DOCSLIB.ORG

Alcohol and Other Drug Withdrawal: Practice Guidelines 2018 Were Funded by the Victorian Department of Health and Human Services

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Alcohol and Other Drug Withdrawal: Practice Guidelines 2018 Were Funded by the Victorian Department of Health and Human Services ALCOHOL AND DRUG ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES THIRD EDITION 2018 Dr Victoria Manning Dr Shalini Arunogiri Dr Matthew Frei Dr Kelly Ridley Katherine Mroz Sam Campbell Prof Dan Lubman ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES Turning Point ACKNOWLEDGEMENTS In the revisions of this resource Turning Point acknowledges the considerable contribution of the following clinicians: Dr Keri Alexander – Turning Point (Eastern Health) Mr Teddy Sikhali – Turning Point (Eastern Health) Ms Rose McCrohan – Uniting ReGen Dr Benny Monheit – Southcity Clinic/Alfred Hospital Members of the Victorian Non-Residential Withdrawal Nurses network. Authors of the previous versions: Pauline Kenny, Amy Swan, Lynda Berends, Linda Jenner, Barbara Hunter & Janette Mugavin. We also acknowledge the contribution of members of the Victorian AoD sector on the previous version of the guidelines which included; Moses Abbatangelo, Regina Brindle, Dr Malcolm Dobbin, Mal Dorian, Dr Matthew Frei, Deb Little Salvation Army, Dr Benny Monheit, Donna Ribton-Turner, Glenn Rutter. Copyright © 2018 State of Victoria 3rd edition printed 2018. ISBN: 978-1-74001-019-1 Paper ISBN: 978-1-74001-020-7 epub The withdrawal guidelines were funded by the Victorian Government. Copyright enquiries can be made to Turning Point, 110 Church Street, Richmond, Victoria 3121, Australia. Published by Turning Point. The Alcohol and Other Drug Withdrawal: Practice Guidelines 2018 were funded by the Victorian Department of Health and Human Services. The responsibility for all statements made in this document lie with the authors. The views of the authors do not necessarily reflect the views and position of the Department of Health and Human Services or Turning Point. The correct citation for this publication is: Manning, V., Arunogiri, S., Frei, M., Ridley, K., Mroz, K., Campbell, S., Lubman, D. (2018). Alcohol and other Drug Withdrawal: Practice Guidelines, 3rd ed. Richmond, Victoria: Turning Point. iii ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES Turning Point Turning Point ACRONYMS AND ABBREVIATIONS CWAS Cannabis Withdrawal Assessment Scale DACAS Drug and Alcohol Clinical Advisory Services AA Alcoholics Anonymous DAMEC Drug and Alcohol Multicultural Education Centre ABI Acquired Brain Injury DHS Department of Human Services AIHW Australian Institute of Health and Welfare DSM Diagnostic and Statistical Manual ALO Aboriginal Liaison Officer ENDS Electronic Nicotine Delivery System AoD Alcohol and Other Drug FAS Foetal Alcohol Syndrome APGAR Score Appearance, Pulse, Grimace, Activity, and Respiration GCS Glasgow Coma Scale ATS Amphetamine-Type Stimulants GHB Gamma-Hydroxybutyric Acid ATSI Aboriginal and Torres Strait Islander GP General Practitioner AUDIT Alcohol Use Disorder IdentificationTest HADS Hospital Anxiety and Depression Scale AWD Alcohol Withdrawal Delirium HIV Human Immunodeficiency irusV AWQ Amphetamine Withdrawal Questionnaire ICD-10 International Classification of Diseases and Health Problems BAC Blood Alcohol Concentration ITP Individual Treatment Plan BD Twice daily LGBTIQ Lesbian, Gay, Bisexual, Transgender, Queer, Intersex or Asexual BI Brief Interventions LSD Lysergic acid diethylamide CALD Culturally and Linguistically Diverse Mane Morning CAM Complementary and Alternative Medicine MAOIs Monoamine Oxidase Inhibitors CANSAS-P Camberwell Assessment of Need Short Appraisal Schedule – Patient Version MB-RP Mindfulness-Based Relapse Prevention CBT Cognitive Behavioural Therapy MDMA Methylenedioxymethamphetamine CEAG Clinical Expert Advisory Group MI Motivational Interviewing CIWA-B Clinical Institute Withdrawal Assessment Scale – Benzodiazepines MIMS Monthly Index of Medical Specialities CM Contingency Management NA Narcotics Anonymous CNS Central Nervous System NADA Working with Diversity in Alcohol & other Drug Settings CPR Cardiopulmonary Resuscitation NCETA National Centre for Education and Training on Addiction CRW Community Residential Withdrawal NDSHS National Drug Strategy Household Survey iv v ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES Turning Point Turning Point Nocte Morning TABLE OF CONTENTS NPS Novel Psychoactive Substances