The effect of naloxone on the preoperative gastric volume and pH

The effect of 4 mg oral naloxone on preoperative gastric volume and pH of gastric aspirate was studied in a double-blind, randomized study. Twenty patients received 10 ml of naloxone (4 mg) mixed with 10 ml of orange juice, and 20 patients received 10 ml of isotonic saline mixed with 10 ml of orange juice, 2 h before surgery. Gastric content was obtained immediately after intubation of the trachea. No significant difference in gastric volume and pH of gastric aspirate was found between the two groups. It is concluded that naloxone does not affect gastric emptying and gastric acid secretion to a degree great enough to protect against aspiration of gastric contents into the lungs.     

Anaesthetic agents and excretion in breast milk

This review is an update on anaesthetic agents and their excretion into breast milk; it presents the reported effects on suckling infants, and discusses the precautions which should be considered. For most anaesthetic agents, there is very sparse information about breast milk excretion and even less published knowledge about the possible effects on the suckling infant. Generally, when an anaesthetic agent is given on a single–dose basis, there is no evidence that it is excreted in breast milk in clinically significant amounts, even if there are detectable concentrations of the drug in the milk. Most anaesthetics are rapidly cleared from the mother, and, consequently, it should be possible to allow suckling as soon as practically feasible after surgery. However, repeated administration of certain opiates and benzodiazepines has been reported to cause adverse effects in neonates, with premature neonates apparently being more susceptible. Thus, in long–term treatment with these drugs, the importance of uninterrupted breast feeding should be assessed against possible adverse drug effects in the neonate.     

Behavioral significance of phasic changes in mesolimbic dopamine-dependent electrochemical signal associated with heroin self-injections

Summary High-speed chronoamperometry with monoamine-selective carbon fiber electrodes was used in rats to monitor, during 5–6 consecutive daily sessions, changes in DA-dependent electrochemical signal in the nucleus accumbens (NAcc) during intravenous heroin (0.1 mg/kg) self-administration (SA) behavior and passive repeated drug injections performed with a temporal scheme similar to that in the SA experiment. In trained animals, biphasic signal fluctuations time-locked to the individual lever-presses were found to accompany all but the first daily SAs. The signal gradually increased by 30–40 nM for the 10 minutes preceding the SA, reached a peak at the moment of lever-press and decreased abruptly by 40 nM for 3–4 min after heroin SA. The cycle then repeated, reaching a new peak at the moment of the next lever-press. Rapid bi-directional fluctuations in signal associated with individual heroin SAs were superimposed on substantial tonic increase in signal baseline (400–500 nM). This increase quickly developed after presentation of heroin-related light cue and the first SA, was relatively stable during all subsequent SAs and decreased towards the baseline after the last SA of a session. Changes in signal baseline induced by repeated heroin SAs depended strongly upon the signal's basal level (r=– 0.787); that signal preferentially increased when its basal values were low (0–300 nM), and decreased when signal was tonically elevated (> 600 nM). Repeated passive heroin injections also induced biphasic signal fluctuations and a similar tonic increase in signal baseline. Although a transient signal decrease (25 nM for 2–4 minutes) followed by a prolonged signal increase occurred after each but not the first passive injection, the gradual pre-injection signal acceleration was absent.Although DOPAC, a principal DA metabolite, may significantly contribute to the tonic increase in electrochemical signal seen during SA session, the changes in extracellular DA may be the main contributor to both the rapid signal increases preceding drug-taking and the transient signal decreases following heroin SA. If so, the present findings suggest that activation of mesolimbic DA cells and increase in DA transmission may be involved in the mediation of motivational and/or activational components of drug-seeking and drug-taking behavior. An acute termination of previous drug- and behavior-associated DA activation with a transient inhibition of DA release, immediately following heroin SA may correlate with the drug's rewarding action, representing a part of a mechanism regulating drug-taking behavior.     

