Dexamethasone suppression test in psychiatric patients with psychoactive substance dependence

The study of the dexamethasone suppression test (DST) in 374 chronic psychiatric patients with concurrent substance dependence, including alcohol, found 97% of nonsuppression associated with affective disorders. The incidence of nonsuppression was 38.5% in major depressive disorder and 27.7% in bipolar affective disorder. This study found no apparent connection between the incidence of nonsuppression and any particular drug group. Predexamethasone plasma concentrations were higher in affective disorders than in other diagnoses. It is concluded that the DST may be of value as part of the clinical approach to the diagnosis of major depressive disorders in a substance-abusing population.

Prolactin and cortisol levels following acute alcohol challenges in women with and without a family history of alcoholism

In a pilot study 5 matched pairs of female social drinkers received both 0.56 g/kg alcohol and placebo in a double-blind crossover design. Family history positive (FHP) women had biological fathers who met criteria for alcohol dependence, and FHN women had no relatives who met these criteria. FHP and FHN women had BALs about 70 mg/dl 60 min after alcohol. FHP subjects had significantly lower prolactin levels 40, 60 and 80 min following alcohol, but higher cortisol levels 130 and 150 min following alcohol. No significant differences in hormone levels occurred after placebo.

Alcohol abuse in chronic schizophrenics: implications for management in the community

This study was designed to investigate the effects of regular alcohol consumption on chronic schizophrenic patients maintained on fluphenazine decanoate in the community. A group of patients who consumed more than 20 units of alcohol per week was compared with those who did not drink or did so only occasionally. It was found that patients in the alcohol group had a higher frequency of previous relapses, a greater severity of positive symptoms and a lower incidence of extrapyramidal side effects except tardive dyskinesia for which there was no difference. Serum fluphenazine levels were lower in this group (NS). It was concluded that patients who regularly consume alcohol tend to be clinically unstable, perhaps because of poor therapeutic control.

Ethanol's fluidizing effects on RBC membranes from children at risk for alcoholism

The fluidizing effects of ethanol on membrane fluidity at 37 degrees C have been assessed using steady-state anisotropy measurements in both children at high risk for developing alcoholism and control children. Erythrocyte membranes were labeled with 1,6-diphenyl-1,3,5-hexatriene (DPH) and fluidity measurements recorded by steady-state fluorescence anisotropy for three ethanol concentrations--0, 0.5 M, and 1.0 M. The in vitro fluidizing effects of acute ethanol treatment by concentration were clearly shown in both groups. However, RBC membranes taken from children at high risk for developing alcoholism showed no significant differences in baseline membrane fluidity or to the fludizing effects of ethanol.

2,3-Butanediol in plasma from an alcoholic mistakenly identified as ethylene glycol by gas-chromatographic analysis

2,3-Butanediol was mistakenly identified as ethylene glycol in plasma specimens from two alcoholic patients. The cyclic phenylboronate ester derivatives of 2,3-butanediol and ethylene glycol had the same retention time when OV-17 was used as the stationary phase for gas chromatography. This led to incorrect diagnosis of ethylene glycol poisoning and unnecessary invasive therapy. Plasma from two chronic alcoholics contained 2,3-butanediol at 3.5 and 3.4 mmol/L. The elimination half-life of 2,3-butanediol was 3.9 days when ethanol was administered during therapy for suspected ethylene glycol poisoning. Low concentrations of 2,3-butanediol might be present in blood of chronic alcoholics as a result of a novel pathway of intermediary metabolism associated with some forms of alcoholism. However, a more likely explanation for fairly high concentrations of 2,3-butanediol is enzymatic production from 2-butanone. This ketone occurs in denatured alcohol preparations often consumed by alcoholics in Sweden.

Disturbances of hypothalamic-pituitary-adrenal axis functioning during ethanol withdrawal in six men

OBJECTIVE

Excessive exposure to glucocorticoids can have neurotoxic effects. The behavioral, cognitive, and neurochemical changes observed following the cessation of heavy drinking, therefore, may be associated with disturbances of the hypothalamic-pituitary-adrenal (HPA) axis. To investigate HPA axis disturbances during the ethanol withdrawal syndrome, the authors examined diurnal changes in plasma cortisol in six alcohol-dependent men following the abrupt discontinuation of alcohol intake.

