1
|
Sun D, Li X, Xu S, Cao S, Quan Y, Cui S, Xu D. Dazhu Hongjingtian injection attenuated alcohol-induced depressive symptoms by inhibiting hippocampus oxidative stress and inflammation through Nrf2/HO-1/NLRP3 signaling pathway. JOURNAL OF ETHNOPHARMACOLOGY 2024; 334:118564. [PMID: 38996946 DOI: 10.1016/j.jep.2024.118564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/18/2024] [Accepted: 07/09/2024] [Indexed: 07/14/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Alcoholic depression, a disorder of the central nervous system, is characterized by alcohol abuse, which causes blood-brain barrier disruption and oxidative damage in the brain. The rhizome of Rhodiola crenulate, from which Dazhu Hongjingtian Injection (DZHJTI) is derived, has been traditionally employed in ethnopharmacology to treat neurological disorders due to its neuroprotective, anti-inflammatory, and antioxidant properties. However, the exact mechanism by which DZHJTI alleviates alcoholic depression remains unclear. AIM OF THE STUDY This study aimed to investigate the antidepressant effects of DZHJTI and its underlying mechanisms in a mouse model of alcohol-induced depression. MATERIALS AND METHODS A model of alcoholic depression was established using C57BL/6J mice, and the effects of DZHJTI on depression-like behaviors induced by alcohol exposure were assessed through behavioral experiments. Histopathological examination was conducted to observe nerve cell damage and microglial activation in the hippocampal region. Oxidative stress indices in the hippocampus, inflammatory factors, and serum levels of dopamine (DA) and 5-hydroxytryptamine (5-HT) were measured using ELISA. Expression of proteins related to the Nrf2/HO-1/NLRP3 signaling pathway was determined by Western blot analysis. RESULTS DZHJTI attenuated depression-like behaviors, neuronal cell damage, oxidative stress levels, inflammatory responses, and microglial activation. It also restored levels of brain-derived neurotrophic factor, brain myelin basic protein, DA, and 5-HT in mice with chronic alcohol exposure. After DZHJTI treatment, the expressions of Nuclear Respiratory Factor 2 (Nrf2) and Heme Oxygenase-1 (HO-1) increased in the hippocampus, whereas the levels of NOD-like receptor thermal protein domain-associated protein 3 (NLRP3), apoptosis-associated speck-like protein containing CARD, cleaved caspase-1, interleukin (IL)-1β, and IL-18 decreased. CONCLUSIONS DZHJTI ameliorates alcohol-induced depressive symptoms in mice through its antioxidant and anti-inflammatory effects, involving mechanisms associated with the Nrf2/HO-1/NLRP3 signaling pathway. This study highlights the potential of DZHJTI as a therapeutic option for alcohol-related depression and suggests the scope for future research to further elucidate its mechanisms and broader clinical applications.
Collapse
Affiliation(s)
- Dingchun Sun
- Key Laboratory of Cellular Function and Pharmacology of Jilin Province, Yanbian University, Yanji, China
| | - Xiangdan Li
- Key Laboratory of Cellular Function and Pharmacology of Jilin Province, Yanbian University, Yanji, China
| | - Songji Xu
- Department of Preventive Medicine, School of Medicine, Yanbian University, Yanji, China
| | - Shuxia Cao
- Key Laboratory of Cellular Function and Pharmacology of Jilin Province, Yanbian University, Yanji, China
| | - Yingshi Quan
- Department of Anesthesiology, Yanbian University Hospital, Yanji, Jilin, China
| | - Songbiao Cui
- Department of Neurology, Yanbian University Hospital, Yanji, Jilin, China.
| | - Dongyuan Xu
- Key Laboratory of Cellular Function and Pharmacology of Jilin Province, Yanbian University, Yanji, China.
| |
Collapse
|
2
|
Winkler GA, Grahame NJ. Home cage voluntary alcohol consumption increases binge drinking without affecting abstinence-related depressive-like behaviors or operant responding in crossed high alcohol-preferring mice (cHAPs). Alcohol 2024; 116:9-19. [PMID: 37838352 PMCID: PMC10947980 DOI: 10.1016/j.alcohol.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 09/29/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023]
Abstract
Chronic alcohol consumption can lead to tolerance and escalation of drinking in humans and animals, but mechanisms underlying these changes are not fully characterized. Preclinical models can delineate which mechanisms are involved. The chronic intermittent ethanol exposure (CIE) procedure uses forced exposure to vaporized alcohol that elicits withdrawal and increased responding for alcohol in operant tasks in C57BL/6J inbred mice. Chronic two-bottle choice (2BC) drinking in the same strain elicits abstinent-related depression-like behavior, suggestive of allostatic changes. Selected lines such as crossed High Alcohol Preferring (cHAP) mice voluntarily drink to blood alcohol concentrations comparable to those attained in CIE and could be used to assess how alcohol affects these same endpoints without the confounds of involuntary vapor inhalation. In three experiments, we assess how 2BC drinking in cHAP mice affects abstinence-related depressive- and anxiety-like behavior, operant responding for alcohol, and binge consumption using drinking-in-the-dark (DID). We hypothesized that cHAPs with home-cage drinking experience would exhibit more depressive behavior after abstinence, increased responding for alcohol in the operant box, and increased DID intake. Of these, a drinking history increased DID intake in female cHAPs only and increased sucrose preference and intake following abstinence, but had no effects on operant responding or NSFT latency and FST immobility following forced abstinence. These results are consistent with recent findings using slice electrophysiology showing tolerance to alcohol's actions on the dorsolateral striatum following 2BC drinking in female, but not male cHAP mice. Overall, these data suggest that cHAPs may require procedures allowing rapid intoxication, such as DID, to demonstrate changes in alcohol's rewarding effects.
Collapse
Affiliation(s)
- Garrett A Winkler
- Addiction Neuroscience, Department of Psychology and Indiana Alcohol Research Center, Indiana University - Purdue University Indianapolis, Indianapolis, IN 46202, United States
| | - Nicholas J Grahame
- Addiction Neuroscience, Department of Psychology and Indiana Alcohol Research Center, Indiana University - Purdue University Indianapolis, Indianapolis, IN 46202, United States.
| |
Collapse
|
3
|
Rolko T, Rauks-Pärgmäe T, Aluoja A, Tõru I, Janno S. Reliability and validity of the Estonian version of the Clinical Institute of Withdrawal Assessment for Alcohol scale. Nord J Psychiatry 2024; 78:347-352. [PMID: 38436948 DOI: 10.1080/08039488.2024.2324061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
AIMS Our aim was to adapt the Clinical Institute of Withdrawal Assessment for Alcohol scale (CIWA-Ar) into Estonian and test its reliability and validity. METHODS A total of 72 patients with alcohol withdrawal syndrome participated in the study. In order to assess the interrater reliability, at first assessment the CIWA-Ar was simultaneously completed by two nurses. In order to assess the sensitivity of the CIWA-Ar to the changes in the severity of the withdrawal syndrome, as well as its correlations to several indices characterizing the subjects' current condition, the CIWA-Ar, the Clinical Global Impression Severity subscale (CGI-S), the visual analogue scales for the assessment of the general feeling of malaise, anxiety and depression were filled in and the vital signs were measured at inclusion, in 4 h and after the withdrawal syndrome had been resolved. RESULTS The intraclass correlation coefficient (ICC) for the Estonian version of the CIWA-Ar total score, used as an indicator of interrater reliability, was excellent. The CIWA-Ar had significant correlations with the psychiatrists' CGI-S ratings of the severity of the patient's condition at all assessment points. Significant correlations were also found between CIWA-Ar and patients' self-ratings, the highest correlations found with self-rated anxiety and general feeling of malaise. CIWA-Ar total score did not correlate with simultaneously measured heart rate, systolic and diastolic blood pressure at the first assessment. At the second assessment, heart rate had a significant correlation with the CIWA-Ar total score. CONCLUSION Our study provides confirmation that the CIWA-Ar tool is well applicable in the Estonian language and culture setting.
