Addiction Treatment Blog

Over the past two decades there appears to have been a shift within health care from an expectation that patients with medical problems should entrust themselves passively to the care of physicians to an expectation that they should co-operate in their own care and indeed have some responsibility for the outcome of medical procedures they undergo. The changes are reflected in the terms we used; the word patient, which means someone who endures, is being replaced by terms such as client or consumer, which suggest a more active and discriminating participant in the medical process.

Nowhere is this shift more clear than when it comes to the question of what is known as informed consent. Informed consent was not an issue in medical practice 20 years ago. Today it forms a central issue in a number of ethical codes from the Nuremberg Code to the Helsinki Code as well as Codes originating from the Food and Drugs Administration (FDA) in the United States and the US Department of Health. Read more…

Separation Liability

Liability for drug induced injuries did not become an issue of general concern until quite recently. However, a number of drug-induced problems from thalidomide in the 1960s to Opren and diethylstilbestrol in the 1970s have caused widespread public disquiet and led to increasing awareness of issues to do with liability. In psychiatry, concern in the UK focuses on the question of benzodiazepine prescribing, while in the US the paramount issue concerns the occurrence of tardive dyskinesia in individuals taking neuroleptics. The question has become an emotive one with some commentators who survey the problem referring to the appalling frequency of drug-induced injury, while others comment on its astonishing tray (1). Whatever the absolute frequencies, contrary probably to public belief, the evidence suggests that the larger the pharmaceutical company, the better its practice regarding drug safety is likely to be (2).

Drug-induced problems may stem from toxic effects of a drug, or toxic effects caused by an impure additive, or from allergic reactions to the drug or its additive. Problems may also stem from over prescribing. For instance, in the case of someone who dies from a resistant bacterial infection, a relative could claim that the subject’s death arose in part from the excessive prescription of antibiotics that in its own right brings about the production of resistant infections. In the case of neuroleptics, problems may be brought about by the overuse of these drugs but this overuse, far from being solely promoted by drug companies stems in part from the current politics of mental health – deaths have stemmed from rapid tranquillisation often by harassed staff in psychiatric units. Read more…

Dementia Treatment

It is not clear yet that damage to the cholinergic pathway is the central deficit in Alzheimer’s dementia. Indeed, it has recently become clear that a number of other neurotransmitters are affected in both Alzheimer’s and other cortical dementias. It is also clear that, because of the interactions between various neurotransmitter systems, it is almost impossible to manipulate one neurotransmitter systems, it is almost impossible to manipulate one neurotransmitter without affecting the others.

Finally, from the vantage point of the 1990s, it seems that many cortical dementias may involve cell protective mechanisms that have been thrown out of gear. Normally, there are a range of mechanisms within cells for neutralizing toxins of various sorts. These often involve the binding of a protein to the toxin, which labels it so that the cell’s own degredative processes destroy the offending agent. In the dementias, however, such mechanisms seem to have been stimulated to the point where the large amounts of cell-protective proteins are produced, to the point where large amounts of cell-protective proteins are produced, to the point that they themselves poison the cell. Whether the stimulus is genetic, viral, toxic (as in aluminium) or some combination of these and other factors is uncertain. The treatment options are to find compounds that will switch off the process or else compounds that will compensate for it. Read more…

Dementia

Part of the problem in finding drugs which may be effective for dementia is that our ideas about what constitutes dementia have been undergoing radical change in recent years. It had been traditional to distinguish between Alzheimer’s dementia, or senile dementia of the Alzheimer’s type (SDAT) and multi-infarct dementia (MID), which is theoretically caused by small strokes which insidiously pick off brain tissue to the point where an individual’s cognitive function is compromised. Read more…

In addition to the types of anxiety mentioned earlier, there are a number of different situations in which anxiety arises according to which it is categorised and treatment given. There are many different occasions of anxiety and in this article, you will find a detailed explanation to each of them in different subjects; such as Stage Fright Anxiety, Panic Disorder, Obsessive Compulsive Disorder, Generalised Anxiety Disorder (GAD), etc. Read more…

Stress Management

Five groups of drugs are used to manage anxiety

• The neuroleptics, particularly chlorpromazine, haloperidol, flupenthixol and thioridazine, which are dealt with in Management of Psychoses, The Neuroleptics, Side Effects of Neuroleptics, The Management of Side Effects, The Use of Psychostimulants in Schizophrenia.
• Tricyclic antidepressants, the MAOIs and the more recent 5-HT reuptake inhibitors, which are dealt with in Management of the Affective Disorders, All You Need To Know About Antidepressants, Side Effects of Antidepressants, The Management of Mania, All You Need To Know About Lithium.
• Minor tranquillisers of the benzodiazepine type, which will be covered later.
• Drugs active on the 5-HT system, which will be covered later.
• Beta-blockers, such as propanolol, which will be covered later.

Types of anxiety

To understand how any of these drugs may be useful, it is necessary to understand the various types of anxiety. The term anxiety covers four sets of experiences, one or other of which may be more prominent in any individual case.

