Addicted Patients Research Articles

The Efficacy of Telepsychiatry in Addiction Patients: A Systematic Review.

Psychiatry is one of the many medical subspecialties that have benefited from the advent of telemedicine. Substance abusetreatment via telepsychiatry expeditiously increased with the start of the pandemic and has broughtchanges to its rules and regulations. In this study, we focused on the prognosis of substance abuse patients treated with telepsychiatry, the various changes that occurred during the pandemic, and the difficulties faced by clinicians using telepsychiatry. PubMed and Google Scholar were searched for relevant articles between January 2010 and July 2022 using both broad and narrow keywords in addition to the MeSH (Medical Subject Heading) approach. The total number of records found was 765. Strict criteria for inclusion and exclusion ensured that only relevant information was collected. After removing duplicates, irrelevant studies, and research that did not meet the inclusion criteria, we were left with 373 studies from both electronic databases. From those, we ultimately retrieved 35 studies, which were subjected to a thorough content search and quality evaluation with the help of specialized instruments, and a total of 19 papers were included in our systematic review. We concluded that telepsychiatry use for substance abuse patients increased during the pandemic, and the prognosis of these patients treated with telepsychiatry was similar to that of in-person treatment. However, a combination of telepsychiatry with in-person sessions showed much better results.

THE SPIRITUAL PSYCHOLOGICAL APPROACH TO DRUG ADDICTS

The purpose of this study is to determine the level of spirituality (religion) that exists in former drug users, by giving this spirituality it is hoped that they will be aware of the dangers of drugs and be able to get closer to God. This study uses qualitative methods with observation data analysis techniques and semi-structured interviews. Determination of purposively selected informants, namely foundation management, former drug addicts who are in the process of rehabilitation and assistants or counselors. Data collection by interview, observation and Focus Group Discussion (FGD) and we also found that the Ar-Rahman Drug Rehabilitation Center can be used as an alternative in spiritual and herbal (non-medical) rehabilitation of drug abuse. Spiritual rehabilitation uses a humanist and familial approach so that drug addict patients can be open, close and trust the counselor in the therapy process. The results and discussion are that former drug addicts at YPRN Ar Rahman Palembang have a low level of understanding of spirituality. In terms of the discussion with the religious teacher at YPRN Ar-Rahman, it was found that the client did not yet have the ability to understand spirituality, only limited to ritual formalities. This is further strengthened by the results of interviews we conducted with direct clients, that they actually believe in God, but do not fully believe in God.

Modern anti-drug policy and human rights

The topic of human rights in the aspect of relations between the state and addicted patients (and in general relations in the sphere of circulation of drugs) remains scantily explored for modern Ukraine, which actualizes further scientific research. The purpose of the article is to determine the authors’ vision of compliance with international human rights standards of the legal anti-drug prohibitions established by the state. To achieve this goal, using the historical-legal, comparative, dialectical, systemic, hermeneutic, sociological methods and legal method of cognition, national and foreign legislation was critically analyzed, international experience in implementing various models of anti-drug policy was studied, and proposals for the draft of a new Criminal Code of Ukraine were formulated. The authors pay special attention to the problems of protecting the rights of drug addicts, legal liability in the field of drug trafficking, legalization of drugs for non-medical needs and compulsory treatment of drug addicts.

PPARγ/Adiponectin axis attenuates methamphetamine-induced conditional place preference via the hippocampal AdipoR1 signaling pathway

