Alcohol dependence in a psychiatric interconsultation unit

2011 ◽  
Vol 26 (S2) ◽  
pp. 119-119
Author(s):  
I. Veiga ◽  
P. Martinez ◽  
L. Vigo ◽  
J. Portillo ◽  
A. Gago
Keyword(s):  
Primary Care ◽  
Alcohol Dependence ◽  
Alcohol Intoxication ◽  
Care Physician ◽  
Medical Admission ◽  
Prevention Strategies ◽  
History Of ◽  
Acute Agitation ◽  
Dsm Iv ◽  
The Mean

AimsTo determine the pattern of alcohol dependence among medical impatients who requires Psychiatric Interconsultation, with the purpose of achieve a better understanding of the problem and to suggest prevention strategies.MethodsSample studied was collected among all inpatients with diagnosis of alcohol dependence (DSM-IV-TR) admitted in our hospital during a study period of 3 years, from january 2007 to may 2010, who required psychiatric interconsultation.Results101 admissions with diagnosis of alcohol dependence were reviewed. There were 80 men (79,20%) and 21 women (20,8%). The mean of age was 53,13 years. The mean days of stay was 14,13. In this study, 60 subjects (59,40) there are medical history of alcohol dependence and 58 (57,42%) psychiatrc history.Aims of admissionAlcohol deprivation 13 cases (12,87%); convulsion 6 (5,94%); acute agitation 5 (4,95%); cranioencephalic trauma 5 (4,95%); alcohol intoxication 5 (4,95%); fracture 4 (3,96%); suicide attempt 6 (3,96%); psychiatric indication 10 (9,9%); primary care indication 3 (0,029%); organic problem secondary to alcohol 32 (31,68%); other 12 (6,11%). 42 patients were admitted in Unidade Medica de Alta precoz (41,58%); Medical 21 (20,79%); Traumatology department 4 (3,96%); Gastroenterology 12 (6,11%); Neurology 3 (0,029%); Other departments 19 (18,81%).ConclusionsThe main cause of medical admission are somatic complications of alcohol, finding that only 9.9% of the income was indicated by the psychiatrist and to 0.029% for the primary care physician. Primary, secondary and tertiary prevention 1, 2 and 3 of these complications should be a target of psychiatry.

scholarly journals Screening for Atrial Fibrillation in American Indian Adults in a Tribal Primary Care Clinic

2021 ◽  
Author(s):  
Stavros Stavrakis ◽  
Khaled Elkholey ◽  
Marty M. Lofgren ◽  
Zain U. A. Asad ◽  
Lancer D. Stephens ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
American Indian ◽  
Primary Care Clinic ◽  
Care Physician ◽  
Racial Groups ◽  
Unique Identifier ◽  
Care Clinic ◽  
Time Period ◽  
History Of

Background American Indian adults have a higher risk of atrial fibrillation (AF) compared with other racial groups. We implemented opportunistic screening to detect silent AF in American Indian adults attending a tribal health system using a mobile, single‐lead ECG device. Methods and Results American Indian patients aged ≥50 years followed in a tribal primary care clinic with no history of AF underwent a 30‐second ECG. A cardiologist overread all tracings to confirm the diagnosis of AF. After AF was confirmed, patients were referred to their primary care physician for initiation of anticoagulation. Patients seen over the same time period, who were not undergoing screening, served as controls. A total of 1019 patients received AF screening (mean age, 61.5±8.9 years, 62% women). Age and sex distribution of those screened was similar to the overall clinic population. New AF was diagnosed in 15 of 1019 (1.5%) patients screened versus 4 of 1267 (0.3%) patients who were not screened (mean difference, 1.2%; 95% CI, 0.3%–2.2%, P =0.002). Eight of 15 with new screen‐detected AF were aged <65 years. Those with screen‐detected AF were slightly older and had a higher CHA 2 DS 2 ‐VASc score than those without AF. Fourteen of 15 patients diagnosed with new AF had a CHA 2 DS 2 ‐VASc score ≥1 and initiated anticoagulation. Conclusions Opportunistic, mobile single‐lead ECG screening for AF is feasible in tribal clinics, and detects more AF than usual care, leading to appropriate initiation of anticoagulation. AF develops at a younger age in American Indian adults who would likely benefit from earlier AF screening. Registration URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03740477.

