alcohol withdrawal symptoms and scalp EEG is helpful to identify this small subgroup (~1% who may require long-term anti-epileptic medication.

  19. Opiate withdrawal behavior after focal brain stimulation.

    Science.gov (United States)

    Williams, D A; Thorn, B E

    1984-11-01

    Electrical stimulation of the brainstem abolishes pain, while continued stimulation induces tolerance to the analgesic effect. Analgesic drugs producing tolerance also induce physical dependence, suggesting that the phenomenon of tolerance is associated with addiction. There is evidence that the neural mechanism for stimulation-produced analgesia is related to the release of opiate substances within the brain. We therefore propose that repeated or protracted brain stimulation elicits dependence upon the endorphins released by electrical stimulation of the neurons themselves. To investigate this possibility, rats were given repetitive bursts of analgesic electrical brain stimulation for two hours. Immediately thereafter, they were injected with the opiate antagonist, naloxone. Behaviors associated with low grade opiate withdrawal were observed. These data suggest that prolonged analgesic stimulation can result in naloxone-precipitated behaviors similar to the behaviors exhibited during opiate withdrawal. PMID:6542676

  20. Alcohol and Breastfeeding

    DEFF Research Database (Denmark)

    Haastrup, Maija Bruun; Pottegård, Anton; Damkier, Per

    2014-01-01

    While the harmful effects of alcohol during pregnancy are well-established, the consequences of alcohol intake during lactation have been far less examined. We reviewed available data on the prevalence of alcohol intake during lactation, the influence of alcohol on breastfeeding......, the pharmacokinetics of alcohol in lactating women and nursing infants and the effects of alcohol intake on nursing infants. A systematic search was performed in PubMed from origin to May 2013, and 41 publications were included in the review. Approximately half of all lactating women in Western countries consume...... alcohol while breastfeeding. Alcohol intake inhibits the milk ejection reflex, causing a temporary decrease in milk yield. The alcohol concentrations in breast milk closely resemble those in maternal blood. The amount of alcohol presented to nursing infants through breast milk is approximately 5...

  1. Alcoholic liver disease: Treatment

    OpenAIRE

    Suk, Ki Tae; Kim, Moon Young; Baik, Soon Koo

    2014-01-01

    The excess consumption of alcohol is associated with alcoholic liver diseases (ALD). ALD is a major healthcare problem, personal and social burden, and significant reason for economic loss worldwide. The ALD spectrum includes alcoholic fatty liver, alcoholic hepatitis, cirrhosis, and the development of hepatocellular carcinoma. The diagnosis of ALD is based on a combination of clinical features, including a history of significant alcohol intake, evidence of liver disease, and laboratory findi...

  2. Alcohol and pregnancy

    OpenAIRE

    Anna Maria Paoletti; Ileana Atzeni; Marisa Orrù; Monica Pilloni; Alessandro Loddo; Martina Zirone; Maria Francesca Marotto; Pierina Zedda; Maria Francesca Fais; Emanuela Stochino Loi; Graziella Boi; Gian Benedetto Melis

    2013-01-01

    Alcohol exerts teratogenic effects in all the gestation times, with peculiar features in relationship to the trimester of pregnancy in which alcohol is assumed. Alcohol itself and its metabolites modify DNA synthesis, cellular division, cellular migration and the fetal development. The characteristic facies of feto-alcoholic syndrome (FAS)-affected baby depends on the alcohol impact on skull facial development during the first trimester of pregnancy. In association there are cerebral damages ...

  3. Recognized homonymous hemianopsia and delirium during the admission examination leading to diagnosis and appropriate treatment of a new stroke

    Directory of Open Access Journals (Sweden)

    Tsymbalov KS

    2016-06-01

    Full Text Available Konstantin S Tsymbalov, Douglas R Fetkenhour Department of Physical Medicine and Rehabilitation, University of Rochester Medical Center, Rochester, NY, USA Abstract: This case report describes the detection of homonymous hemianopsia and delirium during the admission physical examination of a patient with esophageal adenocarcinoma, resulting in the new diagnosis of subacute hemorrhagic stroke. The poststroke visual field defect can result in significant disability and reduction in quality of life. Patients with visual field cut show a severely reduced quality of life and require additional neuropsychological and visual rehabilitation. Only thorough physical examination is able to challenge prior negative positron emission tomography scan, leading to the diagnosis of subacute stroke and, following appropriate treatment, secondary stroke prophylaxis and rehabilitation, instead of brain radiation and chemotherapy. Keywords: physical examination, homonymous hemianopsia, stroke, esophageal tumor 

  4. Post-Injection Delirium/Sedation Syndrome after Olanzapine Long-Acting Intramuscular Injection - Who is at Risk?

    Science.gov (United States)

    Łukasik-Głębocka, Magdalena; Sommerfeld, Karina; Teżyk, Artur; Panieński, Paweł; Żaba, Czesław; Zielińska-Psuja, Barbara

    2015-09-01

    The post-injection olanzapine delirium/sedation syndrome (PDSS) was observed in a 60-year-old Caucasian, schizophrenic, non-smoker and underweight [body mass index (BMI), 18.2 kg/m(2) ] women after the fourth intramuscular injection of 405 mg olanzapine pamoate. Clinical symptoms of PDSS were similar to those of acute oral olanzapine intoxication. The patient received supportive treatment and recovered fully. High olanzapine concentrations in serum, with maximum level of 698 ng/mL, were confirmed by liquid chromatography with tandem mass spectrometry (LC-MS/MS). The authors wonder whether a low BMI and advanced age may predispose patients to PDSS occurrence. PMID:25703610

  5. The Lunch Bunch: an innovative strategy to combat depression and delirium through socialization in elderly sub-acute medicine patients.

    Science.gov (United States)

    Feyerer, Margot; Kruk, Dawn; Bartlett, Nicole; Rodney, Kathy; McKenzie, Cyndi; Green, Patrice; Keller, Lisa; Adcroft, Pat

    2013-01-01

    Hospitalized sub-acute medicine patients face challenges to their functional and cognitive abilities as they await transfer to long-term care facilities or return home. The Continuous Quality Improvement (CQI) Council, representing a multidisciplinary team of healthcare professionals working in the Sub-Acute Medicine Unit (SAMU), implemented a twice-weekly lunch program called the Lunch Bunch in order to combat depression and delirium in our elderly and cognitively impaired patients. The Lunch Bunch initiative includes chaplains, nurses and physiotherapists who have provided a framework through which essential socialization and exercise for this vulnerable population is facilitated. Providing a means for both mental and physical stimulation also allows patients to open up and discuss hidden feelings of loneliness and isolation, thereby beginning a journey of spiritual and emotional healing. PMID:24860951

  6. S100 calcium binding protein B as a biomarker of delirium duration in the intensive care unit – an exploratory analysis

    Directory of Open Access Journals (Sweden)

    Khan BA

    2013-12-01

    Full Text Available Babar A Khan,1–3 Mark O Farber,1 Noll Campbell,2–5 Anthony Perkins,2,3 Nagendra K Prasad,6 Siu L Hui,1–3 Douglas K Miller,1–3 Enrique Calvo-Ayala,1 John D Buckley,1 Ruxandra Ionescu,1 Anantha Shekhar,1 E Wesley Ely,7,8 Malaz A Boustani1–3 1Indiana University School of Medicine, 2Indiana University Center for Aging Research, 3Regenstrief Institute, Inc., 4Wishard Health Services, Indianapolis, 5Department of Pharmacy Practice, Purdue University College of Pharmacy, West Lafayette, 6Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN, 7Vanderbilt University School of Medicine, 8VA Tennessee Valley Geriatric Research Education Clinical Center (GRECC, Nashville, TN, USA Background: Currently, there are no valid and reliable biomarkers to identify delirious patients predisposed to longer delirium duration. We investigated the hypothesis that elevated S100 calcium binding protein B (S100β levels will be associated with longer delirium duration in critically ill patients. Methods: A prospective observational cohort study was performed in the medical, surgical, and progressive intensive care units (ICUs of a tertiary care, university affiliated, and urban hospital. Sixty-three delirious patients were selected for the analysis, with two samples of S100β collected on days 1 and 8 of enrollment. The main outcome measure was delirium duration. Using the cutoff of <0.1 ng/mL and $0.1 ng/mL as normal and abnormal levels of S100β, respectively, on day 1 and day 8, four exposure groups were created: Group A, normal S100β levels on day 1 and day 8; Group B, normal S100β level on day 1 and abnormal S100β level on day 8; Group C, abnormal S100β level on day 1 and normal on day 8; and Group D, abnormal S100β levels on both day 1 and day 8. Results: Patients with abnormal levels of S100β showed a trend towards higher delirium duration (P=0.076; Group B (standard deviation (7.0 [3.2] days, Group C (5.5 [6.3] days, and Group D

  7. Study on causes of delirium in critical patients in ICU%ICU 危重症患者发生谵妄的原因分析

    Institute of Scientific and Technical Information of China (English)

