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Textbook Addiction Medicine 2Nd Edition John B Saunders Et Al Ebook All Chapter PDF
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1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2016
The moral rights of the authorshave been asserted
First Edition published 2009
First Edition, revised and updated 2011
Second Edition published 2016
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
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Published in the United States of America by Oxford University Press
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ISBN 978–0–19–871475–0
Printed and bound in China by
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
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and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
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v
Preface
What is covered?
This handbook provides a practical guide to the management of people with
addictive disorders. The first chapters provide important background infor-
mation and summarize the overall principles of diagnosis and management.
There follow several chapters on specific types or groups of psychoactive
substance. The nature of the substances, their pharmacological properties,
and the clinical syndromes that result are described, together with specific
guidance on diagnosis and management which takes into account both their
generic addictive properties and their specific pathophysiological ones. The
latter part of the book is devoted to the management of specific groups of
patients and people seen in specific settings, together with an account of
relevant medicolegal and ethical issues. Following the main text, the final
chapter comprises a series of practical tools, such as questionnaires, which
assist in systematic clinical practice.
The handbook provides detailed guidelines on how to elicit a history
of substance use and other addictive activities, together with ways of
diagnosing the core clinical syndromes and the physical, psychiatric, and
social disorders that may flow from them. It includes practical guides to
brief intervention, management of intoxication, withdrawal management
(‘intoxication’), pharmacotherapies, and psychological therapies aimed at
relapse prevention, together with an account of support approaches and
the principles and practice of self-help.
viii
Foreword
Addictions are highly prevalent. They cause harm to the afflicted and their
families and are costly to society. While the clinical symptomatology in peo-
ple suffering from addictions is similar around the world, treatment and pre-
vention are not. Research in recent years has provided enormous progress
in our understanding of these disorders resulting in a multitude of new evi-
dence-based treatments. However, most conditions remain under-served
and treatment approaches vary substantially around the world. All of these
facts call for an up-to-date and universal appraisal of the current situation.
A comprehensive overview on emerging strategies would be instrumental
in this and could help to meet the actual challenges.
The Oxford Specialist Handbook—Addiction Medicine provides such a
global perspective. The editors and authors are eminent researchers and
clinicians in our field. They come from a large variety of areas such as
Australia, Asia, Europe, and North America. While the first edition of the
textbook in 2009 already provided a very broad view on addictions and
ways of dealing with them, the revised version gives an update of current
concepts and newly emanating strategies. Important extensions have been
made providing several new chapters and incorporating new fields such as
gambling and gaming as examples for behavioural addictions. The handbook
now also includes evidence-based recommendations from the most recent
clinical guidelines from around the world.
Prof. John Saunders of Sydney and Queensland Universities and his col-
leagues are to be congratulated for their enormous efforts. Their book
Addiction Medicine gives the necessary detail to understand and respond to
actual problems in an individual patient. The long standing teaching experi-
ence of most of its authors has resulted in a text which is well structured
and easy to read and thus offers information not only to the professional
but also to the patient and his or her family and to others in search of some
quick and valid information on the troublesome but also fascinating field of
addiction.
Karl Mann, MD
Emeritus Professor of Addiction Research
Central Institute of Mental Health
Medical Faculty Mannheim
University of Heidelberg
Germany
ix
Contents
Acknowledgements xi
Editors and authors xii
Contributors xv
Symbols and abbreviations xxiii
Index 629
xi
Acknowledgements
and substance use disorders. Her research interests have focused on plate-
let monoamine oxidase activity, and treatment of alcohol and substance use
disorders, alcoholic liver disease and hepatitis C in injecting drug users, and
substance-induced psychosis.
Professor David J. Nutt MA, MB BChir, DM, FRCP, FRCPsych,
FMedSci is Consultant Psychiatrist and the Edmund J. Safra Professor of
Neuropsychopharmacology in the Division of Brain Science, Department
of Medicine, Hammersmith Hospital, Imperial College London. Here he
uses a range of brain imaging techniques to explore the causes of addiction
and other psychiatric disorders and to search for new treatments. He has
published over 400 original research papers, a similar number of reviews
and book chapters, eight government reports on drugs, and 28 books,
including one for the general public, Drugs: Without the Hot Air, that won the
Transmission Prize in 2014. He is currently the President of the European
Brain Council and Founding Chair of DrugScience (formerly the Independent
Scientific Committee on Drugs (ISCD)). Previously he has been president
of the British Association of Psychopharmacology, the British Neuroscience
Association, and the European College of Neuropsychopharmacology. He
broadcasts widely to the general public both on radio and television. In
2010, The Times Eureka science magazine voted him one of the 100 most
important figures in British science, and the only psychiatrist in the list. In
2013, he was awarded the John Maddox Prize from Nature/Sense about
Science for standing up for science.
