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It is important to remember that medical illness and hospitalization can be very stressful, even for the most well adjusted individuals. Under stressful situations, individuals may regress and display personality styles inconsistent with their typical behavior, or may display extremes of typical behavior. Classically, coping has been defined as how an individual manages and attempts to alter a stressful situation. Whereas coping styles are primarily consciously applied behavioral actions, defense mechanisms are largely unconscious, psychological processes used by patients to deal with reality and to maintain self-image. Classically, countertransference was explained as reactions to a patient that represent the past life experiences of the clinician. Although it is not obvious, passive aggression and idealization are very common in dependent clingers. Despite limited evidence for the use of psychotropic medications in personality disorders, they still can have some benefit.
Alcohol withdrawal continues to present significant morbidity and mortality in hospitalized medical/surgical patients. The authors present a case of a patient with delirium tremens requiring up to 1,600 mg/day of lorazepam and discuss alternative treatments for alcohol withdrawal.
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