Laboratory paradigms of impulsivity and alcohol dependence: a review

Impulsivity can be defined as choosing a smaller, immediate reward over a larger, delayed reward. From this perspective, addictive behaviors such as substance abuse and pathological gambling reflect a series of impulsive choices. However, impulsivity is not a homogeneous construct. Laboratory measures of impulsivity reflect two types of processes. The first is related to behavioral inhibition and refers to an individual's ability to appropriately inhibit thoughts or actions. The second is the delay of reward dimension, namely the degree to which immediate (rewarding) consequences have more control over an individual's behavior than consequences that are delayed. In this review, we describe how alcohol is associated with significant impairments in these paradigms. We also suggest that they may have a role in the development of alcohol dependence. These results are in agreement with a model in which delay of gratification might be a marker for early use and/or abuse of alcohol, whereas impairment in behavioral inhibition might be a marker for maintained use in time and, therefore, for progression towards alcohol dependence.

Zonisamide versus diazepam in the treatment of alcohol withdrawal syndrome

INTRODUCTION

Anticonvulsant drugs have been used in the treatment of alcohol detoxification. The purpose of the present study was to evaluate the efficacy and safety of zonisamide in a sample of patients presenting alcohol withdrawal syndrome.

METHOD

In this 3-week, randomized, flexible-dose trial, 40 inpatients with alcohol dependence disorder received zonisamide or diazepam for detoxification. Zonisamide was started at a dose of 400-600 mg/day (week 1), tapering to a minimum dose of 100-300 mg/day (week 3). Diazepam was administered using a similar regimen (from 130-50 mg/day tapering to 5-15 mg/day). Subjects were treated initially (weeks 1 and 2) in an inpatient unit and for the final week in an outpatient facility. During the inpatient period, the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) was used to assess the efficacy of each substance. During the outpatient period the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar), Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, and a craving scale were used.

RESULTS

All subjects completed the study. During the inpatient period both drugs reduced alcohol withdrawal symptoms, but the decrease was more marked in the zonisamide group. At the end of the study (week 3) participants treated with zonisamide showed lower CIWA-Ar scores than subjects receiving diazepam. Also, individuals in the zonisamide group had less craving for alcohol, less anxiety, and less daytime sedation compared with participants treated with diazepam.

CONCLUSION

Zonisamide can be a valuable alternative to benzodiazepines in the prevention of alcohol withdrawal syndrome.

Enteroviruses in Spain over the decade 1998-2007: virological and epidemiological studies

BACKGROUND

Human enteroviruses (HEV) are the commonest cause of viral meningitis as well as other pathologies, therefore HEV characterization is important both in patient management and epidemiological investigation.

OBJECTIVES

A 10-year study of patients with enteroviral infection was carried out in Spain to determine the underlying etiology.

STUDY DESIGN

HEV were fully typed by microneutralisation tests and/or molecular methods.

RESULTS

A collection of 86404 clinical samples were studied in several Spanish laboratories. These were collected from patients with different syndromes, mainly aseptic meningitis (AM), fever, respiratory diseases and acute flaccid paralysis. Of these, 6867 HEV were obtained. At the National Poliovirus Laboratory 2814 were serotypically characterised. Among non-polio enteroviruses, the eight main serotypes were Echovirus 30 (25%), Echovirus 6 (12.4%), Echovirus 13 (8.3%), Echovirus 11 (7.4%) and Echovirus 9 (4.7%), followed by Coxsackievirus B5 (4.2%) and Echovirus 7 and Coxsackievirus A9 (3.7%) each. In AM cases, Echovirus 30 was identified in 39% of them, followed by Echovirus 6 (14%). However, Echovirus 6 was mainly associated with respiratory disease (17%), followed by Echovirus 11 (10%). On the other hand, Echovirus 30, Echovirus 11 and Echovirus 6 contributed equally with 12% of each serotype in the cases of fever.

CONCLUSIONS

The present report complements previous data (Trallero et al.(13)), with the results of HEV incidence in Spain from 1998 to 2007. The surveillance described in this study provided valuable information as to which serotypes are in circulation, the emergence of new HEV and association with clinical manifestations.

Differences Observed by ASI-6 among users of Alcohol, Cocaine and Opiates

Aim:

To identify the differences in the ASI-6 scores according to main substance of consumption among patients with drug use disorder who were included at the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. 186 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Main substance of consumption: 57% alcohol, 19.9% cocaine and 19.4% opiates. Men were 77.4% vs. 81.1% vs. 83.3% (p n.s.), mean ages were 47.12 (SD 10.18) vs. 32.62 (SD 8.20) vs. 36.47 (SD 8.04) years (p< 0.001), and 25.5% vs. 64.9% vs. 55.6% were single (p< 0.001). The greatest severity was found in the Alcohol area in the case of alcohol users (56.86) and in the Family/Social Partner Problems area in the case of cocaine and the opiate users (50.43 and 51.22). Alcohol users had statistically significant greater severity than the other two groups in the Alcohol area (56.86 vs. 49.38 vs. 45.17, p< 0.001) and tended to have lower severity in the Legal area than cocaine users (46.78 vs. 48.43, p 0.079).