    程文涛; 王照华

    2015-01-01

    Objective To explore the main causes of delirium in critical patients in intensive care unit(ICU)in order to reduce the oc-currence of delirium in critical patients of ICU and to provide clinical reference. Methods The clinical data of 431 critical patients in ICU were collected for this study according to the method of treatment for illness after admission,and the related causes for occurrence of delirium were also observed and analyzed. Results Among these 431 patients,delirium had been occurred in 93 cases,and the incidence of delirium was 21. 58% . Patients with age > 60 years old and education at junior high school level,usually administrated with sodium nitrate and imidazole,and accompa-nied with fever,low blood pressure or cardiogenic shocK,electrolyte disorder,mechanical ventilation,infection,hypertension and/ or diabetes were significantly higher in incidence of delirium,and the difference with other patients was statistically significant( P 60岁、初中及以下、使用硝普钠、使用咪唑安定、发热、低血压或心源性休克、电解质紊乱、有机械通气、感染、高血压、糖尿病时谵妄发生率明显增高,差异具有统计学意义( P <0.05);多因素 Logistic 回归分析显示文化程度低、发热、低血压或心源性休克、电解质紊乱、机械通气、感染、高血压、糖尿病是引起患者发生谵妄的独立危险因素( P <0.05)。结论 ICU 危重症患者谵妄发生率高,患者文化程度低、发热、低血压或心源性休克、电解质紊乱、机械通气、感染、高血压、糖尿病是引起谵妄发生的主要原因,应针对以上因素积极进行治疗以减少谵妄发生。

  8. Reversible Encephalopathy and Delirium in patients with chronic renalfailure who had received Ciprofloxacin

    International Nuclear Information System (INIS)

    We describe four patients with chronic renal failure (CRF) who developedsignificant neurotoxicity after receiving short-term ciprofloxacin. Three ofthem had developed encephalopathy with myoclonic jerks and one patient haddelirium. All patients had advanced chronic renal failure (mean estimatedcreatinine clearance 16+-6 ml/min), although they were not yet on renalreplacement therapy). The mean received dose of ciprofloxacin was 2150+-1300mg and symptoms started to appear after the first 24 hours of drug intake.Investigations ruled out other possible causes of these neurologicalpresentations and withdrawal of ciprofloxacin was followed by completeresolution, after a mean of 8.5+- 4 days. Advanced renal failure in allpatients and underlying neurologic disease in two patients may havepredisposed them to the neurotoxicity. The report of these cases should helpto draw the attention of clinicians to the potential occurrence of theseadverse effects in patients with CRF. (author)

  9. SYSTEMIC INFLAMMATION IMPAIRS ATTENTION AND COGNITIVE FLEXIBILITY BUT NOT ASSOCIATIVE LEARNING IN AGED RATS: Possible Implications for Delirium

    Directory of Open Access Journals (Sweden)

    Deborah J Culley

    2014-06-01

    Full Text Available Delirium is a common and morbid condition in elderly hospitalized patients. Its pathophysiology is poorly understood but inflammation has been implicated based on a clinical association with systemic infection and surgery and preclinical data showing that systemic inflammation adversely affects hippocampus-dependent memory. However, clinical manifestations and imaging studies point to abnormalities not in the hippocampus but in cortical circuits. We therefore tested the hypothesis that systemic inflammation impairs prefrontal cortex function by assessing attention and executive function in aged animals. Aged (24-month-old Fischer-344 rats received a single intraperitoneal injection of lipopolysaccharide (LPS; 50 ug/kg or saline and were tested on the attentional shifting task (AST, an index of integrity of the prefrontal cortex, on days 1-3 post-injection. Plasma and frontal cortex concentrations of the cytokine TNFα and the chemokine CCL2 were measured by ELISA in separate groups of identically treated, age-matched rats. LPS selectively impaired reversal learning and attentional shifts without affecting discrimination learning in the AST, indicating a deficit in attention and cognitive flexibility but not learning globally. LPS increased plasma TNFα and CCL2 acutely but this resolved within 24-48 h. TNFα in the frontal cortex did not change whereas CCL2 increased nearly 3-fold 2 h after LPS but normalized by the time behavioral testing started 24 h later. Together, our data indicate that systemic inflammation selectively impairs attention and executive function in aged rodents and that the cognitive deficit is independent of concurrent changes in frontal cortical TNFα and CCL2. Because inattention is a prominent feature of clinical delirium, our data support a role for inflammation in the pathogenesis of this clinical syndrome and suggest this animal model could be useful for studying that relationship further.

  10. Stress and Withdrawal from Chronic Ethanol Induce Selective Changes in Neuroimmune mRNAs in Differing Brain Sites.

    Science.gov (United States)

    Knapp, Darin J; Harper, Kathryn M; Whitman, Buddy A; Zimomra, Zachary; Breese, George R

    2016-01-01

    Stress is a strong risk factor in alcoholic relapse and may exert effects that mimic aspects of chronic alcohol exposure on neurobiological systems. With the neuroimmune system becoming a prominent focus in the study of the neurobiological consequences of stress, as well as chronic alcohol exposure proving to be a valuable focus in this regard, the present study sought to compare the effects of stress and chronic ethanol exposure on induction of components of the neuroimmune system. Rats were exposed to either 1 h exposure to a mild stressor (restraint) or exposure to withdrawal from 15 days of chronic alcohol exposure (i.e., withdrawal from chronic ethanol, WCE) and assessed for neuroimmune mRNAs in brain. Restraint stress alone elevated chemokine (C-C motif) ligand 2 (CCL2), interleukin-1-beta (IL-1β), tumor necrosis factor alpha (TNFα) and toll-like receptor 4 (TLR4) mRNAs in the cerebral cortex within 4 h with a return to a control level by 24 h. These increases were not accompanied by an increase in corresponding proteins. Withdrawal from WCE also elevated cytokines, but did so to varying degrees across different cytokines and brain regions. In the cortex, stress and WCE induced CCL2, TNFα, IL-1β, and TLR4 mRNAs. In the hypothalamus, only WCE induced cytokines (CCL2 and IL-1β) while in the hippocampus, WCE strongly induced CCL2 while stress and WCE induced IL-1β. In the amygdala, only WCE induced CCL2. Finally-based on the previously demonstrated role of corticotropin-releasing factor 1 (CRF1) receptor inhibition in blocking WCE-induced cytokine mRNAs-the CRF1 receptor antagonist CP154,526 was administered to a subgroup of stressed rats and found to be inactive against induction of CCL2, TNFα, or IL-1β mRNAs. These differential results suggest that stress and WCE manifest broad neuroimmune effects in brain depending on the cytokine and brain region, and that CRF inhibition may not be a relevant mechanism in non-alcohol exposed animals. Overall, these

  11. Perillyl Alcohol (Monoterpene Alcohol), Limonene.

    Science.gov (United States)

    Shojaei, Shahla; Kiumarsi, Amir; Moghadam, Adel Rezaei; Alizadeh, Javad; Marzban, Hassan; Ghavami, Saeid

    2014-01-01

    Natural products have a long history of use in traditional medicines and their activities against different diseases have been the focus of many basic and clinical researches in past few decades. The essential oils, volatile liquid containing aroma compound from plants, are known as active ingredients in the herbal medicine. Perillyl alcohol (POH) is usually available through dietary sources and is being explored for its cancer chemoprevention, tumor growth suppression, and regression. Citrus peels are the waste product of juice manufacturing industries and have been considered as a critical problem for environmental green ecology policies for years. One of the most well-known approaches to overcome this problem is transformation of these monoterpene by the use of specific strains of bacteria or yeasts. Limonene (1-methyl-4-isopropyl-cyclohexene) is a monoterpene, as other monoterpenes consists of two isoprene units, that comprises more than 90% of citrus essential oil and it exists in many fruits and vegetables. Although, the anticancer activity of d-limonene has identified nearly two decades ago, it has recently attracted much more attention in translational medicine. In this chapter, we will overview the anticancer effects of POH and d-limonene. Later, we will address the pharmacokinetics of these compounds, highlight the signaling pathways which are targeted by these proteins, review the clinical trials which have been done for these compounds in different cancer models, and finally discuss the future directions of the research in this field that might be more applicable in future cancer therapy strategies. PMID:27102697

  12. Use of hair cortisol analysis to detect hypercortisolism during active drinking phases in alcohol-dependent individuals.

    Science.gov (United States)

    Stalder, Tobias; Kirschbaum, Clemens; Heinze, Kareen; Steudte, Susann; Foley, Paul; Tietze, Antje; Dettenborn, Lucia

    2010-12-01

    The assessment of cortisol levels in human hair has recently been suggested to provide a retrospective index of cumulative cortisol exposure over periods of up to 6 months. The current study examined the utility of hair cortisol analysis to retrospectively detect hypercortisolism during active drinking phases in alcoholics in acute withdrawal (n=23), the normalisation of cortisol output in abstinent alcoholics (n=25) and cortisol levels in age- and gender-matched controls (n=20). Scalp-near 3-cm hair segments were sampled and analysed for cortisol content. Results showed three to fourfold higher cortisol levels in hair samples of alcoholics in acute withdrawal than in those of abstinent alcoholics (p<.001) or controls (p<.001), with no differences between the latter two groups. The current hair cortisol findings closely mirror results of previous research using well-established measures of systemic cortisol secretion and thus provide further validation of this novel method. PMID:20727937

  13. Neural mechanisms underlying morphine withdrawal in addicted patients: a review

    Directory of Open Access Journals (Sweden)

    Nima Babhadiashar

    2015-06-01

    Full Text Available Morphine is one of the most potent alkaloid in opium, which has substantial medical uses and needs and it is the first active principle purified from herbal source. Morphine has commonly been used for relief of moderate to severe pain as it acts directly on the central nervous system; nonetheless, its chronic abuse increases tolerance and physical dependence, which is commonly known as opiate addiction. Morphine withdrawal syndrome is physiological and behavioral symptoms that stem from prolonged exposure to morphine. A majority of brain regions are hypofunctional over prolonged abstinence and acute morphine withdrawal. Furthermore, several neural mechanisms are likely to contribute to morphine withdrawal. The present review summarizes the literature pertaining to neural mechanisms underlying morphine withdrawal. Despite the fact that morphine withdrawal is a complex process, it is suggested that neural mechanisms play key roles in morphine withdrawal.

