Louis A. Faillace

Achieving and maintaining gains among problem drinkers: Process and outcome results

Treatments focused on drinking moderation have had much success in reducing alcohol consumption among problem drinkers not physically dependent on alcohol, but little is known about the variables pertinent to the achievement and maintenance of these behavior changes. The influences of aftercare and the posttreatment use of drinking reduction strategies were studied in this investigation. Male and female problem drinkers first participated in an 8-week drinking reduction program and then were assigned randomly to six months of group afterace, telephone aftercare, or no aftercare. Also studied was a separately recruited no-treatment comparison group comprised of drinkers concerned about their alcohol consumption who were not seeking treatment and participated only in a data collection session and follow-up. Treated subjects significantly reduced their monthly heavy drinking days (64% reduction from pretreatment to the 12-month follow-up point), regardless of aftercare condition. Similar reductions were found for the no-treatment subjects who were only followed over time. Reductions in heavy drinking among the treated subjects were associated with the posttreatment utilization of drinking reduction techniques.

Persistent pain and illness insistence. A medical profile of proneness to surgery.

Although the controversy over “unnecessary surgical procedures” has generated a considerable body of literature relating to the delivery of medical care and professional accountability, little data exist concerning patient factors determining proneness to surgery [l-11]. The few relevant psychiatric reports associated with surgical proneness are of limited clinical usefulness to the primary physician, for they generally stress unconscious factors or psychiatric diagnoses. The results of the present controlled retrospective case study strongly suggest that a particular pattern of persistent pain and illness insistence constitutes an identifiable medical profile of patients at high risk for excessive surgery and acute medical treatment.

The effect of the combination of lithium and haloperidol on brain intermediary metabolism in vivo

The effect of the chronic administration of the combination of lithium and haloperidol has been studied in rat brain in vivo. Lithium was administered in food in amounts sufficient to maintain serum lithium levels of 1.0±0.1 mEq/l; haloperidol (1.5 mg/kg) was given i.p. once daily. Control animals pair-fed with the lithium/haloperidol group received either lithium alone, haloperidol alone, or neither drug. Fifteen days after the beginning of the experiments the brains were instantaneously frozen with a rapid brain-freezing device and multiple metabolites were measured in the perchloric acid extract of the tissue. Intermediates examined included selected metabolites of the glycolytic pathway and the tricarboxylic acid cycle, N-acetylaspartate and cofactors such as ATP, CoA, and acetyl-CoA. Estimates of the effects of the treatments on cytoplasmic and mitochondrial redox states were also made. The results showed only minor effects of any of the treatments on any of the parameters studied and little or nothing to distinguish the combination of lithium and haloperidol from either treatment alone.

Surgery-proneness: a review and clinical assessment.

Abstract The authors review the psychiatric literature on patients who undergo repeated, often ill-advised surgery for pain relief, and report on their own clinical study, which shows that many polysurgery patients have similar social and medical histories as well as common aspects of clinical presentation that identify them as a subgroup of chronic pain patients. Identifying surgery-prone patients and redefining their illness as chronic rather than acute can help reduce the incidence of unnecessary surgery.