ACKNOWLEDGEMENTS .................................................................iii NRT Nicotine Replacement Therapy NSAIDS Non-steroidal anti-inflammatory drugs ACRONYMS AND ABBREVIATIONS ..............................................iv PBS Pharmaceutical Benefits Scheme TABLE OF CONTENTS ...................................................................vii PCP Phencyclidine LIST OF TABLES ...............................................................................x PRN As Necessary LIST OF FIGURES ............................................................................xi QID Four times a day 1 Introduction .................................................................................1 SMART Recovery Self-Management and Recovery Training 1.1 Background ..................................................................................1 SOWS Short Opiate Withdrawal Scale 1.2 Purpose ........................................................................................1 SSRIs Selective Serotonin Receptor Inhibitors 1.3 Allied resources and web access .................................................3 TCAs Tricyclic antidepressants 2 Definitions of Substance Use Disorder & ithdrawalW .............5 TTFC Time to First Cigarette 2.1 ICD-10 ..........................................................................................5 2.2 DSM-5 ..........................................................................................6 TDS Three times a day 2.3 Substance Intoxication .................................................................8 UEC Urea Electrolytes Creatinine 3 Principles of AoD withdrawal .....................................................9 VADDA Victoria’s Alcohol and Drug Association 3.1 Objectives of withdrawal ...............................................................9 VDDI Victorian Dual Diagnosis Initiative 3.2 Continuity of care ....................................................................... 11 YODAA Youth Drug and Alcohol Advice Service 3.3 Therapeutic alliance ................................................................... 11 YSAS Youth Substance Abuse Service 4 Features of AoD withdrawal .....................................................13 WADS Women’s Alcohol and Drug Service 4.1 Withdrawal complications ...........................................................16 WHO World Health Organization 5 Symptomatic and complementary medication use WKS Wernicke-Korsakoff syndrome in withdrawal .............................................................................19 5.1 Symptomatic medications ..........................................................19 5.2 Complementary therapy and supplements .................................20 6 Withdrawal Settings ..................................................................21 6.1 Residential and inpatient withdrawal ..........................................22 vi vii ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES ALCOHOL AND OTHER DRUG WITHDRAWAL GUIDELINES Turning Point Turning Point 6.1.1 Hospital inpatient withdrawal ......................................................22 9.6 Aboriginal and Torres Strait Islander (ATSI) clients ....................52 6.1.2 Community residential withdrawal ..............................................23 9.7 Culturally and linguistically diverse (CALD) clients ....................54 6.2 Non-residential withdrawal settings (home-based withdrawal) ..23 9.8 Clients with acquired brain injury (ABI) or cognitive impairment ..57 6.3 Rural and regional withdrawal support .......................................24 9.9 Clients with housing instability or homelessness .......................60 6.4 Stepped care ..............................................................................24 9.10 LGBTIQ clients ...........................................................................61 6.5 Supportive care ..........................................................................25 9.11 Pregnant women ........................................................................64 7 Assessment ...............................................................................27 9.12 Clients experiencing family violence ..........................................65 7.1 Pre-admission interventions ......................................................29 9.13 Clients with a history of trauma ..................................................67 7.2 Intoxication at assessment .........................................................29 9.14 Families/significant