Condition of the tongue, periodontal and immune statuses in men with alcohol dependence syndrome

2021 ◽  
Vol 26 (1) ◽  
pp. 52-57
Author(s):  
K. A. Kunavina ◽  
A. S. Opravin ◽  
A. G. Soloviev ◽  
O. A. Harkova ◽  
N. V. Davidovich
Keyword(s):  
Alcohol Dependence ◽  
Oral Hygiene ◽  
Immune Status ◽  
Comparison Group ◽  
Alcohol Intoxication ◽  
Periodontal Diseases ◽  
Dorsal Surface ◽  
Chi Squared ◽  
History Of ◽  
Alcohol Dependence Syndrome

Relevance. Oral health problems, particularly periodontal diseases, are frequent complications in people with alcohol dependence syndrome (ADS). The assessment of the periodontal, immune status and the tongue condition in ADS patients by the set of indices is promising. Materials and methods. The periodontal and immune status and the tongue condition were examined in 114 men, of whom 47 were patients with stage II ADS and 67 were subjects without a history of ADS. Pearson's chi-squared test, Mann–Whitney U test, logistic regression, factor analysis were used for statistical analysis. Results. ADS patients have significantly worse oral hygiene (p < 0.001) and 35.5 times higher probability of moderate to severe gum inflammation (p < 0.001). Sextants with bleeding (39.0%) and calculus (25.9%) prevailed among ADS patients whereas most of sextants were healthy (85.8%) in the comparison group. Significant inter-group differences were found for all CPI codes except code 4 (p < 0.001). The dorsal surface tongue coating (63.8%) and minor hyperkeratosis (27.7%) prevailed among ADS patients, while in the comparison group, there were no changes in 34.3% of subjects and coating was present in 38.8% (p = 0.003). The risk of satisfactory to poor oral hygiene was 3.7 times (p = 0.007) higher and the risk of moderate to severe gum inflammation was predicted to be 6.5 times (p = 0.015) higher if the examined subjects had changes in the tongue mucosa. The obtained differences in the level of IgG, TNF-α and cortisol prevailed in ADS patients (p < 0.001). Conclusion. In ADS patients, the severity of periodontal diseases, changes in the tongue mucosa and mucosal immunity imbalance are statistically significant. The considered dental markers of chronic alcohol intoxication are proposed to be used at the treatment and checkup dental visits to screen individuals at risk of alcohol use disorder.

Abstract 274: Primary Care Physician Status is an Important Factor in Addressing Healthcare Disparities in Patients With Cardiovascular Disease

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Ryan King ◽  
Dalia Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Logistic Regression ◽  
Primary Care Physician ◽  
Beta Blocker ◽  
Care Physician ◽  
Cardiac Events ◽  
Cvd Risk ◽  
The Mean

Recent improvements in survival and management of patients with cardiovascular disease (CVD) have resulted from timely use of medications such as beta blockers according to established guidelines. Without medical care provided by a primary care physician (PCP), patients may experience a significant healthcare disparity leading to CVD risk factors not being addressed or not receiving effective preventative therapies. If patients do not have a PCP, then their risk of experiencing CVD complications including an acute myocardial infarction (AMI) may be increased without access to appropriate treatment. We hypothesized that the utilization of preventative therapy depends on patient’s ability to have a PCP. Patients who do not have a PCP are less likely to receive a timely prescription of a beta blocker. Data for this study was collected through a retrospective chart review for 250 patients who presented to the Hartford Hospital Emergency Department for an AMI and were subsequently admitted between August 1, 2016 and April 30, 2018. A Chi square, independent t-test, and logistic regression were used for statistical analysis. A total of 17 patients were excluded due to incomplete documentation. The mean age of 233 patients was 64.64 ± 14.03 years old (range 26-89, males-144, females-89). There were 179 (76.8%) of these patients who had a documented PCP. Out of those with a PCP there were 104 (72.2%, of 144) males as compared to 75 (84.3%, of 89) females, p<0.034. Of the 223 with confirmed information about a beta blocker prescription there were 116 (52.0%) using a beta blocker before this admission for AMI and 99 (85.3%, of 116) of them had a PCP. There were 69 (59.5%, of 116) men and 47 (40.5%, of 116) women using a beta blocker. The mean age of patients using a beta blocker was 69.38 ± 12.9 years vs. 58.99 ± 13.08 years for those without a prescription (p < 0.001). A significant association was also found using logistic regression between PCP status and age groups (> 55 y vs < 55 y), p=0.032, gender, p=0.047, and beta blocker use, p=0.018. Our study shows that being prescribed a beta blocker significantly depends on the patient’s ability to have a PCP. Our study shows that among subjects with AMI, having access to a PCP is an important factor in being prescribed a beta blocker. Identifying barriers to PCP access may improve prevention measures and help bridge disparities resulting in major cardiac events such as myocardial infarction.