  14. The FKBP5 Gene Affects Alcohol Drinking in Knockout Mice and Is Implicated in Alcohol Drinking in Humans.

    Science.gov (United States)

    Qiu, Bin; Luczak, Susan E; Wall, Tamara L; Kirchhoff, Aaron M; Xu, Yuxue; Eng, Mimy Y; Stewart, Robert B; Shou, Weinian; Boehm, Stephen L; Chester, Julia A; Yong, Weidong; Liang, Tiebing

    2016-01-01

    FKBP5 encodes FK506-binding protein 5, a glucocorticoid receptor (GR)-binding protein implicated in various psychiatric disorders and alcohol withdrawal severity. The purpose of this study is to characterize alcohol preference and related phenotypes in Fkbp5 knockout (KO) mice and to examine the role of FKBP5 in human alcohol consumption. The following experiments were performed to characterize Fkpb5 KO mice. (1) Fkbp5 KO and wild-type (WT) EtOH consumption was tested using a two-bottle choice paradigm; (2) The EtOH elimination rate was measured after intraperitoneal (IP) injection of 2.0 g/kg EtOH; (3) Blood alcohol concentration (BAC) was measured after 3 h limited access of alcohol; (4) Brain region expression of Fkbp5 was identified using LacZ staining; (5) Baseline corticosterone (CORT) was assessed. Additionally, two SNPs, rs1360780 (C/T) and rs3800373 (T/G), were selected to study the association of FKBP5 with alcohol consumption in humans. Participants were college students (n = 1162) from 21-26 years of age with Chinese, Korean or Caucasian ethnicity. The results, compared to WT mice, for KO mice exhibited an increase in alcohol consumption that was not due to differences in taste sensitivity or alcohol metabolism. Higher BAC was found in KO mice after 3 h of EtOH access. Fkbp5 was highly expressed in brain regions involved in the regulation of the stress response, such as the hippocampus, amygdala, dorsal raphe and locus coeruleus. Both genotypes exhibited similar basal levels of plasma corticosterone (CORT). Finally, single nucleotide polymorphisms (SNPs) in FKBP5 were found to be associated with alcohol drinking in humans. These results suggest that the association between FKBP5 and alcohol consumption is conserved in both mice and humans. PMID:27527158

  15. The FKBP5 Gene Affects Alcohol Drinking in Knockout Mice and Is Implicated in Alcohol Drinking in Humans

    Directory of Open Access Journals (Sweden)

    Bin Qiu

    2016-08-01

    Full Text Available FKBP5 encodes FK506-binding protein 5, a glucocorticoid receptor (GR-binding protein implicated in various psychiatric disorders and alcohol withdrawal severity. The purpose of this study is to characterize alcohol preference and related phenotypes in Fkbp5 knockout (KO mice and to examine the role of FKBP5 in human alcohol consumption. The following experiments were performed to characterize Fkpb5 KO mice. (1 Fkbp5 KO and wild-type (WT EtOH consumption was tested using a two-bottle choice paradigm; (2 The EtOH elimination rate was measured after intraperitoneal (IP injection of 2.0 g/kg EtOH; (3 Blood alcohol concentration (BAC was measured after 3 h limited access of alcohol; (4 Brain region expression of Fkbp5 was identified using LacZ staining; (5 Baseline corticosterone (CORT was assessed. Additionally, two SNPs, rs1360780 (C/T and rs3800373 (T/G, were selected to study the association of FKBP5 with alcohol consumption in humans. Participants were college students (n = 1162 from 21–26 years of age with Chinese, Korean or Caucasian ethnicity. The results, compared to WT mice, for KO mice exhibited an increase in alcohol consumption that was not due to differences in taste sensitivity or alcohol metabolism. Higher BAC was found in KO mice after 3 h of EtOH access. Fkbp5 was highly expressed in brain regions involved in the regulation of the stress response, such as the hippocampus, amygdala, dorsal raphe and locus coeruleus. Both genotypes exhibited similar basal levels of plasma corticosterone (CORT. Finally, single nucleotide polymorphisms (SNPs in FKBP5 were found to be associated with alcohol drinking in humans. These results suggest that the association between FKBP5 and alcohol consumption is conserved in both mice and humans.

  16. A Case of Withdrawal Psychosis from Internet Addiction Disorder

    OpenAIRE

    Paik, Ahyoung; Oh, Daeyoung; Kim, Daeho

    2014-01-01

    Similar to substance use disorder, patients with Internet addiction disorder (IAD) show excessive use, tolerance and withdrawal symptoms. We report a case of a patient with withdrawal psychosis who showed persecutory delusion and disorganized behaviors in addition to common withdrawal symptoms such as agitation and irritability. A 25-year-old male developed a full-blown psychotic episode within one day after discontinuing an Internet game that he had been playing for at least eight hours a da...

  17. Are withholding and withdrawing therapy always morally equivalent?

    OpenAIRE

    Sulmasy, D P; Sugarman, J

    1994-01-01

    Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fac...

  18. Fetal alcohol effects in alcoholic veteran patients.

    Science.gov (United States)

    Tishler, P V; Henschel, C E; Ngo, T A; Walters, E E; Worobec, T G

    1998-11-01

    Fetal alcohol syndrome is often associated with severe physical and neuropsychiatric maldevelopment. On the other hand, some offspring of women who drank during pregnancy appear to be affected in minimal ways and function relatively well within society. We questioned whether this effect of prenatal alcohol in the adult is generally minimal. To bear on this, we determined whether we could distinguish alcohol-exposed from nonexposed individuals in a population of male veterans, selected because of both their accepted level of function within society (e.g., honorable discharge from the military) and their admission to an alcohol treatment unit (thus, a greater likelihood of parental alcoholism, because of its familial aggregation). Consecutively admitted alcoholics (cases; n = 77) with likely maternal alcohol ingestion during their pregnancy or the first 10 years of life were matched with alcoholics with no maternal alcohol exposure during these periods (controls; n = 161). Each subject completed questionnaires regarding personal birthweight, alcohol, drug, educational and work histories, and family (including parental) alcohol and drug histories. We measured height, weight, and head circumference; checked for facial and hand anomalies; and took a frontal facial photograph, from which measurements of features were made. Data were analyzed by univariate statistics and stepwise logistic regression. No case had bona fide fetal alcohol syndrome. With univariate statistical analyses, the cases differed from the controls in 10 variables, including duration of drinking, width of alae nasae, being hyperactive or having a short attention span, and being small at birth. By stepwise logistic regression, the variables marital status, small size at birth, duration of drinking, and the presence of a smooth philtrum were marginally (the first two) or definitely (the last two) significant predictors of case status. Analysis of only the 37 cases in whom maternal prenatal drinking was

  19. [Normative definition of staff requirement for a guideline-adherent inpatient qualified detoxification treatment in alcohol dependence].

    Science.gov (United States)

    Kiefer, F; Koopmann, A; Godemann, F; Wolff, J; Batra, A; Mann, K

    2016-03-01

    The central element of the "qualified withdrawal treatment" of alcohol dependence is - in addition to physical withdrawal treatment - psychotherapy. The treatment of the underlying addictive disorder that is displayed by intoxication, harmful behaviour and withdrawal symptoms is only possible with a combination of somatic and psychotherapeutic treatment elements. The successfully established multimodal therapy of the "qualified alcohol withdrawal treatment", postulated in the current S3-Treatment Guidelines, requires a multi-disciplinary treatment team with psychotherapeutic competence. The aim of the present work is to calculate the normative staff requirement of a guideline-based 21-day qualified withdrawal treatment and to compare the result with the staffing regulations of the German Institute for Hospital Reimbursement. The present data support the hypothesis that even in the case of a hundred per cent implementation of these data, adequate therapy of alcohol-related disorders, according to the guidelines, is not feasible. This has to be considered when further developing the finance compensation system based on the described superseded elements of the German Institute for Hospital Reimbursement. PMID:26842899

  20. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) – short version

    OpenAIRE

    DAS-Taskforce 2015; Baron, Ralf; Binder, Andreas; Biniek, Rolf; Braune, Stephan; Buerkle, Hartmut; Dall, Peter; Demirakca, Sueha; Eckardt, Rahel; Eggers, Verena; Eichler, Ingolf; Fietze, Ingo; Freys, Stephan; Fründ, Andreas; Garten, Lars

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the “Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care”. Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  1. Are the Long-Acting Intramuscular Formulations of Risperidone or Paliperidone Palmitate Associated with Post-Injection Delirium/Sedation Syndrome? An Assessment of Safety Databases

    OpenAIRE

    Alphs, Larry; Gopal, Srihari; Karcher, Keith; Kent, Justine; Kern Sliwa, Jennifer; Kushner, Stuart; Nuamah, Isaac; Singh, Jaskaran

    2011-01-01

    Long-acting injectable (LAI) formulations of antipsychotics are valuable treatment alternatives for patients with psychotic disorders, and understanding their safe use is critical. Post-injection delirium/sedation syndrome (PDSS) has been reported following treatment with one atypical antipsychotic LAI. Clinical databases of risperidone LAI and paliperidone palmitate were explored to identify if cases of PDSS had been observed. No cases of PDSS were identified in 15 completed trials of 3,164 ...

