Monday, December 31, 2007


This blog and sleepdoctor reached 100,000 hits a few minutes ago.
Thanks for reading.

Saturday, December 22, 2007

Anticonvulsants for Alcoholism

Several studies studies support the use of the anticonvulsant Topiramate (Topamax) for alcohol dependence.
A new study supports the use of Gabapentin (Neurontin) in the early post-withdrawal period:
NEW YORK (Reuters Health) Dec 17 - The anticonvulsant gabapentin reduces alcohol consumption and craving during treatment for alcohol dependence, Brazilian researchers report in the Journal of Clinical Psychiatry for November.
Dr. Fernando A. Furieri, at the Vitoria Municipal Addiction Treatment Center, and Dr. Ester M. Nakamura-Palacios, at the Federal University of Espirito Santo in Vitoria, conducted a randomized, double-blind trial involving 60 subjects, whose average consumption exceeded 35 drinks per week.
After a 7-day treatment for acute withdrawal, subjects were randomly assigned to gabapentin up to 600 mg/day, or placebo for 28 days. Thirty-nine patients had used diazepam during the acute phase; 15 in the placebo group and 13 in the gabapentin continued to do so during the trial phase.
The number of drinks per day, per week, and over the 4-week course of treatment had declined significantly more in the gabapentin group than in the placebo group. Gabapentin was also associated with fewer heavy drinking days and more days of abstinence. The authors note that 20 subjects in the gabapentin group and 13 in the placebo group maintained complete abstinence.
According to scores on the Obsessive Compulsive Drinking Scale, craving for alcohol was also reduced significantly more by gabapentin.
"Gabapentin has shown great potential in the treatment of alcohol dependence and withdrawal syndromes," either as monotherapy or as an add-on pharmacotherapy, the authors conclude.
J Clin Psychiatry 2007;68:1691-1700.

Non-anticonvulsants useful for the treatment of alcohol dependence include antabuse, naltrexone, and acamprosate.

Saturday, December 08, 2007

The World's most dangerous country

Different duty of care for psychiatrists and internists

A member of iMedExchange posted about this article:
A general practitioner who slept with a patient's wife -- who was also a patient -- can't be sued for malpractice in Pennsylvania, a three-judge panel concluded, affirming a decision issued by the Philadelphia Court of Common Pleas last year in Long v. Ostroff. Sexual misconduct "may be unethical," the court noted, but state law doesn't recognize such a claim for professional negligence because a general practitioner's duty of care doesn't prohibit that behavior. Unlike psychiatrists, who have a "special duty" to refrain from engaging in sexual relations with a patient's spouse, general practitioners don't have such a duty, Senior Judge Justin M. Johnson explained.
I wonder which standard would apply to me. I am boarded in Internal Medicine and Psychiatry. I primarily practice sleep medicine, which is a subspecialty of both internal medicine and psychiatry. Most insurance plans don't recognize sleep medicine as a specialty, and some list me as internal medicine and some as psychiatry. I took the old sleep boards as well as the new sleep boards (results pending) as an internist. As much as the legal process fascinates me, I guess I better not try to become the subject of a Supreme Court case.

Wednesday, December 05, 2007


LAS VEGAS (AP) -- David "Chip" Reese, a card star who won one of the biggest cash games in the world and three World Series of Poker championships, has died. He was 56.
Reese died in his sleep and was found by his son early Tuesday morning at his Las Vegas home after suffering from symptoms of pneumonia, said poker great Doyle Brunson, his longtime friend.

Despite winning three World Series champion's bracelets over the last four decades, including a $1.8 million HORSE event in 2005 that combines five poker disciplines, Reese focused his attention on high-stakes cash games away from the limelight.
"I've seen him with a million dollars in front of him," said Dalla, describing how Reese would put out racks of $5,000 chips "like he was betting a few bucks."
Reese was part of a generation of players in the 1970s that challenged established greats like Brunson, Thomas "Amarillo Slim" Preston Jr. and Walter Clyde "Puggy" Pearson, Dalla said.