scholarly journals Dofetilide-induced anorexia in an older adult

2018 ◽  
Vol 9 (7) ◽  
pp. 367-372 ◽  
Author(s):  
Jerald V. Felipe ◽  
Danielle R. Fixen ◽  
Sunny A. Linnebur
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Body Weight ◽  
Primary Care Physician ◽  
Care Physician ◽  
Temporal Association ◽  
Appetite Loss ◽  
History Of ◽  
Medication Changes ◽  
Maximum Weight Loss

An 84-year-old woman presented to her primary care physician with an unexplained 4-month history of weight and appetite loss after initiation of dofetilide 125 mcg orally twice daily for atrial fibrillation. She was noted to have lost 2.5 kg, which was a 3.6% decrease from her initial body weight of 69.4 kg. After excluding other etiologies for her anorexia, such as medication changes or changes in other diseases or conditions, her primary care physician and cardiologists elected to continue dofetilide but monitor the patient’s appetite and body weight. After 7 months of dofetilide use with persistent appetite loss, the cardiology team discontinued dofetilide. Continued weight loss was observed until approximately 1 month after stopping dofetilide, with a maximum weight loss of 2.9 kg or a 4.2% decrease. Improvements in appetite were reported 2 months after discontinuing dofetilide, with minor increases in weight that eventually stabilized. In this case, while taking dofetilide, the patient experienced anorexia leading to weight loss that subsided after discontinuation of the drug. Based on the temporal association between the patient’s changes in appetite and body weight and treatment with dofetilide, the drug was most likely the cause of the patient’s anorexia. We are unaware of other reports of anorexia associated with dofetilide, but clinicians may want to consider the drug as a potential cause for otherwise unexplained changes in appetite or body weight.

Suicidal Attempts and Life Events Among Depressive Adult Outpatients

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
G. Amara ◽  
A. Braham ◽  
S. Ben Nasr ◽  
B. Ben Hadj Ali
Keyword(s):  
Life Events ◽  
Stressful Life Events ◽  
Stressful Life ◽  
Major Depressive ◽  
Suicidal Attempts ◽  
History Of ◽  
Dsm Iv ◽  
The Mean ◽  
Psychiatric Department ◽  
Early Life Events

Aims:Although a relationship between experience of problematic life events and suicidal behaviour has been recognized during last decades, few studies of life events have been realized among depressive adults.The aim of this study was to determine the correlations between life events and suicidal attempts among depressive adult patients.Methods:Eighty adult outpatients were recruited from the psychiatric department of Farhat Hached hospital of sousse (in Tunisia). All patients were followed up for a Major Depressive Disorder (MDD) according to the DSM IV criteria. They also were in remission for at least four weeks. For life events we used the EVE scale of Ferreri which permitted to assess event nature, event number and patient strategies in front of stressful life events.Results:The gender ratio of the sample was 1.35 and the mean age was 44.4 ± 12.9 years.Twenty five percent of the sample have committed at least one suicidal attempt.Suicidal attempts were positively correlated with the total number of life events (p = 0.001), the number of early life events (p = 0.024) and the number of stressful life events (p < 0.001). Patients with a history of suicidal attempts were more likely to cope negatively with life events (p < 0.001).Conclusion:To prevent suicide, psychotherapies focusing on stress coping could be a good therapeutic alternative among patients with MDD.

scholarly journals Maximizing patient benefit through a reversed pathway from specialist to generalist: the case of chronic pain