  2. Evidence and consensus based guideline for the management of delirium, analgesia, and sedation in intensive care medicine. Revision 2015 (DAS-Guideline 2015) - short version

    OpenAIRE

    Baron, R.; Binder, A.; Biniek, R; Braune, S; Buerkle, H; Dall, P.; Demirakca, S; Eckardt, R; Eggers, V; Eichler, I; Fietze, I.; Freys, S; Fründ, A; Garten, L; Gohrbandt, B

    2015-01-01

    In 2010, under the guidance of the DGAI (German Society of Anaesthesiology and Intensive Care Medicine) and DIVI (German Interdisciplinary Association for Intensive Care and Emergency Medicine), twelve German medical societies published the "Evidence- and Consensus-based Guidelines on the Management of Analgesia, Sedation and Delirium in Intensive Care". Since then, several new studies and publications have considerably increased the body of evidence, including the new recommendations from th...

  3. Intramammary antibiotics in dairy goats : withdrawal periods of three intramammary antibiotics compared to recommended withdrawal periods for cows

    OpenAIRE

    J. Karzis; E.F. Donkin; I.M. Petzer

    2007-01-01

    Intramammary antibiotics are registered and tested for use in dairy cattle. This study investigated withdrawal periods of three intramammary antibiotics (Curaclox LC [Norbrook Pharmacia AH]), Spectrazol Milking Cow (Schering-Plough Animal Health) and Rilexine 200 LC (Logos Agvet [Virbac]) in dairy goats and compared them to withdrawal periods recommended for use in cattle. Three trials were carried out in two different herds. The withdrawal periods for Curaclox LC in eight relatively lo...

  4. 19 CFR 19.6 - Deposits, withdrawals, blanket permits to withdraw and sealing requirements.

    Science.gov (United States)

    2010-04-01

    ... and sealing requirements. 19.6 Section 19.6 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION... withdraw and sealing requirements. (a)(1) Deposit in warehouse. The port director may authorize the deposit... any seal found, upon arrival of the vehicle or container at the warehouse, to be broken, missing,...

  5. Spontaneous reduction of prolactinoma post cabergoline withdrawal

    Directory of Open Access Journals (Sweden)

    Sampath Kumar Venkatesh

    2012-01-01

    Full Text Available Prolactinomas are common pituitary tumors usually highly responsive to dopamine agonists. Around 70-90% of the prolactinomas exhibit decrease in tumor size, though variably with these agents. Uncommonly, there may be little or no shrinkage in pituitary tumor. In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely. We report here a case showing only modest reduction in prolactinoma with cabergoline given for a period of one and a half years. Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy.

  6. 75例术后瞻妄临床特征及危险因素分析%Clinical features and risk factors in 75 postoperative delirium patients

    Institute of Scientific and Technical Information of China (English)

    穆雪侠; 王建武; 刘晓敏; 邓大丽

    2012-01-01

    目的 探讨术后谵妄患者的临床特征,并分析谵妄发生的相关因素.方法 收集术后谵妄患者75例的临床资料,抽取同期住院的术后不发生谵妄患者为对照组进行比较.结果 结果分析表明年龄>60岁(P=0.000)、术中输血(P=0.032)与谵妄发生有关,术后并发症(P=0.113)、睡眠障碍(P=0.086)、应激(P=0.058)与术后谵妄发生无相关性;分析表明术后谵妄的发生与年龄>60岁(P=0.037)、术中输血(P=0.041)有关.术后非立即苏醒者较立即苏醒者的谵妄潜伏期显著缩短(P 0. 05 ). Anesthesia waking time and delirium incubation period had no relation with it. The prognosis was good. Conclusion Elderly patient and blood transfusions are the risk factors of delirium. The postoperative complications, sleep disorders, stress promote the delirium.

  7. Alcohol Use and Older Adults

    Science.gov (United States)

    ... version of this page please turn Javascript on. Alcohol Use and Older Adults Alcohol and Aging Adults of any age can have ... Escape (Esc) button on your keyboard.) What Is Alcohol? Alcohol, also known as ethanol, is a chemical ...

  8. Alcohol: A Women's Health Issue

    Science.gov (United States)

    ... itself can cause serious long-term health consequences. Alcohol in Women’s Lives: Safe Drinking Over a Lifetime ... much, and how often to drink. What Are Alcohol Abuse and Alcoholism? Alcohol abuse is a pattern ...

  9. Deciding to quit drinking alcohol

    Science.gov (United States)

    Alcohol use disorder - quitting drinking; Alcohol abuse - quitting drinking; Quitting drinking; Quitting alcohol ... a drinking problem when your body depends on alcohol to function and your drinking is causing problems ...

  10. Alcohol in moderation

    DEFF Research Database (Denmark)

    Mueller, Simone; Lockshin, Larry; Louviere, Jordan J.

    2011-01-01

    Purpose: The study examines the market potential for low and very low alcohol wine products under two different tax regimes. The penetration and market share of low alcohol wine are estimated under both tax conditions. Consumers’ alcoholic beverage purchase portfolios are analysed and those...... products identified, which are jointly purchased with low alcohol wines. The effect of a tax increase on substitution patterns between alcoholic beverages is examined. Methodology: In a discrete choice experiment, based on their last purchase, consumers select one or several different alcoholic beverages...... volume is estimated under the current tax regime. Between six to eight percent of consumers are expected to adopt low alcohol wine alternatives as part of their alcoholic beverage portfolio. Consumers of cask wine and light beer are more likely and consumers of medium-full strength beer and spirits...

  11. Myths about drinking alcohol

    Science.gov (United States)

    ... gov/ency/patientinstructions/000856.htm Myths about drinking alcohol To use the sharing features on this page, ... We know much more about the effects of alcohol today than in the past. Yet, myths remain ...

  12. Women and Alcohol

    Science.gov (United States)

    ... turn JavaScript on. Feature: Rethinking Drinking Women and Alcohol Past Issues / Spring 2014 Table of Contents Women react differently than men to alcohol and face higher risks from it. Pound for ...

  13. Benzyl Alcohol Topical

    Science.gov (United States)

    Benzyl alcohol lotion is used to treat head lice (small insects that attach themselves to the skin) in adults ... children less than 6 months of age. Benzyl alcohol is in a class of medications called pediculicides. ...

  14. Alcohol and Cancer Risk

    Science.gov (United States)

    ... Overview Cancer Prevention Overview–for health professionals Research Alcohol and Cancer Risk On This Page What is ... in the risk of colorectal cancer. Research on alcohol consumption and other cancers: Numerous studies have examined ...

  15. Alcohol and Migraine

    Science.gov (United States)

    ... on Pinterest Follow us on Instagram DONATE TODAY Alcohol and Migraine Abuse, Maltreatment, and PTSD and Their ... to Migraine Altitude, Acute Mountain Sickness and Headache Alcohol and Migraine Anxiety and Depression Caffeine and Migraine ...

  16. Alcohol and pregnancy

    Science.gov (United States)

    ... group of defects in the baby known as fetal alcohol syndrome. Symptoms can include: Behavior and attention problems Heart ... risk of giving birth to a child with fetal alcohol syndrome . The more you drink, the more you raise ...

  17. Fetal Alcohol Spectrum Disorders

    Science.gov (United States)

    ... Daily life skills, such as feeding and bathing Fetal alcohol syndrome is the most serious type of FASD. People with fetal alcohol syndrome have facial abnormalities, including wide-set and narrow ...

  18. Alcohol use disorder

    Science.gov (United States)

    ... have problems with alcohol if you: Are a young adult under peer pressure Have depression, bipolar disorder , anxiety disorders , or schizophrenia Can easily obtain alcohol Have low self-esteem Have problems with relationships Live a stressful lifestyle ...

  19. Alcohol and Pregnancy

    Medline Plus

    Full Text Available ... Your e-mail was sent. Save to my dashboard Sign in or Sign up to save this ... saved this page It's been added to your dashboard . Alcohol and pregnancy 3:07 Drinking alcohol while ...