METHOD

Plasma cortisol concentrations were quantified every 30 minutes for 24 hours in the early stage (1 day after cessation) and the middle to late stage (3 days after cessation) of the ethanol withdrawal syndrome as well as after the resolution of acute symptoms (8 days or more after cessation).

RESULTS

Plasma cortisol concentrations were almost twice as high during acute withdrawal as they were following recovery. The duration of the cortisol diurnal cycle on the first day of withdrawal was negatively correlated with the severity of withdrawal.

CONCLUSIONS

There is a marked activation of the HPA axis associated with the ethanol withdrawal syndrome. The authors hypothesize that this activation may account for some of the signs and symptoms of acute and subacute withdrawal. They discuss the potential long-term physiological effects of the episodic increases in cortisol associated with repeated episodes of ethanol withdrawal. The alterations in cortisol rhythmicity during early withdrawal may also have clinical implications.

A genetic study of platelet adenylate cyclase activity: evidence for a single major locus effect in fluoride-stimulated activity

The activity of membrane-bound platelet adenylate cyclase, when stimulated in vitro by several compounds (including fluoride), is significantly reduced in alcoholics compared with control subjects. We have begun a study of the genetics of this enzyme activity. Complex segregation analysis of basal (unstimulated) platelet adenylate cyclase activity in families reveals a mode of inheritance that cannot be accounted for by a simple mixed model of transmission. By contrast, adenylate cyclase activity stimulated by fluoride ion reveals a single major locus effect with a modest multifactorial background. These results suggest that a single factor in the second-messenger pathway may (a) account for the majority of individual differences in stimulation of adenylate cyclase of fluoride and (b) help explain the reduced activities previously observed in alcoholics.

The syndrome of alcoholic ketoacidosis

PURPOSE

To further elucidate the clinical spectrum of alcoholic ketoacidosis (AKA).

PATIENTS AND METHODS

A case series of 74 patients with AKA defined as a wide anion gap metabolic acidosis unexplained by any other disorder or toxin, including any patient with a history of chronic alcohol abuse. The setting was the Medical Emergency Department at Grady Memorial Hospital in Atlanta, Georgia, a university-affiliated inner-city hospital.

RESULTS

AKA is a common disorder in the emergency department, more common than previously thought. The acid-base abnormalities are more diverse than just a wide-gap metabolic acidosis and often include a concomitant metabolic alkalosis, hyperchloremic acidosis, or respiratory alkalosis. Lactic acidosis is also common. Semiquantitative serum acetoacetate levels were positive in 96% of patients. Elevated blood alcohol levels were present in two thirds of patients in whom alcohol levels were determined, and levels consistent with intoxication were seen in 40% of these patients. Electrolyte disorders including hyponatremia, hypokalemia, hypophosphatemia, hyperglycemia, hypocalcemia, and hypomagnesemia were common on presentation. The most common symptoms were nausea, vomiting, and abdominal pain. The most common physical findings were tachycardia, tachypnea, and abdominal tenderness. Altered mental status, fever, hypothermia, or other abnormal findings were uncommon and reflected other underlying processes.

CONCLUSIONS

AKA is a common disorder in chronic malnourished alcoholic persons. The acid-base abnormalities reflect not only the ketoacidosis, but also associated extracellular fluid volume depletion, alcohol withdrawal, pain, sepsis, or severe liver disease. Although the pathophysiology is complex, the syndrome is rapidly reversible and has a low mortality.

Serum lipase levels in chronic alcoholics

Using an elevated serum amylase level to diagnose acute pancreatitis in an alcoholic patient with abdominal pain may not be appropriate, because hyperamylesemia is common in asymptomatic alcoholics without acute pancreatitis. To determine whether serum lipase also suffers from the same drawback, we undertook a prospective study involving 202 asymptomatic alcoholics admitted to the detoxification unit of our hospital. Sixty-six of the 202 patients had serum lipase levels above the normal range (0-213 U/L). Of these 66, 55 (83%) had levels that were one to two times normal, while 11 patients had levels ranging between two and three times normal. No patient exceeded three times the normal level. This background information is important in the interpretation of serum lipase levels in alcoholic patients with abdominal pain.

