Stop Alcohol Addiction

Alcohol Free Forever

This powerful guide walks you step-by-step through exactly what you need to do to free yourself from your alcohol addiction without going through AA meetings or expensive sessions. There are three main types of relaxation techniques you can practice when you feel upset and stressed. If you practice regularly, they will become part of your lifestyle and you may find yourself habitually more relaxed as a result. Part 2 will exercise Neuro Linguistic Programming to release thoughts and a technique of progressive muscle relaxation also negative situations. Because of the mind body connection, exercises to relax the body will also flow through the mind. Much of the stress we feel is because of our resistance to certain feelings or emotions. Alcohol Free Forever is a lifesaver ebook. This guide was extremely eye-opening and the daily emails make it extremely easy to quit and to establish a routine that did not involve alcohol. Continue reading...

Alcohol Free Forever Summary


4.8 stars out of 16 votes

Contents: Ebook, Daily Emails
Author: Mark Smith
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My Alcohol Free Forever Review

Highly Recommended

I usually find books written on this category hard to understand and full of jargon. But the writer was capable of presenting advanced techniques in an extremely easy to understand language.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

Medical consequences of longterm alcoholism Harmful effects

The principal harmful effects of heavy drinking include liver pathology (hepaptitis, hepatoma, cirrhosis), neurological complications, and cancers of the mouth, larynx, oesophagus, and breast. Medical sequelae are likely to start to present in middle age in those alcoholics and smokers who started drinking and smoking in their youth. Women achieve higher blood alcohol concentrations than men after the consumption of equivalent doses per body weight. The most likely explanation for this is that there is a lower volume of distribution of alcohol in women because the solubility of alcohol is greater in water than in fat and women tend to have proportionally more fat and less body water than men. The higher blood alcohol concentration may cause greater organ toxicity than in men. Women tend to present with more severe liver disease (particularly alcoholic hepatitis) and do so after drinking less and over a shorter period of time than men. Women are more likely than men to die from...

Treatment of alcohol dependence and abuse

A formal diagnosis of alcoholism can have enormous personal implications for a patient. Therefore, assessment should be detailed.2 Alcohol abuse and dependence have a variable course characterized by periods of remission and relapse. There are three components to alcoholism (i) physiological dependence (symptoms of withdrawal), (ii) psychological dependence (alcohol used as self-medication), and (iii) habit (the incorporation of drinking into the framework of daily living). Alcohol dependence is treated in two stages withdrawal and detoxification, followed by further interventions to prevent relapse.

Immediate treatment detoxification the control of alcohol withdrawal syndrome

In heavy, chronic drinkers, withdrawal symptoms begin 6-48 hours after the last drink, peak within 24-48 hours, and gradually resolve within five to seven days. The severity of withdrawal symptoms increases with each withdrawal episode. Severe withdrawal (grand mal convulsions, delirium tremens) occurs in 2-5 of heavy-drinking chronic alcoholics. With treatment, mortality is about 1 , death usuallybeing caused by cardiovascular collapse or concurrent infection. are sedating, produce cognitive impairment, are addictive, and may interact additively with alcohol. An alternative approach is to use non-sedating, non-addictive, anticonvulsant agents such as carbamazepine and valproic acid, which have been used successfully for many years in Europe.44 However, these drugs have hematological side effects and liver toxicity, so patients have to be medically screened before use. Alcoholics should be admitted to hospital for detoxification if they are likely to have severe, life-threatening...

Alcoholics Anonymous Women for Sobriety and 12step facilitation therapy

Alcoholics Anonymous (AA) is a worldwide spiritual program that addresses people from all social strata. Group members share their experiences in a confidential environment and provide each other with help and support in order to maintain sobriety. AA and similar self-help groups follow 12 steps that alcoholics should work through during recovery. There are women-only AA groups. Twelve-step facilitation (TSF) is a formal treatment approach incorporating AA and similar 12-step programs.46 Women for Sobriety (WFS) is a rapidly expanding worldwide organization of women for women. The purpose is to help women recover from all aspects of addiction (physiological, mental, and emotional) through the discovery of self, gained by sharing experiences, hopes, and encouragement with other women in similar circumstances. The WFS New Life program starts by accepting alcoholism as a disease, getting rid of negative thoughts (guilt, shame), creating and practicing a new, positive view of self, using...

Beneficial effects of alcohol consumption

Before the age of 60, breast cancer is a more important cause of death than heart disease. Later on, the risk of heart disease exceeds that of breast cancer, so the benefits of moderate drinking are more apparent. The consumption of at least one drink a day by mid-life and elderly women is associated with a 20 reduction in the risk of cardiovascular disease compared with non-drinkers.38 Like men, women appear to experience a U-shaped relationship between alcohol consumption and coronary artery disease.

Alcoholism and Hypoglycemia

Alcoholics are very susceptible to hypoglycemia. In addition to poor nutrition and the feet that alcohol is metabolized to acetate (acetyl CoA), the high amounts of cytoplasmic NADH formed by alcohol dehydrogenase and acetaldehyde dehydrogenase interfere with gluconeogenesis. High NADH favors the formation of

Wine and the heart is wine more cardioprotective than ethanol

The evidence summarized above demonstrates that light-to-moderate drinking is associated with a lower risk of coronary heart disease compared with non-drinkers, and that the protective effect appears to be genuine, independent of known biases and confounding factors. The evidence also suggests that heavy drinking does not provide protection against heart disease, and that it may, in fact, be associated with a higher risk compared with non-drinkers. The question remains whether, among moderate drinkers, wine is associated with a higher degree of protection against heart disease compared with other alcoholic beverages. This problem is addressed in this section. There have been very few studies directly comparing the effect of different types of alcoholic beverages on the risk of coronary heart disease. In the mid-1990s, Rimm and colleagues reviewed the literature and addressed this question (Rimm et al. 1996). They found clear evidence of a strong inverse relationship between moderate...

Alcoholic cardiomyopathy

An apparent relation between chronic intake of large amounts of alcohol and heart disease was noted by several clinicians and pathologists in the nineteenth century (Friedreich 1861 Walsche 1873 Strumpel 1890 Steell 1893 Osler 1899). A German pathologist (Bollinger 1884) described the 'Munchener Bierherz' among Bavarian beer drinkers, who reportedly averaged 432 litres per year. In 1900, an epidemic of heart disease due to arsenic-contaminated beer occurred in Manchester, UK. This led to the confusion of arsenic toxicity with damage from alcohol (Steell 1906). The great cardiologist William MacKenzie (MacKenzie 1902) described cases of heart failure attributed to alcohol and first used the term 'alcoholic heart disease'. Early in the twentieth century, there was general doubt that alcohol had a direct role in producing heart muscle disease, although some (Vaquez 1921) took a strong view in favour of such a relationship. After the appearance of detailed descriptions of cardiovascular...

Alcohol and allcause mortality

Perhaps the most reliable information on the effects of alcohol came from studies on mortality. For all-cause mortality, virtually all prospective studies have found a U-shaped or J-shaped association with alcohol consumption (Marmot 1984 Marmot and Brunner 1991 Royal College of Physicians Alcohol consumption (drinks day) Figure 5.1 Alcohol consumption and all-cause mortality in US men and women (based on Thun et al. 1997). 1995 Rimm et al. 1996 Corrao et al. 2000). In general, moderate drinkers have lower mortality than non-drinkers there seems to be little association between consumption and mortality within moderate intake levels. At higher intake levels, the mortality risk curve starts to rise again above that of non-drinkers. This is well illustrated by the American Cancer Prevention Study, the largest study on alcohol and mortality in individuals to date. It examined the drinking habits and other life-style factors in nearly half a million US adults, and recorded deaths...