  20. Children of alcoholics

    Directory of Open Access Journals (Sweden)

    Robert Oravecz

    2002-09-01

    Full Text Available The author briefly interprets the research – results, referring to the phenomenon of children of alcoholics, especially the psychological and psychopathological characteristics of children of alcoholics in adolescence and young adulthood. The author presents a screening study of adolescents. The sample contains 200 high school students at age 18. The aim of the survey was to discover the relationship between alcohol consumption of parents, PTSD - related psychopathological symptoms and reported life quality of their children. The study confirmed the hypothesis about a substantial correlation between high alcohol consumption of parents, higher psychopathological symptom - expression and lower reported life quality score of their children. Higher PTSD-related symptomatology in children of alcoholics is probably resulted by home violence, which is very often present in family of alcoholics. The article also evaluated the results regarding suicide ideation of children of alcoholics, which is definitely more frequent and more intense than in their peers living in non alcohol – dependent families.

  1. Fetal Alcohol Exposure

    Science.gov (United States)

    ... a woman drinks while pregnant. Alcohol can disrupt fetal development at any stage during a pregnancy—including at ... Clinical Diagnoses IOM Diagnoses Fetal Alcohol Syndrome ... pregnancy can disrupt normal development of the face and the brain. In fact, ...

  2. Overview of Alcohol Consumption

    Science.gov (United States)

    ... you drink, you increase your blood alcohol concentration (BAC) level, which is the amount of alcohol present in your bloodstream. The higher your BAC, the more impaired you become by alcohol’s effects. ...

  3. Alcohol Alert: Link Between Stress and Alcohol

    Science.gov (United States)

    ... Hodgkinson, C.A.; Yuan, Q.; et al. The influence of GABrA2, childhood trauma, and their interaction on alcohol, heroin, and ... Articles examine different sources of stress, such as childhood abuse and ... stress influences the development of alcohol abuse and dependence, and ...

  4. Traumatic neurosis in the etiology of alcoholism: Viet Nam combat and other trauma.

    Science.gov (United States)

    Lacoursiere, R B; Godfrey, K E; Ruby, L M

    1980-08-01

    Traumatic neurosis from Viet Nam combat or other sources includes many symptoms that can be effectively self-medicated with alcohol, at least initially. These symptoms include chronic anxiety and restlessness, insomnia, and recurrent frightening dreams. Repeated self-medication with alcohol results in tolerance and a need to increase the amount consumed. Attempts to decrease consumption or to abstain can lead to alcohol withdrawal symptoms similar to and exacerbating the initial symptoms of traumatic neurosis. Continuing alcohol use, with the establishment of a vicious circle, can follow. The authors present three case examples. They note that treatment of alcoholism under the conditions described requires specific attention to the underlying traumatic neurosis. PMID:7416301

  5. Alcohol and Atherosclerosis

    Institute of Scientific and Technical Information of China (English)

    Gao Yinglan; Song Jingyu; Jin Junshuo; Zhong Xiuhong; Ren Xiangshan; Liu Shuangping

    2005-01-01

    Objectives To study the relationship between alcohol and atherosclerosis (AS).Methods The paper reviewed the mechanism of the alcohol leading to AS from four aspects such as the introduction of alcohol and AS, imbalance of oxidationantioxidation system, oxygen free radical (OFR) and endothelium cell (EC) apoptosis, apoptosis and AS.Results Excessive alcohol could lead to imbalance of oxidation-antioxidation system, and increase OFR, in the meanwhile, OFR could lead to EC apoptosis,which could lead to AS.

  6. Alcohol Saliva Strip Test

    OpenAIRE

    Thokala, Madhusudhana Rao; Dorankula, Shyam Prasad Reddy; Muddana, Keertrthi; Velidandla, Surekha Reddy

    2014-01-01

    Alcohol is a factor in many categories of injury. Alcohol intoxication is frequently associated with injuries from falls, fires, drowning, overdoses, physical and sexual abusements, occupational accidents, traffic accidents and domestic violence. In many instances, for forensic purpose, it may be necessary to establish whether the patients have consumed alcohol that would have been the reason for the injury/accidents. Combining rapidity and reliability, alcohol saliva strip test (AST) has bee...

  7. GABAB receptor ligands for the treatment of alcohol use disorder: preclinical and clinical evidence

    Directory of Open Access Journals (Sweden)

    Roberta eAgabio

    2014-06-01

    Full Text Available The present paper summarizes the preclinical and clinical studies conducted to define the anti-alcohol pharmacological profile of the prototypic GABAB receptor agonist, baclofen, and its therapeutic potential for treatment of alcohol use disorder (AUD. Numerous studies have reported baclofen-induced suppression of alcohol drinking (including relapse- and binge-like drinking and alcohol reinforcing, motivational, stimulating, and rewarding properties in rodents and monkeys. The majority of clinical surveys conducted to date – including case reports, retrospective chart reviews, and randomized placebo-controlled studies – suggest the ability of baclofen to suppress alcohol consumption, craving for alcohol, and alcohol withdrawal symptomatology in alcohol-dependent patients. The recent identification of a positive allosteric modulatory binding site, together with the synthesis of in vivo effective ligands, represents a novel, and likely more favorable, option for pharmacological manipulations of the GABAB receptor. Accordingly, data collected to date suggest that positive allosteric modulators of the GABAB receptor reproduce several anti-alcohol effects of baclofen and display a higher therapeutic index (with larger separation – in terms of doses – between anti-alcohol effects and sedation.

  8. Alcohol and liver

    Institute of Scientific and Technical Information of China (English)

    Natalia Osna

    2009-01-01

    @@ Liver is a primary site of ethanol metabolism, which makes this organ susceptible to alcohol-induced damage.Alcoholic liver disease (ALD) has many manifestations and complicated pathogenesis. In this Topic Highlight, we included the key reviews that characterize new findings about the mechanisms of ALD development and might be of strong interest for clinicians and researchers involved in liver alcohol studies.

  9. Television: Alcohol's Vast Adland.

    Science.gov (United States)

    2002

    Concern about how much television alcohol advertising reaches underage youth and how the advertising influences their attitudes and decisions about alcohol use has been widespread for many years. Lacking in the policy debate has been solid, reliable information about the extent of youth exposure to television alcohol advertising. To address this…

  10. Alcohol and Pregnancy

    Medline Plus

    Full Text Available ... this page It's been added to your dashboard . Alcohol and pregnancy 3:07 Drinking alcohol while you are pregnant ... birth defects. Learn about the dangers of drinking alcohol during pregnancy. Stanford Prematurity Research Center Launch 3:25 Newborn ...

  11. Alcoholism's Hidden Curriculum.

    Science.gov (United States)

    Gress, James R.

    1988-01-01

    Discusses children of alcoholics as victims of fetal alcohol syndrome, family violence, retarded social development, and severe emotional scars. These children bring family roles to school that allow survival in the alcoholic home but are dysfunctional outside it. Educators can take certain steps to address these students' problems. Includes six…

  12. Preventive Effects of Forced Exercise against Alcohol-induced Physical Dependency and Reduction of Pain Perception Threshold

    Directory of Open Access Journals (Sweden)

    Majid Motaghinejad

    2014-01-01

    Full Text Available Background: Treatment of postabstinence syndrome of alcohol is one of the major strategies of alcoholism treatment. Exercise can be modulated major brain pathways such as a reward system and pain perception centers. The aim of this study was to evaluation the effects of forced exercise in the management of alcohol dependence and pain perception alteration which induced by alcoholism. Methods: 72 adult male rats were divided into 2 major groups: (1 40 of them was divided into groups of positive control (alcohol dependent negative control and alcohol dependent groups under treatment by forced exercise, diazepam (0.4 mg/kg and forced exercise in combination with diazepam and alcohol withdrawal signs, and blood cortisols, were measured in this groups. (2 32 rats were divided into control, alcohol dependent (without treatment, and alcohol-dependent groups under treatment by forced exercise or indometacin (5 mg/kg and then pain perception was assessed by using writhing test, tail-flick and hot plate test. Results: Forced exercise, diazepam, and their combinations significantly attenuates withdrawal syndrome to 20 ± 2, 22 ± 1.3 and 16 ± 2 and blood cortisol level to 6.8 ± 1.3,7.9 ± 1.2 and 5.8 ± 1.1, respectively, in comparison with the positive control group (P < 0.05 and P < 0.001. In alcohol dependent animal under treatment by forced exercise, pain response significantly inhibited with 37%, 57% and 38% decreases in writhing test, hot plate, and tail-flick test, respectively, in comparison with alcohol dependent (without treatment group (P < 0.05. Conclusions: This study suggested that forced exercise can be useful as adjunct therapy in alcoholism patient and also can be effective in modulation of pain threshold reduction that was induced by alcohol dependency.