DNA-repair capacity and lipid peroxidation in chronic alcoholics

The possible impact of long-term overexposure to ethanol was studied in a group of chronic alcoholics in the psychiatric hospital. The level of DNA methylation and unscheduled DNA synthesis (UDS) induced by N-methyl-N-nitrosourea (MNU) in lymphocytes and lipid peroxidation (LPO) in plasma were used as markers of injury caused by alcohol abuse. The data were correlated with plasma levels of some natural antioxidants (vitamins A, C and E) and vitamin B12. The following results were obtained. The degree of DNA methylation by MNU in lymphocytes was the same in the exposed and control groups under our experimental conditions. The DNA excision-repair capacity of lymphocytes measured as UDS was decreased in alcoholics (p less than 0.01) and LPO in plasma was significantly higher (p less than 0.01) as a consequence of alcohol overconsumption. By the simple regression method, a correlation was found between LPO and vitamin C levels (LPO = -0.078 x vit. C + 1.9; p less than 0.05) and between UDS and LPO values (UDS = -0.384 x LPO + 4.1; p less than 0.05). These results support the hypothesis of a connection of cell membrane status and DNA damage and repair and the possible role of active oxygen species in cell damage caused by ethanol.

Changes in the incidence of alcohol-impaired driving in the United States, 1973-1986

Studies of motor vehicle fatality data have indicated that alcohol involvement in fatal crashes has declined substantially in the United States since 1980. To determine the actual incidence of alcohol-impaired drivers on U.S. roads, a national roadside survey using portable breath-testing devices was carried out in 32 localities in the spring of 1986. The same sampling design and survey procedures used in a 1973 national roadside survey were followed as much as possible. The 1986 survey found 3.1% of the late-night weekend drivers to have a blood alcohol concentration (BAC) of 0.10% or more, compared to 4.9% of drivers in 1973. Similarly, 8.3% of the 1986 drivers were at or above 0.05% BAC, compared to 13.5% in 1973. The data indicate that the incidence of alcohol-impaired driving on weekend nights has fallen by one-third or more in the United States since 1973 and that the decline affected most population subgroups.

Leukocyte lipid profile in chronic alcoholics

Polymorphonuclear leukocytic (PNML) lipid content was studied in chronic alcoholic and normal control subjects. Chronic alcoholic subjects showed abnormal liver function and abnormal serum lipid profile. PMNL obtained from chronic alcoholic subjects exhibited decreased free cholesterol and phospholipid contents, with a significant increase in cholesterol to phospholipid ratio. Although, there was no change in the free fatty acids, the levels of triglycerides were significantly elevated.

The simplified technique of high resolution two-dimensional polyacrylamide gel electrophoresis: biomedical applications in health and disease

The application of our simplified technique of high resolution two-dimensional polyacrylamide gel electrophoresis (2-D PAGE) to human body fluids is reviewed. Serum/plasma protein changes associated with alcohol abuse, familial dyslipoproteinemia ("fish-eye" disease), and myocardial infarction are demonstrated. High resolution 2-D PAGE of amniotic fluid, cerebrospinal fluid, urine, and saliva is shown with reference to the work of others, and the detection of pink-violet staining "lumicarmines" in sweat and tear fluid is reported for the first time. General aspects relating to the methodology are discussed. These include sample preparation, the choice of electrophoresis conditions (denaturing or nondenaturing) and detection method (Coomassie Brilliant Blue or silver), and the effects of native protein pretreatment with sodium dodecyl sulfate prior to silver staining or isoelectric focusing gel shrinkage in glycerol prior to second-dimensional sodium dodecyl sulfate-polyacrylamide gel electrophoresis.

[Ulcerating gout tophi. Surgical therapy in a patient with hyperuricemia, hyperlipidemia and alcohol abuse]

We report on a 51-year-old male patient who had been suffering from gouty arthritis and podagra with relapsing attacks of severe pain for the last 10 years. We treated two tophaceus deposits on the left heel with the CO2 laser and conventional enucleating surgery. These tophi had immobilized the patient for months and it had not been possible to control them by conservative therapy.