2021 ◽  
Author(s):  
Ioannis Karageorgiou ◽  
Stamatios Kokkinakis ◽  
Neofytos Maliotis ◽  
Christos Lionis ◽  
Emmanouil K Symvoulakis
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Sleep Disturbances ◽  
Care Physician ◽  
The Past ◽  
Appropriate Treatment ◽  
Oral Corticosteroids ◽  
Dose Oral ◽  
History Of ◽  
Chronic Pain Conditions

Polymyalgia Rheumatica (PMR) is a syndrome characterized by chronic pain and/or stiffness in the neck, shoulders or upper arms and hips. It affects adult patients usually over 50 years old and is treated with low-dose oral corticosteroids. In this case, a 68-year-old female with a history of PMR, diagnosed by a specialist sporadically seen in the past, presented to a primary care physician due to herpes zoster (HZ) infection. Thorough history taking, along with a careful review of previous laboratory results, raised serious doubts concerning her diagnosis (PMR). Because the patient described diffuse pain throughout her body, sleep disturbances and a depressed emotional state, fibromyalgia was suspected instead and appropriate treatment was given. The patient remained free of symptoms and corticosteroids for almost a year. Information from this case may help to point out that PMR is a disorder that can be easily confused with other chronic pain conditions with similar manifestations, especially when the initial diagnosis is sped up in terms of consultation depth and care continuity. Under certain circumstances, primary care can lead to improved clinical outcomes.

scholarly journals Effects of discontinuation of chronic medication in primary care: a systematic review of deprescribing trials

2018 ◽  
Vol 68 (675) ◽  
pp. e663-e672 ◽  
Author(s):  
Sioe Lie Thio ◽  
Joana Nam ◽  
Mieke L van Driel ◽  
Thomas Dirven ◽  
Jeanet W Blom
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Care Physician ◽  
Evidence Based ◽  
Chronic Medication ◽  
Primary Care Settings ◽  
Number Of Patients ◽  
The Mean ◽  
Randomised Controlled

BackgroundPolypharmacy is becoming more prevalent and evaluation of appropriateness of medication use is increasingly important. The primary care physician often conducts the deprescribing process; however, there are several barriers to implementing this.AimTo examine the feasibility and safety of discontinuation of medication, with a focus on studies that have been conducted in the community, that is, primary care (or general practice) and nursing homes.Design and settingThis systematic review included randomised controlled trials published in 2005–2017, which studied withdrawal of long-term drugs prescribed in primary care settings and compared continuing medication with discontinuing.MethodPubMed and EMBASE searches were conducted and the extracted data included the number of patients who successfully stopped medication and the number of patients who experienced relapse of symptoms or restarted medication.ResultsA total of 27 studies reported in 26 papers were included in this review. The number of participants in the studies varied from 20 to 2471 and the mean age of participants ranged from 50.3 years to 89.2 years. The proportion of patients who successfully stopped their medication varied from 20% to 100%, and the range of reported relapse varied from 1.9% to 80%.ConclusionOnly a few studies have examined the success rate and safety of discontinuing medication in primary care, and these studies are very heterogeneous. Most studies show that deprescribing and cessation of long-term use seem safe; however, there is a risk of relapse of symptoms. More research is needed to advise physicians in making evidence-based decisions about deprescribing in primary care settings.

scholarly journals Depersonalisation disorder: clinical features of 204 cases

2003 ◽  
Vol 182 (5) ◽  
pp. 428-433 ◽  
Author(s):  
Dawn Baker ◽  
Elaine Hunter ◽  
Emma Lawrence ◽  
Nicholas Medford ◽  
Maxine Patel ◽  
...  
Keyword(s):  
Age Of Onset ◽  
Past History ◽  
Self Report ◽  
Anxiety And Depression ◽  
Dissociative Amnesia ◽  
Male Preponderance ◽  
History Of ◽  
Dsm Iv ◽  
The Mean ◽  
State Examination

BackgroundDepersonalisation disorder is a poorly understood and underresearched syndrome.AimsTo carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic.MethodA total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM–IV criteria.ResultsThe mean age of onset was 22.8 years; early onset was associated with greater severity There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM–IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. ‘Dissociative amnesia’ was not prominent.ConclusionsDepersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted.

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