others ..........................................................67 7.3 Physical health ...........................................................................29 10 Alcohol .......................................................................................71 7.4 Mental health ..............................................................................30 11 Nicotine ......................................................................................91 8 Aftercare ....................................................................................33 12 Cannabis ..................................................................................105 8.1 Planning for post-withdrawal support .........................................33 13 Opioids .....................................................................................115
Load more

Recommended publications
  • Oral Presentations September 23Rd - Rooms 1,2 and 3
    Oral Presentations September 23rd - Rooms 1,2 and 3 Presentation Date Abstract Authors Presenter´s name - Theme Title Code indicated by the author 18498 Thomas Smits; Femke Gresnigt; Thomas Smits Clinical Toxicology/drugs of PERFORMANCE OF AN IMMUNOASSAY Eric Franssen; Milly Attema-de abuse METHOD FOR GAMMA-HYDROXYBUTYRIC Jonge ACID (GHB) IN PATIENTS PRESENTED AT THE EMERGENCY DEPARTMENT, A PROSPECTIVE STUDY 18499 Thomas Smits; Femke Gresnigt; Thomas Smits Clinical Toxicology/drugs of DO WE NEED POINT-OF-CARE TESTING OF Milly Attema-de Jonge; Eric abuse GAMMA-HYDROXYBUTYRIC ACID (GHB) AT Fransse THE EMERGENCY DEPARTMENT? September 23 18730 Lilian H.J. Richter; Julia Menges; Lea Wagmann Clinical Toxicology/drugs of NEW PSYCHOACTIVE SUBSTANCES: Lea Wagmann; Simon D. Brandt; abuse METABOLIC FATE, ISOZYME-MAPPING, 13:30 - 14:45 Folker Westphal; Veit Flockerzi; AND PLASMA PROTEIN BINDING OF 5-APB- ROOM 1 Markus R. Meyer NBOME, 2C-B-FLY-NB2ETO5CL, AND 2C-B- FLY-NBOME 18985 Annelies Cannaert; Marie Annelies Cannaert Clinical Toxicology/drugs of HIDE AND SEEK: OVERCOMING THE Deventer; Melissa Fogarty; abuse MASKING EFFECT OF OPIOID Amanda L.A. Mohr; Christophe P. ANTAGONISTS IN ACTIVITY-BASED Stove SCREENING TESTS 18740 Souleiman El Balkhi ; Roland Souleiman El Balkhi Clinical Toxicology/drugs of METABOLIC INTERACTIONS BETWEEN Lawson; Franck Saint-Marcoux abuse OXYCODONE, BENZODIAZEPINES OR DESIGNER BENZODIAZEPINES PLAY AN IMPORTANT ROLE IN OXYCODONE INTOXICATIONS 19050 Brenda de Winter F de Velde; MN Brenda de Winter Anti-infective drugs POPULATION
    [Show full text]
  • Management of Status Epilepticus
    Published online: 2019-11-21 THIEME Review Article 267 Management of Status Epilepticus Ritesh Lamsal1 Navindra R. Bista1 1Department of Anaesthesiology, Tribhuvan University Teaching Address for correspondence Ritesh Lamsal, MD, DM, Department Hospital, Institute of Medicine, Tribhuvan University, Nepal of Anaesthesiology, Tribhuvan University Teaching Hospital, Institute of Medicine, Tribhuvan University,Kathmandu, Nepal (e-mail: [email protected]). J Neuroanaesthesiol Crit Care 2019;6:267–274 Abstract Status epilepticus (SE) is a life-threatening neurologic condition that requires imme- diate assessment and intervention. Over the past few decades, the duration of seizure Keywords required to define status epilepticus has shortened, reflecting the need to start thera- ► convulsive status py without the slightest delay. The focus of this review is on the management of con- epilepticus vulsive and nonconvulsive status epilepticus in critically ill patients. Initial treatment ► neurocritical care of both forms of status epilepticus includes immediate assessment and stabilization, ► nonconvulsive status and administration of rapidly acting benzodiazepine therapy followed by nonbenzodi- epilepticus azepine antiepileptic drug. Refractory and super-refractory status epilepticus (RSE and ► refractory status SRSE) pose a lot of therapeutic problems, necessitating the administration of contin- epilepticus uous infusion of high doses of anesthetic agents, and carry a high risk of debilitating ► status epilepticus morbidity as well as mortality. ► super-refractory sta- tus epilepticus Introduction occur after 30 minutes of seizure activity. However, this working definition did not indicate the need to immediately Status epilepticus (SE) is a medical and neurologic emergency commence treatment and that permanent neuronal injury that requires immediate evaluation and treatment. It is associat- could occur by the time a clinical diagnosis of SE was made.
