Cocaine/"crack" dependence among psychiatric inpatients

Article Abstract:

The proliferation of 'crack', a highly addictive cocaine derivative, is causing much concern. Among those who are addicted to this drug are psychiatric patients. Treatment of these individuals is complex, and factors to be considered include symptoms, drug abuse pattern, and the underlying psychiatric disorder. To further characterize and describe cocaine-dependent psychiatric patients, 40 inpatients in a general hospital were evaluated. All of the subjects had used cocaine on a weekly basis for a least three months prior to hospitalization, and had general psychiatric symptoms. The sample consisted of 29 men and 11 women; 24 individuals were black, 11 were white, and five were Hispanic. The majority of the patients were single, separated, or divorced; the economic status of most subjects was low, and 33 percent received public assistance. Fifteen reported prior dependence on another drug. Many subjects (63 percent) were high school drop-outs, and 65 percent had been in jail at least once. Psychiatric evaluations revealed that 43 percent had personality disorders, 33 percent had schizophrenic disorders, and 13 percent had affective (mood) disorders. Symptoms included depression, suicidal thinking, paranoia, and auditory hallucinations. Eighty-eight percent of the patients were dependent on the 'crack' type of cocaine. Patients with personality disorders used larger quantities of the drug, used cocaine more frequently, and started abusing the drug at a younger age. Patients with psychiatric disorders who are also dependent on cocaine require a multidimensional treatment approach which may incorporate medications, psychotherapy, and social interventions. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Cocaine abuse, Drug use

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Characteristics of psychotic inpatients with high or low HVA levels at admission

Article Abstract:

Elevated blood levels of homovanillic acid (HVA), a metabolite of dopamine, and 3-methoxy-4-hydroxyphenylglycol (MHPG), a metabolite of norepinephrine, have been found in psychotic patients who respond favorably and rapidly to moderate doses of antipsychotic medications (neuroleptics). In an earlier study, a pretreatment HVA plasma level of 18 nanograms per milliliter was almost always associated with a rapid and positive neuroleptic response. To further explore this finding, 85 patients with nonorganic and various psychotic diagnoses who had participated in the earlier study were divided into a high-HVA group (43 patients) and a low-HVA group (42 patients). The groups were then compared on a variety of diagnostic, demographic, historical and clinical variables. Fasting levels of free HVA and MHPG in the plasma were assessed by gas chromatography and mass spectrometry. As in the earlier study, the high-HVA group demonstrated a relatively good early neuroleptic response and tended to have better prognostic profiles than their low-HVA counterparts. MHPG levels did not differ between groups. High-HVA males tended to be older and married. High-HVA females tended to have fewer auditory hallucinations and were less prone to psychomotor retardation than low-HVA females. Results indicate that an elevated pretreatment plasma HVA-level may be a good predictor of a favorable and rapid neuroleptic response. Associations between pretreatment high-HVA plasma levels and long-term responses to neuroleptic treatment have not yet been evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Measurement, Testing, Physiological aspects, Antipsychotic drugs, Antipsychotic agents, Homovanillic acid

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Clinical assessment of the risk of violence among psychiatric inpatients

Article Abstract:

Research suggests that it is very difficult to predict violent behavior with any real accuracy, but the courts continue to require clinicians to make such judgements. Analysis of the current literature on the prediction of violence, however, suggests that the short-term prediction of violent behavior may be more accurate than long-term prediction. The majority of studies have addressed only the latter. In the present investigation, nurses and physicians rated the probability that 149 psychiatric patients would physically attack someone else on the ward in the short-term (within seven days of admission). The subjects were 22 nurses and 42 physicians; ward behavior of the patients was measured using the Overt Aggression Scale. As estimated risk of violent behavior increased for these patients, the actual proportion of assaults increased. However, overall violence tended to be overpredicted by the physicians and nurses, who showed relative agreement in their predictions. These results indicate that while not perfectly accurate, the short-term prediction of violent behavior may be more reliable than previously thought. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Risk factors, Psychotherapy patients, Violence in hospitals, Hospital violence

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