Coronary heart disease

In the early 1900s, reports appeared of an inverse relation between heavy alcohol drinking and atherosclerotic disease (Cabot 1904 Hultgen 1910), but others (Wilens 1947 Ruebner et al. 1961) explained this as an artefact due to the premature deaths of many heavy drinkers. Early studies of alcoholics and problem drinkers suggested a high CHD rate (Wilens 1947 Ruebner et al. 1961), but some of these studies did not allow for the role of traits associated with alcoholism, such as cigarette smoking. Such studies can tell nothing about the role of light moderate drinking. These have consistently shown a reduced risk of acute myocardial infarction and death from CHD in light moderate drinkers compared with alcohol-abstainers (Moore and Pearson 1986 Marmot and Brunner 1991 Maclure 1993 Renaud et al. 1993 Klatsky 1994 Rehm et al. 1997). Because the symptom angina pectoris is subjective, it is difficult to quantify. Thus, angina is less used as a study endpoint and has been relatively little...

The influence of wine consumption on agerelated macular degeneration

Over the past several decades, attention has focused on the negative health consequences of alcohol. In addition to ocular anomalies among children with fetal alcohol syndrome, epidemiological studies indicate that chronic alcoholism is associated with a higher risk of cataract, keratitis and colour vision deficiencies. Not until the past few decades have we begun to explore the dichotomy of the health effect of alcohol. Many studies have attributed any beneficial effect of alcohol to red wine. Specifically, the last decade has witnessed a significant increase in our understanding of the health benefit of moderate wine consumption. wine intake was responsible for the lower rate of ARMD observed with alcohol intake. The association between ARMD and wine consumption was maintained after adjustment for several confounding variables. Although the evidence suggested that moderate amounts of alcohol in general may have a beneficial effect on ARMD, significant benefit was only noted among...

Peripheral vascular disease

This term is usually used to refer to atherosclerotic disease in the aorta or large extremity arteries, and is far more common in the vessels to the legs than in those to the arms. The risk factors are similar to those for CHD, except that smoking and diabetes are especially strong predictors (Hirsch et al. 2001). The prognosis is related to the very high prevalence of concomitant CHD and cerebrovascular disease. There are sparse data about the role of alcohol, but data from the Framingham Heart Study (Djousse et al. 2000) show a U-shaped relation of alcohol intake to risk of leg claudication, a common symptom of peripheral vascular disease. As for CHD, these data suggest a protective effect of moderate alcohol intake.

Alcohol and cardiovascular disease

The vast majority of cardiovascular deaths in Europe are from coronary heart disease and from cerebrovascular disease (stroke), with the proportion of each varying between countries. Stroke can be caused either by a blood clot in the cerebral circulation (ischaemic strokes) or by brain haemorrhage (haemorrhagic strokes). Cardiovascular diseases deserve more attention for two reasons first, cardiovascular diseases are the most common cause of death in middle-aged and older groups in most countries second, the association between alcohol consumption and cardiovascular diseases is complex and not yet fully understood. Results of the numerous studies of alcohol and coronary heart disease are remarkably consistent (for reviews, see Marmot 1984 Marmot and Brunner 1991 Royal College of Physicians 1995 Rimm et al. 1996 Doll 1997 Fagrell et al. 1999 Corrao et al. 2000). The evidence suggests that the relation between alcohol and both coronary heart disease and stroke follows a U-shaped or...

Conclusion and public health implication

The overall health risks of a heavy drinker will be reduced by reduction of drinking or abstinence. 3. Light to moderate drinkers, who constitute the majority of people, need no change in drinking habits for health reasons, except in special circumstances. * Arsenic- cobalt-beer-drinkers' disease.

List of figures

Figure 5.1 Alcohol consumption and all-cause mortality Figure 5.2 Alcohol consumption and mortality from coronary Figure 5.3 Alcohol consumption and mortality from coronary Figure 13.1 Percentage of people with age-related macular degeneration by wine consumption in the First National Health and Nutrition Examination Survey. 287 Figure 13.2 Differences in the incidence of age-related macular degeneration between wine-drinkers and non-wine-drinkers in the Third National Health and Nutrition Examination Survey. 288

Ancient China

Examples of prescriptions include one where animal parts were mixed in wine to procure an abortion rub a mixture of lizard's liver, skin of the cicada locust and wine on to the navel. Or the flesh of a pit viper was prepared by placing the snake in a gallon of wine then burying the sealed jar under a horse's stall for one year. The resultant liquid was a cure for apoplexy, fistula, stomach pain, heart pain, colic, haemorrhoids, worms, flatulence and bleeding from the bowel. Alcoholism could be cured by donkey's placenta mixed in wine, the liver of a black cat in wine for malaria, and to cure a bad cold an owl was smothered to death, plucked and boiled, its bones charred and taken with wine (Read 1931-7).

Cardiac arrhythmias

An association of heavier alcohol consumption with atrial arrhythmias has been observed for decades, typically occurring after a large meal accompanied by much alcohol. This has been called the 'holiday heart phenomenon' on the basis of the observation (Ettinger et al. 1978) that supraventricular arrhythmias in alcoholics without overt cardiomyopathy were most likely to occur on Mondays or between Christmas and New Year's Day. Various atrial rhythm disturbances have been reported to be associated with binge-drinking atrial fibrillation is the commonest manifestation. The problem typically resolves with abstinence, with or without other specific treatment. A Kaiser Permanente study (Cohen et al. 1988) compared atrial arrhythmias in 1322 people reporting six or more drinks per day with arrhythmias in 2644 light drinkers. The relative risk in the heavier drinkers was at least doubled for each of the following atrial fibrillation, atrial flutter, supraventricular tachycardia, and atrial...


Amount of wine that is beneficial is unknown at the moment. Misclassification of ARMD, bias in alcohol consumption recall, geographic differences and associated environmental influence, and heritability offer additional explanations for the differential effect of wine on ARMD between different studies. It should also be emphasized that a large proportion of the studies on wine and ARMD to date either do not have the sample size or the information on wine consumption required to detect an association. Although age correlates highly with the occurrence of ARMD, it is unclear whether the influence of age is a reflection of cumulative environmental insults associated with reactive oxygen molecules and or health behaviours, and therefore whether it is an additional confounder. The negative association with wine and the intake frequency that is involved in this association warrants further investigation.

Helicobacter pylori

A number of studies has investigated the protective role of alcohol against infection by H. pylori. In a study performed in southern Germany, the relationship between alcohol consumption and active infection with H. pylori was examined. The amount and type of alcohol consumed was determined by a standardized questionnaire infection with H. pylori was measured by a standard technique used for diagnosis. The study showed an inverse relationship between alcohol consumption and infection with H. pylori. This relationship was stronger for wine than for beer. The magnitude of this effect is considerable, with alcohol-drinkers only one-third as likely to be infected as non-drinkers (Brenner et al. 1999). One study of Danish adult lifestyles (Rosenstock et al. 2000), among others, has shown similar results and supports the hypothesis that wine is effective in preventing H. pylori infection. As wine has been shown to prevent H. pylori infection, moderate wine-drinking may prevent stomach...

Hypertension HTN

Association between heavy drinking and HTN was then ignored for more than Dozens of cross-sectional studies almost unanimously show higher mean blood pressures and or higher HTN prevalence with increasing alcohol-drinking. Reviews (MacMahon 1987 Keil et al. 1993 Klatsky 1995, 2000) detail this observation in North American, European, Australian and Japanese populations and show its independence from adiposity, salt intake, education, cigarette smoking, and several other potential confounders. Most studies show no increase in blood pressure at light-moderate alcohol drinking, but there are some that raise the question of a continuous relation at all drinking levels to higher blood pressure. This may be an example of a spuriously low threshold for harm resulting from systematic underreporting of drinking. Several studies show an unexplained J-shaped curve in women (Klatsky et al. 1977 Criqui et al. 1981 Witteman et al. 1990), with lowest pressures in lighter drinkers. An early Kaiser...