Methamphetamine (METH) is a highly addictive psychostimulant. The adipocyte-derived hormone adiponectin has a broad spectrum of functions in the brain. However, limited research has been conducted on the effect of adiponectin signaling on METH-induced conditioned place preference (CPP) and knowledge of the underlying neural mechanisms is scarce. The METH induced adult male C57/BL6J mice model were used for testing the therapeutic activities of intraperitoneal injection of AdipoR agonist AdipoRon and peroxisome proliferator-activated receptor gamma (PPARγ)-selective agonist rosiglitazone, adiponectin receptor 1 (AdipoR1) overexpression in hippocampal dentate gyrus (DG), and chemogenetic inhibiting the neural activity of DG, and the changes of neurotrophic factors, synaptic molecules, glutamate receptors, and inflammatory cytokines were also measured. We found that adiponectin expression was significantly reduced in METH addicted patients and mice. Our findings also showed that injection of AdipoRon or rosiglitazone alleviated the METH-induced CPP behavior. Moreover, the expression of AdipoR1 in the hippocampus was also reduced, and AdipoR1 overexpression blocked the development of METH-induced CPP behavior through regulatory effects on neurotrophic factors, synaptic molecules, and glutamate receptors. The observed inhibitory neural activity of the hippocampal dentate gyrus (DG) induced via a chemogenetic approach produced a therapeutic effect on the METH-induced CPP behavior. Finally, we identified an abnormal expression of some key inflammatory cytokines through the PPARγ/Adiponectin/AdipoR1 axis. This study demonstrates that adiponectin signaling is a promising diagnostic and therapeutic target for METH addiction.

The comparison of post OPCABG complications between opium addicted and non- addicted patients

Objectives: Opium addiction is one of the fundamental public health problems today that could influence cardiovascular disease outcomes. Recent studies have shown that opium addiction may increase the risk of postoperative complications in patients undergoing on-pump coronary artery bypass graft surgery. In this retrospective cross-sectional study, we aimed to assess whether opium addiction may affect the postoperative complications of off-pump coronary artery bypass graft surgery (OPCAB) (1).
 Methods: In this cross-sectional study, we searched the clinical records of all patients who underwent OPCAB surgery from 2017/03/21/ to 2018/03/19/ at Afshar and Seyed Al-Shohada Hospitals in Yazd, Iran. We evaluated the patients for postoperative complications. Complete patient demographic and clinical data collected through a review of patient records. Finally, the collected data were analyzed using SPSS software version 18.
 Results: A total of 889 patients (667 (76.2%) non-addicted, 127 (14.3%) opium addicts, and 86 (9.6%) smokers and opium addicts) met our criteria and were included in the study. The average age of the participants was 62.09 ± 9.8 years. Frequency distribution of the most postoperative variables such as intubation duration, intensive care unit (ICU) stay, postoperative bleeding volume, pack cell count, need for fresh frozen plasma (FFP), platelet injection volume, need for reoperation, need for intra-aortic balloon pump, as well as Atrial fibrillation (AF) rhythm showed no significant difference between the three groups. However, the only significant difference between the three groups reported the need for postoperative use of inotropic drugs (p=.001).
 Conclusions: According to the results, the only complication that differed significantly in the three patient groups after OPCAB was the need for inotropic drugs.

Proactive psychiatry of addiction: toward the normalization of early prevention

AbstractMost substance use disorders (SUDs) emerge in adolescence and young adulthood. Early interventions in young people may reduce the risk and severity of SUD and other mental disorders. However, we are not able to reach our young people early enough for prevention and treatment, and when we do, they often already show a high concentration of comorbid mental disorders and signs of a chronic intermittent course of SUD. Hence, we must reach our addicted young patients at an earlier stage, when symptoms are still mild or transient, or perhaps even before that – when they only show precursors of possible dysfunction.One of the most prominent precursors of dysfunction is our ability – or lack thereof – to control or "self-regulate" our behaviors, cognitions, and emotions. Many scientists argue that poor self-regulation is perhaps the core determinant of the development of mental health disorders, including addiction. Several prospective general population studies have shown that poor childhood self-control early in life is a strong predictor of many negative outcomes later in life, up to 20 to 30 years later in adulthood. Although correlational in nature, these findings suggest that early childhood interventions that are deliberately aimed at improving self-regulation may be effective in preventing these negative life outcomes, and that early prevention and intervention targeted at improving self-control may reduce the risk of a broad array of psychiatric and social problems, including addiction. Indeed, several recent large-scale systematic reviews have suggested that self-regulation skills are malleable and can be learned through instruction and practice, and perhaps most so in the early years, roughly around 3 to 6 years, when there is a steep increase in learning curve, when the plasticity of the brain is still high, and when self-regulation skills are still very much in development.This presentation provides an overview of the rationale and study findings of early prevention of substance use disorders and other mental health disorders. In terms of broad prevention, much can be gained by widespread, consistent implementation and normalization of early prevention at the pre- and elementary school level.Disclosure of InterestNone Declared

