The use and abuse of topical corticosteroids

An atypical case of "Foix-Chavany syndrome", is described. A definite diagnosis could be achieved through an electromyographic and reflessological investigation (jaw reflex, blink reflex, perioral reflex), when a poor clinical history was not helping towards a definite diagnostic conclusion. It is proposed that the diagnosis of "Foix-Chavany syndrome" should not be limited only to classical "facial diplegia of cortical origin" or to "facio-linguo-pharyngo-laryngo-masseter paralysis of cortico-subcortical origin". Considering the great clinical variability of a syndrome with a common anatomical substrate, it is proposed to use the eponym for all syndromes characterized by: 1) a motor deficit in the cephalic district with relative integrity of motor function of the limbs; 2) a dissociation between loss of voluntary motility and preservation of reflex and automatic motility.     

Physostigmine--its use and abuse

Physostigmine salicylate, a cholinesterase inhibitor, has been shown to reverse the effects of certain drugs with anticholinergic properties. The paper provides a brief historical account of physostigmine, reviews the cholinergic drugs and their effects and suggests a management protocol based on physiologic criteria. Twenty-six overdose cases, recently treated with physostigmine, are summarized. The controversy regarding the etiology of seizures following physostigmine administration is discussed.     

The use and abuse of human figure drawings.

Reviews data-based studies on human figure drawings and concludes that there is little support for their validity or for their use as devices to assess personality, behavior, emotion, or intellectual functioning. Ease of administration and anecdotal reports of predictive accuracy are presented as explanations for their continued usage. Existing valid measures of behavioral and cognitive functioning render the use of human figure drawings superfluous. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing staff perceptions of the use and reduction in the use of physical restraints

Substance P (SP) is a neuropeptide found in both the central and peripheral nervous system. In the skin, SP-containing neurons stimulate the release of histamine from connective tissue mast cells (MC). SP also can potentiate neoangiogenesis and induce dermal fibrosis. MC-derived histamine has potent vasoactive effects, is angiogenic, and promotes tissue fibroplasia. In addition to histamine, MC contain many other angiogenic factors and a variety of cytokines, growth factors, and proteolytic enzymes implicated in tissue remodeling, and normal as well as tumor-associated neoangiogenesis. Many MC-derived factors, including histamine, can enhance melanoma cell growth directly. MC often concentrate around cutaneous melanomas which also frequently are associated with angiogenesis and peritumoral fibrosis. The precise mediators of these responses have not been well defined. We evaluated by immunohistochemistry cutaneous lesions representing stages of progression of malignant melanoma and its precursor lesions for the expression of SP. SP was expressed in 17/25 (68%) primary invasive malignant melanomas, 2/5 (40%) metastatic melanomas, 6/10 (60%) melanomas in situ, 7/12 (58%) atypical (dysplastic) nevi, and 4/10 (40%) spindle and epithelioid cell (Spitz) nevi, but was not detected in any (0/11, 0%) acquired benign melanocytic nevi (p<0.05). Invasive melanomas were immunolabeled in both the intraepidermal and the dermal components of the lesions. For those atypical and Spitz nevi which expressed SP, most of the immunoreactive melanocytes were located at the dermal-epidermal junction overlying areas of papillary dermal fibrosis. The results show differential expression of SP among cutaneous melanocytic lesions and suggest that the expression of this neuropeptide together with other factors may contribute to some of the host responses associated with these lesions.     

Patient restraints

This is the first column in a new feature that focuses on the questions health care managers ask the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Both the JCAHO and Nursing Management's editors urge you, the readers, to submit your questions (see address at end of column).     

Substance use and abuse among children and teenagers.

During the past several years, there has been a renewed national concern about drug abuse, culminating in the current "war on drugs." In this review, we emphasize that even though child or teenage drug use is an individual behavior, it is embedded in a sociocultural context that strongly determines its character and manifestations. Our focus is on psychoactive substances both licit (cigarettes and alcohol) and illicit (e.g., cannabis and cocaine). We feel that it is critical to draw a distinction between use and abuse of drugs and to do so from a multidimensional perspective that includes aspects of the stimulus (drug), organism (individual), response, and consequences. Our selective review of substance use and abuse among children and adolescents covers epidemiology (patterns and extent of drug use), etiology (what generates substance use), prevention (how to limit drug use), treatment (interventions with drug users), and consequences (effects and outcomes of youthful drug use). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug use and abuse (2nd ed.).