    [Show full text]
  • Insomnia Across the Lifespan: Treating This Common Condition
    2/20/2019 Insomnia Across the Lifespan: Treating This Common Condition Wendy L. Wright MS, ANP-BC, FNP-BC, FAANP, FAAN, FNAP Adult / Family Nurse Practitioner Owner – Wright & Associates Family Healthcare @ Amherst and @ Concord, NH Owner – Partners in Healthcare Education © Wright, 2019 1 1 Disclosures • Speaker Bureau: Pfizer, Merck, Sanofi Pasteur • Consultant: Pfizer, Merck, Sanofi Pasteur © Wright, 2019 2 2 Objectives • Upon completion of this session, the participant will be able to: • Discuss the incidence and prevalence of insomnia across the lifespan • Identify the appropriate work-up of the individual with insomnia • Discuss nonpharmacologic and pharmacologic treatment options for the patient with insomnia © Wright, 2019 3 3 Wright, 2019 1 2/20/2019 What Is Insomnia? • Insomnia: • Difficulty initiating or maintaining sleep; sleep that is nonrestorative despite having an adequate opportunity and no abnormal environmental circumstances; and accompanied by daytime somnolence (Sateia, M.J. et. al, 2017) © Wright, 2019 4 4 What Is Insomnia? • DSM-V definition: • Difficulty initiating and / or • Difficulty maintaining and / or • Waking earlier than desired AND • Occurring at least 3 nights per week for at least 3 months AND • Dissatisfaction with sleep http://www.psychiatrictimes.com/special-reports/review-changes-dsm-5-sleep-wake-disorders accessed 08- 08-2018 © Wright, 2019 5 5 DSM-5 Diagnostic Criteria https://practicingclinicians.com/CE-CME/sleep/enhancing-the-management-of-insomnia-in-older-patients/MPCE90716 © Wright, 2019 6
    [Show full text]
  • Neonatal Drug Withdrawal Abstract
    Guidance for the Clinician in Rendering Pediatric Care CLINICAL REPORT Neonatal Drug Withdrawal Mark L. Hudak, MD, Rosemarie C. Tan, MD,, PhD, THE abstract COMMITTEE ON DRUGS, and THE COMMITTEE ON FETUS AND Maternal use of certain drugs during pregnancy can result in transient NEWBORN neonatal signs consistent with withdrawal or acute toxicity or cause KEY WORDS opioid, methadone, heroin, fentanyl, benzodiazepine, cocaine, sustained signs consistent with a lasting drug effect. In addition, hos- methamphetamine, SSRI, drug withdrawal, neonate, abstinence pitalized infants who are treated with opioids or benzodiazepines to syndrome provide analgesia or sedation may be at risk for manifesting signs ABBREVIATIONS of withdrawal. This statement updates information about the clinical CNS—central nervous system — presentation of infants exposed to intrauterine drugs and the thera- DTO diluted tincture of opium ECMO—extracorporeal membrane oxygenation peutic options for treatment of withdrawal and is expanded to include FDA—Food and Drug Administration evidence-based approaches to the management of the hospitalized in- 5-HIAA—5-hydroxyindoleacetic acid fant who requires weaning from analgesics or sedatives. Pediatrics ICD-9—International Classification of Diseases, Ninth Revision — – NAS neonatal abstinence syndrome 2012;129:e540 e560 SSRI—selective serotonin reuptake inhibitor INTRODUCTION This document is copyrighted and is property of the American fi Academy of Pediatrics and its Board of Directors. All authors Use and abuse of drugs, alcohol, and tobacco contribute signi cantly have filed conflict of interest statements with the American to the health burden of society. The 2009 National Survey on Drug Use Academy of Pediatrics. Any conflicts have been resolved through and Health reported that recent (within the past month) use of illicit a process approved by the Board of Directors.