Heavy and Chronic Cannabis Use Impact on Human Emotions: BOLD-fMRI Study

IntroductionLong term cannabis use has been expanding drastically over the last two decades and has become a major health issue worldwide. Recent studies demonstrate that brain complications in adults with cannabis use are associated with cognitive and emotional impairments, but little is known about the relationship between structural alterations and behavioral manifestations. Therefore, studying the relationship between alterations of emotional system, in parallel with structural degenerative phenomena is very critical.ObjectivesHence, the aim of this study is to demonstrate such alterations by making use of appropriate paradigms during BOLD-fMRI scans. Positive, negative and neutral emotions were examined, in relations with DTI and functional connectivity.Methods11 cannabis addicted patients volunteered for the study. Volunteers were fully healthy. However, any additional comorbidity was a strict criterion of exclusion, and a healthy general state was an indispensable criterion of inclusion. Additionally, it was excluded any patient that have any additional substance use such as tobacco, alcohol, cocaine, etc. And strict use of cannabis was a must.All patients underwent blood and urine assessments to ensure the selection criteria.All patients underwent BOLD-fMRI and anatomical MRI using both motor and emotional paradigm.The motor task consisted of rest alternating with finger tapping. The emotional task included 3 conditions. Positive, neutral and negative were each alternating with silent mental counting. The fMRI data was processed using SPM12 package. A sample of 12 age-matched controls was also included.ResultsThe present results are based on analysis of behavioral and BOLD-fMRI data of 11patients and similar age-matched controls. Analysis of behavioral data showed an alteration of emotional abilities in cannabis addicted patients compared to controls. Analysis of fMRI data revealed significant changes of activation within a large cortical network including prefrontal cortex and parietal cortex, and that emotional responses and BOLD signal were inversely correlated.ConclusionsThese findings demonstrate that the brain of cannabis addicted patients undergoes and emotional alterations that parallel silent structural degenerative phenomena. Although the causal mechanisms are still to be investigated, the fact that functional impairments can be detected in emotional, cognitive and motor domains calls for the development of preventive measures using neurobehavioral tools for this population of patient, and even in at risk users.Disclosure of InterestNone Declared

The Relationship between Selected Factors (Temperament, Bipolar Traits, Sleep Quality, Severity of Addiction) and Depressive Symptoms in Alcohol-Dependent Men.

Clinical and epidemiological studies have demonstrated a relationship between alcohol addiction and mood disorders. Alcohol-dependent patients with depression tend to demonstrate clinically more severe manic symptoms, which complicates the process of diagnosis and therapy. However, the predictors indicating the risk of mood disorders in addicted patients remain unclear. The aim of the study was to examine the relationship between personal dispositions, bipolar traits, depth of addiction, quality of sleep, and depressive symptoms in alcohol-dependent men. The study group comprised 70 men (age M = 46.06, SD = 11.29) diagnosed with alcohol addiction. The participants completed a battery of questionnaires: BDI, HCL-32, PSQI, EPQ-R and MAST. The results were tested using Pearson's correlation quotient and general linear model. The findings indicate that some of the studied patients are likely to have mood disorders of clinically significant severity. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in alcohol-dependent patients. Among the components of sleep quality, problems with falling asleep and waking up at night appear to be most strongly associated with depressive symptoms. The intensity of depressive symptoms may relate to the intensity of certain bipolar features, such as risk-taking activity and irritability. High neuroticism and poor sleep quality are independent predictors of depressive symptoms in the studied group.