Vegetarianism And Coronary Heart Disease A Observational Studies

Data on mortality rates in Western vegetarians are available from the early study reported by Phillips et al.76 and from four other cohort studies that included a large proportion of vegetarians. Two of these studies were conducted among Seventh-Day Adventists in California, two among members of the Vegetarian Society and others in Britain, and one among the readers of vegetarian magazines in Germany. A pooled analysis of original data from these five cohort studies was published recently48,52 and included data for 76,000 men and women (of whom 28,000 were vegetarians). Importantly, the vegetarians and the non-vegetarians in each study had a shared interest in healthy living or a similar social religious background. All results were adjusted for age, sex, and smoking, and a random effects model was used to calculate pooled estimates of effect for all studies combined. Further adjustments for body mass index, alcohol consumption, exercise, and education level had little effect on the...

Alternative Explanations for Low Cancer Risk in Vegetarians

Alcoholic beverage consumption is also associated with increase in cancer risk for several types of cancer. Cancer of the oral cavity, pharynx, larynx, esophagus, and liver are associated with excess alcohol consumption and, in some instances, alcohol may act synergistically with tobacco in cancer initiation.66

Drinking patterns and ethnicity

Over time and per occasion, the proportion of heavy drinkers is the same in each group.30 A survey of 64 500 African-American women aged 21-69 years from across the USA, enrolled in the Black Women's Health Study, found that the prevalence of current drinking was highest among women aged 40-49 As in men, the prevalence of heavy drinking and alcoholism in Caucasian women is highest in the young (aged 18-29 years) and decreases continuously with age, but in African-American women the prevalence rises to a high point in the 30-64 age group before declining.30 Abstention and light drinking pat-ternsmay be more determined by cultural, social, and historical characteristics than are problem drinking and alcoholism.30

Central pontine myelinolysis

Central pontine myelinolysis was originally described in alcoholism and malnutrition. Nowadays it is most commonly seen in patients who have been hyponatraemic, in whom it is thought to have been produced by osmotic injury from over-zealous correction of the hyponatraemia (especially correction which is too rapid).

Anticraving medications

The most promising medications are the opioid antagonist, naltrexone, and acamprosate, a glutamate antagonist, which have been shown to exert modest effects on the reduction of alcohol consumption.49 These drugs, either used separately or in combination (currently being tested), are likely to be the beginning of pharmacotherapies targeting multiple neurotransmitters. Further studies are needed to identify subgroups of alcoholics who may be the most responsive to these drugs. Several studies have shown that naltrexone (50 mg four times daily), also used in the post-detoxification treatment of heroin addicts, reduces alcohol consumption in both men and women alcoholics. Its use is effective when combined with psychosocial treatment in reducing relapse rates.50,51 A recent preliminary study has found that taking naltrexone two hours before an anticipated high-risk situation reduces alcohol consumption in early problem drinkers, particularly women.52 Acamprosate, used extensively in...

DTerms Relating to Potential Suicides

The person's actions or behaviors may suddenly change greatly. A very thrifty person may suddenly begin spending more money than he earns. A moderate drinker may increase his alcohol consumption. (5) Alcoholics in the family. (g) Unexplained change from usual behavior patterns. A non- drinker begins drinking to excess. A person who hates guns suddenly buys one.

Potential Explanations For The Antiobesity Effect Of A Vegetarian Diet

While data indicate that vegetarians may weigh less than other population subsets, it does not necessarily follow that it is their avoidance of meat that is responsible. Vegetarians are also more likely to adopt other healthy life-style habits, such as regular exercise and reduced alcohol consumption, that also impact their lack of obesity. There is some evidence, however, that eating more vegetables and abstaining from meat does play a significant role in their leaner profiles. A study by Kahn and others of 79,000

Metformin and Sulfonylurea

Because they contain metformin, metformin and sulfonylurea combination products are not indicated with serum creatinines greater than 1.4 mg dL in women and 1.5 mg dL in men or creatinine clearances less than 60 mL minute, or in congestive heart failure, respiratory conditions prone to acidosis, chronic alcoholism, significant hepatic disease, or any history of significant hypoxia or lactic acidosis. The same restrictions for withholding this product before any studies using iodinated contrast materials, as discussed in the Subheading entitled The Biguanides, are applicable.

Social Phobia and Bipolar Disorder The Significance of a Counterintuitive and Neglected Comorbidity

Marked neuro-vegetative symptoms and inability to talk fluently during oral examinations. During adolescence, she reported major problems in speaking in public, coping with the opposite sex, and performing in a lot of social situations, she blushed heavily and made every effort to avoid these situations. She sought psychiatric help for the first time in her life at the age of 26 upon the insistence of her parents. She was treated with paroxetine (40mg day) and after a few weeks her social phobia improved. In the following months she appeared less embarrassed in interpersonal contexts, social anxiety completely disappeared and impudence and shamelessness took its place. She felt elated and increasingly self-confident and progressively developed the firm belief that other people could be envious of her because of her qualities and abilities. She started to drink alcohol at night and she became aggressive towards her parents, who prevented her from spending money and having sexual...

The answers are 402e 403a 404b Wallace 14e pp 811 814 Health belief model the likelihood of taking a health action is

The answers are 413-b,f,h, 414-c,d,e, 415-c,h. (Wallace, 14 e, p 824. Fauci, 14 e full text , pp 563, 568, 605-609.) Moderate alcohol consumption appears to be a risk factor also for breast cancer. Tobacco use is also associated with cancer of the lip, oral cavity, pharynx, pancreas, larynx, bladder, and kidney.

Problems That Occur During Sleep

There are other well-documented cases of sleep-related violence including other homicides, attempted suicides, self-injury, damage to objects, and indecent exposure. These reports have been found to be due to sleepwalking, sleep inertia, REMS behavior disorder (see Chapter 10), nocturnal seizures, or excessive sleepiness due to sleep deprivation (but often accompanied by alcohol intake), jet lag, or sleep disorders such as narcolepsy and sleep apnea (see Chapter 10). Such incidences are more common than might be expected, generally thought to involve 2 of adults. However, individuals rarely repeat these behaviors.

The answer is a Fauci 14e pp 14511455 Massive lifethreatening hemoptysis is 100 cc of blood in 24 h The most common

Seizure, alcoholism, or illicit drug use. Patients complain of several days or weeks of malaise and fever while the abscess develops. Patients eventually complain of chills, cough, pleuritic chest pain, and cough productive of putrid sputum. Due to position at the time of loss of consciousness and to the anatomy of the lung, the lung segments most often involved in lung abscesses include the posterior segment of the right upper lobe (wide, short, and vertically placed) and the superior segments of both lower lobes. Patients with poor dental hygiene are prone to developing anaerobic infections if aspiration occurs.

Nonketotic Hyperosmolar Coma

Vitamin B3 ( NIACIN) deficiency is commonly seen in alcoholics and is less frequendy seen in patients with GI disorders or elderly patients. It is usually accompanied by other B vitamin deficiencies. The typical observed triad consists of dermatitis, dementia, and diarrhea. p. 168

Acid Indigestion Heartburn And Stomach Ulcers

Acid indigestion and 'heartburn' often come from eating too much heavy or greasy food or from drinking too much alcohol or coffee. These make the stomach produce extra acid, which causes discomfort or a 'burning' feeling in the stomach or mid-chest. Some people mistake the chest pain, called 'heartburn', for a heart problem rather than indigestion. If the pain gets worse when lying down, it is probably heartburn.