Conclusions:

Cocaine users were the youngest and used to be single. The ASI-6 only differentiated in the severity of the Alcohol area. Further studies including a higher proportion of cocaine and opiate users are needed.

Physical Health of Patients with Drug use Disorders

Aim:

To describe the physical health profile of patients with drug use disorders who were included in the study of adaptation-validation of the Addiction Severity Index 6th version (ASI-6) into Spanish.

Method:

Multicentre, observational, longitudinal, prospective study. A total of 194 substance dependent/abuser individuals were included. Assessments were made with the Spanish ASI-6.

Results:

Men were 79.9%, mean ages were 41.08 (SD 11.64), 42.3% were single and 87.6% were acute patients. The severity score in the Physical Health area was 44.32 (SD 9.51). The most prevalent diseases were: 25.3% hepatitis, 11.9% had high blood pressure, 8.2% cirrhosis or hepatic disease, 6.7% epilepsy or convulsions and 5.7% tuberculoses. No statistically significant differences were found according to gender. Acute patients had statistically significant higher proportion of pregnant woman (2.3% vs. 0% p< 0.05) and lower proportion of diabetes (3.5% vs. 12.5% p= 0.05).

Conclusions:

Patients with drug use disorders have a mild-moderate severity of physical health. Physical health is not influenced by gender, but it is by the clinical state.

Phytotherapy and psychiatry: bibliometric study of the scientific literature from the last 20 years

In diverse areas of therapy, including psychiatry, increasing interest in herbal medicine has been shown in recent years. Plants have a wide range of traditional uses, but only a few have been approved therapeutically. Moreover, to our knowledge, no bibliometric analyses on medicinal plants used in psychiatry have been carried out to date. We performed a bibliometric study on scientific publication related to phytotherapy in the psychiatry area during the period 1986-2006. Using the platform Embase.com, including the EMBASE and MEDLINE databases, we selected those documents including the descriptors plant*, herb*, phytotherapy*, phytomedicine*, pharmacognosy*, and psychiatry* (with all diagnostic criteria). The plants' indications were selected according to the PDR for Herbal Medicines. As a bibliometric indicator of the production, Price's Law was applied. Another indicator included was the national participation index (PI) for overall scientific production. A total of 21,409 original documents were obtained. Our data confirm a fulfillment of Price's Law related to scientific production on medicinal plants in Psychiatry. This was observed after we made a linear fit (y=135.08x-466.38; r=0.92) and another fit to an exponential curve (y=132.26e(0.1497x); r=0.99). The plants most widely mentioned in the psychiatric literature were St. John's wort (Hypericum perforatum L.; n=937) and ginkgo (Ginkgo biloba L.; n=694). The countries with the highest percentages of documents were the United States (29.44%), Germany (9.41%) and Japan (8.75%), and those with highest proportional PI were India (IPa=0.935) and China (IPa=0.721). Productivity on medicinal plants in the psychiatry area increased during the period 1986-2006. Nevertheless, documents about therapeutic herbs in this medical field are still relatively few in number.

Psychopathology and Wisconsin Card Sorting Test performance in male schizophrenic patients: influence of dual diagnosis

BACKGROUND

Different neuropsychological studies have shown schizophrenic patients to have executive function deficits, as illustrated by their performance in neuropsychological tasks such as the Wisconsin Card Sorting Test (WCST); certain studies have described a relationship between these deficits and negative symptoms. Schizophrenic patients also exhibit a high lifetime prevalence (40-50%) of comorbid substance use disorders (SUDs). However, little attention has been paid to this comorbidity (dual diagnosis) in studies associating executive functions and negative symptoms.

SAMPLING AND METHODS

Our objective is to investigate the relationship between performance in the WCST and psychopathology as measured by the Positive and Negative Syndrome Scale (PANSS) in a sample of 65 male schizophrenic patients with a history of SUDs (Sch SUD+) and in a sample of 48 male schizophrenic patients without such history (Sch SUD-).

RESULTS

In the Sch SUD- group, patients who completed 4 or more categories in the WCST ('good performers') obtained a mean score of 21.2 +/- 8.8 on the negative subscale of the PANSS, compared with a mean score of 27.8 +/- 8.6 in those who completed 3 or less ('poor performers'); these differences were statistically significant (p = 0.015). In the Sch SUD+ group, however, no association was found between WCST performance and the PANSS negative subscale score.

CONCLUSIONS

The presence of a history of comorbid SUDs should be taken into consideration in studies investigating executive functions and negative symptoms in schizophrenia.