There may be mental anxiety, which roughly translates as worry or a mental preoccupation with things that might go wrong. This may also include intrusive ideas or thoughts or impulses, which are of a distressing nature. This form of anxiety may be present without much in the line of physical symptoms such as increased muscular tension, increased heart rate, sweating or shaking of the hands. Read more…

Lithium Pellets

There are some suggestions from as early as the 2nd century AD that spring waters that were alkaline (which would be expected with a high concentration of lithium salts) were known to be of some use in the treatment of overactive states such as mania (1).

Lithium itself was isolated first by August Arfwedson in 1817. It was named lithium as it was found in stone – lithos being the Greek for stone. During the 1850s alkaline compounds, like lithium, were known to be of some use in preventing gout by interfering with the precipitation of uric acid in the blood and joints. At the time mania and melancholia were often seen as being part of the same family of diseases as gout and this led to the use of lithium for these conditions also. As early as 1880, the use of lithium in this manner led Carl Lange to suggest that it might have a role in preventing episodes of periodic depression.

Surprisingly, however, despite these discoveries and what would now appear to be correct hunches, lithium slipped out of use for mood disorders and had to be rediscovered in 1949. In part this was because of its side effects. In the middle of the 19th century, several investigators took lithium and noted that it caused increased urine flow, tremor of the hands and difficulties with memory or concentration, which led to wariness regarding its use. Later in the 1930s, it was used as part of a salt restriction diet in the United States and in many cases it caused such clear cut toxicity that its use was banned by the Foods and Drugs Administration (FDA). Read more…

There are seven major physical treatments for depression at present.

• Tricyclic Antidepressants (Table 1). These have until recently been by far the most widely used.
• The Monoamine Oxidase Inhibitors (MAOIs) (Table 2).
• Reversible Inhibitors of Monoamine Oxidase (RIMAs) (Table 3).
• 5-HT Reuptake Inhibitors (Table 4).
• Other Antidepressants (Table 5).
• Treatments for Bipolar Disorders or Prophylaxis of Recurrent Disorders (Table 6).
• Others (Table 7)

In the last category, a number of other treatments are marketed for or used for depression and they often work, but whether they are antidepressants in the same sense as electroconvulsive therapy (ECT), imipramine or phenelzine is a matter of dispute. The 5-HT-1a agonist, buspirone, has in addition been marketed as an antidepressant, and a further compound from this group, flesinoxan, looks as though it may also emerge as an antidepressant.

Finally, there is also ECT, the mechanism of action of which, and its use clinically will not be discussed at any length in this article. Its role when antidepressants fail to work and in cases of mania will be considered at a later stage. Read more…

Coping with stress can be hard at times.

The term ‘affective disorder‘ is sometimes taken to encompass both the mood and anxiety disorders. In this blog, it will be restricted to the former. Two disorders will be considered, depression and mania. Depression will be covered first followed by a consideration of mania and then the question of prophylaxis of recurrent episodes of a bipolar disorder, be they depressive or manic.

It is perhaps more difficult to specify exactly what antidepressants do than it is for any other drug that acts on the brain. In the following articles, I will employ an ulcer model of depression in an attempt to clarify the issues. This model, however, simplifies both ulcers and depression and this should be borne in mind. In clear cut cases of depression, an ulcer model performs passably. But in less clear-cut cases, the difficulty in pinpointing what it is that antidepressants do re-emerges.

Another way to consider the issues is by considering what the terms ‘mood’ and ‘emotion’ mean. These are notoriously difficult to define, but one way the problem has been approached is to define them in relation to each other – to compare, for instance, the relation of mood to emotions with the relation between climate and weather, or the relation between the pedal and the keys of the piano. Read more…

Learning from Burnout: Developing Sustainable Leaders and Avoiding Career Derailment

We were inspired to write our book, ‘Learning from burnout: developing sustainable leaders and avoiding career derailment’ for reasons of personal biography as well as professional practice. The former concern one of us burning out in their early thirties while working as a human resources executive for an IT company; the latter relates to our consultancy work with organisations helping them manage and develop their leadership talent. We noticed an increasing trend among this population towards action addicted, adrenalized working lives and what appeared to be – based on the number who were burning out – unsustainable approaches to the pursuit of career. At the same time we recognised that organisations were becoming increasingly more demanding and absorptive, and as a consequence, work and workplaces increasingly more all consuming. Like the high speed internet connections that serve our offices and our homes, work seemed to be always on. It had become a seven day a week preoccupation which was always there, brought into every facet of human life through the wonders of the Blackberry and the mobile phone. Work, it seemed, never slept, and those enslaved to it were sleeping a great deal less than they used to.

Burnout was the inevitable consequence of this heady combination of addictive behaviour and organisational greediness, or so it seemed to us. But when we referred to the literature on burnout we discovered that the leading authorities in the field believed burnout was largely caused by organisations, rather than both the organisation and those who work for them. We thought this rather odd. It did not resonate with our own experience of burnout, or with what we were seeing among the high achievers with whom we were working.

In addition, the self help industry’s claims that burnout can occur to anyone has devalued its meaning as a serious psychological condition. Apparently you are equally vulnerable to burnout whether you’re an over-stressed baby boomer, in a bad marriage, having a mid life crisis or a female indoor sex worker. As a result, the term has – to all intents and purposes – become meaningless. Read more…