Dr E. Jane Marshall MB BCh BAO MRCP (Ireland) FRCPsych is a
Consultant Psychiatrist in Alcohol Services at the South London and
Maudsley NHS Foundation Trust and Senior Lecturer in the Addictions
at the National Addiction Centre, Institute of Psychiatry, King’s College
London. She trained in Psychiatry at St Patrick’s Hospital, Dublin, and St
Bartholomew’s and the Maudsley Hospitals in London. Her clinical work
is currently focused on a specialist out-patient and in-patient alcohol ser-
vice, and also a service for addicted healthcare professionals. She is lead
clinician for the MSc programme in Addiction at the Institute of Psychiatry.
Research interests include the evaluation of treatment for alcohol prob-
lems in specialist and generalist settings and, in particular, and treatment for
addicted healthcare professionals. Dr Marshall acts as a medical supervisor
and examiner for the General Medical Council and as a medical advisor
for the General Dental Council. Within the Royal College of Psychiatrists
she is Co-Director of Flexible Training, and a member of the executive
committee of the Faculty of the Addictions and Psychiatrists’ Support
Service Committee. Dr Marshall has contributed to national guidelines, and
has been a member of a number of Working Parties, including the Royal
College of Physicians Working Party on Alcohol in the General Hospital
(2001); an Alcohol Concern Research Forum (2002); and a Department of
Health Working Group on Alcohol-related Brain Damage (2007).
Professor Walter Ling, MD, is Professor of Psychiatry and the Founding
Director of the Integrated Substance Abuse Programs (ISAP) at UCLA,
one of the foremost substance abuse research groups in the US. He is
board certified in neurology and psychiatry, is active in research and clinical
work, and has been listed in ‘Best Doctors in America’. Dr Ling’s research
in opiate pharmacotherapy provided pivotal information for the approval
xiv EDITORS AND AUTHORS
Contributors
ECHO echocardiogram
ED emergency department
EDOU emergency department observation unit
EEG electroencephalogram
EMR Eastern Mediterranean region
ERCP endoscopic retrograde cholangiopancreatography
ESR erythrocyte sedimentation rate
EU European Union
EUC electrolytes, urea, and creatinine
FAE fetal alcohol effects
FAS fetal alcohol syndrome
FASD fetal alcohol spectrum disorder
FBC full blood count
FCTC World Health Organization Framework Convention
on Tobacco Control
FLAGS Feedback, Listen, Advice, Goals, Strategies (acronym
for core elements of brief intervention)
fMRI functional magnetic resonance imaging
FTQ Fagerström tolerance questionnaire
GABA gamma aminobutyric acid
GAD generalized anxiety disorder
GCS Glasgow coma scale
GDP gross domestic product
GGT gamma-glutamyl transferase
GHB gamma hydroxybutyrate
GI gastrointestinal
GIT gastrointestinal tract
GP general practitioner
HADS Hospital Anxiety and Depression Scale
Hb haemoglobin
HBcAb hepatitis B core antibody
HBeAg hepatitis B e antigen
HBsAg hepatitis B surface antigen
HBV hepatitis B virus
Hct haematocrit
HCV hepatitis C virus
xxvi SYMBOLS AND ABBREVIATIONS
Molossus Geoffr.
Art und Unterart verhalten sich in Bezug auf das Vorkommen von
Spatelhaaren ganz übereinstimmend. Untersucht wurden von M.
rufus: 3 Exemplare von Peru (2 Stuttgart), 1 von Surinam (dsgl.) und
1 von Jamaica (dsgl.); von M. rufus obscurus: 1 von Central Peru
(Stuttgart), 3 von Surinam (dsgl.), 1 von Cuba und 1 von Tobago
(Antillen).