Collapse
Affiliation(s)
- Teelia Rolko
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
| | | | - Anu Aluoja
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Psychiatry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Innar Tõru
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Psychiatry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Sven Janno
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Psychiatry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|
4
|
Ratner JA, Blaney H, Rastegar DA. Management of alcohol withdrawal syndrome in patients with alcohol-associated liver disease. Hepatol Commun 2024; 8:e0372. [PMID: 38251886 PMCID: PMC10805424 DOI: 10.1097/hc9.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024] Open
Abstract
Alcohol-associated liver disease is a common and severe sequela of excessive alcohol use; effective treatment requires attention to both liver disease and underlying alcohol use disorder (AUD). Alcohol withdrawal syndrome (AWS) can be dangerous, is a common barrier to AUD recovery, and may complicate inpatient admissions for liver-related complications. Hepatologists can address these comorbid conditions by learning to accurately stage alcohol-associated liver disease, identify AUD using standardized screening tools (eg, Alcohol Use Disorder Identification Test), and assess risk for and symptoms of AWS. Depending on the severity, alcohol withdrawal often merits admission to a monitored setting, where symptom-triggered administration of benzodiazepines based on standardized scoring protocols is often the most effective approach to management. For patients with severe liver disease, selection of benzodiazepines with less dependence on hepatic metabolism (eg, lorazepam) is advisable. Severe alcohol withdrawal often requires a "front-loaded" approach with higher dosing, as well as intensive monitoring. Distinguishing between alcohol withdrawal delirium and HE is important, though it can be difficult, and can be guided by differentiating clinical characteristics, including time to onset and activity level. There is little data on the use of adjuvant medications, including anticonvulsants, dexmedetomidine, or propofol, in this patient population. Beyond the treatment of AWS, inpatient admission and outpatient hepatology visits offer opportunities to engage in planning for ongoing management of AUD, including initiation of medications for AUD and referral to additional recovery supports. Hepatologists trained to identify AUD, alcohol-associated liver disease, and risk for AWS can proactively address these issues, ensuring that patients' AWS is managed safely and effectively and supporting planning for long-term recovery.
Collapse
Affiliation(s)
- Jessica A. Ratner
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Hanna Blaney
- Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Darius A. Rastegar
- Division of Addiction Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
5
|
Malone D, Costin BN, MacElroy D, Al‐Hegelan M, Thompson J, Bronshteyn Y. Phenobarbital versus benzodiazepines in alcohol withdrawal syndrome. Neuropsychopharmacol Rep 2023; 43:532-541. [PMID: 37368937 PMCID: PMC10739082 DOI: 10.1002/npr2.12347] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 06/29/2023] Open
Abstract
AIM Phenobarbital, a long-acting barbiturate, presents an alternative to conventional benzodiazepine treatment for alcohol withdrawal syndrome (AWS). Currently, existing research offers only modest guidance on the safety and effectiveness of phenobarbital in managing AWS in hospital settings. The study objective was to assess if a phenobarbital protocol for the treatment of AWS reduces respiratory complications when compared to a more traditionally used benzodiazepine protocol. METHODS A retrospective cohort study analyzing adults who received either phenobarbital or benzodiazepine-based treatment for AWS over a 4-year period, 2015-2019, in a community teaching hospital in a large academic medical system. RESULTS A total of 147 patient encounters were included (76 phenobarbital and 71 benzodiazepine). Phenobarbital was associated with a significantly decreased risk of respiratory complications, defined by the occurrence of intubation (15/76 phenobarbital [20%] vs. 36/71 benzodiazepine [51%]) and decreased incidence of the requirement of six or greater liters of oxygen when compared with benzodiazepines (10/76 [13%] vs. 28/71 [39%]). There was a significantly higher incidence of pneumonia in benzodiazepine patients (15/76 [20%] vs. 33/71 [47%]). Mode Richmond Agitation Sedation Scale (RASS) scores were more frequently at goal (0 to -1) between 9 and 48 h after the loading dose of study medication for phenobarbital patients. Median hospital and ICU length of stay were significantly shorter for phenobarbital patients when compared with benzodiazepine patients (5 vs. 10 days and 2 vs. 4 days, respectively). CONCLUSION Parenteral phenobarbital loading doses with an oral phenobarbital tapered protocol for AWS resulted in decreased risk of respiratory complications when compared to standard treatment with benzodiazepines.
Collapse
Affiliation(s)
| | - Blair N. Costin
- Duke Regional HospitalDurhamNorth CarolinaUSA
- Duke University HospitalDurhamNorth CarolinaUSA
| | | | - Mashael Al‐Hegelan
- Duke Regional HospitalDurhamNorth CarolinaUSA
- Duke University HospitalDurhamNorth CarolinaUSA
| | - Julie Thompson
- Duke University School of NursingDurhamNorth CarolinaUSA
| | - Yuriy Bronshteyn
- Duke University HospitalDurhamNorth CarolinaUSA
- Durham Veterans Health AdministrationDurhamNorth CarolinaUSA
| |
Collapse
|
6
|
Affiliation(s)
- Alexander Alexiou
- Barts Health NHS Trust, London, UK
- London's Air Ambulance, Royal London Hospital, London
| | - Thomas King
- Barts Health NHS Trust, London, UK
- London's Air Ambulance, Royal London Hospital, London
| |
Collapse
|
7
|
Williams J, Collins L, Norman A, O'Neill H, Lloyd-Jones M, Ogden E, Bonomo Y, Pastor A. A Placebo-Controlled Randomized Trial of Vigabatrin in the Management of Acute Alcohol Withdrawal. Alcohol Alcohol 2023; 58:40-45. [PMID: 36161306 DOI: 10.1093/alcalc/agac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 08/14/2022] [Accepted: 08/14/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To undertake a double blinded randomised placebo-controlled trial to assess the efficacy of vigabatrin, a GABA-transaminase inhibitor, as a benzodiazepine sparing agent in the management of acute alcohol withdrawal syndrome in a residential setting. METHODS We enrolled 120 patients with alcohol use disorder who were randomly assigned to either treatment with vigabatrin (2g/day for 4 days) or placebo. The primary outcome was defined as the number of participants in each treatment arm needing diazepam for withdrawal management. A secondary outcome prespecified was the total dose of diazepam received by participants in each treatment arm. Participants were recruited on admission to a residential withdrawal unit at St Vincent's Hospital Melbourne from December 2014 to April 2019. RESULTS No significant difference was observed in the number of participants requiring benzodiazepines during their residential withdrawal stay with 44 participants (78.6%) in placebo arm requiring at least one dose of diazepam compared to 38 (66.7%) in vigabatrin arm (p = .156). An 18.1% difference was observed between the proportion of participants who received a total dose of >100mg of diazepam during their residential withdrawal stay in placebo arm (32.1%), compared to vigabatrin arm (14.0%, p = .022). There were higher rates of reported adverse events in placebo arm with nine (15.0%) participants reporting adverse events compared with two (3.3%) participants in vigabatrin arm (p = .027). CONCLUSION Vigabatrin significantly reduced the number of participants requiring >100mg diazepam over the course of their alcohol withdrawal and was associated with a reduction in adverse effects when compared to placebo.