    [Show full text]
  • Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW
    Guideline Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW Summary To provide the most up-to-date knowledge and current level of best practice for the treatment of withdrawal from alcohol and other drugs such as heroin, and other opioids, benzodiazepines, cannabis and psychostimulants. Document type Guideline Document number GL2008_011 Publication date 04 July 2008 Author branch Centre for Alcohol and Other Drugs Branch contact (02) 9424 5938 Review date 18 April 2018 Policy manual Not applicable File number 04/2766 Previous reference N/A Status Active Functional group Clinical/Patient Services - Pharmaceutical, Medical Treatment Population Health - Pharmaceutical Applies to Area Health Services/Chief Executive Governed Statutory Health Corporation, Board Governed Statutory Health Corporations, Affiliated Health Organisations, Affiliated Health Organisations - Declared Distributed to Public Health System, Ministry of Health, Public Hospitals Audience All groups of health care workers;particularly prescribers of opioid treatments Secretary, NSW Health Guideline Ministry of Health, NSW 73 Miller Street North Sydney NSW 2060 Locked Mail Bag 961 North Sydney NSW 2059 Telephone (02) 9391 9000 Fax (02) 9391 9101 http://www.health.nsw.gov.au/policies/ space space Drug and Alcohol Withdrawal Clinical Practice Guidelines - NSW space Document Number GL2008_011 Publication date 04-Jul-2008 Functional Sub group Clinical/ Patient Services - Pharmaceutical Clinical/ Patient Services - Medical Treatment Population Health - Pharmaceutical
    [Show full text]
  • Substance Abuse and Dependence
    9 Substance Abuse and Dependence CHAPTER CHAPTER OUTLINE CLASSIFICATION OF SUBSTANCE-RELATED THEORETICAL PERSPECTIVES 310–316 Residential Approaches DISORDERS 291–296 Biological Perspectives Psychodynamic Approaches Substance Abuse and Dependence Learning Perspectives Behavioral Approaches Addiction and Other Forms of Compulsive Cognitive Perspectives Relapse-Prevention Training Behavior Psychodynamic Perspectives SUMMING UP 325–326 Racial and Ethnic Differences in Substance Sociocultural Perspectives Use Disorders TREATMENT OF SUBSTANCE ABUSE Pathways to Drug Dependence AND DEPENDENCE 316–325 DRUGS OF ABUSE 296–310 Biological Approaches Depressants Culturally Sensitive Treatment Stimulants of Alcoholism Hallucinogens Nonprofessional Support Groups TRUTH or FICTION T❑ F❑ Heroin accounts for more deaths “Nothing and Nobody Comes Before than any other drug. (p. 291) T❑ F❑ You cannot be psychologically My Coke” dependent on a drug without also being She had just caught me with cocaine again after I had managed to convince her that physically dependent on it. (p. 295) I hadn’t used in over a month. Of course I had been tooting (snorting) almost every T❑ F❑ More teenagers and young adults die day, but I had managed to cover my tracks a little better than usual. So she said to from alcohol-related motor vehicle accidents me that I was going to have to make a choice—either cocaine or her. Before she than from any other cause. (p. 297) finished the sentence, I knew what was coming, so I told her to think carefully about what she was going to say. It was clear to me that there wasn’t a choice. I love my T❑ F❑ It is safe to let someone who has wife, but I’m not going to choose anything over cocaine.
    [Show full text]
  • International Standards for the Treatment of Drug Use Disorders
    "*+,-.*--- -!"#$%&-'",()0"ÿ23 45 "6789!"7(@&A($!7,0B"67$!C#+D"%"*+,9779C&B"!7%EE F33"*+,-.*--- -!"#$%&-'",()0" International standards for the treatment of drug use disorders REVISED EDITION INCORPORATING RESULTS OF FIELD-TESTING International standards for the treatment of drug use disorders: revised edition incorporating results of field-testing ISBN 978-92-4-000219-7 (electronic version) ISBN 978-92-4-000220-3 (print version) © World Health Organization and United Nations Office on Drugs and Crime, 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons. org/licenses/by-nc-sa/3.0/igo). Under the terms of this license, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO or UNODC endorses any specific organization, products or services. The unauthorized use of the WHO or UNODC names or logos is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons license. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO) or the United Nations Office on Drugs and Crime (UNODC). Neither WHO nor UNODC are responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the license shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization (http://www.