Items 640 through 641

A 32-year-old man presents with severe abdominal pain. He describes the pain as sharp and diffuse. He does not drink alcohol or take any medications. He has a past medical history significant for peptic ulcer disease over 5 years ago. The patient has stable vital signs and has no orthostatic changes. You observe the patient to be lying very still on the emergency room stretcher. On physical examination, he has a rigid abdomen and decreased bowel sounds. He has localized left upper quadrant guarding and rebound tenderness. There is referred rebound tenderness on palpation of the right upper quadrant. Rectal examination is FOBT negative. Which of the following is the best method of confirming the diagnosis in this patient

Vitamin Deficiency Beriberi

Discussion Vitamin (niacin) deficiency (pellagra) is commonly seen in alcoholics and is less frequently seen in patients with GI disorders or in elderly patients. In patients with carcinoid syndrome, tryptophan, the precursor of niacin, is used up to form serotonin. It is usually accompanied by other B vitamin deficiencies. The typical observed triad consists of dermatitis, dementia, and diarrhea.

Very LowDensity Lipoprotein VLDL Low Density Lipoprotein LDL

Increased VLDL levels are primarily caused by type IV hyperlipidemia, a common form of increased lipoproteins that is sometimes familial. Type IV hyperlipidemia is also called endogenous hypertriglyceridemia. Other diseases associated with elevated VLDLs include alcoholism, obesity, diabetes mellitus, chronic renal disease, and pancreatitis. A diet rich in fatty foods and animal fats may also elevate LDL and VLDL levels. Malnutrition and malabsorption syndromes will result in decreased LDL and VLDL levels.

Decreased arousal andor plateau

Lifestyle changes are critical and should include moderation of alcohol intake, exercise, smoking cessation, weight loss, and stress management. Medications that can be discontinued or reduced in dosages should be changed (Table 5.7). Additionally, just as psychotropic agents can significantly reduce

Answers and Explanations

Hypertrophy of the smooth endoplasmic reticulum (choice E) in the liver is associated with conditions that stimulate the cytochrome P450 detoxification systems (e.g., barbiturate use and alcoholism). Vitamin B12, or cobaJamin, deficiency can lead to megaloblastic anemia (choice C), with or without associated nervous system neuropathy. This vitamin is required for two reactions in the human body the methylation of homocysteine to methionine and the conversion of methylmalonyl-CoA to succinyl-CoA. Folic acid deficiency is associated with megaloblastic anemia and neural tube defects in newborns (choice D). The coenzyme form of this vitamin is tetrahydro-folic acid, which acts as a carrier of one-carbon fragments in metabolism. A deficiency of folic acid is most commonly seen in pregnancy and alcoholism. Mild, thiamine (vitamin B,) deficiency (choice E) leads to peripheral neuropathy (dry beriberi). More severe vitamin depletion leads to high-output cardiac failure (wet beriberi) and the...

Explicit Diagnostic Criteria For Schizophrenia

The St Louis or Feighner definition of schizophrenia 97 rests upon three criteria the presence of a chronic illness with at least 6 months of symptoms, in the absence of a period of depressive or manic symptoms sufficient to qualify for affective disorder the presence of delusions or hallucinations or verbal production that makes communication difficult because of the lack of a logical or understandable organization and at least three of the following manifestations being single, poor premorbid social adjustment or work history, family history of schizophrenia, absence of alcoholism or drug abuse within one year of onset of psychosis, and onset of illness prior to age 40.

Primary prevention and risk factors

Although men experience UI, women are twice as likely to suffer the symptoms (Figure 21.1). The risk of UI increases with age, but it should not be considered a natural part of aging. Young women may also have incontinence during physical activity and postpartum. The risk of UI is related to body mass and race, but not to parity, caffeine or alcohol intake, smoking, physical activity, or previous gynecological surgery.25

Pathogenesis And Immunity

Contributing to the clinical illness (as opposed to the usual outcome of asymptomatic carriage) are poorly defined. Even during epidemics, only 1 in 1000 to 5000 colonized patients develops disease.4,10,23 Various predisposing factors have been proposed to explain this discrepancy, including crowding, low socioeconomic status, poor general health, a preceding upper viral respiratory tract infection, and alcoholism.1 Simultaneous outbreaks of meningococcal and influenza infections have been described in institutional and community settings.61 The role of viral infections in the enhancement of meningococcal dissemination is unproved32,61,74 and the precise factors that contribute to the development of overt clinical illness are at present poorly understood.

Characteristic Symptoms Of Schizophrenia

Anhedonia or loss of feeling has been proposed as a central 23 or cardinal 24 feature of schizophrenia. Chapman et al 25 designed questionnaires of social and physical anhedonia. Physical anhedonia covers pleasures such as admiring the beauty of sunsets, eating, drinking, singing, being massaged. Social anhedonia covers pleasures such as being with friends or being with other people. In a study by Watson et al 26 , anhedonia was significantly more frequent in patients with schizophrenia than in patients with alcohol dependency. In a recent study by Blanchard et al 27 , patients with schizophrenia reported significantly greater physical and social anhe-donia than controls. In a study by Cook and Simukonda 28 , social but not physical anhedonia was significantly higher in patients with schizophrenia than in subjects from a hospital staff control group. Concerning the specificity of anhedonia, Harrow et al 29 found that only chronic, not acute, schizophrenics were significantly...

CErgotamine Tartrate with Caffeine and Pentobarbital Cafergot PB

This product is used in the treatment of migraine headaches. The pentobarbital is added for its sedative effect. The product is supplied in both tablet and suppository dosage forms. The usual dose of the tablet form is two tablets at the onset of a migraine headache and one tablet every one-half hour. The maximum number of tablets which can be taken per day is 6, per week is 10, and per month is 30. The dosage of the suppository form is one suppository at the onset of a migraine headache and one suppository after one hour. The maximum number of suppositories is two per day and five per week. This preparation may cause drowsiness because of the sedative effect produced by pentobarbital. The patient should be cautioned not to drink alcohol while under the influence of this medication.

Endocrine Causes of Obesity

Many patients are concerned that they have a metabolic or glandular cause for their obesity. This may be a reflection of the frustration that some of these individuals feel over the difficulties that they have had in battling a weight problem over many years. They may be looking for a medical explanation of why they have not succeeded in their goal of losing weight. Endocrine causes of serious obesity are not common. The three most commonly cited are hypothyroidism, Cushing's syndrome, and hypothalamic obesity. To evaluate the patient for hypothyroidism, questions can be asked about cold intolerance, constipation, irregular menses, fatigue, or depression. The presence of easy bruisability, proximal muscle weakness (difficulty getting out of a chair, trouble getting things out of a high cupboard), a change in appearance, or osteoporosis may be signs of hypercortisolism. The patient can be examined for signs of hypothyroidism including bradycardia, cool dry skin, a firm palpable...

State Trait Anxiety Inventory

Disinhibited aggressive behavior occurs following traumatic brain injury. The exact incidence is not well known (see Chapter 2). The disinhibited behavior is often called impulsive aggression. Where this has been studied, a higher incidence of premorbid aggressive behavior is noted, and the aggressive persons generally are younger. They also had more preinjury impulsive, irritable, and antisocial features than nonaggressive controls.31 A review of data from the Viet Nam Head Injury Study revealed that patients with frontal ventral medial lesions consistently demonstrated more aggressive and violent tendencies than control patients or patients with lesions in other brain areas. The optimistic news from this study is that most of the aggression was by verbal confrontation rather than physical assault. However, this type of behavior did have a significant adverse impact and disruptive influence upon family activities.32 When one looks at outcomes of traumatic brain injury regarding...