Gaba and endorphln mechanisms in relation to the effects of benzodiazepines on feeding and drinking

1. 1. Behavioural actions of benzodiazepines have a number of significant characteristics. Anxiolytic effects are demonstrable both clinically and experimentally; in addition, there is excellent evidence for a reinforcing effect of these compounds, and a direct involvement in ingestional responses. This review focusses on the effects of benzodiazepines on the latter feeding and drinking responses.

2. 2. A necessary mediator of benzodiazepine action in the central nervous system appears to be the facilitation of inhibitory GABAergic neurotransmission. It follows, therefore, that behavioural consequences of benzodiazepine action may depend crucially on enhanced GABAergic activity in the brain. Evidence for some involvement of GABAergic mechanisms in the control of feeding and drinking responses is reviewed. Only a few data are so far available to link benzodiazepines effects on ingestional behaviour directly to GABAergic transmission.

3. 3. A major current theme in the psychopharmacology of feeding and drinking behaviour is the possible involvement of endogenous opioid peptides. There is a strong suggestion in the experimental data that there are links between benzodiazepine and endorphinergic mechanisms in relation to ingestional responses. A promising future line of approach appears to be a delineation of benzodiazepine-GABA-endorphin interrelations in the control of food and water consumption.

我国部分地区非法成瘾物质使用第三次流行病学调查 第二部分:非法成瘾物质使用种类及方法

目的 :作为第三次全国非法成瘾物质使用流行病学调查报告的第二部分 ,本文报告我国 2 0 0 0年 6个吸毒高发区非法成瘾物质使用种类和方法。方法 :整群抽样 ,采用自行设计的调查表 ,以挨户、线索和机构调查相结合的方式调查了 5 374 7例 15a及 15a以上社区人群 (男 2 812 6 ,占 5 2 3% ,女 2 5 6 2 1,占 4 7 7% )的非法成瘾物质使用情况。结果 :使用者最近一个月非法使用的成瘾物质中 ,97 18%为海洛因 ,2 4 5 %为阿片 ,其它种类罕见 ;采用烫吸和静脉注射者所占比例分别为 6 8 4 2 %和2 2 98% ;75 99%的使用者使用频度在 7- 2 7次 周之间。结论 :目前我国非法使用的成瘾物质仍以阿片类为主 ,其中海洛因占首位 ,阿片次之 ;使用途径仍以烫吸为主 ,静脉注射其次。对其它非法成瘾物质使用流行病学调查仍有待深入     

Use of Standardized Patients to Evaluate the Physicians in Residence Program

Abstract

The purpose of this study was to evaluate the efficacy of the Physician in Residence (PIR) program at the Hazelden Residential Program of New York City as a substance abuse training approach using standardized patients (SP) and self-report ratings. Using an objective rating scale, two experienced drug counselors evaluated four videotaped interviews carried out by housestaff pre- and post-enrollment in the PIR program. In addition, housestaff completed self-report ratings regarding their knowledge, attitudes, and skills of substance abuse. Of the 23 housestaff who completed both pre- and post-PIR program videotape sessions, significant improvements were noted in both observer and self-reported ratings. Overall, self-report ratings showed a greater percent improvement than the counselor ratings. The PIR program may be an efficacious approach to teach substance abuse clinical skills to housestaff.     

Literacy-Free 12 Step Expressive Arts Curriculum Enhances Engagement and Treatment Outcomes for Dually Diagnosed Substance Use and Mental Health Disorders

ABSTRACT

This study evaluated the efficacy of the Literacy-Free 12 Step Expressive Arts Therapy© curriculum in enhancing personal change and treatment outcomes for populations dually diagnosed with substance use and mental health disorders. It supplemented standard rehabilitation treatment for 47 individuals in a U.S. facility by incorporating 12 Step guidelines, cognitive behavioral therapy, rational emotive behavior therapy, and expressive arts activities. Pre-session and post-session participant ratings revealed positive increases for commitment to recovery, attitude toward making lifestyle changes, and hopefulness. Compared to 101 inpatients at the same facility, curriculum participants evidenced less drop-out, higher treatment completion, and greater personal investment in recovery.