  13. ETRR-2 control rod withdrawal accident

    International Nuclear Information System (INIS)

    A safety evaluation of Egypt new reactor, Egypt Test and Research Reactor number 2 (ETRR-2), has been completed successfully. Intensive efforts have been made for design basis accidents (DBA) analysis. The present work presents analysis of one of these accidents, i.e. the uncontrolled reactivity insertion accident (RIA) due to erroneous withdrawal of control rod (CR) during normal operating conditions. The reactivity insertion may be fast or slow, depending on the speed of CR withdrawal. The availability of the scam system is considered. The reactivity insertion function (RIF) is modeled by: 1 - an approximate ramp functions (RF), and 2 - actual S(cosine) function (CF). A computer code TRANSP19 is developed for the analysis. It models RIA of material test and research reactors (MTR). The code was verified against results obtained from RETRAN 02 and PARET codes and showed a good agreement. The study shows that ETRR-2 core, MTR type, withstands this type of perturbation, fast or slow, in condition that the shutdown system (SHDS) is available. Otherwise the coolant, clad, and fuel temperatures may exceed their design goal values [safety limits (SL)] and the clad may ruptures, coolant may boil, and the fuel may damage. The core reciprocal period never exceeds 140 s-1 for all accident cases (minimum period is 21.98 s) which demonstrates that no explosion other than sonic blockage could occur

  14. 21 CFR 870.1800 - Withdrawal-infusion pump.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Withdrawal-infusion pump. 870.1800 Section 870.1800 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... pump. (a) Identification. A withdrawal-infusion pump is a device designed to inject accurately...

  15. 17 CFR 242.405 - Withdrawal of margin.

    Science.gov (United States)

    2010-04-01

    ... account after such withdrawal is sufficient to satisfy the required margin for the security futures and...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as...

  16. 19 CFR 177.6 - Withdrawal of ruling requests.

    Science.gov (United States)

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Withdrawal of ruling requests. 177.6 Section 177.6 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY (CONTINUED) ADMINISTRATIVE RULINGS General Ruling Procedure § 177.6 Withdrawal of ruling...

  17. 21 CFR 900.6 - Withdrawal of approval.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Withdrawal of approval. 900.6 Section 900.6 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... committed fraud, or has submitted material false statements to the agency, FDA may withdraw its approval...

  18. 15 CFR 10.13 - Withdrawal of a published standard.

    Science.gov (United States)

    2010-01-01

    ... DEVELOPMENT OF VOLUNTARY PRODUCT STANDARDS § 10.13 Withdrawal of a published standard. (a) Standards published... organization, or that lack of government sponsorship would result in significant public disadvantage for legal... advantages and disadvantages of amendment, revision, development of a new standard, or withdrawal with...

  19. Opiate Withdrawal Complicated by Tetany and Cardiac Arrest

    Directory of Open Access Journals (Sweden)

    Irfanali R. Kugasia

    2014-01-01

    Full Text Available Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.

  20. Alcohol and atherosclerosis

    DEFF Research Database (Denmark)

    Tolstrup, Janne; Grønbaek, Morten

    2007-01-01

    Light to moderate alcohol intake is known to have cardioprotective properties; however, the magnitude of protection depends on other factors and may be confined to some subsets of the population. This review focuses on factors that modify the relationship between alcohol and coronary heart disease...... (CHD). The cardioprotective effect of alcohol seems to be larger among middle-aged and elderly adults than among young adults, who do not have a net beneficial effect of a light to moderate alcohol intake in terms of reduced all-cause mortality. The levels of alcohol at which the risk of CHD is lowest...... and the levels of alcohol at which the risk of CHD exceeds the risk among abstainers are lower for women than for men. The pattern of drinking seems important for the apparent cardioprotective effect of alcohol, and the risk of CHD is generally lower for steady versus binge drinking. Finally, there is some...

  1. On molybdenum (6) alcoholates

    International Nuclear Information System (INIS)

    Synthesis techniques for molybdenum (6) alcoholates of MoO(OR)4 (1) and MoO2(OR)2 (2) series by means of exchange interaction of corresponding oxychloride with MOR (M=Li, Na) are obtained. These techniques have allowed to prepare 1(R=Me, Et, i-Pr) and 2(R=Me, Et) with 70-98 % yield. Methylates are also prepared at ether interchange of ethylates by methyl alcohol. Metal anode oxidation in corresponding alcohol may be used for 1 synthesis. Physicochemical properties of both series alcoholates, solubility in alcohols in particular, depend on their formation conditions coordination polymerism. Alcoholates of 1 are rather unstable and tend to decomposition up to 2 and ether. It is suggested to introduce NaOR microquantities to stabilize those alcoholates

  2. Incidência de delirium durante a internação em unidade de terapia intensiva em pacientes pré-tratados com estatinas no pós-operatório de cirurgia cardíaca

    Directory of Open Access Journals (Sweden)

    Julia Niehues da Cruz

    2012-03-01

    Full Text Available OBJETIVO: Determinar a associação entre a administração pré-operatória de estatina e o delírium pós-operatório em uma corte prospectiva de pacientes submetidos à cirurgia cardíaca. MÉTODOS: Foram analisados pacientes adultos internados na unidade de terapia intensiva após cirurgia cardíaca entre janeiro e junho de 2011. A triagem para delirium foi realizada utilizando o Confusion Assessment Method para analisar delirium em uma unidade de terapia intensiva (CAM-ICU e Delirium Screening Checklist para terapia intensiva (ICDSC durante a internação na terapia intensiva RESULTADOS: Cento e sessenta e nove pacientes foram submetidos à cirurgia cardíaca eletiva, dos quais 40,2% estavam utilizando estatina no pré-operatório. Delirium foi identificado em 14,9% dos pacientes que não utilizavam estatina comparado com 11,8% dos que utilizavam (p=0,817 quando avaliados pelo CAM-ICU. Utilizando o ICDSC 18,8% dos pacientes que não usam estatina comparado com 10.3% dos que usam (p=0,191. CONCLUSÃO: Não há relação entre uso de estatinas com a ocorrência de delirium em pacientes submetidos a cirurgia cardíaca.

  3. Intrathecal Clonidine Pump Failure Causing Acute Withdrawal Syndrome With 'Stress-Induced' Cardiomyopathy.

    Science.gov (United States)

    Lee, Hwee Min D; Ruggoo, Varuna; Graudins, Andis

    2016-03-01

    Clonidine is a central alpha(2)-agonist antihypertensive used widely for opioid/alcohol withdrawal, attention deficit hyperactivity disorder and chronic pain management. We describe a case of clonidine withdrawal causing life-threatening hypertensive crisis and stress-induced cardiomyopathy. A 47-year-old man with chronic back pain, treated with clonidine for many years via intrathecal pump (550 mcg/24 h), presented following a collapse and complaining of sudden worsening of back pain, severe headache, diaphoresis, nausea and vomiting. A few hours prior to presentation, his subcutaneous pump malfunctioned. On presentation, vital signs included pulse 100 bpm, BP 176/103 mmHg, temperature 37.8 °C and O2 saturation 100 % (room air). Acute clonidine withdrawal with hypertensive crisis was suspected. Intravenous clonidine loading dose and a 50 mcg/h infusion were commenced. Five hours later, severe chest pain, dyspnoea, tachycardia, hypoxia, with BP 180/120 mmHg and pulmonary edema ensued. ECG showed sinus tachycardia with no ST elevation. Repeated intravenous clonidine doses were given (25 mcg every 5-10 min), with ongoing clonidine infusion to control blood pressure. Glyceryl trinitrate infusion, positive pressure ventilation and intravenous benzodiazepines were added. Bedside echocardiogram showed stress-induced cardiomyopathy pattern. Serum troponin-I was markedly elevated. His coronary angiography showed minor irregularities in the major vessels. Over the next 3 days in the ICU, drug infusions were weaned. Discharge was 12 days later on oral clonidine, metoprolol, perindopril, aspirin and oxycodone-SR. Two months later, his echocardiogram was normal. The intrathecal pump was removed. We report a case of stress-induced cardiomyopathy resulting from the sudden cessation of long-term intrathecal clonidine. This was managed by re-institution of clonidine and targeted organ-specific therapies. PMID:26370679

  4. Dependence induced increases in intragastric alcohol consumption in mice.

    Science.gov (United States)

    Fidler, Tara L; Powers, Matthew S; Ramirez, Jason J; Crane, Andrew; Mulgrew, Jennifer; Smitasin, Phoebe; Cunningham, Christopher L

    2012-01-01

    Three experiments used the intragastric alcohol consumption (IGAC) procedure to examine the effects of variations in passive ethanol exposure on withdrawal and voluntary ethanol intake in two inbred mouse strains, C57BL/6J (B6) and DBA/2J (D2). Experimental treatments were selected to induce quantitative differences in ethanol dependence and withdrawal severity by: (1) varying the periodicity of passive ethanol exposure (three, six or nine infusions/day); (2) varying the dose per infusion (low, medium or high); and (3) varying the duration of passive exposure (3, 5 or 10 days). All experiments included control groups passively exposed to water. B6 mice generally self-infused more ethanol than D2 mice, but passive ethanol exposure increased IGAC in both strains, with D2 mice showing larger relative increases during the first few days of ethanol access. Bout data supported the characterization of B6 mice as sippers and D2 mice as gulpers. Three larger infusions per day produced a stronger effect on IGAC than six or nine smaller infusions, especially in D2 mice. Increased IGAC was strongly predicted by cumulative ethanol dose and intoxication during passive exposure in both strains. Withdrawal during the passive exposure phase was also a strong predictor of increased IGAC in D2 mice. However, B6 mice showed little withdrawal, precluding analysis of its potential role. Overall, these data support the hypothesis that dependence-induced increases in IGAC are jointly determined by two processes that might vary across genotypes: (1) tolerance to aversive postabsorptive ethanol effects and (2) negative reinforcement (i.e. alleviation of withdrawal by self-administered ethanol). PMID:21955048

  5. National Institute on Alcohol Abuse and Alcoholism

    Science.gov (United States)

    ... day 12 hours ago Areas of Interest Scientists & Researchers Certificates of Confidentiality Data and Safety Monitoring Guidelines NIAAA-Funded Research Centers Clinicians Helping Patients Who Drink Too Much Alcohol Screening and Brief Intervention for Youth Clinical Trials ...