Cross-analyzing addiction specialist and patient opinions and experiences about addictive disorder screening in primary care to identify interaction-related obstacles: a qualitative study

BackgroundPromptly identifying individuals with addictive disorders reduces mortality and morbidity and improves quality of life. Although screening in primary care with the Screening, Brief Intervention and Referral Treatment strategy has been recommended since 2008, it remains underutilized. This may be due to barriers including lack of time, patient reluctance or perhaps the timing and approach for discussing addiction with their patients.ObjectiveThis study aims to explore and cross-analyze patient and addiction specialist experiences and opinions about early addictive disorder screening in primary care to identify interaction-related screening obstacles.Design and participantsQualitative study with purposive maximum variation sampling among nine addiction specialists and eight individuals with addiction disorders conducted between April 2017 and November 2019 in Val-de-Loire, France.Main MeasuresUsing a grounded theory approach, verbatim data was collected from face-to-face interviews with addiction specialists and individuals with addiction disorders. These interviews explored their opinions and experiences with addiction screening in primary care. Initially, two independent investigators analyzed the coded verbatim according to the data triangulation principle. Secondly, convergences and divergences between addiction specialist and addict verbatim categories were identified, analyzed, and conceptualized.Key ResultsFour main interaction-related obstacles to early addictive disorder screening in primary care were identified and conceptualized: the new concepts of shared self-censorship and the patient's personal red line, issues not addressed during consultations, and opposition between how physicians and patients would like to approach addictive disorder screening.ConclusionsTo continue analysis of addictive disorder screening dynamics, further studies to examine the perspectives of all those involved in primary care are required. The information revealed from these studies will provide ideas to help patients and caregivers start discussing addiction and to help implement a collaborative team-based care approach.Trial registrationThis study is registered with the Commission Nationale de l’Informatique et des Libertés (CNIL) under No. 2017–093.

The Lack of Influence of Homozygous Long Allele of the 5-HTTLPR Gene on the Severity of Alcohol Craving During 6 Weeks of Rehab Hospitalisation in Comparison to Not Homozygous and Homozygous Short Alleles - Preliminary Report.

The aim of this study was to assess changes in the severity of alcohol craving according to allelic variants of the 5-HTTLPR gene polymorphism during hospitalisation and their association with selected clinical variables in alcohol-dependent patients. The study is exploratory. Participants were investigated at the 2nd and 6th week of alcohol-dependence therapy in the addiction treatment unit. Recruitment was conducted among alcohol-dependent patients from several Polish drug treatment centres. The total sample size was 130 persons (12 females and 118 males). Study subjects' mean age was 43.0 years. Patients were investigated twice by using the Penn Alcohol Craving Scale (PACS) and Beck Depression Inventory (BDI), and once by using Short Alcohol Dependence Data Questionnaire (SADD) and taking a swab for genetic testing. The polymorphism of the gene encoding the serotonin transporter 5-HTTLPR (SLC6A4) was determined from isolated DNA and its homozygous variants of short/short or long/long alleles and heterozygous short/long alleles were analysed. At 6th week of the follow-up, there was a decrease in the severity of alcohol craving in half of subjects with the short/short allele (p = 0.033) and in one-fifth of subjects with the long/short allele (p = 0.002) of the 5-HTTLPR gene. In subjects with long/long allele of the 5-HTTLPR gene, there was no change in the severity of alcohol craving between 2nd and 6th weeks of the study (p = 0.242). There was no statistical influence of the homozygous long allele of the 5-HTTLPR gene on severity of alcohol craving during 6 weeks of rehab hospitalisation in comparison to not homozygous and homozygous short alleles. The s-allele was associated with decrease of alcohol craving. It may point on the potential need for differentiated rehabilitation methods depending on the genetic diversity of addicted patients and its role in the severity of alcohol craving.

Comparison of the Effect of Intravenous Fentanyl with Low-Dose Ketamine on Pain Relief in Patients Taking Methadone and Suffering from Limb Fractures.

