The seven categories of alternative medicine, as established by the National Institutes of Health Office of Alternative Medicine, are mind-body interventions, bioelectromagnetic therapies, alternative systems of medical practice, manual healing methods,
Chronic pelvic pain in women may involve more than the gynecologic organ systems. Urologic, gastrointestinal, musculoskeletal and psychiatric disease processes may be contributing factors, the majority of which can be treated medically. A thorough histo
A basic approach to the patient presenting with acute monoarthritis includes a careful history, a physical examination and a selected battery of laboratory tests and radiographs. Because of the possibility of septic joint, rapid assessment and treatment
Uncommon headache syndromes can be classified into two broad categories: (1) urgent conditions, including subarachnoid hemorrhage, giant cell arteritis and bacterial meningitis, and (2) special syndromes, such as cluster headache, migraine with aura and
The etiology of primary nocturnal enuresis remains somewhat controversial but may include genetic factors, decreased functional bladder capacity, increased diuresis at night, and constipation. Deep sleep and emotional illness usually play only a minimal
In evaluating recurrent childhood infections, the physician must keep in mind the rarity of true immunodeficiency and the frequency of atopy, day care, exposure to cigarette smoke and anatomic variations as predisposing factors in recurrent childhood il
Recent reviews of the effect of estrogen on the cardiovascular system suggest that long-term estrogen replacement therapy after menopause may prevent cardiovascular disease in women who are at risk. Short-term effects of estrogen on coronary vascular re
Chlamydia trachomatis and Trichomonas vaginalis are common sexually transmitted infections associated with adverse pregnancy outcome. Since patients are frequently asymptomatic, diagnosis on the basis of symptoms or physical findings is unreliable. If m
Acute cholecystitis is a common abdominal condition resulting from chemical or bacterial inflammation of the gallbladder. It is generally related to gallstones and subsequent unresolved obstruction. Early surgery is the treatment of choice because of th
Lindane has been the primary therapy for scabies for more than 30 years. However, because of neurotoxic side effects attributed to this drug, alternative drugs such as 5 percent permethrin have been used, particularly in the pediatric population where t
Date: August, 1991
Alcohol abuse and alcoholism are CoStlY problems to society. Alcoholic patients are seen frequently in the primary care setting; but they are often not optimally diagnosed and treated. Magruder-Habib and colleagues review the recognition, diagnosis and treatment of alcoholism in primary care.
Physicians should approach the diagnosis of alcoholism by asking pertinent historical questions, by being sensitive to physical presentation and by using laboratory and other diagnostic tests. Patient history, physical examination and laboratory tests are not sensitive predictors of alcoholism, but are useful in raising suspicions of alcoholism. The most accurate screening tools are questionnaires, such as the CAGE Questionnaire (see table) and the Michigan Alcohol Screening Test, and should be used routinely by primary care physicians.
If a screening test is positive, the physician should use standard criteria to confirm the diagnosis of alcoholism. A formal diagnosis of alcoholism makes seeking care for treatment legitimate and may improve third-party payment for treatment.
Intervention is difficult, but the primary care physician should be aware of community resources and should be skilled at determining when and how to make treatment referrals. Trials of treatment and management techniques for early stage alcoholism should be conducted. One of the most effective programs in existence is Alcoholics Anonymous. Many alcoholics are unwilling to enter treatment. However, in such cases, the physician may be able to work with family members. Most treatment programs demonstrate better effectiveness with family involvement.
Although more research is needed in the recognition and treatment of alcoholism in primary care settings, diligent application of current knowledge will allow physicians to help many patients with their alcohol problems. (Journal of Family Practice, April 1991, vol. 32, p. 406.)
COPYRIGHT 1991 American Academy of Family PhysiciansCOPYRIGHT 2004 Gale Group