Plasma Coagulation Factor Tests

A high-fat diet may cause decreased prothrombin levels, whereas alcohol consumption may increase prothrombin levels. Many drugs can interfere with blood prothrombin levels. Medications that result in an increased level include chlorpromazine, methyldopa salicylates, barbiturates, and sulfonamides. Decreased levels are associated with anabolic steroids, digitalis, estrogens, and vitamin K.

Chapter Summary continued

Multiple sclerosis is a chronic relapsing-remitting disorder of probable autoimmune origin characterized by recurrent episodes of demyelination (causing plaques ) and defective remyelination in the brain (including optic nerves) and spinal cord, which results in progressive (but variable in time and from person to person) neurological deficits (visual changes, sensation changes, motor changes, neuropsychiatry disturbances). Central pontine myelinosis is a rare, potentially fatal, focal demyelination of the basis pontis possibly related to over-rapid correction of hyponatremia in malnourished patients and alcoholics.

Prevention of chronic disease

Conclusions from such observational studies can be flawed if the users are different from the non-users. HT users are, in fact, very different from non-users. These differences, rather than HT, are responsible for many if not all of estrogen's apparent health benefits. HT users tend to be more affluent, leaner, and more educated. They exercise more often and drink alcohol more frequently. Women who had healthier behaviors were more likely to be prescribed and to use HT.9

Neuropsychiatric syndromes

There are recognized risk factors for the development of neuropsychiatric disturbances after traumatic brain injury. These include increased age, atherosclerosis, and alcoholism. These interfere with or delay the restorative processes occurring in the central nervous system following brain injury.1 There is not a good classification system for neuropsychiatric disorders seen following traumatic brain injury.2 Moreover, the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV), classification of organic mental disorders leaves much to be desired. The clinician will experience great difficulty attempting to classify traumatic brain injury syndromes within the framework of the DSM-IV.124 Except for dementia due to head trauma, all other applicable disorders found in the DSM-IV are classified as disorder due to general medical condition. Thus, there is no scientifically validated way to use the commonly accepted psychiatric classification system, other than in a...

Mary Anne Enoch Md Mrcgp

Case Mrs A., a middle-aged, smartly dressed woman who prided herself on her homemaker skills, came to see her family practitioner, Dr B., complaining of tiredness, depressed mood, anxiety, disturbed sleep, and weight gain. Dr B. knew that her husband, a well-known local politician, had recently left her for a younger woman, so he tactfully avoided that subject, asking instead after her grown children who lived out of state. After questioning Mrs A. about her symptoms, Dr B. concluded that she might be hypothyroid, depressed, anemic, or all three, and ran the appropriate tests. Several visits later, after normal test results and a failed trial of antidepressants, Dr B. was feeling baffled until Mrs A. finally broke down in tears and revealed the cause of her symptoms. She had been a heavy drinker in her youth but had managed to stop when she had decided to have children. However, the recent stress and humiliation of her husband's desertion and subsequent loss of self-esteem, social...

Disorders Of The Intestines

Cirrhosis is a disease of the liver characterized by degeneration and necrosis of liver cells with fatty deposits. Although the specific cause is unknown, malnutrition, vitamin deficiency, and alcoholism definitely are causative factors and contribute to progression of the disease process. The liver has a number of vital functions in the body and, hence, cirrhosis is a serious condition. A wide variety of symptoms may be present, but treatment almost always consists of adequate rest, abstinence from alcohol, and a carefully selected diet. Vitamin supplements may be necessary for the patient. There is no cure for cirrhosis and the outlook for the improvement of the patient is not good. Only 50 percent of the patients who have cirrhosis survive beyond two years and only 35 percent survive beyond five years.

Fetal Alcohol Syndrome

Include microcephaly, short palpebral fissures, maxillary hypoplasia, short nose, a smooth philtrum. and a smooth upper lip. Cardiac anomalies are common, specifically septal defects. Occasionally, patients have ptosis, cleft lip, cervical vertebral malformations, tetralogy of Fallot, and coarctation of the aorta. Infants appear as failure to thrive because of having thin adipose tissue. Findings may be subtle or full-blown, depending on maternal alcohol intake during pregnancy. Two drinks a day may result only in smaller birth size, 4-6 drinks a day may cause only subtle physical findings, whereas 8-10 drinks a day can result in severe fetal alcohol syndrome. There is no specific therapy.

Mood disorder due to a medical condition

Women have lower rates of alcohol dependence than men however, the physiological consequences of alcohol are worse for women. Estimated rates of depression in alcoholic women range from 40 to 70 .6 For some of these women, the depression predates the alcohol abuse, perhaps indicating a tendency to self-medicate.36 Efforts to treat the depression are ineffective until the alcohol consumption is stopped. It is not uncommon in middle-aged women for unrecognized alcoholism to explain why a depression remains refractory to treatment.

Sustained treatment prevention of relapse

There is considerable evidence that long-lasting neurobiological changes in the brains of alcoholics contribute to the persistence of craving. At any stage during recovery, relapse can be triggered by internal factors (craving for alcohol, depression, and anxiety) or external factors (environmental triggers, social pressures, life events, taking drugs, and narcotics). Depression is associated with relapse in women but not in men. For both sexes the severity of alcoholism is a predictor of relapse, but for women a measure of psychological functioning and social networks are predictive of outcome. Married men are less likely to relapse after treatment. For women, being married contributes to relapse in the short term.45 Alcoholic women appear to receive less support from family and friends than do non-alcoholic women, both in childhood and adulthood.42 The development of new, fulfilling social roles and an effective social support network (such as through Alcoholics Anonymous or Women...

Treatment of problem drinking the use of brief intervention in family practice

The family physician can play a key role in recognizing problem drinking and can often intervene successfully, particularly in the early stages. Several formal screening instruments for problem drinking alcoholism are available.2 Brief intervention is a short-term, counseling strategy based on motivational enhancement therapy that concentrates on changing patient behavior and increasing patient compliance with therapy. It is designed for health professionals who are not specialists in addiction.43 (e.g. Alcoholics Anonymous). For brief intervention to be successful, the physician must encourage self-motivation and optimism and be non-judgmental and supportive. Brief intervention has been shown to be effective for helping socially stable problem drinkers to reduce or stop drinking, for motivating alcohol-dependent patients to enter long-term alcohol treatment, and for treating some alcohol-dependent patients in whom the goal is abstinence. It is generally necessary to have only four or...

Comorbidity with other psychiatric disorders

Alcoholism is complicated by the fact that, particularly in women, it is often accompanied by other psychiatric disorders therefore, a holistic approach is required for treatment. Comorbid conditions include tobacco use, drug abuse, major depression, anxiety disorders, bulimia nervosa, and antisocial personality disorder (ASPD).4 Alcohol problems predict the subsequent use of tran-quilizing drugs in older women.5 Severe alcoholism, impulsivity, and suicidal tendencies also tend to coexist but are more likely to group in men.6 ASPD and antisocial symptoms are more prominent in male alcoholics, whereas in women alcoholism is often associated with anxiety (particularly social phobia) and affective disorders.4 Major depression is much more common in women than in men, and many studies have shown that antecedent depression is a risk factor for problem drinking. In women, there is a strong relationship between depression and smoking depressed individuals are more likely to smoke and are...