  6. Withdrawal of cerivastatin from the world market

    Directory of Open Access Journals (Sweden)

    Pitt Bertram

    2001-09-01

    Full Text Available Abstract Cerivastatin was recently withdrawn from the market because of 52 deaths attributed to drug-related rhabdomyolysis that lead to kidney failure. The risk was found to be higher among patients who received the full dose (0.8 mg/day and those who received gemfibrozil concomitantly. Rhabdomyolysis was 10 times more common with cerivastatin than the other five approved statins. We address three important questions raised by this withdrawal. Should we continue to approve drugs on surrogate efficacy? Are all statins interchangeable? Do the benefits outweigh the risks of statins? We conclude that decisions regarding the use of drugs should be based on direct evidence from long-term clinical outcome trials.

  7. Alcohol Advertising and Alcohol Consumption by Adolescents

    OpenAIRE

    Henry Saffer; Dhaval Dave

    2003-01-01

    The purpose of this paper is to empirically estimate the effects of alcohol advertising on adolescent alcohol consumption. The theory of brand capital is used to explain the effects of advertising on consumption. The industry response function and the evidence from prior studies indicate that the empirical strategy should maximize the variance in the advertising data. The approach in this paper to maximizing the variance in advertising data is to employ cross sectional data. The Monitoring th...

  8. Chronic and acute alcohol administration induced neurochemical changes in the brain: comparison of distinct zebrafish populations.

    Science.gov (United States)

    Chatterjee, Diptendu; Shams, Soaleha; Gerlai, Robert

    2014-04-01

    The zebrafish is increasingly utilized in the analysis of the effects of ethanol (alcohol) on brain function and behavior. We have shown significant population-dependent alcohol-induced changes in zebrafish behavior and have started to analyze alterations in dopaminergic and serotoninergic responses. Here, we analyze the effects of alcohol on levels of selected neurochemicals using a 2 × 3 (chronic × acute) between-subject alcohol exposure paradigm randomized for two zebrafish populations, AB and SF. Each fish first received the particular chronic treatment (0 or 0.5 vol/vol% alcohol) and subsequently the acute exposure (0, 0.5 or 1.0% alcohol). We report changes in levels of dopamine, DOPAC, serotonin, 5HIAA, glutamate, GABA, aspartate, glycine and taurine as quantified from whole brain extracts using HPLC. We also analyze monoamine oxidase and tyrosine hydroxylase enzymatic activity. The results demonstrate that compared to SF, AB is more responsive to both acute alcohol exposure and acute alcohol withdrawal at the level of neurochemistry, a finding that correlates well with prior behavioral observations and one which suggests the involvement of genes in the observed alcohol effects. We discuss correlations between the current results and prior behavioral findings, and stress the importance of characterization of zebrafish strains for future behavior genetic and psychopharmacology studies. PMID:24381007

  9. Prior alcohol consumption does not impair go/no-go discrimination learning, but causes over-responding on go trials, in rats.

    Science.gov (United States)

    Pickens, Charles L; Fisher, Hayley; Bright, Nicholas; Gallo, Mark; Ray, Madelyn H; Anji, Antje; Kumari, Meena

    2016-10-01

    Prior alcohol use is associated with impaired response inhibition in humans, including in laboratory go/no-go discrimination tasks. In two experiments, we determined whether chronic intermittent access to alcohol would alter go/no-go discrimination learning. Rats received 4-6 weeks of chronic intermittent access to 20% alcohol (alone or accompanied by saline or 1.5g/kg alcohol injections) or water. Rats then began discrimination training 4-5days after the end of the alcohol access. Each lever was available for 40s with one lever intermittently reinforced ("active lever") and the other lever non-reinforced ("inactive lever"). The rats given access to alcohol without concurrent alcohol injections drank ∼10g/kg/24-h on average during the last three weeks of alcohol access. The groups given alcohol injections (Alcohol+Injection groups) exhibited suppressed drinking, but the Alcohol+Injection groups exhibited higher blood alcohol spikes than all other alcohol groups (195 vs. 85-90mg/dl, respectively). We found no evidence for impaired go/no-go discrimination learning in either experiment. However, the alcohol access groups with moderate-to-high average alcohol consumption (>3g/kg/24-h) exhibited over-responding to the active lever compared to the water-only groups. One group given alcohol injections (Alcohol+Injection group) that exhibited very low voluntary drinking (<1g/kg/24-h) did not exhibit the over-responding effect, suggesting that the total 24-h alcohol dose matters more than short-lived blood alcohol spikes. Our findings are in accord with previous research showing that repeated alcohol withdrawal causes over-responding for responses that lead to limited reinforcement. Future work will determine the psychological and neurobiological basis of this behavioral change. PMID:27327103

  10. Alcohol and pregnancy

    Directory of Open Access Journals (Sweden)

    Anna Maria Paoletti

    2013-06-01

    Full Text Available Alcohol exerts teratogenic effects in all the gestation times, with peculiar features in relationship to the trimester of pregnancy in which alcohol is assumed. Alcohol itself and its metabolites modify DNA synthesis, cellular division, cellular migration and the fetal development. The characteristic facies of feto-alcoholic syndrome (FAS-affected baby depends on the alcohol impact on skull facial development during the first trimester of pregnancy. In association there are cerebral damages with a strong defect of brain development up to the life incompatibility. Serious consequences on fetal health also depends on dangerous effects of alcohol exposure in the organogenesis of the heart, the bone, the kidney, sensorial organs, et al. It has been demonstrated that maternal binge drinking is a high factor risk of mental retardation and of delinquent behaviour. Unfortunately, a lower alcohol intake also exerts deleterious effects on fetal health. In several countries of the world there is a high alcohol use, and this habit is increased in the women. Therefore, correct information has to be given to avoid alcohol use by women in the preconceptional time and during the pregnancy. Preliminary results of a study performed by the authors show that over 80% of pregnant and puerperal women are not unaware that more than 2 glasses of alcohol/week ingested during pregnancy can create neurological abnormalities in the fetus. However, after the information provided on alcoholic fetopathy, all women are conscious of the damage caused by the use of alcohol to the fetus during pregnancy. This study confirms the need to provide detailed information on the negative effects of alcohol on fetal health. Proceedings of the 9th International Workshop on Neonatology · Cagliari (Italy · October 23rd-26th, 2013 · Learned lessons, changing practice and cutting-edge research

  11. Clinico-demographic profile, sexual dysfunction and readiness to change in male alcohol dependence syndrome inpatients in a tertiary hospital.

    Science.gov (United States)

    Pandey, A K; Sapkota, N; Tambi, A; Shyangwa, P M

    2012-03-01

    Persons with prolonged and heavy alcohol use generally suffer from alcohol dependence syndrome (ADS) and develop physical, sexual as well as psychiatric co-morbidity. Successful recovery to normalcy depends on multiple factors including patient's motivation. To study clinico-demographic profile, reasons for initiating alcohol use, sexual and psychiatric disorders and eagerness for treatment and quitting alcohol in ADS inpatients. Fifty consecutive ADS inpatients with matching controls were enrolled. Clinico-demographic profile, factors for initiating alcohol use, psychiatric and sexual co-morbidity and want for treatment and being abstinent was studied applying relevant scales. All subjects were males with a mean age of 37.5 years, 80% were married, majority were Hindu (88%) and from nuclear families (56%). Fifty two percent had an education level of Graduation or more and 68% of patients reported peer pressure to be the initiating factor for alcohol use. Seventy six percent had psychiatric co-morbidity including personality Problems and other Psychiatric disorders 19(38%), delirium tremens 14 (28.00%) and Mood disorders 12(24%).Depression being most common mood disorder (14%). Nicotine was the most common other substance of use 32 (64%). Sixty eight percent of the patient reported one or another sexual dysfunction. 68% of ADS inpatients acknowledged of having problems related to their drinking, expressed desire for change and were eager to avail treatment and to remain abstinent. ADS patients commonly suffer from psychiatric co-morbidity and sexual dysfunctions. They also wish to have effective treatment and to quit alcohol. PMID:23441492

  12. Mitragynine attenuates withdrawal syndrome in morphine-withdrawn zebrafish.

    Science.gov (United States)

    Khor, Beng-Siang; Jamil, Mohd Fadzly Amar; Adenan, Mohamad Ilham; Shu-Chien, Alexander Chong

