Question

Miss R is diagnosed with bipolar disorder and prescribed valproic acid (Depakote), 250 mg, PO, tid. Things were going fairly well until a month into therapy, when she stops taking the medication. She admits she became moody, angry, and emotionally labile after stopping the medications, which “(she) just couldn’t tolerate.”

Q1: What are some reasons she might have stopped her medications?

Miss R is seen two weeks later in the clinic for follow up after an incident outside a local nightclub for which she was arrested, and taken to the ED by police, and then to jail after being examined and “sobering up.”

She had “created a scene” in the club parking lot, dancing on several cars and singing loudly.. She began an angry physical confrontation with a male friend who was leaving the club just as it was closing. Her blood alcohol level was 0.15 as measured by breathalyzer.

Miss R is initially agitated and angry and says the “guy at the club” was her fiancée, and he was being dishonest and unfaithful.

A few minutes later, she is sobbing, telling you her “world is unraveling… (she’s) drinking… a lot … has started smoking, in part to “get her weight back in control,” and “has stopped eating.”

Q2: What questions should we ask Miss R at this point in time?

Ms. R tells her nurse that she is “ready to check in for help.”

The nurse learns that Miss R. chronically abuses alcohol.

Q3: What symptoms and signs of alcohol abuse might Ms. R exhibit?

Q4: What sorts of tests might we order when assessing her health? Might she need nutritional replacement therapy?

Q5:What sort of treatment should Miss R be offered for alcohol use disorder?

Answer 1

ALCOHOL ABUSE

Alcoholic abuse is a disease in which a person is consuming too much of alcohol and can lead to some dangerous conditions like alcohol poisoning,cirrhosis and hypertension.

ANSWER 1

• The person may be having fear of pottential side effects of the medicine
• Inability to afford the cost of the medicine
• Misunderstanding-the patient may not be knowing the need of taking this medicines
• Administration of oo many medications or increased number of medications at a time
• Lack of symptoms
• No changes in symptoms even after takig this medications.
• Worry-Concerns about becoming dependent on a medicine
• Mistrust towards the medication as well as towards the physician

ANSWER 2

• Are you experiencing craving of alcohol?
• Have you ever felt like you should cut back on your alcohol consumption level?
• Are you hiding how much you are drinking from anyone close to you?
• Do you have any personal issues?
• Are you drinking alone regularly?
• Is alcohol in any way controlling your life?
• Do you experience backout when you drink?
• Have friends and family expressed concern towards your drinking habits?
• Have ever being a time that you tried to quite the drinking alcohol?
• Why did you stoped taking medications?
• Do you drink regularly?
• Do you experience any type od alcohol withdrawal symtoms such as shevering,or vomiting in the morning?

ANSWER 3

• Aggression
• Agitation
• Emotionally liable
• Problems with coordination
• Euphoria
• Extreme mood wing
• Sobbing

ANSWER 4

• CBC(Complete Blood Test)
• MCV(Mean Corpuscular Volume) to know the size of RBC
• GGT(Gamma Glutamyl Transferase) It is a liver enzyme that is increased by heavy alcohol intake
• LFT(Liver Function Test) to understand the functioning of the liver

ANSWER 5

• Detox and Withdrawl
• Administration of Antabuse eg: Disulfiram

Detoxification and withdrawl may takes 2-7 days

• Injected medications

Vivitrol, a version of grug naltrexone is injected once in a month or this can be taken in a pill form

• Spiritual practice

People who areinvolved in some of the spiritual practice are found easily recovered from alcoholism

• Behavioural therapy
• Psychological counselling
• Family therapy