Mental health articles

OF mental health care and mentally ill

February, 2013

Managing alcohol dependence

Managing alcohol dependence Detoxification Alcohol dependence usually requires controlled withdrawal (detoxifi cation) with an attenuation therapy (such as a benzodiazepine), as abrupt cessation of alcohol can induce one of the withdrawal states (Box 14.5). Detoxifi cation is increasingly taking place in the community, but inpatient detoxifi cation is recommended for those at risk of suicide, […]

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Recognising problem drinking

Recognising people with alcohol-related problems is diffi cult – probably less than 20% are known to their general practitioner (although problem drinkers consult their GP twice as frequently as those whose alcohol consumption is within the safe limits), and a large proportion are missed in accident and emergency departments. Recognition is particularly diffi cult among […]

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Alcohol-related problems

18,500 deaths a year in England and Wales are related to alcohol consumption 300 of these deaths are the direct result of alcoholic liver damage (the true fi gure is probably many times higher but is hidden by under-reporting on death certifi cates) Just over 1 in 1000 people die per year of an alcohol-related […]

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Prevalence of alcohol-related problem

Prevalence of alcohol-related problems as follows: 1 As with any drug of addiction, there are four levels of alcohol use. Social drinking: only about 10% of the population are teetotal. 2 At risk consumption: this is the level of alcohol intake that, if maintained, poses a risk to health. The Health of the Nation gives […]

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Mental Health Problems in Old Age

The health service has changed apace since the fi rst edition of this ABC. Top-down management of services has made sweeping changes in the mental health services for adult’s of working age, achieved with (from an older adult’s perspective) massive fi nancial investment. Older adults mental health services have also had to change, responding to […]

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How to prescribe opioids

General practitioners may use blue FP10 (MDA) prescriptions, which allow daily instalments on a single prescription, thus reducing the risk of overdose or diversion into the black market. Prescriptions for controlled drugs must: • • • • • • Be written in indelible ink Be signed and dated by the doctor State the form and […]

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How to treatment of borderline personality disorder

Treatment of borderline personality disorder as follows: Psychological approaches Treatment of people with borderline personality is not easy, and there are relatively few controlled trials examining the effects of therapy. Roth and Fonagy tried to establish some overall goals of therapy and guidelines for who may benefi t from it most. They suggested the following: […]

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Treating opioid dependence

Maintenance, either with methadone mixture (1 mg/mL) or buprenorphine should be the mainstay of management for opioid dependence, certainly until the patient is able and willing to withdraw (‘detoxify’) and achieve abstinence. Methadone maintenance treatment has been shown to be effective in reducing health, criminal and social harms in trials, including many randomised, doubleblind studies. […]

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Withdrawal from non-opioid drugs

To withdraw a patient from any benzodiazepine, fi rst convert the misused drug into an equivalent dose of diazepam, chosen because of its long half-life. Reduce the diazepam dose by 2 mg a fortnight over a period of two to six months. Even those individuals on large amounts of benzodiazepines can be reduced fairly rapidly. […]

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Dependence syndrome

The dependence syndrome is a cluster of symptoms, not all of which need be present for a diagnosis of dependence to be made. The key feature is a compulsion to use drugs, which results in overwhelming priority being given to drug-seeking behaviour. Other features are tolerance (need to increase drug dose to achieve desired effect), […]

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