    2011-01-01

    A major obstacle in treating drug addiction is the severity of opiate withdrawal syndrome, which can lead to unwanted relapse. Mitragynine is the major alkaloid compound found in leaves of Mitragyna speciosa, a plant widely used by opiate addicts to mitigate the harshness of drug withdrawal. A series of experiments was conducted to investigate the effect of mitragynine on anxiety behavior, cortisol level and expression of stress pathway related genes in zebrafish undergoing morphine withdrawal phase. Adult zebrafish were subjected to two weeks chronic morphine exposure at 1.5 mg/L, followed by withdrawal for 24 hours prior to tests. Using the novel tank diving tests, we first showed that morphine-withdrawn zebrafish display anxiety-related swimming behaviors such as decreased exploratory behavior and increased erratic movement. Morphine withdrawal also elevated whole-body cortisol levels, which confirms the phenotypic stress-like behaviors. Exposing morphine-withdrawn fish to mitragynine however attenuates majority of the stress-related swimming behaviors and concomitantly lower whole-body cortisol level. Using real-time PCR gene expression analysis, we also showed that mitragynine reduces the mRNA expression of corticotropin releasing factor receptors and prodynorphin in zebrafish brain during morphine withdrawal phase, revealing for the first time a possible link between mitragynine's ability to attenuate anxiety during opiate withdrawal with the stress-related corticotropin pathway. PMID:22205946

  13. Bipolar disorder and comorbid alcoholism: prevalence rate and treatment considerations.

    Science.gov (United States)

    Frye, Mark A; Salloum, Ihsan M

    2006-12-01

    Classic Kraepelian observations and contemporary epidemiological studies have noted a high prevalence rate between bipolar disorder and alcoholism. The extent to which these two illnesses are comorbid (i.e., two distinct disease processes each with an independent course of illness), genetically linked, or different phenotypic expressions of bipolar illness itself continues to be investigated. It is increasingly clear that co-occurring alcohol abuse or dependence in bipolar disorder phenomenologically changes the illness presentation with higher rates of mixed or dysphoric mania, rapid cycling, increased symptom severity, and higher levels of novelty seeking, suicidality, aggressivity, and impulsivity. It is very encouraging that interest and efforts at evaluating pharmacotherapeutic compounds has substantially increased over the past few years in this difficult-to-treat patient population. This article will review the clinical studies that have evaluated the effectiveness of conventional mood stabilizers (lithium, carbamazepine, divalproex, and atypical antipsychotics) in the treatment of alcohol withdrawal and relapse prevention in patients with alcoholism and in the treatment of bipolar disorder with comorbid alcoholism. A number of add-on, adjunctive medications, such as naltrexone, acamprosate, topiramate, and the atypical antipsychotics quetiapine and clozapine, may be candidates for further testing. PMID:17156154

  14. Tobacco withdrawal symptoms mediate motivation to reinstate smoking during abstinence.

    Science.gov (United States)

    Aguirre, Claudia G; Madrid, Jillian; Leventhal, Adam M

    2015-08-01

    Withdrawal-based theories of addiction hypothesize that motivation to reinstate drug use following acute abstinence is mediated by withdrawal symptoms. Experimental tests of this hypothesis in the tobacco literature are scant and may be subject to methodological limitations. This study utilized a robust within-subject laboratory experimental design to investigate the extent to which composite tobacco withdrawal symptomatology level and 3 unique withdrawal components (i.e., low positive affect, negative affect, and urge to smoke) mediated the effect of smoking abstinence on motivation to reinstate smoking. Smokers (≥10 cigarettes per day; N = 286) attended 2 counterbalanced sessions at which abstinence duration was differentially manipulated (1 hr vs. 17 hr). At both sessions, participants reported current withdrawal symptoms and subsequently completed a task in which they were monetarily rewarded proportional to the length of time they delayed initiating smoking, with shorter latency reflecting stronger motivation to reinstate smoking. Abstinence reduced latency to smoking initiation and positive affect and increased composite withdrawal symptom level, urge, and negative affect. Abstinence-induced reductions in latency to initiating smoking were mediated by each withdrawal component, with stronger effects operating through urge. Combined analyses suggested that urge, negative affect, and low positive affect operate through empirically unique mediational pathways. Secondary analyses suggested similar effects on smoking quantity, few differences among specific urge and affect subtypes, and that dependence amplifies some abstinence effects. This study provides the first experimental evidence that within-person variation in abstinence impacts motivation to reinstate drug use through withdrawal. Urge, negative affect, and low positive affect may reflect unique withdrawal-mediated mechanisms underlying tobacco addiction. PMID:25961814

  15. Increased anxiety and other similarities in temperament of alcoholics with and without antisocial personality disorder across three diverse populations.

    Science.gov (United States)

    Ducci, Francesca; Enoch, Mary-Anne; Funt, Samuel; Virkkunen, Matti; Albaugh, Bernard; Goldman, David

    2007-02-01

    According to Cloninger's model, type I alcoholics are thought to be innately vulnerable to anxiety and depression. In contrast, type II alcoholics are thought to have increased likelihood of antisocial personality disorder (ASPD) and reduced anxiety. However, allostatic activations of stress, anxiety, and dysphoria may be a common thread in alcohol use disorders (AUDs). Our aim was to find commonalities and differences in temperament of alcoholics with and without ASPD in three diverse populations. By sib-sib comparisons, we also evaluated the extent to which the temperament traits were moderated by familial factors including inheritance. We compared harm avoidance (HA), novelty seeking (NS), and reward dependence (RD) in alcoholics with ASPD, alcoholics without ASPD, and controls. Correlations for each temperament dimension were evaluated in pairs of siblings concordant and discordant for AUD. Participants were derived from three independent populations: Finnish Caucasians (N=453, men=100%, including a sample of alcoholic criminals), a Plains American Indian community sample (N=378; men=42%), and a subset of the familial and predominantly Caucasian Collaborative Study on the Genetics of Alcoholism (COGA) sample (N=967, men=47%). In all the three populations, both alcoholics with and without ASPD were higher in HA than controls. The increase of HA among alcoholics as compared to controls ranged from 54% to 12%. In two populations (COGA and Finns), NS was highest in alcoholics with ASPD, intermediate in alcoholics without ASPD, and lowest in controls. HA levels were correlated in sib-pairs concordant (either affected or unaffected) for AUD but not in discordant pairs. In conclusions, despite cultural diversity and different modes of ascertainment we found a consistent pattern of elevated HA in all groups of alcoholics, including alcoholics with ASPD. Even in alcoholics with long-term exposure to the anxiogenic effects of repeated cycles of alcohol withdrawal

  16. [Upgrade on alcohol abuse].

    Science.gov (United States)

    Bordini, L; Riboldi, L

    2010-01-01

    Problematic use of alcohol configures an element of interest in the context of preventive interventions aimed to ensuring the performance of any work in safety conditions. To contrast the acute alcohol abuse in the workplace the existing legislation provides alcoholimeters controls and prohibition of recruitment and administration of alcohol. Recent legislation (D.Lgs. 81/08) establishes health surveillance for alcohol dependence and appears still incomplete and difficult to apply. Clinical diagnostic tools available to the physician for alcohol dependence identification are well-defined and recently improved thanks to new laboratory markers with high sensitivity and specificity (CDT) and self-administered questionnaires. In this contest we are awaiting for legislative action to specify conditions and procedures for inspections in the workplace in order to face the problem of alcohol dependence without excessive bureaucracy and with more attention to preventive aspects. PMID:21438261

  17. Fetal Alcohol Spectrum Disorders

    OpenAIRE

    Warren, Kenneth R.; Hewitt, Brenda G.; Thomas, Jennifer D.

    2010-01-01

    The adverse effects of prenatal alcohol consumption have long been known; however, a formal description and clinical diagnosis of these effects was not introduced until 1973. Since then, the distinction of the wide range of effects that can be induced by prenatal alcohol exposure, and, consequently, the terminology to describe these effects has continued to evolve. Although much progress has been made in understanding the consequences of prenatal alcohol exposure, challenges still remain in p...

  18. Alcohol Consumption in Students

    OpenAIRE

    Tran, Cathy

    2010-01-01

    Drinking behaviour among university students is a serious public health concern. Reasons for drinking are complex and many factors contribute to this behaviour. Previous research has established links between personality factors and alcohol consumption and also between metacognitions and alcohol consumption. Few studies have looked into how personality traits and metacognitions interact. This study investigated the relationships between personality, metacognitions and alcohol consumption in a...

  19. ADOLESCENTS AND ALCOHOL

    OpenAIRE

    SPEAR, LINDA PATIA

    2013-01-01

    The high levels of alcohol consumption characteristic of adolescence may be in part biologically based, given that elevated consumption levels are also evident during this developmental transition in other mammalian species as well. Studies conducted using a simple animal model of adolescence in the rat has shown adolescents to be more sensitive than adults to social facilitatory and rewarding effects of alcohol, but less sensitive to numerous alcohol effects that may serve as cues to limit i...

  20. Children of alcoholics

    OpenAIRE

    Robert Oravecz

    2002-01-01

    The author briefly interprets the research – results, referring to the phenomenon of children of alcoholics, especially the psychological and psychopathological characteristics of children of alcoholics in adolescence and young adulthood. The author presents a screening study of adolescents. The sample contains 200 high school students at age 18. The aim of the survey was to discover the relationship between alcohol consumption of parents, PTSD - related psychopathological symptoms and ...