Given the significance of pain control in addicted patients and the prominence of not using opioids due to patient's drug dependence, the present study aimed at comparing and evaluating the effect of intravenous fentanyl with low-dose ketamine on pain relief in patients taking methadone and suffering from limb fractures. The present double-blind randomized clinical trial was performed on 100 patients taking methadone and suffering from limb fractures. The patients were divided into two groups receiving 1 μg/kg single dose of fentanyl and 0.3 mg/kg single dose of ketamine (low-dose ketamine). Patients' pain scores and the incidence rate of complications were recorded before the intervention, and 15, 30, and 60 min after drug administration and were then compared between the two groups. The mean pain score of patients 15 min after the intervention was significantly lower in the low-dose ketamine group with a mean of 2.50 ± 1.34 as compared with the fentanyl group with a mean of 7.10 ± 1.43 (P < 0.001). However, the mean pain score was not significantly different between the two groups 30 and 60 min after the intervention (P > 0.05). In addition, the incidence rate of complications was not significantly different between the two groups (P > 0.05). According to the results of this study, low-dose ketamine as compared with fentanyl relieves pain in the mentioned patients with a faster effect and in a shorter time although no difference can be found between the pain scores of the two groups 30 and 60 min after the intervention.

Mental Health, Environmental, and Socioeconomic Geographic Factors of Severe Drug Addiction: Analysis of Rehabilitation Center Data in Indonesia.

A growing number of recent literatures have attempted to document the factors related to drug use in different contexts, but limited studies analyzed the factors related to patient's severity level. We aimed to examine the correlates of behavioral, environmental, socioeconomic, geographic factors, and severe drug addiction. We used a sample of 6790 people who use drugs (PWUD) from rehabilitation centers during 2019 to 2020 in Indonesia. Data were obtained from Drugs Rehabilitation Information System (SIRENA) by the Indonesian National Narcotics Agency (BNN) during 2019 to 2020. SIRENA used the adapted version of WHO's Addiction Severity Index (ASI), which assesses patient's addiction severity level and relevant factors. A composite of the ASI factors is classified as "poor" or "serious" if its score is 4 or higher. The data was analyzed using logistic regression model to estimate correlations of severe drug addiction. We found a high prevalence (65.08%) of our sample reported having severe drug addiction, which needed intervention and support. Poor psychiatric condition (OR = 4.02, CI: 2.97-5.44), serious work-related issue (OR = 2.10, 1.75-2.51), poor medical condition (OR = 2.01, 1.32-3.06), and serious family and social problems (OR = 2.56, 2.15-3.05) were significantly associated with severe drug addiction. Male users had higher odds of severe drug addiction (OR = 1.81, 1.55-2.20), compared to female counterparts. Patients in urban areas had higher odds of severe drug addiction (OR = 1.19, 1.1-1.3) than those in rural. Those in less developed regions (eg, Sumatera, Kalimantan, and Sulawesi) had higher odds of severe drug addiction (OR = 2.33, 1.9-2.9), compared to those in the most developed region (eg, Java and Bali). This evidence can help policymakers in refining the harm reduction policies in Indonesia and other countries with similar settings.

The relationship between obsession and addiction relapse with the mediation of sensation seeking in methamphetamine dependent patients

Background and Aim: In addition to the direct effect on the body, substance abuse causes psychiatric disorders such as depression, anxiety, social and economic pressures. The present study was conducted with the aim of determining the relationship between obsession and addiction relapse with the mediation of sensation seeking in self-reported addicts. Methods: The current research design was descriptive and correlational research design of the structural equation model type. The statistical population of the present study was all the methamphetamine addicted patients who were in the process of withdrawal who referred to the substance abuse treatment centers of Tehran city in 2022, out of which 250 people were selected by available sampling method. And they responded to Wright's (1993) Addiction Recurrence Questionnaire, Hodgson and Rachman's (1977) Thought-Practice Obsession and Marvin Zuckerman's (1978) Sensation Seeking Questionnaires. The data were analyzed using structural equation modeling method and Lisrel 8.80 software. Results: The results showed that there is a statistically significant relationship between obsessive thoughts, excitement seeking and addiction relapse (P&lt;0.01). Also, sensation seeking plays a mediating role in the relationship between obsessive thoughts and addiction relapse (P&lt;0.01). Conclusion: It can be concluded that sensation seeking plays a mediating role in the relationship between obsessive thoughts and addiction relapse.

