Prime medications for alcohol use management in the longer term are disulfiram, acamprosate and naltrexone.
Acamprosate
- Cleared by the kidneys, so exercise caution in renal impairment
Naltrexone
- Check and monitor liver function
Prime medications for alcohol use management in the longer term are disulfiram, acamprosate and naltrexone.
Acamprosate
Naltrexone
Long-acting depots wear off towards the end, so they might need to be given more frequently.
Administering a medication with food means something like 10 minutes on either side of actual meal ingestion.
Let’s explore the romantic undertones of lithium!
Podcast
Neurology finds where the lesion is but then can’t do anything about it.
Psychiatry has no idea where the lesion is but gives medications and ECT to fix the problem.
A particular breed of falsified collegiality is siding with the foe of a foe. This has a convenient name: pseudo-altruism.
Pseudo-altruism is a pattern of behavior used by people who have a problem in coping satisfactorily with repressed rage. Observed in both individual and group psychotherapy, it allows the discharge of unacceptable impulses through professed concern about others. This model involves the interaction of at least three people. One individual, A, unable to acknowledge his rage toward a second person, B, comes to the assistance of a third party, C, whom he is convinced has been injured by B. A attacks B or encourages C to do so. In this way A, who experiences difficulty in discharging aggression directly, finds an acceptable means of doing so. He convinces himself that his aggression is warranted by B’s behavior and that he acted solely out of concern for C’s welfare. The pseudo-altruistic pattern thus includes denial, rationalization, and at times projective identification.
Edelson SR. Pseudo-altruism. Psychiatr Q. 1981 Summer;53(2):106-9. doi: 10.1007/BF01064894. PMID: 7330125.
A rant about escaping the hamster wheel of goal-setting. Rely more on your internal scripts.
Podcast
Pareidolia is the tendency to see visual meaning where there isn’t any, like a face in toast, because humans evolved to detect patterns. Here is the most poetic pareidolia entry ever.
A 20-year-old woman presented to our emergency department after a cliff-jumping adventure went awry. The ultrasound of the aorta was benign, but a “Darth Vader” sign found off the reflection of the spine was no Jedi mind trick. The ability to detect an aneurysm is insignificant next to the power of the Force!
Pareidolia is a phenomenon of recognizing patterns, shapes and familiar objects — often faces — where they do not actually exist. There are several well-known examples in popular culture, including most recently a perception of Vladimir Putin’s resemblance in a flock of birds, the image of Jesus on toast or the “Face on Mars” captured by the Viking 1 orbiter. Examples achieving popular notoriety are found in medicine as well, particularly with diagnostic imaging.
Pareidolia is recognized in humans as young as eight months old. Compared with other types of illusion, pareidolia is unique in how the illusion often becomes more intense with increased attention to it. Similar neural processes trigger pareidolic illusions and visual hallucinations, which has led to speculation that pareidolia represents a susceptibility to visual hallucinations. Conversely, other studies have shown that the right temporal lobe discriminates between real and illusory faces but is highly suggestible, consistent with a more benign prognosis.
Could there be more to pareidolia than sheer entertainment value? Simply put, pareidolia is perceiving a meaningful pattern in meaningless noise. In medicine, we learn to detect illness patterns in the noise of nonspecific signs and symptoms.
Baylis, J., & Ting, D. K. (2015). Pareidolia and clinical reasoning: the pattern awakens. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 187(18), 1364. https://doi.org/10.1503/cmaj.151079
To form proper memories, a few steps must be followed.
Firstly, the event must be experienced. The sheer imagination of things that aren’t really true might represent psychosis. That’s a whole other matter.
Secondly, a memory must be created.
Thirdly, the memory must be consolidated. That is, placed into long-term storage in an organised way. In other words, the internal librarian of your brain grabs the recollection and shoves it into a mental shelf with some kind of labelling and retrieval system. That way, you can access it again when needed, providing you don’t have any overdue fines. That could be a metaphor for brain injury or anything that disrupting usual functioning.
In PTSD, the consolidation phase is messed up. Because the memory isn’t stored away properly, it involuntarily, inconveniently and semi-randomly replays. And since it’s not actually linked to a shelf place, it’s experienced in fragments that appear to be current. This explains the re-experiencing phenomenon.
In case of traumatic memory as in PTSD, the process of memory consolidation seems to fail. The traumatic memory trace stays primarily located in subcortical and primary perceptual areas, leaving it tightly coupled to its autonomic and perceptual markers, and lacking the appropriate integration in autobiographical, cortical memory networks. Exposure to a trauma trigger subsequently results in a solely involuntarily retrieved memory trace (intrusion), that is very hard to verbalize, often fragmented in time, and consisting for the most part of primary sensory information (images, smell, sounds) that is linked to physiological fear symptoms (Brewin, 2011). Due to the lack of autobiographical context, the memory is relived as happening in the present. Thus a failure to properly consolidate and thus emotionally depotentiate potentially traumatic memories may form the neural basis of key PTSD symptoms like unwanted memories, intrusive flashbacks, nightmares, hyperarousal, and dissociation. Reduction of PTSD symptoms is accomplished by successful transfer to pre-existent, cortical memory circuits.
This might explain why journalling is thought to be so helpful for processing emotional trauma. The explicit step-through of event recollection places it in the realm of a more logical part of the brain, for a grounding effect. Elaborating on the details of the event helps give it labels and keywords, allowing it to ultimately earn a place of belonging on the memory shelf.
Broca: frontal
Wernicke: temporal