Collapse
Affiliation(s)
- James Williams
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Lisa Collins
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Amanda Norman
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Helen O'Neill
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Martyn Lloyd-Jones
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Edward Ogden
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| | - Adam Pastor
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Victoria, 41 Victoria Parade, Fitzroy VIC 3065, Australia
| |
Collapse
|
8
|
Genetic and genomic signatures in ethanol withdrawal seizure-prone and seizure-resistant mice implicate genes involved in epilepsy and neuronal excitability. Mol Psychiatry 2022; 27:4611-4623. [PMID: 36198764 DOI: 10.1038/s41380-022-01799-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 12/14/2022]
Abstract
Alcohol withdrawal is a clinically important consequence and potential driver of Alcohol Use Disorder. However, susceptibility to withdrawal symptoms, ranging from craving and anxiety to seizures and delirium, varies greatly. Selectively bred Withdrawal Seizure-Prone (WSP) and Seizure-Resistant (WSR) mice are an animal model of differential susceptibility to withdrawal and phenotypes with which withdrawal severity correlates. To identify innate drivers of alcohol withdrawal severity, we performed a multi-omic study of the WSP and WSR lines and F2 mice derived from them, using genomic, genetic, and transcriptomic analyses. Genes implicated in seizures and epilepsy were over-represented among those that segregated between WSP and WSR mice and that displayed differential expression in F2 mice high and low in withdrawal. Quantitative trait locus (QTL) analysis of ethanol withdrawal convulsions identified several genome-wide significant loci and pointed to genes that modulate potassium channel function and neural excitability. Perturbations of expression of genes involved in synaptic transmission, including GABAergic and glutamatergic genes, were prominent in prefrontal cortex transcriptome. Expression QTL (eQTL) analysis fine mapped genes within the peak ethanol withdrawal QTL regions. Genetic association analysis in human subjects provided converging evidence for the involvement of those genes in severity of alcohol withdrawal and dependence. Our results reveal a polygenic network and neural signaling pathways contributing to ethanol withdrawal seizures and related phenotypes that overlap with genes modulating epilepsy and neuronal excitability.
Collapse
|
9
|
Front-Loaded Versus Low-Intermittent Phenobarbital Dosing for Benzodiazepine-Resistant Severe Alcohol Withdrawal Syndrome. J Med Toxicol 2022; 18:198-204. [PMID: 35668289 DOI: 10.1007/s13181-022-00900-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 05/05/2022] [Accepted: 05/10/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Phenobarbital is frequently used to manage severe alcohol withdrawal. The purpose of this study was to compare the incidence of mechanical ventilation in patients with benzodiazepine-resistant alcohol withdrawal between front-loaded and low-intermittent phenobarbital dosing strategies. METHODS In this retrospective before-after study, we analyzed patients that received phenobarbital for severe alcohol withdrawal syndrome in a tertiary medical ICU. Patients received low-intermittent phenobarbital doses (260 mg intravenous push × 1 followed by 130 mg intravenous push every 15 min as needed) from January 2013 to July 2015, and front-loaded phenobarbital doses (10 mg/kg intravenous infusion over 30 min) from July 2015 to January 2017. RESULTS In total, 87 patients met inclusion criteria for this study: 41 received low-intermittent phenobarbital and 46 received front-loaded phenobarbital). The incidence of mechanical ventilation was 13 (28%) in the front-loaded dosing group vs. 26 (63%) in the low-intermittent dosing group (odds ratio 4.4 [95% CI 1.8-10.9]). The cumulative dose of phenobarbital administered and serum phenobarbital levels were similar between both groups, although the front-loaded group had significantly lower benzodiazepine requirements than the low-intermittent group (median 86 mg [IQR 24-197] vs. 228 mg [115-298], P < 0.01) and reduced need for any continuous sedative infusion (OR 7.7 [95% CI 1.6-27], P < 0.01). There was no difference in respiratory failure or hypotension. CONCLUSIONS Front-loaded phenobarbital dosing, when compared to low-intermittent phenobarbital dosing, for benzodiazepine-resistant alcohol withdrawal was associated with significantly lower mechanical ventilation incidence and continuous sedative use.
Collapse
|
10
|
Wong M. Reversal Agents in Sedation and Anesthesia Practice for Dentistry. Anesth Prog 2022; 69:49-58. [PMID: 35377935 DOI: 10.2344/anpr-69-01-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/02/2022] [Indexed: 11/11/2022] Open
Abstract
Reversal agents are defined as any drug used to counteract the pharmacologic effects of another drug. Several pharmacologic antagonists serve as essential drugs in the contemporary practices of sedation providers and anesthesiologists. Reversal or "antidote" drugs, such as flumazenil and naloxone, are often used in unintentional overdose situations involving significant benzodiazepine- and/or opioid-induced respiratory depression. Within the context of skeletal muscle relaxation, neostigmine and sugammadex are routinely used to reverse the effects of nondepolarizing neuromuscular blocking agents. In addition, the alpha-adrenergic antagonist phentolamine is used in dentistry as a local anesthetic reversal agent, decreasing its duration of action by inducing vasodilation. This review article discusses the pharmacology, uses, practical implications, adverse effects, and precautions needed for flumazenil, naloxone, neostigmine, sugammadex, and phentolamine within the context of sedation and anesthesia practice for dentistry.