Review of book, Stephen A. Maisto, Mark Galizio, and Gerard J. Connors. Drug Use and Abuse (2nd ed.) Fort Worth, TX: Harcourt Press, 1995, 500 pp. Reviewed by Mitch Earleywine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comment on "The use and abuse of human figure drawings."

Comments on R. W. Motta et al's (see record 1994-04005-001) conclusion that the use of human figure drawings to assess intelligence is invalid. While Motta et al are generally successful in documenting the shortcomings of these tests, their literature review is not exhaustive. However, the arguments of Motta et al should be heeded because they are based on empirical data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of familial risk, personality, and expectancies on alcohol use and abuse.

This study tested a structural model of the association between familial risk, personality risk, alcohol expectancies, and alcohol abuse in a sample of 224 young adult offspring of alcoholics and 209 offspring of nonalcoholics. The results provided support for 2 personality-risk pathways, a social deviance proneness and an excitement/pleasure seeking path, that accounted for a significant portion of the association between a familial alcoholism and alcohol abuse. The path from familial alcoholism to social deviance proneness lead directly to alcohol problems. The path from familial alcoholism to excitement/ pleasure seeking was associated with increased drinking, which, in turn, was associated with alcohol problems. Positive alcohol expectancies accounted for part of the association between excitement seeking and alcohol use. The results suggest 2 different biopsychosocial mechanisms that elevate risk for abuse in the offspring of alcoholics. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The use of anatomical dolls to assess child sexual abuse: A critical review.

Reviews the empirical literature to investigate the following 2 aspects of the controversial use of anatomical dolls to assess for child sexual abuse: (1) Are anatomical dolls valid tools to assess child sexual abuse? (2) What progress has been made toward the development of an anatomical doll interview that is objective and standardized? 16 empirical studies were located which have assessed children's reactions to anatomical dolls. Criteria used to evaluate the studies are listed. In regard to validity, the empirical data suggest that children who have been referred for sexual abuse respond differently to anatomical dolls than nonabused children. Furthermore, considerable progress has been made toward the development of an objective assessment protocol and reliable scoring criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Substance use and abuse among patients with comorbid dysthymia and substance disorder

This study determines the substance use and abuse patterns among patients with comorbid substance-related disorder (SRD) and dysthymia in SRD-dysthymia as compared with patients with SRD only. Differences in use and abuse patterns could be useful for (a) understanding motivations for use, such as self-treatment, and (b) assisting clinicians to identify cases of dysthymia among SRD patients. Retrospective and current data were obtained regarding history of substance use and current SRD diagnoses. Two university medical centers with alcohol-drug programs located within departments of psychiatry were the settings. A total of 642 patients was assessed. of whom 39 had SRD-dysthymia and 308 had SRD only. Data on past usc were collected by a research associate using a questionnaire. Current SRD and dysthymia diagnoses were made by psychiatrists specializing in addiction. The patients with SRD-dysthymia and SRD only did not differ with regard to use of alcohol, tobacco, and benzodiazepines. The patients with SRD-dysthymia started caffeine use at an earlier age, had shorter "use careers" of cocaine, amphetamines, and opiates, and had fewer days of cocaine and cannabis use in the last year. They also had a lower rate of cannabis abuse/dependence. This study indicated that patients with dysthymia and SRD have exposure to most substances of abuse that is comparable to patients with SRD only. However, they selectively use certain substances less often than patients with SRD only. Early use of caffeine may reflect self-treatment for depressive symptoms among patients with SRD-dysthymia.     

Moral and social issues regarding pregnant women who use and abuse drugs

Pregnant women who abuse drugs, such as alcohol, cocaine, and marihuana may face a variety of legal and social responses, including involuntary commitment, forced treatment, and criminal sanctions. These programs are intended to remedy apparent maternal-fetal conflicts but paradoxically may encourage some women to avoid beneficial medical and social services or to seek abortion. Although pregnant women have ethical duties to give due consideration to their offspring, these moral obligations fail to justify coercive and punitive programs regarding substance abuse. Coercive fetal protection policies may undermine pregnant women's trust and cooperation, violate their autonomy, weaken our civil liberties, and raise a host of ethical problems relating to race, gender, and class prejudice. Education and drug treatment programs, rather than punitive and coercive measures, may better help pregnant women fulfill their moral duties to refrain from abusing substances.