Introduction to Nicotine Addiction

Psychiatry No Responses »
May 152012

Tobacco was first introduced into European society by Hernandez de Toledo in the sixteenth century. Cigarette smoking is a major preventable cause of disease worldwide.Tobacco addiction, the second-leading cause of death in the world, is a culprit for approximately 5 million deaths each year or 1 in 10 adult deaths.

Nicotine meets the criteria of a highly addictive drug. Nicotine is a potent psychoactive drug that induces euphoria, serves as a reinforcer of its use, and leads to nicotine withdrawal syndrome when it is absent. As an addictive drug, nicotine has 2 very potent issues: it is a stimulant and it is also a depressant.Nicotine in cigarette smoke affects mood and performance and is the source of addiction to tobacco.

Clinical Presentation

Nicotine addiction is classified as nicotine use disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The criteria for this diagnosis include any 3 of the following within a 1-year time span:

  • Tolerance to nicotine with decreased effect and increasing dose to obtain same effect
  • Withdrawal symptoms after cessation
  • Smoking more than usual
  • Persistent desire to smoke despite efforts to decrease intake
  • Extensive time spent smoking or purchasing tobacco
  • Postponing work, social, or recreational events in order to smoke
  • Continuing to smoke despite health hazards

 

  • Nicotine withdrawal is classified as a nicotine-induced disorder according to the DSM-IV-TR. Symptoms include difficulty concentrating, nervousness, headaches, weight gain due to increased appetite, decreased heart rate, insomnia, irritability, and depression. These symptoms peak in the first few days but eventually disappear within a month.
  • Symptoms of nicotine toxicity, otherwise known as acute nicotine poisoning, include nausea, vomiting, salivation, pallor, abdominal pain, diarrhea, and cold sweat.
  • A previous history of depression, use of antidepressants in the past, and onset of depression during previous quit attempts should be obtained.

Physical Effects

  • Physical effects of nicotine use include increased heart rate, accelerated blood pressure, and Continue reading »
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Gallbladder and bile duct cancers

General Surgery No Responses »
May 132012
Cancer of the gallbladder is rare, constituting less than 1% of all cancer cases. It’s usually found coincidentally in patients with cholecystitis; 1 in 400 cholecystectomies reveals cancer.
This disease is most prevalent in women over age 60. It’s rapidly progressive and usually fatal; patients seldom live 1 year after diagnosis. The poor prognosis is because of late diagnosis; gallbladder cancer usually isn’t diagnosed until after cholecystectomy, when it’s typically in an advanced, metastatic stage.
Extrahepatic bile duct cancer is the cause of about 3% of all cancer deaths in the United States. It occurs in both men and women between ages 60 and 70 (incidence is slightly higher in men). The usual site is at the bifurcation in the common duct.
Cancer at the distal end of the common duct is commonly confused with pancreatic cancer. Characteristically, metastasis occurs in local lymph nodes and in the liver, lungs, and peritoneum.
Causes
Many consider gallbladder cancer a complication of gallstones. This inference rests on circumstantial evidence from postmortem examinations: 60% to 90% of all gallbladder cancer patients also have gallstones. Postmortem data from patients with gallstones show gallbladder cancer in only 0.5%.
Adenocarcinoma accounts for 85% to 95% of all cases of gallbladder cancer; squamous cell carcinoma accounts for 5% to 15%. Mixed-tissue types are rare.
Lymph node metastasis is present in 25% to 70% of patients at diagnosis. Direct extension to the liver is common (46% to 89% of patients); direct extension to the cystic and the common bile ducts as well as the stomach, colon, duodenum, and jejunum produces obstructions. Metastasis also occurs through the portal or hepatic veins to the peritoneum, ovaries, and lower lung lobes.
The cause of extrahepatic bile duct cancer isn’t known, but statistics reveal an unexplained increased incidence of this cancer in patients with ulcerative colitis. This association may be Continue reading »
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Introduction to Phobias

Psychiatry No Responses »
Apr 072012
Defined as a persistent and irrational fear of a specific object, activity, or situation, a phobia results in a compelling desire to avoid the perceived hazard. The patient recognizes that his fear is out of proportion to any actual danger, but he can’t control it or explain it away.
Three types of phobias exist: agoraphobia, the fear of being alone or of open space; social, the fear of embarrassing oneself in public; and specific, the fear of a single, specific object or situation, such as animals or heights.
About 7% of all Americans suffer from a phobic disorder. In fact, phobias are the most common psychiatric disorders in women and the second most common in men. More men than women experience social phobias, whereas agoraphobia and specific phobias are more common in women.
A social phobia typically begins in late childhood or early adolescence; a specific phobia usually begins in childhood. Most phobic patients have no family history of psychiatric illness, including phobias.
Agoraphobia and social phobia tend to be chronic; however, new treatments are improving the prognosis. A specific phobia usually resolves spontaneously as the child mature
Causes
A phobia develops when anxiety about an object or a situation compels the patient to avoid it. The precise cause of most phobias is unknown. Psychoanalytic theory holds that the phobia is actually repression and displacement of an internal conflict. Behavior theorists view phobia as a stimulus-response reflex, whereby the patient avoids a situation or object that causes anxiety.
Signs and symptoms
The phobic patient typically reports signs of severe anxiety when confronted with the feared object or situation. A patient with agoraphobia, for example, may complain of dizziness, a sensation of Continue reading »
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