Collapse
Affiliation(s)
- Michelle Wong
- Dental Anesthesiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Quijano Cardé NA, De Biasi M. Behavioral characterization of withdrawal following chronic voluntary ethanol consumption via intermittent two-bottle choice points to different susceptibility categories. Alcohol Clin Exp Res 2022; 46:614-627. [PMID: 35102570 PMCID: PMC9018532 DOI: 10.1111/acer.14785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Alcohol is among the most commonly abused drugs worldwide. Cessation of chronic alcohol consumption can result in the appearance of withdrawal symptoms that commonly promote relapse in individuals with alcohol use disorder (AUD). Thus, preclinical models of voluntary alcohol consumption, in which animals manifest spontaneous signs of withdrawal after alcohol cessation, can be useful for studying AUD and its treatment. The intermittent two-bottle choice paradigm (I2BC) has been used extensively to examine alcohol intake in rodents. However, previous studies have reported conflicting observations regarding its potential to result in the spontaneous manifestation of withdrawal upon alcohol cessation. METHODS We employed a battery of behavioral tests to examine the emergence of affective and physical signs of withdrawal in female and male mice exposed to alcohol in the I2BC for 10 weeks. Specifically, mice of both sexes undergoing 24-h withdrawal from the I2BC were tested for physical signs of withdrawal, anxiety-like behavior in the open field arena (OFA) and elevated plus maze (EPM), and anxiety/compulsive-like behavior in the marble burying test (MBT). The main outcomes from these tests were combined into a behavioral severity score to describe the overall behavioral phenotype. RESULTS Both female and male mice undergoing withdrawal from the I2BC displayed elevated physical signs of withdrawal and anxiety-associated behavior in the EPM and MBT. Analysis of the overall behavioral severity score revealed more severe phenotypes in female and male mice undergoing withdrawal from the I2BC than controls. Additionally, stratification of the mice based on severity scores demonstrated a differential distribution of severities between the exposure groups. CONCLUSIONS We confirmed that a significant fraction of mice chronically exposed to alcohol in the I2BC display spontaneous withdrawal. In addition, we showed that computing a severity score from a combination of behavioral metrics can be useful in preclinical research to model evaluation tools used in patients with AUD.
Collapse
Affiliation(s)
- Natalia A Quijano Cardé
- Pharmacology Graduate Group, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Mariella De Biasi
- Pharmacology Graduate Group, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Psychiatry, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
12
|
Gakare SG, Varghese SS, Patni PP, Wagh SA, Ugale RR. Prevention of glutamate excitotoxicity in lateral habenula alleviates ethanol withdrawal-induced somatic and behavioral effects in ethanol dependent mice. Behav Brain Res 2022; 416:113557. [PMID: 34453973 DOI: 10.1016/j.bbr.2021.113557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 12/22/2022]
Abstract
Ethanol withdrawal commonly leads to anxiety-related disorder, a central factor toward negative reinforcement leading to relapse. The lateral habenula (LHb), an epithalamic nucleus, has emerged to be critical for both reward and aversion processing. Recent studies have also implicated the hyperactivity of LHb, adding to the emergence of negative emotional states during withdrawal from addictive drugs. Herein, we have studied the effects of glutamate transporter inhibitor (PDC), GluN2B-containing NMDAR antagonist (Ro25-6981), and intracellular calcium chelator (BAPTA-AM) injection in LHb on ethanol withdrawal symptoms. We found that ethanol 4 g/kg 20 % w/v intragastric (i.g.) for 10 days followed by 24 h of withdrawal showed a significant increase in somatic signs characterized by vocalization, shaking, and scratching. It also increased locomotor activity and anxiety-like behavior, collectively showing expression of ethanol withdrawal symptoms. The intra-LHb administration of PDC (0.5 ng) worsened the effect of ethanol withdrawal, whereas Ro25-6981 (2 and 4 ng) and BAPTA-AM (6.5 and 13 ng) significantly reversed ethanol withdrawal-induced behavior evident by a decrease in somatic signs, locomotor activity, and anxiety-like behavior. Further, pretreatment of Ro25-6981 and BAPTA-AM reduced the neuronal loss, whereas PDC increased it compared to the vehicle-treated group, as evidenced by NeuN staining. Altogether, our results suggest that increased glutamate, GluN2B activation, and likely calcium increase indicative of glutamate excitotoxicity-induced neuronal loss in LHb possibly endorse the emergence of ethanol withdrawal symptoms, while their inhibition might help in alleviating the ethanol withdrawal symptoms.
Collapse
Affiliation(s)
- Sukanya G Gakare
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India
| | - Shejin S Varghese
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India
| | - Paras P Patni
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India
| | - Samruddhi A Wagh
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India
| | - Rajesh R Ugale
- Department of Pharmaceutical Sciences, Rashtrasant Tukadoji Maharaj Nagpur University, Nagpur 440 033, India.
| |
Collapse
|
13
|
Zhu X, Huang J, Huang S, Wen Y, Lan X, Wang X, Lu C, Wang Z, Fan N, Shang D. Combining Metabolomics and Interpretable Machine Learning to Reveal Plasma Metabolic Profiling and Biological Correlates of Alcohol-Dependent Inpatients: What About Tryptophan Metabolism Regulation? Front Mol Biosci 2021; 8:760669. [PMID: 34859050 PMCID: PMC8630631 DOI: 10.3389/fmolb.2021.760669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
Alcohol dependence (AD) is a condition of alcohol use disorder in which the drinkers frequently develop emotional symptoms associated with a continuous alcohol intake. AD characterized by metabolic disturbances can be quantitatively analyzed by metabolomics to identify the alterations in metabolic pathways. This study aimed to: i) compare the plasma metabolic profiling between healthy and AD-diagnosed individuals to reveal the altered metabolic profiles in AD, and ii) identify potential biological correlates of alcohol-dependent inpatients based on metabolomics and interpretable machine learning. Plasma samples were obtained from healthy (n = 42) and AD-diagnosed individuals (n = 43). The plasma metabolic differences between them were investigated using liquid chromatography-tandem mass spectrometry (AB SCIEX® QTRAP 4500 system) in different electrospray ionization modes with scheduled multiple reaction monitoring scans. In total, 59 and 52 compounds were semi-quantitatively measured in positive and negative ionization modes, respectively. In addition, 39 metabolites were identified as important variables to contribute to the classifications using an orthogonal partial least squares-discriminant analysis (OPLS-DA) (VIP > 1) and also significantly different between healthy and AD-diagnosed individuals using univariate analysis (p-value < 0.05 and false discovery rate < 0.05). Among the identified metabolites, indole-3-carboxylic acid, quinolinic acid, hydroxy-tryptophan, and serotonin were involved in the tryptophan metabolism along the indole, kynurenine, and serotonin pathways. Metabolic pathway analysis revealed significant changes or imbalances in alanine, aspartate, glutamate metabolism, which was possibly the main altered pathway related to AD. Tryptophan metabolism interactively influenced other metabolic pathways, such as nicotinate and nicotinamide metabolism. Furthermore, among the OPLS-DA-identified metabolites, normetanephrine and ascorbic acid were demonstrated as suitable biological correlates of AD inpatients from our model using an interpretable, supervised decision tree classifier algorithm. These findings indicate that the discriminatory metabolic profiles between healthy and AD-diagnosed individuals may benefit researchers in illustrating the underlying molecular mechanisms of AD. This study also highlights the approach of combining metabolomics and interpretable machine learning as a valuable tool to uncover potential biological correlates. Future studies should focus on the global analysis of the possible roles of these differential metabolites and disordered metabolic pathways in the pathophysiology of AD.