Confused Andor Violent Behavior

(2) Alcohol (acute intoxication and alcohol withdrawal syndrome). i. Severe situational stress anxiety. 5-4. ACUTE ALCOHOL INTOXICATION b. Acute disorientation can occur with varying levels of alcohol intake in an inexperienced drinker (young, elderly, and so forth). Normally, the average adult would have to drink enough to become sedated before becoming disoriented. Disorientation often e. Alcohol withdrawal syndromes occur in a person who is used to constant alcohol intake. When the supply is withdrawn, the patient may manifest alcohol hallucinations and or delirium tremens.

Allergic Bronchopulmonary Aspergillosis

Alcoholism, drug abuse, administration of sedatives or anesthesia, head trauma, and seizures or other neurologic disorders are most often responsible for the development of aspiration pneumonia. Because anaerobes are the dominant flora of the upper respiratory tract (outnumbering aerobic or facultative bacteria by 10 to 1), they are the dominant organisms in aspiration pneumonia of particular importance are Bacteroides melaninogemcus (Prevotella melaninogenica) and other Bacteroides species (slender, pleomorphic, pale gram-negative rods), Fusobacterium nucleatum (slender gram-negative rods with pointed ends), and anaerobic or microaerophilic streptococci and Peptostreptococcus (small gram-positive cocci in chains or clumps).

Lifestyle changes and nonpharmacological therapy

Diet and weight reduction, if needed, are the primary treatments. A low-fat, low-salt diet is important. Weight loss of 10-20 may obviate or reduce the need for pharmacological therapy. Patients who lose weight may be able to stop medication. A weight loss of 10 kg may reduced a woman's risk of hypertension by 26 . Alternatively, an increase in weight of 1 kg is associated with a 12 risk of developing hypertension.7 Reducing alcohol consumption is also important.

Pharmacotherapy of alcohol addiction

Only 30-60 of alcoholics maintain at least one year of abstinence with psychosocial therapies alone. This is not much of an improvement over the more than 20 of alcoholics who achieve long-term sobriety without active treatment. More effective therapies are clearly needed.

Environmental factors

Emotional trauma and impaired social circumstances are also vulnerability factors for problem drinking in women. Women are more likely than men to self-medicate with alcohol they often attribute the start of their problem drinking to a traumatic life event and the continuance of heavy drinking to stressors.22 Never married, divorced, and separated women are generally the heaviest drinkers and have the highest rates of drinking-related problems. More women alcoholics are separated or divorced or are likely to have an alcoholic spouse, compared with men alcoholics.22 Partnership dissolution may be a risk factor for increased drinking in women who are not problem drinkers obversely, in women who are already drinking heavily, separation or divorce can lead to a reduction in problem drinking, perhaps due to stress resolution.23 Heavy drinking in women is associated with a lack of social roles, non-traditional jobs, rapid acculturation in ethnic minority women, adverse childhood...

Sources Of Variation And Bias

Repellent dose, application method, and exposure time must be standardised and always reported. The use of scented cosmetic products 12 hours prior to and during testing should be avoided, as some of these may be slightly repellent, such as Avon Skin-So-Soft (Schreck and McGovern, 1989). Smoking must not be allowed, and there is evidence that alcohol consumption increases individual attraction to mosquitoes (Shirai et al., 2002). Ideally, the repellents should be tested on an experienced team of collectors to reduce variation in individual ability to collect mosquitoes. Each repellent must be tested by several individuals over a number of occasions since the attractiveness to mosquitoes of specific individuals varies (Lindsay et al., 1993) due to variations in skin emanations (review in Braks et al., 1999). Rutledge and Gupta (1999) have analysed data from 19 repellent tests in the literature. They show that the minimum number of subjects needed to determine protection levels of...

Q Fever in the Immunocompromised Host and During Pregnancy

Two recently recognized manifestations of Q fever include fever in immunocompromised patients and Q fever during pregnancy. The latter has been infrequently recognized but is a growing problem, especially in southern France and Israel. A recent study of 66 human immunodeficiency virus type 1 (HIV-1) seropositive persons living in Bangui, Central Africa Republic, found that 11 (16.7 ) were also seropositive for C. burnetii. Two of the seven HIV-infected patients for whom clinical data were available had a history compatible with symptomatic Q fever.17 Investigators in France found that 10.4 of 500 HIV-positive persons in Marseilles had Q fever antibodies at a titer equal to or greater than 1 225 compared with 4.1 of 925 healthy blood donors. They also found that 5 of 63 patients hospitalized with Q fever from 1987 to 1989 in Marseilles were HIV-positive. In France, 20 of patients with chronic Q fever were immunocompromised. These patients had cancer, chronic myeloid leukemia, acquired...

Boutonneuse Fever Mediterranean Spotted Fever

Boutonneuse fever differs from RMSF in a lower untreated case fatality rate (4 vs. 23 ) the presence of a tache noire (eschar) a 1-cm focus of vascular rickettsial infection and injury leading to epidermal and dermal necrosis at the site of tick bite inoculation of rickettsiae in 72 of cases and lower incidence of myalgia, petechiae, stupor, and cough.60 Illness can be severe in patients with underlying disease such as cardiac failure or diabetes, old age, alcoholism, and glucose-6-phosphate dehydrogenase deficiency.61

Geographic Distribution

Pellagra is endemic in nonindustrialized countries with a high rate of malnutrition where corn constitutes the dietary basis. It predominates in farmers. Epidemics have been described in refugees of Mozambique and Cuba. In 1990 an epidemic in Malawi, affecting approximately 900,000 refugees, was the most extensive since World War II (Int J Epidemiol 1993 22(3) 504-11). The low frequency of pellagra in Mesoamerica may be due, to corn processing with calcium hydroxide before it is consumed in the form of tortillas. This process promotes the liberation of niacin from certain conjugated forms. In the United States pellagra has practically disappeared although it can be observed in chronic alcoholics, the elderly, retarded persons, diabetics, in intestinal malabsorption or people with carcinoid tumors.

How the Healthy Digestive System Works

Caloric intake should not be confused with nutrition. It is possible for a person to take in enough calories and still be malnourished. That can happen when the nutrients necessary for proper nourishment are not fully absorbed or when the calories are taken in from nonnutritive items. For instance, alcohol has a lot of calories but little nutritional value, which is why alcoholics can be simultaneously overweight and malnourished. In the case of an individual with inflammatory bowel disease, malabsorption and malnourishment are potential problems, as we will see in chapter 3.


Moderate alcohol drinkers than in comparable people who drink no alcohol.34 Although non-drinkers differ in many ways from drinkers, anal Few studies have reported on alcohol intake in Western vegetarians, but the data available suggest that their alcohol intake is relatively low.52 In theory, this might cause a slight increase in risk of CHD relative to non-vegetarians. However, there is no evidence that alcohol reduces CHD risk among vegetarians in the Oxford Vegetarian Study, CHD risk did not decrease with increasing alcohol intake,53 while in the studies of Seventh-Day Adventists, alcohol intake is very low and no data on alcohol and CHD risk have been published.

Lamina Propria

Cirrhosis of the liver, common in chronic alcoholics, is caused by alcohol poisoning at such frequent intervals that the hepatocytes cannot recover fully between bouts of drinking. When this happens, fibroblasts grow in place of the hepatocytes and the liver becomes irreversibly clogged with connective tissue.


Beriberi is vitamin B1 (thiamine) deficiency, and the name is derived from the Sinhalese meaning extreme weakness. In developed countries, it is sometimes seen as part of the nutritional deficiency associated with alcoholism. It is thus usually accompanied by other stigmata of alcoholism, especially Wernicke's encephalopathy (q.v.).

Corrective Actions

Once a critical limit has been violated, it is important to determine what corrective action(s) should be taken (Table 10.1). Preferably, there should be a number of feasible corrective actions developed in anticipation of problems. For example, if bottles are missing the alcohol consumption warning label, the corrective action is to apply the correct label.