    [Show full text]
  • Drugs That Act in the Cns
    DRUGS THAT ACT IN THE CNS Anxiolytic and Hypnotic Drugs Dr Karamallah S. Mahmood PhD Clinical Pharmacology 1 OTHER ANXIOLYTIC AGENTS/ A. Antidepressants Many antidepressants are effective in the treatment of chronic anxiety disorders and should be considered as first-line agents, especially in patients with concerns for addiction or dependence. Selective serotonin reuptake inhibitors (SSRIs) or serotonin/norepinephrine reuptake inhibitors (SNRIs) may be used alone or prescribed in combination with a benzodiazepine. SSRIs and SNRIs have a lower potential for physical dependence than the benzodiazepines and have become first-line treatment for GAD. 2 OTHER ANXIOLYTIC AGENTS/ B. Buspirone Buspirone is useful for the chronic treatment of GAD and has an efficacy comparable to that of the benzodiazepines. It has a slow onset of action and is not effective for short-term or “as-needed” treatment of acute anxiety states. The actions of buspirone appear to be mediated by serotonin (5-HT1A) receptors, although it also displays some affinity for D2 dopamine receptors and 5-HT2A serotonin receptors. Buspirone lacks the anticonvulsant and muscle-relaxant properties of the benzodiazepines. 3 OTHER ANXIOLYTIC AGENTS B. Buspirone The frequency of adverse effects is low, with the most common effects being headaches, dizziness, nervousness, nausea, and light-headedness. Sedation and psychomotor and cognitive dysfunction are minimal, and dependence is unlikely. Buspirone does not potentiate the CNS depression of alcohol. 4 V. BARBITURATES The barbiturates were formerly the mainstay of treatment to sedate patients or to induce and maintain sleep. Today, they have been largely replaced by the benzodiazepines, primarily because barbiturates induce tolerance and physical dependence and are associated with very severe withdrawal symptoms.
    [Show full text]
  • Running Head: PHARMACOLOGICAL TREATMENT for METHAMPHETAMINE
    Running head: PHARMACOLOGICAL TREATMENT FOR METHAMPHETAMINE PHARMACOLOGICAL TREATMENT FOR METHAMPHETAMINE DEPENDENCE By BRINN CULVER A project submitted in partial fulfillment of the requirements for the degree of MASTER OF NURSING WASHINGTON STATE UNIVERSITY Department of Nursing APRIL 2014 PHARMACOLOGICAL TREATMENT FOR METHAMPHETAMINE ii To the Faculty of Washington State University: The members of the Committee appointed to examine the dissertation/thesis of BRINN CULVER find it satisfactory and recommend that it be accepted. Julie DeWitt-Kamada, DNP, ARNP, PMHNP Chair Anne Mason, DNP, ARNP, PMHNP Dawn Rondeau, DNP, ACNP, FNP PHARMACOLOGICAL TREATMENT FOR METHAMPHETAMINE iii PHARMACOLOGICAL TREATMENT FOR METHAMPHETAMINE DEPENDENCE Abstract By Brinn Culver Washington State University April 2014 Chair: Julie DeWitt-Kamada Methamphetamine (MA) is a highly addictive drug whose abuse causes widespread global consequences. The negative impact of MA use on individuals and communities warrants its consideration as a public health concern. MA has a complicated pharmacological action, and chronic use results in neurological dysfunction, including deficits in dopamine. Changes in dopaminergic function make treatment of MA dependence especially challenging, and the mainstay treatment of psychotherapy is insufficient in addressing dopamine deficit. Pharmacological treatments are being explored, but no medication has attained Federal Drug Administration approval, as it requires proof of achieving abstinence. From a harm reduction standpoint, several
    [Show full text]
  • Behandling Av Ångestsyndrom
    Behandling av ångestsyndrom En systematisk litteraturöversikt Volym 2 September 2005 SBU • Statens beredning för medicinsk utvärdering The Swedish Council on Technology Assessment in Health Care SBU utvärderar sjukvårdens metoder SBU (Statens beredning för medicinsk utvärdering) är en statlig myn- Behandling av ångestsyndrom dighet som utvärderar sjukvårdens metoder. SBU analyserar nytta och kostnader för olika medicinska metoder och jämför vetenskapens stånd- punkt med svensk vårdpraxis. Målet är ett bättre beslutsunderlag för En systematisk litteraturöversikt alla som avgör vilken sjukvård som ska bedrivas. Välkommen att besöka SBU:s hemsida, www.sbu.se Volym 2 SBU ger ut tre serier av rapporter. I den första serien presenteras utvär- deringar som utförts av SBU:s projektgrupper. Dessa