Internal Mechanisms and Therapeutic Strategies for the Internet Novel Addiction

The web literature flourished, but large cohorts of addicted patients in the web fiction have also fostered. At present, the phenomenon of network novel addiction, as a subclass of network addiction, has received researchers' attention. On the basis of previous research, we have explained the internal mechanisms of internet novel addiction, borrowed from other treatment methods for behavioral addiction and internet addiction, and proposed corresponding intervention measures based on the characteristics of internet novels. We have also proposed treatment strategies for internet novel addiction behavior.

Relationship between Self-Efficacy, Social Support and Treatment Motivation among Addict Patients

Relationship between Self-Efficacy, Social Support and Treatment Motivation among Addict Patients

An oncogene addiction phosphorylation signature and its derived scores inform tumor responsiveness to targeted therapies

PurposeOncogene addiction provides important therapeutic opportunities for precision oncology treatment strategies. To date the cellular circuitries associated with driving oncoproteins, which eventually establish the phenotypic manifestation of oncogene addiction, remain largely unexplored. Data suggest the DNA damage response (DDR) as a central signaling network that intersects with pathways associated with deregulated addicting oncoproteins with kinase activity in cancer cells.ExperimentalDesignWe employed a targeted mass spectrometry approach to systematically explore alterations in 116 phosphosites related to oncogene signaling and its intersection with the DDR following inhibition of the addicting oncogene alone or in combination with irradiation in MET-, EGFR-, ALK- or BRAF (V600)-positive cancer models. An NSCLC tissue pipeline combining patient-derived xenografts (PDXs) and ex vivo patient organotypic cultures has been established for treatment responsiveness assessment.ResultsWe identified an ‘oncogene addiction phosphorylation signature’ (OAPS) consisting of 8 protein phosphorylations (ACLY S455, IF4B S422, IF4G1 S1231, LIMA1 S490, MYCN S62, NCBP1 S22, P3C2A S259 and TERF2 S365) that are significantly suppressed upon targeted oncogene inhibition solely in addicted cell line models and patient tissues. We show that the OAPS is present in patient tissues and the OAPS-derived score strongly correlates with the ex vivo responses to targeted treatments.ConclusionsWe propose a score derived from OAPS as a quantitative measure to evaluate oncogene addiction of cancer cell samples. This work underlines the importance of protein phosphorylation assessment for patient stratification in precision oncology and corresponding identification of tumor subtypes sensitive to inhibition of a particular oncogene.

Transcriptomics and metabolomics together reveal the underlying mechanism of heroin hepatotoxicity

Researches on heroin are more about addiction and some infectious diseases it causes, but liver fibrosis caused by heroin abuse and the mechanism of heroin hepatotoxicity in addicts are ignored. To explore the mechanism of heroin hepatotoxicity, mice in heroin group were intraperitoneally injected by heroin (10 mg/kg) once a day for 14 consecutive days, while mice in heroin withdraw group underwent another 7 days without heroin administration after the same treatment as heroin group. The levels of alanine aminotransferase （ALT）and aspartate aminotransferase （AST） in serum, as biochemical indexes, were applied to evaluate liver damage. H & E staining and oil red O staining were used to observe the pathological changes of liver. Transcriptomics and metabolomics were applied to detect genes and metabolites in livers. The results of biochemical analysis and pathological examination showed that heroin induced liver damage and lipid loss in mice, and these mice did not return to normal completely after a short-term withdrawal. A total of 511 differential genes and 78 differential metabolites were identified by transcriptomics and metabolomics. These differential genes and metabolites were significantly enriched in pathways like lipid metabolism, arachidonic acid metabolism, glutathione metabolism, TCA cycle. And after undergoing 7-day withdrawal of heroin, most of the above differential genes and metabolites did not return to normal. Our study revealed the hepatotoxicity of heroin and that short-term withdrawal of heroin did not fully restore liver function. In addition, transcriptomics and metabolomics revealed that lipid metabolism and arachidonic acid metabolism may be potential therapeutic targets of heroin hepatotoxicity, providing a basis for the treatment of heroin addiction patients in the future.

