Substance Abuse and Addictive Disorders - CRASH! Medical Review Series
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- Опубліковано 22 лип 2024
- (Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
Dear Dr. Bolin,Thank you so much for your EXCELLENT presentation. I live with a 60 yr. old man who is in denial of his alcohol addiction. I worry that he may have developed cirrhosis and may get hepatic encephalopathy...his Doctor says he's fine...NOT!!! Thank you for the info about Pedialite and thiamine. He smokes and has a bad cough like emphysema or copd.....also I think every teenager should see this presentation.They would definitely learn from it. I did!!!! Thank you!
This made for a great study guide for my psychopathology class. Thank you Paul
Thank you. Great review for tomorrows quiz!!
Thanks a bunch bro, ya are smart,ya have been helping me a lot
Thanks Paul.
😊 Thank you, I’ll need to learn about this for next semester:)
that's great work! thank you so much :) :)
Thanks Dr. you are Simply the best :)
Awesomely informative and perfectly explained! Thank you so much! 😊😊 29/3/2019
thanks for video
thank you so much
I thought you avoid BBs in Sympathomimetic toxidrome? Also dont you have to be careful with flumazenil in chronic users as to not cause a status epilepticus? Thx for uploading
السلام عليكم أما بعد هل يمكن أضافه اللغه ألعربيه على كل مقاطع الفيديو وشكراً
you are very helpful 10q so much.
Hi Dr. Paul! Would giving the morning-after pill be part of the procedure of treating a date-rape drug victim? Also, if the victim refuses involvement of law enforcement, should the clinician still inform them? A lot of the ethics questions I come across are pretty much about the patient not wanting something which, theoretically what we learn we should do.
Also, in the beginning of the video, you talked about the cannabis-withdrawal syndrome and then later in the video, you said there's no withdrawal in taking marijuana. Is the information in the beginning the updated one?
Thank you so much for your awesome videos by the way! :)
+Livvy Liv To respond to your questions: Regarding the morning-after pill, I don't expect it to come up on the exam. There are several reasons for this. First, many physicians will have ethical objections to providing the pill. The exam will not dock you for this purpose. Second, many hospitals do not permit their physicians to prescribe it and if they do there will often be guidelines on when it may or may not be prescribed. For instance, at the Catholic hospital I worked at (which actually pioneered a protocol now used by Catholic hospitals nationwide), we were permitted to prescribe the pill if, and only if, an endocrine battery (LH and progesterone) indicated that she was not presently in the ovulatory phase (roughly day 12-16 in a 28-day cycle). In my personal opinion, it was cumbersome: No two women are alike, and even hormone levels cannot tell for sure whether she has ovulated. But all this just illustrates how complex the issues are surrounding this. Otherwise we were to make referrals if the woman explicitly requested the pill or other reproductive counseling. If, in the highly unlikely event, the clinical case simulation on Step 3 were to give you a rape question, I would check off the pill because "considering it" is part of the treatment plan.
Regarding marijuana, yes, the updated information w/ the DSM-5 at the beginning is what you should go by. Cannabis-withdrawal syndrome is a new entity.
Hope this helps.
Ok, thanks a lot! What about issues regarding informing law enforcement? Are these usually up to the patient? If they refuse to have their case reported to the police, like having been raped or overdosed on illegal drugs, do they have a say in whether or not their case gets reported?
I'm not preparing for the USMLE but the Australian licensing exam. However, I doubt they differ very much.
+Livvy Liv In the U.S., there is very little a physician can do with law enforcement when it comes to adult patients. The only time we interact with law enforcement in the context of adult patients is when they pose an immediate risk to themselves or others. Generally this is in a psychiatric setting. I'm not sure of any jurisdiction that permits reporting rape when the patient does not give consent. This would likely be a patient privacy violation. On the other hand, if the patient does give consent, the physician plays a central role in gathering medical evidence of rape (including, but not limited to: inspecting for certain bodily fluids, collecting and storing the patient's clothing, and acting as the patient's advocate with law enforcement; most hospitals employ social workers that specialize in this).
With children or dependent adults, on the other hand, we have much more laterality in reporting to law enforcement. Obviously if we suspect rape in a child (under 18), we are mandated to report it.
When in doubt, consult a social worker or your hospital's legal department.