utvärderingar Projektgrupp åtföljs alltid av en sammanfattning och slutsatser fastställda av SBU:s Lars von Knorring Ingrid Håkanson styrelse och råd. Denna rapportserie ges ut med gula omslag. I den andra (ordförande) (projektassistent) serien, med vita omslag, presenteras aktuella kunskaper inom något Viveka Alton Lundberg Agneta Pettersson område av sjukvården där behov av utvärdering kan föreligga. Den tredje Vanna Beckman (projektledare under serien, Alert-rapporterna, avser tidiga bedömningar av nya metoder inom (deltog 1995–2002) perioden 2004–2005) hälso- och sjukvården. Susanne Bejerot Per-Anders Rydelius Roland Berg Sten Thelander (deltog 1995–2002) (projektledare under Cecilia Björkelund perioden 1995–2004) Per Carlsson Helene Törnqvist (deltog 1995–1999) (deltog 1999–2005) Elias Eriksson Kristian Wahlbeck (deltog 1995–2001) (deltog 2002–2005) Tom Fahlén Hans Ågren Mats Fredrikson Rapporten ”Behandling av ångestsyndrom” består av två volymer (nr 171/1+2) och kan beställas från: Externa granskare SBU, Box 5650, 114 86 Stockholm Fredrik Almqvist Per Høglend Besöksadress: Tyrgatan 7 Alv A.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines
    The ICD-10 Classification of Mental and Behavioural Disorders: Clinical descriptions and diagnostic guidelines World Health Organization F10 - F19 Mental and behavioural disorders due to psychoactive substance use Overview of this block F10. – Mental and behavioural disorders due to use of alcohol F11. – Mental and behavioural disorders due to use of opioids F12. – Mental and behavioural disorders due to use of cannabinoids F13. – Mental and behavioural disorders due to use of sedative hypnotics F14. – Mental and behavioural disorders due to use of cocaine F15. – Mental and behavioural disorders due to use of other stimulants, including caffeine F16. – Mental and behavioural disorders due to use of hallucinogens F17. – Mental and behavioural disorders due to use of tobacco F18. – Mental and behavioural disorders due to use of volatile solvents F19. – Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances Four- and five-character codes may be used to specify the clinical conditions, as follows: F1x.0 Acute intoxication .00 Uncomplicated .01 With trauma or other bodily injury .02 With other medical complications .03 With delirium .04 With perceptual distortions .05 With coma .06 With convulsions .07 Pathological intoxication F1x.1 Harmful use F1x.2 Dependence syndrome .20 Currently abstinent .21 Currently abstinent, but in a protected environment .22 Currently on a clinically supervised maintenance or replacement regime [controlled dependence] .23 Currently abstinent, but receiving treatment with
    [Show full text]
  • OCUFLOX (Ofloxacin Ophthalmic Solution) 0.3% Sterile
    ® OCUFLOX (ofloxacin ophthalmic solution) 0.3% sterile DESCRIPTION OCUFLOX® (ofloxacin ophthalmic solution) 0.3% is a sterile ophthalmic solution. It is a fluorinated carboxyquinolone anti-infective for topical ophthalmic use. Chemical Name: (±)-9-Fluoro-2,3-dihydro-3-methyl-10-(4-methyl-1-piperazinyl)-7-oxo-7H-pyrido[1,2,3-de]-1,4-benzoxazine-6- carboxylic acid. Contains: Active: ofloxacin 0.3% (3 mg/mL). Preservative: benzalkonium chloride (0.005%). Inactives: sodium chloride and purified water. May also contain hydrochloric acid and/or sodium hydroxide to adjust pH. OCUFLOX® solution is unbuffered and formulated with a pH of 6.4 (range - 6.0 to 6.8). It has an osmolality of 300 mOsm/kg. Ofloxacin is a fluorinated 4-quinolone which differs from other fluorinated 4-quinolones in that there is a six member (pyridobenzoxazine) ring from positions 1 to 8 of the basic ring structure. CLINICAL PHARMACOLOGY Pharmacokinetics Serum, urine and tear concentrations of ofloxacin were measured in 30 healthy women at various time points during a ten-day course of treatment with OCUFLOX® solution. The mean serum ofloxacin concentration ranged from 0.4 ng/mL to 1.9 ng/mL. Maximum ofloxacin concentration increased from 1.1 ng/mL on day one to 1.9 ng/mL on day 11 after QID dosing for 10 1/2 days. Maximum serum ofloxacin concentrations after ten days of topical ophthalmic dosing were more than 1000 times lower than those reported after standard oral doses of ofloxacin. Tear ofloxacin concentrations ranged from 5.7 to 31 mcg/g during the 40 minute period following the last dose on day 11.
    [Show full text]