Collapse
Affiliation(s)
- Xiuqing Zhu
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Jiaxin Huang
- Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Shanqing Huang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yuguan Wen
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Xiaochang Lan
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Xipei Wang
- Department of Medical Sciences, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chuanli Lu
- Guangzhou Rely Medical Diagnostic Technology Co. Ltd., Guangzhou, China
| | - Zhanzhang Wang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| | - Ni Fan
- Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China.,Department of Substance Dependence, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Dewei Shang
- Department of Pharmacy, The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Guangdong Engineering Technology Research Center for Translational Medicine of Mental Disorders, Guangzhou, China
| |
Collapse
|
14
|
Rafi H, Rafiq H, Farhan M. Inhibition of NMDA receptors by agmatine is followed by GABA/glutamate balance in benzodiazepine withdrawal syndrome. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2021. [DOI: 10.1186/s43088-021-00125-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Drug withdrawal syndrome occurs due to abrupt cessation of an addictive substance. Dependence to diazepam can be manifested by withdrawal syndrome which may include symptoms such as irritability, psychosis, sleep disturbance, seizures, mood disturbance, and anxiety. Studies have described the therapeutic role of agmatine in various neurological disorders such as depressive mood, learning deficits, anxiety, memory impairment, and psychosis. Various studies have also validated agmatine as a putant neuromodulator and revealed its mechanism of action with other neurotransmitters. The study was designed to reveal the potentials of agmatine in benzodiazepine withdrawal syndrome by maintaining GABA/glutamate balance. The study aimed to determine the underlying mechanism of action of agmatine at synaptic level using behavioral and biochemical evaluations.
Results
Agmatine significantly enhanced locomotion in open filed test and decreased anxiety as observed in elevated plus maze test (p < 0.01). Agmatine also reduced withdrawal symptoms scores along with compulsive behaviors in marble burying test and improved muscular strength by decreasing latency to fall in inverted screen test (p < 0.01). Moreover, agmatine established GABA/glutamate balance by increasing GABA levels and decreased glutamate concentration significantly (p < 0.01).
Conclusion
The present study reveals the possible mechanism of action of agmatine on NMDA receptor at GABA interneurons and glutamate post synaptic neuron that may lead to GABA/glutamate balance during withdrawal syndrome.
Collapse
|
15
|
Ostap-Chec M, Opalek M, Stec D, Miler K. Discontinued alcohol consumption elicits withdrawal symptoms in honeybees. Biol Lett 2021; 17:20210182. [PMID: 34129796 PMCID: PMC8205535 DOI: 10.1098/rsbl.2021.0182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/24/2021] [Indexed: 01/04/2023] Open
Abstract
The honeybee continues to be developed as a model species in many research areas, including studies related to the effects of alcohol. Here, we investigate whether workers display one of the key features of alcoholism, namely withdrawal symptoms. We show that workers fed for a prolonged time on food spiked with ethanol, after discontinuation of access to such food, exhibited a marked increase in the consumption of ethanol and a slight increase in mortality. We additionally show that withdrawal symptoms do not include an increase in appetitiveness of ethanol diluted in water. Our results demonstrate that workers can develop alcohol dependence, which might be especially important in the natural setting of repeated exposure to ethanol in floral nectar and for their potential as a model of alcohol addiction.
Collapse
Affiliation(s)
- Monika Ostap-Chec
- Institute of Environmental Sciences, Faculty of Biology, Jagiellonian University, Gronostajowa 7, 30-387 Kraków, Poland
| | - Monika Opalek
- Institute of Environmental Sciences, Faculty of Biology, Jagiellonian University, Gronostajowa 7, 30-387 Kraków, Poland
| | - Daniel Stec
- Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University, Gronostajowa 9, 30-387 Kraków, Poland
| | - Krzysztof Miler
- Institute of Systematics and Evolution of Animals, Polish Academy of Sciences, Sławkowska 17, 31-016 Kraków, Poland
| |
Collapse
|
16
|
Wang A, Park A, Albert R, Barriga A, Goodrich L, Nguyen BN, Knox E, Preda A. Iatrogenic Delirium in Patients on Symptom-Triggered Alcohol Withdrawal Protocol: A Case Series. Cureus 2021; 13:e15373. [PMID: 34249526 PMCID: PMC8248506 DOI: 10.7759/cureus.15373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/15/2022] Open
Abstract
In this report, we present a case series involving four patients placed on the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) protocol for alcohol or sedative-hypnotic withdrawal syndromes, who developed delirium on sustained or increasing symptom-triggered benzodiazepine dosages. In each of the four cases, delirium was not present on admission and resolved in the hospital itself with fixed benzodiazepine tapers. Cases were selected from an electronic medical record database of patients admitted to a United States-based university hospital and placed on CIWA-Ar between 2017 and 2018. This case series illustrates the major limitations of CIWA-Ar including its subjective nature, its susceptibility to inappropriate patient selection, and its requirement for providers to consider alternative etiologies to alcohol and benzodiazepine withdrawal syndromes. These cases demonstrate the necessity of considering other assessment and treatment options such as objective alcohol withdrawal scales, fixed benzodiazepine tapers, and even antiepileptics. An effective systems-based approach to overcoming these challenges may include setting time limits on CIWA-Ar orders within the electronic health record (EHR) system.
Collapse
Affiliation(s)
- Alex Wang
- Psychiatry and Neurology, University of California Irvine School of Medicine, Irvine, USA
| | - Andrew Park
- Psychiatry and Neurology, University of California Irvine Medical Center, Orange, USA
| | - Ralph Albert
- Psychiatry and Neurology, University of California Irvine School of Medicine, Irvine, USA
| | - Alyssa Barriga
- Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, USA
| | - Leigh Goodrich
- Psychiatry and Neurology, University of California Irvine Medical Center, Orange, USA
| | - Bao-Nhan Nguyen
- Psychiatry and Neurology, University of California Irvine Medical Center, Orange, USA
| | - Erin Knox
- Psychiatry and Neurology, University of California Irvine Health Sciences, Orange, USA
| | - Adrian Preda
- Psychiatry and Neurology, University of California Irvine Medical Center, Orange, USA
| |
Collapse
|
17
|
Pribék IK, Kovács I, Kádár BK, Kovács CS, Richman MJ, Janka Z, Andó B, Lázár BA. Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol - Revised: A systematic review-based meta-analysis. Drug Alcohol Depend 2021; 220:108536. [PMID: 33503582 DOI: 10.1016/j.drugalcdep.2021.108536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the Clinical Institute Withdrawal Assessment for Alcohol - Revised (CIWA-Ar) is a gold standard tool for the clinical evaluation of alcohol withdrawal syndrome (AWS), a systematic analysis using the total scores of the CIWA-Ar as a means of an objective follow-up of the course and treatment of AWS is missing. The aims of the present study were to systematically evaluate scientific data using the CIWA-Ar, to reveal whether the aggregated CIWA-Ar total scores follow the course of AWS and to compare benzodiazepine (BZD) and non-benzodiazepine (nBZD) therapies in AWS. METHODS 1054 findings were identified with the keyword "ciwa" from four databases (PubMed, ScienceDirect, Web of Science, Cochrane Registry). Articles using CIWA-Ar in patients treated with AWS were incorporated and two measurement intervals (cumulative mean data of day 1-3 and day 4-9) of the CIWA-Ar total scores were compared. Subgroup analysis based on pharmacotherapy regimen was conducted to compare the effectiveness of BZD and nBZD treatments. RESULTS The random effects analysis of 423 patients showed decreased CIWA-Ar scores between the two measurement intervals (BZD: d = -1.361; CI: -1.829 < δ < -0.893; nBZD: d = -0.858; CI: -1.073 < δ < -0.643). Sampling variances were calculated for the BZD (v1 = 0.215) and the nBZD (v2 = 0.106) groups, which indicated no significant group difference (z = -1.532). CONCLUSIONS Our findings support that the CIWA-Ar follows the course of AWS. Furthermore, nBZD therapy has a similar effectiveness compared to BZD treatment based on the CIWA-Ar total scores.