Cerebral lesions and causes of death in male alcoholics. A forensic autopsy study

Autopsies on 195 male alcoholics aged 30-64 years who died outside hospitals and nursing homes in Oslo from 1984 to 1988, were carried out at the Institute of Forensic Medicine, Rikshospitalet. In 127 cases brain tissue was examined neuropathologically, 86 (67.7%) showed abnormalities and 28 contained lesions of more than one type. Lesions associated with alcoholism were found in 61 cases (48%), 18 (14.2%) showed Wernicke's encephalopathy, 47 (37%) cerebellar atrophy, 2 central pontine myelinolysis and 1 hepatic encephalopathy. Subdural haematoma and/or cortical contusions were found in 30 cases (23.6%) and cerebrovascular lesions in 19 (15%). Of the 195 cases, 22 had a history of recurrent convulsive attacks of which 19 were examined neuropathologically and 13 had focal damage that could have caused epileptic fits. Although cerebral damage was more frequent among vagrants and other persons dependent on social support, 50% of the alcoholics living in their own homes were also affected. Alcohol-related disease was considered the cause of death in 15 of 127 cases examined neuropathologically and 9 of these died from acute Wernicke's encephalopathy all of whom were sober at death. Although the post mortem analyses included neuropathological examination of the brain, the cause of death remained unknown in 27 (21%) of the 127 cases.

Importance of age upon the increase in HDL2-cholesterol in the alcoholic

An inverse relationship has been found between high density lipoprotein cholesterol (HDL-C) and the incidence of coronary disease. A controversy exists in the international literature as to which sub-fraction, HDL2-C or DHL-C, rises after ethanol ingestion. This paper studies a comparison of the levels of circulating cholesterol, HDL-C, HDL2-C and HDL3-C in two groups: a control group of 44 healthy subjects who had no ethanol in over a year, and a second one made up off 40 chronic alcoholics, who consumed between 80 and 160 gr. of ethanol per day. The alcoholic population showed lower levels of cholesterol and higher levels of HDL-C, HDL2-C and HDL3-C. When compared with the control group, the increase was in alcoholics 58% for HDL2-C and 29% for HDL3-C. An analysis of the different age groups shows an increase of 110% in HDL2-C, in alcoholics between ages 31 and 40, as compared with their control group. An increase of 81% occurred between ages 51 and 60, but rarely rose 20% between ages 21 and 30, as well as between 51 and 60. The maximum rise of HDL3-C in drinkers, related to their control group, was 38% during the fourth decade of life. The conclusion is that the HDL2-C subfraction rises in chronic alcoholics, and the changes in other HDL-C subfractions are more useful when they are placed at the different individual's decades of age, than when taken from complete population samples.

[The validity of laboratory tests in the diagnosis of alcoholism and alcoholic liver injury]

The authors assessed the value of commonly available laboratory examinations for the diagnosis of suspected excessive alcohol intake and suspected liver damage by alcohol. They tested the validity of aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gammaglutamyl transferase (GMT), the blood sugar level, serum cholesterol, bilirubinaemia, ferrinaemia and mean corpuscular volume (MCV). The highest validity as regards sensitivity of the examination was recorded in the MCV with a sensitivity of 0.78 and examination of GMT with a sensitivity of 0.72. By combination of MCV and GMT in an alternative manner, the sensitivity rose to 0.87. Evaluation of the groups by the method of discrimination analysis, using all ten parameters, revealed the possibility of 100% correct classification of non-alcoholic subjects and a 86.2% correct qualification of alcoholic subjects.

Estimation of blood alcohol concentrations in young male drinkers

This research examined individual differences in the ability to self-monitor the effects of alcohol. Thirty-nine male subjects consumed 0.75 ml/kg alcohol and estimated their blood alcohol concentrations (BACs) at peak BAC and on the ascending and descending limbs of the blood alcohol curve. Family history of alcohol dependence did not affect the accuracy of estimation of BACs. Subjects who reported lower levels of subjective intoxication underestimated their BACs more than did subjects who reported higher levels of subjective intoxication. Subjects with less behavioral impairment underestimated their BACs more than subjects with greater behavioral impairment on the ascending limb of the blood alcohol curve. Accuracy was better on the ascending limb compared with peak BAC and the descending limb, and accuracy became worse over time on the descending limb. It appears that cues to the effects of alcohol rapidly become unavailable on the descending limb, which may contribute to decisions concerning further alcohol consumption and driving after drinking.