FEATURES OF PSYCHOTHERAPEUTIC WORK WITH FAMILIES OF DRUG DEPENDENT PATIENTS

The article characterizes the types of relationship configurations in chemically dependent families; the internal conflicts of the addict's personality are described; the role of shame in the addiction formation is highlighted. The theoretical principles of understanding the family relationships configurations essence and its specificities in families with drug addicts are presented.&#x0D; It is presented that the most typical for families with drug addicts are symbiotic-conflict and conflict types of family relationships configurations, which allow the interaction participants to realize a dependent type of attachment. The phenomenon of family configurations repetition in different generations of the same family is revealed and described.&#x0D; Some practical psychotherapeutic techniques in dealing with addicted patients are highlighted. In particular, the differences in the implementation of psychotherapy of families of drug addicts with a predominance of symbiotic-conflict (reduction of emotional dependence) or conflict (search for other ways of communication) types of configurations are shown.&#x0D; The role of shame in working with drug addicts is described, constructive and non-constructive variants of the influence of shame on the process of overcoming excessive use are differentiated.&#x0D; Based on the description of the prevailing types of intrapersonal conflicts in drug addicts, appropriate strategies for psychotherapeutic work with them are presented.

Pathology of Infectious Diseases

Part 1 General principles: changing spectrum of human infectious diseases host-parasite interplay role of pathology in diagnosis of infections types of tissue responses to infection microscopic detection of pathogenic organisms. Part 2 Viral infections: viral pathogenesis viral diseases of the digestive system viral skin rashes systemic and hematopoietic viral disorders adult immunodeficiency syndrome (AIDS) arboviral and zoonotic viral fevers viral encephalitis and myelitis viral myocarditis viral skin growths. Part 3 Chlamydial infections: chlamydial pathogenesis chlamydial diseases. Part 4 Rickettsial infections: rickettsial pathogenesis rickettsial diseases. Part 5 Mycoplasma infections: mycoplasma pathogenesis diseases caused by mycoplasmas. Part 6 Bacterial infections: bacterial pathogenesis diseases caused by pyogenic cocci diseases caused by common gram-negative bacteria bacterial diseases of childhood enteric bacterial diseases clostridial diseases zoonotic bacterial diseases rare gram-negative infections treponemal diseases mycobacterial diseases diseases caused by streptomycetales. Part 7 Fungal and algal infections: fungal pathogenesis superficial mycoses opportunistic mycoses endemic fungal diseases diseases caused by algae (protothecosis). Part 8 Protozoal infections: protozoal pathogenesis diseases caused by luminal protozoa diseases caused by bloodstream protozoa diseases caused by intracellular protozoa. Part 9 Helminthic infections: helminthic pathogenesis diseases caused by tissue nematodes filarial diseases diseases caused by cestodes diseases caused by trematodes. Part 10 Patients at special risk of infection: general risk categories residents and travellers in endemic areas pregnant women and neonates infants and elderly persons the poor, homeless, the addicted patients genetically predisposed immunosuppressed and leukopenic patients AIDS patients. Epilogue: the sience and art of infectious disease medicine.

Independent Complaint Offices for Psychiatry in Germany

Acquisition of meaning and methods of independent complaint offices. Digital and postal survey. The most frequent concerns are dissatisfaction with inpatient treatment, legal care and communication with patients. Networking is gaining in importance. Complainants are referred more often. Increased enquiries from men and addiction patients. Improvement is possible in strengthening the law on complaint offices, promoting trialogical staffing and better communication by professionals.