Care of the Cut Cord

If the cord becomes dirty or has a lot of dried blood on it, clean it gently with medical alcohol or strong drinking alcohol, or with gentian violet. Do not put anything else on the cord dirt and dung are especially dangerous. They can cause tetanus and kill the baby, see pages 182-183.

Diabetes and alcohol

Most people with diabetes drink alcohol and it is perfectly safe to do so. However, it is important to be aware that if you are treated with insulin, alcohol makes the occurrence of a hypo more likely and this increased risk continues for some time after you stop drinking. When someone has a hypo a number of hormones are produced that make the liver release glucose into the bloodstream. If that person has drunk some alcohol, even as little as two pints of beer or a double measure of spirits, the liver will not be able to release glucose and hypo reactions will be more sudden and more severe. This effect may be compounded by the fact that alcohol alters your perception and you may be less aware of your hypo symptoms. Therefore, when you are under the influence of alcohol you are not in the best shape to react appropriately and quickly. Most alcoholic drinks also contain some carbohydrate, which tends to increase the glucose in the blood. The overall effect therefore of a particular...


Postemetic rupture of the esophageal wall ( BOERHAAVE'S SYNDR.OMK) is usually seen following protracted and forceful vomiting of solid food it is common in alcoholics, bulimics, and pregnant women and in any condition that increases intra-abdominal pressure. The esophagus has three anatomic constrictions the cardiac (the most common site of rupture), the aortic arch, and the cricopharyngeal.


A 75-year-old smoker and alcohol abuser is hospitalized for evaluation of a squamous cell carcinoma of the larynx. On his second hospital day, he complains of sweating, tremors, and vague gastrointestinal distress. On physical examination, he is anxious with a temperature of 101 F, heart rate of 104, BP of 150 100, and a respiratory rate of 22 breaths per minute. Later that day, he has three generalized tonic-donic seizures. Which of the following is the most likely cause of his seizures (A) Alcohol withdrawal

Electrolyte Tests

Hypomagnesemia, decreased plasma magnesium, is usually due to some type of chronic dietary or intestinal absorption problem. Diseases such as ulcerative colitis, chronic alcoholism, chronic pancreatitis, and chronic diarrhea will exhibit decreased magnesium levels. Other situations that result in hypomagnesemia include toxemia of pregnancy, hyperthyroidism, hypoparathyroidism, cirrhosis of the liver, and excessive secretion of the hormone aldosterone.


Alcohol is a significant pressor agent. Heavy drinkers (more than 31 of wine day) have significantly more hypertension than those drinking less than 11 of wine day. Alcohol should be reduced to moderate amounts. Those with resistant or difficult-to-treat hypertension should discontinue alcohol intake. Hypertensive patients with optimal blood pressure control may be allowed light to moderate alcohol consumption. For a woman, this means less than 15 ml ethanol (360 ml beer, 150 ml wine, 30 ml 100-proof whiskey) per day, preferably consumed with meals.

Specific Discussion

An upper lobe cavitary lesion in a patient with underlying COPD suggests TB or NTM (MOTT). AFB-positive smears may culture out Mycobacterium kansasii or M. avium-intracellulare complex (MAC). Another possibility is nocardia infection. Actinomyces can present as upper lobe cavitary disease but is not acid-fast-positive on smear and is commonly seen with skin infection and fistula formation. The diagnosis of M. avium disease (MAC) is established by fulfilling clinical radiographic and culture criteria. The diagnosis should be suspected with symptoms of cough, fever, and weight loss with progressive infiltrates, cavitation, and multiple nodules. Patients without underlying lung disease who have chronic pulmonary infections are predominantly women and nonsmokers. High-resolution CT scan typically shows multiple small nodules with bronchiectasis. The diagnosis must be established bacteriologically since some nontuberculous mycobacteria are commonly found in nature and...


The answers are 8-1 c, 8-2 d. (Sadock, 7 e, p 962.) Alcohol withdrawal delirium (delirium tremens) is the most severe form of alcohol withdrawal. In this syndrome, coarse tremor of the hands, insomnia, anxiety, agitation, and autonomic hyperactivity are accompanied by severe agitation, confusion, and tactile or visual hallucinations. When alcohol use has been heavy and prolonged, withdrawal phenomena start within 8 h of cessation of drinking. Symptoms reach peak intensity between the second and the third day of abstinence and are usually markedly diminished by the fifth day. In a milder form, withdrawal symptoms may persist for weeks as part of a protracted syndrome. Wernicke's psychosis is an encephalopathy cause by severe thiamin deficiency and usually associated with prolonged and severe alcohol abuse. It is characterized by confusion, ataxia, and ophthalmoplegia. In alcohol hallucinosis, vivid auditory hallucinations start shortly after cessation or reduction of...

Items 477478

A 32-year-old woman with alcoholism and cocaine use dating back at least 10 years comes to the emergency room after 48 h of recurrent vomiting and hematemesis. She reports abdominal discomfort that preceded the vomiting by a few days. For at least 36 h, she has been unable to keep ethanol in her stomach. Intravenous fluid replacement is started while she is being transported to the emergency room, and while in the emergency room she complains of progressive blurring of vision. Over the course of 1 h, she becomes increasingly disoriented, ataxic, and dysarthric.


I had a bladder infection and I knew that there was more to it. I realised that there was a lot more to it in terms of the whole psychology. I could understand that my body was responding to my own thinking and I was responding to my environment with my thinking. I came from a family of alcoholics, so I was also looking for my healing, so I got involved with the Wellness Centre.


Osteoporosis is a multi-factorial disorder characterized by bone loss over an extended period of time. As a result of the decrease in bone density, the risk of fracture at various sites increases, making osteoporosis one of the most debilitating diseases known to mankind. Over the years, improved nutritional status and the advancements made in the field of medicine and science have caused a significant increase in the aging population and the prevalence of osteoporosis-related fractures.6 Currently, osteoporosis is considered one of the major public health problems in the United States, affecting over 20 million people annually. The percentage of hospitalization due to osteoporotic fractures is on a steady rise and is accompanied by an escalating cost of treatment that has surpassed 10 billion dollars a year.7-9 Considering the magnitude of the condition, it is imperative to understand the etiology and risk factors of the disease in order to develop treatment and prevention...


Medical and psychosocial problems, the patient's motivation to change, and the patient's gender. The genders differ in the causes and consequences of alcoholism and in comorbidity, communication styles, levels of self-esteem, interpersonal relationships, and societal roles. Mixed-gender treatment groups are usually composed primarily of men and may, therefore, ignore women's issues. For all these reasons, women might do better in integrated women-oriented treatment approaches (bearing in mind that women alcoholics are not themselves a homogeneous group theymay differ in age, ethnicity, experience of abuse, symptom severity, etc.). The treatment of women alcoholics includes three unique concerns, including 39 psychological issues associated with alcoholism more commonly in women than in men, such as past sexual or physical abuse, poor self-esteem, guilt, and shame Treatment programs for women do exist, but research on the impact of these services on both access and outcome is...


Phobias are characterized by unreasonable or excessive fear of social situations (social anxiety disorder) or of specific objects or situations (specific phobia). Phobic patients strenuously attempt to avoid the trigger object or situation, and experience extreme anxiety if exposure cannot be avoided. Although sufferers relatively rarely seekmedical advice, social anxiety is the most common anxiety disorder and the third most common psychiatric disorder in the USA (exceeded only by depression and alcohol dependence).50 The overall lifetime prevalence is estimated to be 13 ,38 but the prevalence is 1.5 times greater in women than

Genetic factors

Inheritable vulnerability factors for addiction can be classified broadly into three categories. First, having certain heritable personality traits may predispose an individual to seek out and consume large quantities of alcohol (self-medication) and, therefore, increase their chances ofbecoming addicted. Neuroticism and anxious temperament have been associated with alcoholism Second, a heritable differential response to the effects of alcohol is associated with alcoholism vulnerability. A lower response to the sedating effects of alcohol has been shown in both men and women to be associated with a fourfold increase in the risk for alcoholism over time.13 Large, well-constructed, population-based twin studies have shown that the heritability (the genetic component of interindividual variation in vulnerability) of alcoholism is around 50-60 .10,14,15 More severe alcoholism may have a greater genetic component. Although there is no gender difference in the heritability of...