+Livvy Liv Oh! And with regards to illegal drugs. No - we can't report it. The rationale is logical: If patients had to fear us reporting them to the authorities, they would be less likely to seek medical attention. However, if their intention is to use drugs to commit suicide, then you can involuntarily admit them for psychiatric observation.
+Paul Bolin Thank you so much for your detailed explanation. That makes a lot of sense. I'll be watching all your videos as I do my revision! :)
Thanks a lot sir...
thanks 😀
lol the only patient i saw use inhalants was in his 40s. but, i did psych at the VA exclusively.
Great job on very difficult subject but a word up...According to DSM-5 The legal consequences of use of Cannabinoids has been essentially removed or at least mitigated in DSM-5. Not sure that I agree with this especially in some circumstances. However there is at least some truth to this.
In any case using arrests and legal consequences could likely lead to an incorrect DSM-5 DX. IE DEPENDING ON THE NEIGHBORHOOD, color or race of the individual is highly subjective. As I heard in another lecture it has been proposed that a Caucasian individual walking late at night in a predominanatly ethnic or minority neighborhood might lead to detention and search, and this was supposedly one of the reasons they removed legal from the criteria which had been present in DSM4.
There also may be different rates of incarceration or consequences once the reefer is discovered in different communities for possession.
There appears to be much confusion on this as well as many other issues in DSM 5. very frustrating as can easily see both points. One could also argue however that just because it is legal in Amsterdam doesn’t mean that if I use it in a city where the death penalty is imposed means I don’t have a disorder. If I’m using despite the death penalty that should be enough for the diagnosis. One could also argue on this basis that if I know in this neighborhood I have a high chance of being searched and suffering severe consequences then obviously my judgement is severely impaired as a result. And shouldn’t need 2 or 3 other criteria (just exclude deficits in executive function, as in dementia would perhaps be a better diagnosis depending on presentation. That is regardless of the morality of the behavior.
In addition very few ppl rated legal problems as a reason for identifying a substance abuse in DSM 4, but these studies were done in a metropolitan area with very high access to subways etc. if you don’t drive which is one of the leading if not the leading cause for legal difficulties. Net this might come out a lot higher if they did not perform these studies in a metroppolitan area and only interviewed older patients and included any past history or arrest. Then need to multiply big time because most ppl who are driving intoxicated make it home and are not arrested
Extasy is usually a mixture of amphetamines and MDMA and it can be lethal by the means of causing dehydration and hyperthermia. I would also disagree that cannabis is not dangerous. It can precipitate psychotic symptoms in some patients which have stopped using it, not to say anything about amotivational syndrome and overall lifestyle of heavy users.
wouldn't giving a Beta blocker to cocaine intoxication cause unbalanced effect of cocaine on Alpha receptors
+hassan shafique They are second line therapy in the event of life-threatening hypertension, tachycardia, or aortic dissection. Benzodiazepines should be used first; that's why I listed them first. Nitroglycerin may be used, too.
Paul Bolin, M.D. benzos are addicting
"kids are stupid" ..lol!
dog detected :D
sir what is effect of cannabis , what kind of symptoms most of patients take drugs when he or she feel depressed
Booze is ridiculously cheap! A six pack should be $ 50! A ounce of grass should be $10
Linda Root WTF. R U HIGH
What problems can be caused by not giving thiamine?
Wernicke's encephalopathy.
Whether one single bolus of glucose can actually it is dubious in reality, but that's what is taught in medical school.
Tammy Sigmon - Cerebellar degeneration and cardiovascular dysfunction. The risk may be small, but I teach my students never to take unnecessary risks. If you suspect the patient is an alcoholic or abuses alcohol, no harm in going for the banana bag.
ohn!
Diazepam itself is long acting!
doggo at 31:38 :D
legalize ranch
What kinds of drugs are the most dangerous drugs to use? Everybody knows because people die from these drugs. You can kill people with these drugs if you really don't like someone. These drugs we are talking about here are not so bad as what is really going on in America these days. Why are we wasting so much time on these drugs? I used to smoke cigarettes, why are we not including smoking when we talk about coffee and even marijuana? I quit smoking long ago because it was too expensive but coffee is better. I try to drink tea more and even soup. So the doctor prescribes drugs and then you are a fool. You aren't even informed about these stupid drugs, properly. It should be against the law to not properly inform a person. They feed these drugs to children and we worry about alcohol and marijuana?