Collapse
Affiliation(s)
- Ildikó Katalin Pribék
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary.
| | - Ildikó Kovács
- Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bettina Kata Kádár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Csenge Sára Kovács
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Mara J Richman
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa Street 8, H-1085, Budapest, Hungary; Endeavor Psychology, 10 Newbury Street, Boston, MA, 02116, USA
| | - Zoltán Janka
- Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bálint Andó
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bence András Lázár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary.
| |
Collapse
|
18
|
Sharma L, Sharma A, Dash AK, Bisht GS, Gupta GL. A standardized polyherbal preparation POL-6 diminishes alcohol withdrawal anxiety by regulating Gabra1, Gabra2, Gabra3, Gabra4, Gabra5 gene expression of GABA A receptor signaling pathway in rats. BMC Complement Med Ther 2021; 21:13. [PMID: 33407346 PMCID: PMC7789136 DOI: 10.1186/s12906-020-03181-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Alcohol abuse is a major problem worldwide and it affects people's health and economy. There is a relapse in alcohol intake due to alcohol withdrawal. Alcohol withdrawal anxiety-like behavior is a symptom that appears 6-24 h after the last alcohol ingestion. METHODS The present study was designed to explore the protective effect of a standardized polyherbal preparation POL-6 in ethanol withdrawal anxiety in Wistar rats. POL-6 was prepared by mixing the dried extracts of six plants Bacopa monnieri, Hypericum perforatum, Centella asiatica, Withania somnifera, Camellia sinesis, and Ocimum sanctum in the proportion 2:1:2:2:1:2 respectively. POL-6 was subjected to phytochemical profiling through LC-MS, HPLC, and HPTLC. The effect of POL-6 on alcohol withdrawal anxiety was tested using a two-bottle choice drinking paradigm model giving animals' free choice between alcohol and water for 15 days. Alcohol was withdrawn on the 16th day and POL-6 (20, 50, and 100 mg/kg, oral), diazepam (2 mg/kg) treatment was given on the withdrawal days. Behavioral parameters were tested using EPM and LDT. On the 18th day blood was collected from the retro-orbital sinus of the rats and alcohol markers ALT, AST, ALP, and GGT were studied. At end of the study, animals were sacrificed and the brain was isolated for exploring the influences of POL-6 on the mRNA expression of GABAA receptor subunits in the amygdala and hippocampus. RESULTS Phytochemical profiling showed that POL-6 contains major phytoconstituents like withaferin A, quercetin, catechin, rutin, caeffic acid, and β-sitosterol. In-vivo studies showed that POL-6 possesses an antianxiety effect in alcohol withdrawal. Gene expression studies on the isolated brain tissues showed that POL-6 normalizes the GABAergic transmission in the amygdala and hippocampus of the rats. CONCLUSION The study concludes that POL-6 may have therapeutic potential for treating ethanol-type dependence.
Collapse
Affiliation(s)
- Lalit Sharma
- Department of Pharmacy, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India
| | - Aditi Sharma
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India
| | - Ashutosh Kumar Dash
- School of Pharmaceutical Sciences, Shoolini University, Solan, Himachal Pradesh, 173229, India
- Natural Product Chemistry Division, CSIR-Indian Institute of Integrative Medicine, Jammu, 180001, India
| | - Gopal Singh Bisht
- Department of BT/BI, Jaypee University of Information Technology, Waknaghat, Solan, Himachal Pradesh, 173234, India
| | - Girdhari Lal Gupta
- Department of Pharmacology, Shobhaben Pratapbhai Patel School of Pharmacy & Technology Management, Shri Vile Parle Kelavani Mandal's Narsee Monjee Institute of Management Studies University, Mumbai, Maharashtra, 400056, India.
- School of Pharmacy & Technology Management, Shri Vile Parle Kelavani Mandal's Narsee Monjee Institute of Management Studies, Shirpur Campus, Shirpur, Maharashtra, 425405, India.
| |
Collapse
|
19
|
Sanvisens A, Zuluaga P, Short A, Rubio G, Gual A, Torrens M, Fuster D, Bolao F, Rodríguez de Fonseca F, Muga R. Sex-specific Associations of Alcohol Withdrawal in Patients Admitted for the Treatment of Alcohol Use Disorder. J Addict Med 2021; 15:68-73. [PMID: 32769772 DOI: 10.1097/adm.0000000000000704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There are sex differences in the pattern of alcohol consumption and in the complications of alcohol use disorder (AUD). We aimed to identify sex-specific differences in the factors associated with alcohol withdrawal syndrome (AWS) among patients that requested a first treatment for AUD. METHODS We enrolled 313 patients (75% men) with a Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD diagnosis that started treatment between 2014 and 2016. We collected socio-demographics, the type and amount of alcohol and other substances consumed, and clinical and laboratory parameters. According to Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) AUD criteria, AWS occurred when patients experienced 2 or more clinical signs/symptoms and/or consumed alcohol to relieve symptoms. Logistic regression models were used to determine factors associated with AWS according to sex. RESULTS The median age of participants was 50 years (interquartile range [IQR]: 43-54 years). The median age of starting alcohol consumption was 16 years (IQR: 14-18 years). Notably, 69% of participants smoked tobacco, and 61% had a family history of AUD; 18% currently used cannabis, and 7.7% used cocaine. Overall, 73% of patients exhibited AWS criteria, and men (76.5%) were more likely than women (64.6%) to report AWS (P = 0.038). In the adjusted analysis, factors associated with AWS were the age at starting alcohol consumption (odds ratio [OR] for every 5 years = 1.89, 95% confidence interval [CI]: 1.69-2.08), and cannabis use (OR = 2.8, 95% CI: 1.04-7.7) in men, and a family history of AUD in women (OR = 2.85 95% CI: 1.07-7.54). CONCLUSIONS factors associated with AWS differ by sex which may have clinical implications for proactive management of AWS during treatment for AUD.