Alterations of ATP levels and of energy parameters in the blood of alcoholic and nonalcoholic patients with liver damage

Blood adenine nucleotides were determined in patients with alcoholic and non-alcoholic liver diseases. They included patients with alcoholic hepatitis (AH), alcoholic liver cirrhosis (ALC), non-alcoholic liver cirrhosis (NALC), and amoebic liver abscess (ALA) (28 patients). A decrease of 28% to 39% in blood ATP levels was observed among the patients with AH and the cirrhotic groups, respectively (p less than 0.05), whereas no significant changes in blood ATP levels were detected in the ALA group. Although total blood adenine nucleotides were significantly diminished in AH, ALC, and NALC groups, the AH patients retained their energy relationships within normal range. On the other hand, the cirrhotic groups, independently of their etiology, failed to maintain an adequate ATP/ADP ratio, energy charge, and phosphorylation potential in the blood, suggesting a decreased energy availability in their blood cells. Nevertheless, the mechanism involved in these effects remains to be elucidated, a failure of the damaged liver to supply purines to extra-hepatic tissues might be a major event altering the blood energy parameters.

Response of three hormones to diazepam challenge in sons of alcoholics and controls

This study evaluates the hypothesis that the decreased reaction to ethanol reported for sons of alcoholics will also be observed following infusions of a benzodiazepine. The investigation compared 37 men who were family history positive for alcoholism with 37 family history negative controls on postinfusion levels of cortisol, prolactin, and growth hormone following 0.12 and 0.20 mg/kg of diazepam given IV over 7 minutes. The results demonstrated no evidence of a decreased response for the sons of alcoholics on the levels of these three hormones.

Plasma norharman (beta-carboline) levels are elevated in chronic alcoholics

Based on the hypothesis that condensation products of neurotransmitters with aldehydes are involved in the pathogenesis of alcoholism, aromatic beta-carbolines (norharman and harman) were measured in the blood plasma of alcoholics and nonalcoholics. The identity of the extracted compounds was confirmed by various elution conditions of the high performance liquid chromatography (HPLC), newly developed radioreceptor assays, and the mass spectrum of norharman. The levels of norharman and harman in nonalcoholics were unchanged after a load with ethanol (1 g/kg body weight). The norharman levels of the alcoholics were significantly higher than that of the nonalcoholic controls (99.5 +/- 26.6 pg/ml vs. 26.9 +/- 10.7 pg/ml; p less than 0.001) and did not change significantly during a 3-week detoxication period. In the subgroup of alcoholics with delirium or hallucinosis, a slight increase of norharman during detoxication could be detected while in alcoholics with vegetative withdrawal symptoms norharman levels dropped slightly over time (p = 0.07). No difference was found with respect to harman between nonalcoholics and alcoholics. These results suggest disturbed regulatory processes in the formation and/or metabolism of norharman in alcoholics. Further investigations are needed to reveal a possible marker function of norharman in alcoholic patients.

Disulfiram implant: a double-blind placebo controlled follow-up on treatment outcome

Seventy-six alcohol-dependent patients participated in a study of the clinical effect of implanted disulfiram (DS). The patients were randomized to a DS group (n = 40), receiving a subcutaneous abdominal implantation of 10 x 100 mg DS tablets and a placebo group (PL group) receiving an implantation of 9 x 100 mg calcium phosphate tablets together with one calcium phosphate tablet containing 1 mg DS. Both groups believed they were receiving DS. At admission there was no significant difference between the DS and PL groups with regard to demographic characteristics, psychosocial adjustment, drinking variables, medical disorders, or laboratory results. After a study period of approximately 300 days, 63 patients (33 DS; 30 PL) were assessed using a battery of tests. There was no significant difference between the groups with regard to reduction in average alcohol consumption, number of days to the first alcohol intake after implantation, or level of psychosocial function. Nevertheless, both groups reduced their ethanol consumption significantly, probably due to the psychological deterrent effect. The DS implant did result in a significantly higher incidence of wound complications. This study does not support the idea that a 1-g DS implant has any significant clinical effect different from the implant containing only 1 mg DS (placebo).