Detecting and treating alcohol problems in mid-life women can be both challenging and complex because of the secrecy, the layers of comorbidity, and the frequent undercurrent of (often suppressed) past adverse life events, particularly childhood sexual abuse. Nevertheless, family physicians are in a good position to diagnose and treat problem drinking because most adults visit their primary care physician at least once every two years and women in particular usually consult their physicians more frequently. In addition, there is often a trusting doctor-patient relationship, built up over years. Screening for alcohol problems needs to become routine in the same way that screening for smoking is now widespread. However, it maybe harder for physicians to diagnose drinking problems in mid-life women, partly because this is a group that they may assume to be low risk, partly because they may feel uncomfortable asking about a condition with a built-in social stigma, and partly because many...


The ceiling for low-risk alcohol use (advocated by the US government) is one standard drink per day and no more than three drinks per occasion for women, and two standard drinks per day and no more than four drinks per occasion for men. In the USA, the standard drink is 12 g of ethanol (equivalent to one 360-ml bottle of beer (4.5 ), one 150-ml glass of wine (12.9 ), or 45 ml of 80-proof distilled spirits). In the UK, the standard drink (unit) is 8 g of ethanol, and the ceiling for safe daily drinking is set at three to four units for men and two to three units for women. A meta-analysis of cohort studies evaluating the relationship between alcohol consumption and death from all causes found that the relative risk of death (due to cirrhosis, cancer, and injury) increased significantly in women consuming two to three U.S. standard drinks per day compared with four for men.32 In some individuals, problem drinking progresses into alcoholism. The essential features of addiction are loss...


She has a long-standing history of alcohol abuse and has been to the emergency room several times for alcoholic gastritis. Also called palmar fibromatosis, it is of unknown etiology but is associated with alcoholism and manual labor. Dupuytren's contracture is associated with diabetes, alcoholism, and anticonvulsant medications.

Oral Cancer

The most common form of oral cancer is squamous cell carcinoma. It is most commonly found on the lips, especially the lower lip. Inside the mouth, the posterior lateral border of the tongue is the most common site for squamous cell carcinoma, followed by the floor of the mouth. Oral cancer (figures 2-7 and 2-8) may appear as leukoplakia (white plaque), erythroplakia (velvet-red plaque), or an ulceration. The red patches (plaques) have a much higher potential of becoming malignant than do the white plaques. Oral cancer is painless during the initial phase of development. It is generally found in older individuals, occurring with greater frequency in males. Metastatic potential varies with location. Cancer of the lip tends to metastasize later in development, while cancer of the tongue tends to metastasize early. Tobacco is regarded as the most important contributing factor for developing oral cancer. With the use of smokeless tobacco, there is a significantly higher risk of developing...


A temporary increase in triglycerides can be triggered by alcohol consumption and a pretest meal high in fats. Pregnancy, oral contraceptives, and estrogen are also associated with elevated values. Drugs that may decrease triglyceride levels include ascorbic acid, the antitumor enzyme asparaginase, and lipid-lowering agents such as clofibrate.

Selection Of Donors

It has been demonstrated that unpaid donors are to be preferred as there is no increased risk (5 to 15 times) of post transfusion hepatitis following the transfusion of blood from commercial source (paid donor) when compared to unpaid donors' blood. Payment for blood, per se, does not affect the quality of the blood of course, but this practice may attract undesirable donors, such as alcoholics or drug addicts, in whom the risk of hepatitis is high. In addition, the commercial donor is less likely to be reliable in terms of giving an accurate history of his present and past health.

Secondary Depression

Just what these illnesses are should do much to shape the clinician's management of specific patients. For instance, because persistent alcohol abuse markedly reduces the likelihood of recovery from MDD 9 , the clinician must first detect alcoholism and then direct treatment efforts at the achievement of abstinence, often in the face of the patient's efforts to maintain treatment focus on depressive symptoms instead. Patients with borderline personality disorder are often inappropriately treated for psychotic features when they report intracranial voices, and for rapid cycling bipolar illness when they display mood lability, irritability and reckless behavior. Tricyclic antidepressants are unlikely to be helpful and benzodiazepines may markedly worsen affairs. These patients often improve when the focus of treatment is shifted away from the pharmacological management of depressive symptoms and toward the patient's own control over impulsiveness and anger.


Keeping these biases in mind, data from twin studies can be used to estimate the heritability of a trait (i.e., the proportion of variation in a trait that can be attributed to genetic factors). One simple measure of heritability is (CMZ - CDZ) (1 - CD2), where C is the concordance rate for MZ twins and CDZ is the concordance rate for DZ twins. For example, studies of alcoholism show that the concordance rate for MZ twins tends to be 0.6 or higher, whereas it is 0.3 or lower for DZ twins. If these figures are used in the equation, the heritability of alcoholism is estimated to be 0.43.


Alcoholics can also develop ketoacidosis. In alcoholic ketoacidosis, 3-hydroxybutyrate is the major ketone body produced because there is usually a high NADH NAD ratio in the liver. The urinary nitroprusside test detects only acetoacetate and may dramatically underestimate the extent of ketosis in an alcoholic. 3-Hydroxybutyrate levels (p-hydroxybutyrate) should always be measured in these patients.

Neuroendocrine Tests

The hypothalamic-pituitary-growth hormone system. The release of growth hormone (GH) from the anterior pituitary is regulated by hypothalamic peptides, especially GH-releasing hormone (GHRH) and somatostatin, which in turn are controlled by the classic neurotransmitters and insulin-like growth factor-1. Blunted GH response has been reported following administration of insulin, L-dopa, d-amphetamine, clonidine and GHRH, but the findings are equivocal 149 . The blunted GH secretion to clonidine is not only observed in depression and panic attacks, but also in GAD and social phobia. However, the abnormality is not observed in schizophrenia or obsessive-compulsive disorder (OCD). On the other hand, some investigators have observed no difference between depressed patients and controls in the clonidine GH or GHRH GH challenges 149,150 . In a recent study, an enhanced GH release in response to pyridostigmine (PYD) in subjects with major depression (sensitivity 63 ), but not inpatients with...

Longterm Management

Valvular disease, long-term therapy for HF should be initiated, including both nonphar-macologic supportive measures and pharmacologic therapy. Nonpharmacologic measures include salt restriction (aiming for less than 2 g sodium per day), smoking cessation, elimination of alcohol intake, aerobic exercise as tolerated, and fluid restriction in patients with impaired renal function, refractory HF, or psychogenic polydipsia. Patients who are prone to developing congestive symptoms should monitor their weight daily and report any rapid weight gain in excess of 3 to 5 lb.


Hypertension can increase one-year post-acute MI mortality by 50 percent control of hypertension favorably affects prognosis. Appropriate nondrug and pharmacologic therapy can be combined to achieve a blood pressure goal of 140 90 mm Hg. Sodium restriction, weight reduction, limiting of alcohol intake to less than two drinks per day, and exercise are initial recommendations, followed by treatment with a beta-blocker, ACE inhibitor, and or other suitable agents as needed.

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