Collapse
Affiliation(s)
- Arantza Sanvisens
- Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol - IGTP, Universitat Autònoma de Barcelona, Spain (AS, PZ, DF, RM); Alcohol Unit, Hospital Universitari Son Espases - IdISPa, Palma de Mallorca, Spain (AS); Department of Psychiatry, Hospital Universitario 12 de Octubre - Instituto i+12, Universidad Complutense de Madrid, Spain (GR); Department of Psychiatry, Hospital Clínic de Barcelona - IDIBAPS, Universitat de Barcelona, Spain (AG); Department of Neuropsychiatry and Addictions, Hospital del Mar - IMIM, Universitat Autònoma de Barcelona, Spain (MT); Department of Internal Medicine, Hospital Universitari de Bellvitge- IDIBELL, L'Hospitalet de Llobregat, Spain (FB); IBIMA Biomedical Research Institut - Málaga, Spain (FRdF)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Nickell CG, Thompson KR, Pauly JR, Nixon K. Recovery of Hippocampal-Dependent Learning Despite Blunting Reactive Adult Neurogenesis After Alcohol Dependence. Brain Plast 2020; 6:83-101. [PMID: 33680848 PMCID: PMC7903006 DOI: 10.3233/bpl-200108] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background: The excessive alcohol drinking that occurs in alcohol use disorder (AUD) causes neurodegeneration in regions such as the hippocampus, though recovery may occur after a period of abstinence. Mechanisms of recovery are not clear, though reactive neurogenesis has been observed in the hippocampal dentate gyrus following alcohol dependence and correlates to recovery of granule cell number. Objective: We investigated the role of neurons born during reactive neurogenesis in the recovery of hippocampal learning behavior after 4-day binge alcohol exposure, a model of an AUD. We hypothesized that reducing reactive neurogenesis would impair functional recovery. Methods: Adult male rats were subjected to 4-day binge alcohol exposure and two approaches were tested to blunt reactive adult neurogenesis, acute doses of alcohol or the chemotherapy drug, temozolomide (TMZ). Results: Acute 5 g/kg doses of EtOH gavaged T6 and T7 days post binge did not inhibit significantly the number of Bromodeoxyuridine-positive (BrdU+) proliferating cells in EtOH animals receiving 5 g/kg EtOH versus controls. A single cycle of TMZ inhibited reactive proliferation (BrdU+ cells) and neurogenesis (NeuroD+ cells) to that of controls. However, despite this blunting of reactive neurogenesis to basal levels, EtOH-TMZ rats were not impaired in their recovery of acquisition of the Morris water maze (MWM), learning similarly to all other groups 35 days after 4-day binge exposure. Conclusions: These studies show that TMZ is effective in decreasing reactive proliferation/neurogenesis following 4-day binge EtOH exposure, and baseline levels of adult neurogenesis are sufficient to allow recovery of hippocampal function.
Collapse
Affiliation(s)
- Chelsea G Nickell
- University of Kentucky, Department of Pharmaceutical Sciences, Lexington, KY, USA
| | - K Ryan Thompson
- The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| | - James R Pauly
- University of Kentucky, Department of Pharmaceutical Sciences, Lexington, KY, USA
| | - Kimberly Nixon
- University of Kentucky, Department of Pharmaceutical Sciences, Lexington, KY, USA.,The University of Texas at Austin, College of Pharmacy, Austin, TX, USA
| |
Collapse
|
21
|
Thiercelin N, Plat A, Garin A, Azuar J. [Alcohol withdrawal delirium: What's new for an old disease?]. Rev Med Interne 2020; 42:330-337. [PMID: 33218791 DOI: 10.1016/j.revmed.2020.10.383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/08/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
The management of alcohol withdrawal syndrome is a frequent work in both community medicine and hospital wards. One of the most severe complications of alcohol withdrawal is Delirium Tremens (DT). The purpose of this development is to update knowledge on this complication in terms of diagnosis, evaluation and therapeutic approaches. It also proposes a reflection on the trajectory of care during and after DT.
Collapse
Affiliation(s)
- N Thiercelin
- Centre hospitalier des quatre villes, unité d'addictologie, 141 grande rue, 91570 Sèvres, France.
| | - A Plat
- Clinique des Epinettes, 51, bis rue des Epinettes, 75017 Paris, France
| | - A Garin
- Service de réanimation, centre hospitalier général de Dreux, 44, avenue J.F.-Kennedy, 28100 Dreux, France
| | - J Azuar
- APHP GHU Nord, Site Lariboisière Fernand-Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France; Inserm UMRS-1144 Optimisation thérapeutique en neuropsychopharmacologie, Université de Paris, Paris, France; FHU NOR-SUD, Paris, France
| |
Collapse
|
22
|
McLean C, Tapsell L, Grafenauer S, McMahon AT. Nutritional Care of Patients Admitted to Hospital for Alcohol Withdrawal: A 5-Year Retrospective Audit. Alcohol Alcohol 2020; 55:489-496. [PMID: 32628260 DOI: 10.1093/alcalc/agaa060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/27/2020] [Accepted: 06/05/2020] [Indexed: 11/12/2022] Open
Abstract
AIM The aim of this study was to describe the characteristics and the nutritional approaches implemented with patients undergoing alcohol withdrawal. METHODS A retrospective analysis of medical records for patients admitted to a tertiary hospital for alcohol withdrawal was completed over a 5-year period 2013-2017. Data on nutrition-related assessment and management were extracted and descriptively analysed. RESULTS A total of 109 medical records were included (M = 73, F = 36), with the mean age of patients 47.3 years (SD ± 11.2, range 22-70). The average length of stay was 3.7 days (SD ± 3.9, range 0.70-27.8). Approaches towards nutritional care emerged from micronutrient assessment and supplementation and/or dietetic consultation. Nutrition-related biochemistry data was available for most patients, notably serum levels of sodium, urea and creatinine (102 patients; 93.5%) and magnesium and phosphate (66 patients, 60.5%). There was evidence of some electrolyte abnormalities on admission to hospital. Eight patients had serum micronutrient status assessed; no patients had serum thiamine levels assessed. Parenteral thiamine was provided to 96 patients (88.0%) for 1.9 days (SD ± 1.1, range 1.0-6.0) with a mean dose of 2458.7 mg (SD ± 1347.6, range 300-6700 mg). Multivitamin supplementation was provided to 24 patients (22.0%). Only 23 patients (21.2%) were seen by a dietician of whom 16 underwent a comprehensive nutritional assessment and 3 were screened using the malnutrition screening tool. CONCLUSION Inconsistent nutritional assessment and management practices were identified across a diverse population group, whilst nutritional professionals were underutilized. Future research should benchmark current guidelines and multidisciplinary approaches considering the role of nutritional specialists in the team.
