ALCOHOL DEPENDENCE SYNDROME TOBACCO DEPENDENCE SYNDROME

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A 33yr old male , who is shopkeeper by occupation 

C/O •alcohol consumption since 10 years (360 ml whisky per day)

• Tobacco consumption since 10 years (2 judebail per day)

Patient was apparently asymptomatic 10 years back then he started consuming whisky 90 ml per day and gradually increased to 360 ml per day. Financial stressors present, eye openers present. Patient experiences sleep disturbance, tremors, fear, palpitation when not consuming alcohol. Patient is aware about harmful effects of alcohol but consuming despite of awareness. Patient started having judebail 10 years back half back per day and increase it to two packs per day. Patient experience is headache irritability and not consuming judebail. Patient is aware about harmful effects of judebail , but consuming it despite awareness. 

History of seizures episode one day after stopping alcohol 2 episodes till now- 6 months and one month ago.

Associated with loss of consciousness tonic and clonic movements of upper limb and lower limb, uprolling of eyeBall 

 History of occasional loss of interest, decreased appetite death wishes at times.

No history of head injury, any other substance use, flight of ideas,grandiosity

K/C/O Chronic pancreatitis diagnosed 1 year ago ( on Tab.Pancreatin and Tab.levosulpride)

PERSONAL HISTORY:-

Diet - mixed

Appetite- lost

Sleep- inadequate

Bowel and bladder movements- Regular 

Addictions-

•Alcohol consumption since 10 years- Daily 360ml whisky

•Tobacco chewing- since 10 years

GENERAL EXAMINATION:

Pt is conscious,coherent,cooperative

Height -168cms

Weight - 72kgs

Bp-120/80 mmHg

Pr-82bpm

Temp -98.5°F

SpO2- 99%@RA

INVESTIGATIONS:

TREATMENT:

1.TAB.LIBRIUM 25mg

     1—1—2 for 3 days

           ↓

     1—x—2 for 3 days

           ↓

      x—x—2 for 3 days

2. Tab.baclofen xl po/bd

3.Tab.nodict 50mg po/bd

4.Tab.benfomet plus po/od

5.Tab.Mecupan 40mg po/od

6.Tab.pregaba M 75mg po/od

7.Tab.Propranolol 20mg po/od

8.Nicotex gums 2mg sos

On 25/3/22,

Patient c/o  suspicion that other patients are consuming alcohol

Hearing of voices of friends

Suspicion that other patients might harm him

Then started Tab.SIZODON PLUS PO/OD

From 1/5/22,stopped taking Tab.sizodone

 

Present Treatment:

1.Tab.Baclofen xl 20mg po/od

2.Tab.nodict  50mg po/od

3.Tab.Mecupan 40mg Sos

4.Tab.pregabalin M 75mg po/od

5.Protein x powder 2tsp 

6.Tab.Telmisartan 20mg po/od

7.Tab.Lasix 

   1(40mg)—x—1(20mg)

8.Nicotex gums 2mg

   1—x—x