Etwas unterhalb der Nasenlöcher bis nahe zum Mundrand ein meist
scharf begrenztes, annähernd dreieckiges oder trapezoides Feld,
sehr dicht bestanden mit Spatelhaaren vorwiegend mittlerer, aber
auch geringerer Ausbildung, letztere Formen besonders an den
seitlichen Rändern des Feldes und in seinem unteren Theile, wo die
Länge der einzelnen Haare grösser wird. Sonst am Kopfe keine
Spatelhaare. — Felder an den Füssen locker bestanden mit Haaren
von wenig ausgeprägter bis annähernd mittlerer Form.
G e r v a i s (Expéd. de Castelnau, Zool. Mammif. 57, Paris 1855) hat
das Feld an der Schnauze bei M. rufus und rufus obscurus bemerkt
und kennzeichnet seine gröberen Verhältnisse ganz zutreffend: „…
la supérieure [sc. lèvre] est garnie au-dessous du nez de poils
sétiformes très courts et en brosse.“
D o b s o n (PZS. 1876, 712; Catal. 1878, 415) sagt über die Haare
an der Schnauze: „… the upper margin of the nasal disk thus formed
on each side is finely and evenly toothed, a n d t h e i n t e r n a s a l
ridge covered with short spoon-shaped hairs,
similar to those forming a broad patch between
t h e n o s t r i l s a n d u p p e r l i p i n M. rufus, b u t s t r i c t l y
l i m i t e d t o t h i s r i d g e ..“ 26. Ich bemerke dazu, dass für die mir
vorliegenden Exemplare gerade dieser Art der Ausdruck
„löffelförmige Haare“ kaum gerechtfertigt erscheint, doch kann ja an
D o b s o n s Exemplaren die Form besser ausgebildet gewesen sein.
Cheiromeles Horsf.
Tafel XI, Fig. 11 u. 11 a–d, Tafel X, Fig. 6, 20, 21 a–e, 22, 23, 24 u.
25
Dies gilt zunächst für Molossus temmincki (Lund), wie aus der
Bemerkung B u r m e i s t e r s 27 „die Lippen mit H a k e n b o r s t e n 28
gleichmässig zerstreut besetzt“ ganz klar hervorgeht.
Rechnen wir die zuletzt erwähnten 8–9 Arten den von uns
untersuchten hinzu, so würden wir bis jetzt Spatelhaare oder
stellvertretende Borsten bei etwas mehr als der Hälfte der bekannten
Molossiden im Gesicht anzunehmen haben. Für ziemlich sicher
können wir es halten, dass sie allen Arten von Molossus und
Nyctinomus an den Aussenseiten der ersten und fünften Zehe
zukommen, da die Verdickung dieser Zehen als allgemeiner
Charakter der beiden Gattungen aufgeführt wird (vgl. D o b s o n ,
Catal. 1878, 404), die verdickten Stellen aber bei allen untersuchten
Arten solche Haare tragen und durch die Anhäufung ihrer Bälge
verursacht sind.
Innerhalb des Genus Molossus bilden die Haare bei rufus, rufus
obscurus und nasutus eine scharf begrenzte compacte Gruppe
unterhalb der Nasenlöcher, bei abrasus und perotis nehmen sie ein
längliches leistenartiges Feld zwischen ihnen ein.
Mit Rücksicht auf die Bezahnung werden Molossus rufus (und rufus
obscurus) einerseits, abrasus und perotis andererseits
verschiedenen Untergattungen (Molossus Ptrs. und Promops Gerv.)
zugetheilt, und nasutus, der danach allerdings zu Promops gehört,
ist doch in anderer Beziehung „quite intermediate between M. rufus
and M. abrasus“ (D o b s o n , Catal. 1878, 415), so dass auch die
dem Subgenus Molossus entsprechende Anordnung der
Spatelhaare bei nasutus nichts Auffälliges hat.
1 D o b s o n , Monograph of the group Molossi: PZS. 1876, 712; die Stelle ist
wörtlich übernommen in desselben Autors Catal. Chiropt. Brit. Mus. Lond. 1878,
415. ↑
2 Von neueren Werken wurden eingesehen:
von ältern:
ausserdem:
3 S. besonders