Collapse
Affiliation(s)
- Cameron McLean
- Nutrition and Dietetics Department, St George Hospital, Kogarah, 2217 New South Wales, Australia.,Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, 2500 New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, 2500 New South Wales, Australia
| | - Linda Tapsell
- Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, 2500 New South Wales, Australia.,Illawarra Health and Medical Research Institute, Wollongong, 2500 New South Wales, Australia
| | - Sara Grafenauer
- Nutrition and Dietetics, School of Medicine, University of Wollongong, Wollongong, 2500 New South Wales, Australia
| | - Anne-Therese McMahon
- Public Health Nutrition, School of Health and Society, University of Wollongong, 2500 New South Wales, Australia
| |
Collapse
|
23
|
Burkhardt G, Adorjan K, Kambeitz J, Kambeitz-Ilankovic L, Falkai P, Eyer F, Koller G, Pogarell O, Koutsouleris N, Dwyer DB. A machine learning approach to risk assessment for alcohol withdrawal syndrome. Eur Neuropsychopharmacol 2020; 35:61-70. [PMID: 32418843 DOI: 10.1016/j.euroneuro.2020.03.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 03/04/2020] [Accepted: 03/27/2020] [Indexed: 02/01/2023]
Abstract
At present, risk assessment for alcohol withdrawal syndrome relies on clinical judgment. Our aim was to develop accurate machine learning tools to predict alcohol withdrawal outcomes at the individual subject level using information easily attainable at patients' admission. An observational machine learning analysis using nested cross-validation and out-of-sample validation was applied to alcohol-dependent patients at two major detoxification wards (LMU, n = 389; TU, n = 805). 121 retrospectively derived clinical, blood-derived, and sociodemographic measures were used to predict 1) moderate to severe withdrawal defined by the alcohol withdrawal scale, 2) delirium tremens, and 3) withdrawal seizures. Mild and more severe withdrawal cases could be separated with significant, although highly variable accuracy in both samples (LMU, balanced accuracy [BAC] = 69.4%; TU, BAC = 55.9%). Poor outcome predictions were associated with higher cumulative clomethiazole doses during the withdrawal course. Delirium tremens was predicted in the TU cohort with BAC of 75%. No significant model predicting withdrawal seizures could be found. Our models were unique to each treatment site and thus did not generalize. For both treatment sites and withdrawal outcome different variable sets informed our models' decisions. Besides previously described variables (most notably, thrombocytopenia), we identified new predictors (history of blood pressure abnormalities, urine screening for benzodiazepines and educational attainment). In conclusion, machine learning approaches may facilitate generalizable, individualized predictions for alcohol withdrawal severity. Since predictive patterns highly vary for different outcomes of withdrawal severity and across treatment sites, prediction tools should not be recommended for clinical practice unless adequately validated in specific cohorts.
Collapse
Affiliation(s)
- Gerrit Burkhardt
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany.
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany; Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
| | - Joseph Kambeitz
- Department of Psychiatry and Psychotherapy, University of Cologne, Germany
| | - Lana Kambeitz-Ilankovic
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany
| | - Florian Eyer
- Department of Clinical Toxicology, TUM School of Medicine, Technical University of Munich, Germany
| | - Gabi Koller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany
| | - Nikolaos Koutsouleris
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany
| | - Dominic B Dwyer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich Nussbaumstr. 7, 80336 Munich, Germany
| |
Collapse
|
24
|
Wolf C, Curry A, Nacht J, Simpson SA. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open Access Emerg Med 2020; 12:53-65. [PMID: 32256131 PMCID: PMC7093658 DOI: 10.2147/oaem.s235288] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.
Collapse
Affiliation(s)
- Chelsea Wolf
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashley Curry
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Nacht
- Denver Health Medical Center, Denver, CO, USA
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Scott A Simpson
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| |
Collapse
|
25
|
Nejad S, Nisavic M, Larentzakis A, Dijkink S, Chang Y, Levine AR, de Moya M, Velmahos G. Phenobarbital for Acute Alcohol Withdrawal Management in Surgical Trauma Patients-A Retrospective Comparison Study. PSYCHOSOMATICS 2020; 61:327-335. [PMID: 32199629 DOI: 10.1016/j.psym.2020.01.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Alcohol withdrawal syndrome (AWS) in surgical trauma patients is associated with significant morbidity and mortality. Benzodiazepines, commonly used for withdrawal management, pose unique challenges in this population given the high prevalence of head trauma and delirium. Phenobarbital is an antiepileptic drug that offers a viable alternative to benzodiazepines for AWS treatment. METHODS This is a retrospective chart review of patients with active alcohol use disorder who presented to a level 1 trauma center over a 4-year period and required medication-assisted management for AWS. The primary outcome variable examined was the development of AWS and associated complications. Additional outcomes measured included hospital length of stay, mortality, and medication-related adverse events. RESULTS Of the 85 patients in the study sample, 52 received a fixed-dose benzodiazepine-based protocol and 33 received phenobarbital-based protocol. In the benzodiazepine-based protocol group, 25 patients (48.2%) developed AWD and 38 (73.1%) developed uncomplicated AWS, as compared to 0 patients in the phenobarbital-based protocol (P = 0.0001). There were 10 (19.2%) patients with medication adverse side effects in the benzodiazepine-based protocol group versus 0 patients in the phenobarbital-based protocol group. There were no statically significant differences between the 2 groups as pertains to rates of other AWS-related complications, patient mortality, or length of stay. CONCLUSION The use of a phenobarbital-based protocol in trauma patients with underlying active alcohol use disorder resulted in a statistically significant decrease in the incidence of AWD and uncomplicated AWS secondary to AWS when compared to patients treated with a fixed-dose benzodiazepine-based protocol.
Collapse
Affiliation(s)
- Shamim Nejad
- Division of Psychosocial Oncology - Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Mladen Nisavic
- Addiction Consult Service, Avery D. Weismann, Psychiatry Consultation Service, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Andreas Larentzakis
- First Department of Propaedeutic Surgery, Hippokration General Hospital of Athens, Athens Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Suzan Dijkink
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Yuchiao Chang
- Trauma, Emergency Surgery and Surgical Critical Care Service, Massachusetts General Hospital, Boston, MA
| | - Alexander R Levine
- Assistant Professor of Pharmacy Practice, University of Saint Joseph School of Pharmacy, Department of Pharmacy Practice, Hartford, CT
| | - Marc de Moya
- Division of Trauma and Acute Care Surgery, Milton and Lidy Lunda/Charles Aprahamian Professor of Trauma Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - George Velmahos
- Trauma, Emergency Surgery and Surgical Critical Care Service, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
26
|
McLean C, Tapsell L, Grafenauer S, McMahon A. Systematic review of nutritional interventions for people admitted to hospital for alcohol withdrawal. Nutr Diet 2019; 77:76-89. [DOI: 10.1111/1747-0080.12593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/17/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022]
Affiliation(s)
- Cameron McLean
- Nutrition and Dietetics DepartmentSt George Hospital Kogarah New South Wales Australia
- Nutrition and DieteticsSchool of Medicine, University of Wollongong Wollongong New South Wales Australia
| | - Linda Tapsell
- Nutrition and DieteticsSchool of Medicine, University of Wollongong Wollongong New South Wales Australia
| | - Sara Grafenauer
- Nutrition and DieteticsSchool of Medicine, University of Wollongong Wollongong New South Wales Australia
| | - Anne‐Therese McMahon
- Public Health NutritionSchool of Health and Society, University of Wollongong Wollongong New South Wales Australia
| |
Collapse
|
27
|
Roberts AJ, Khom S, Bajo M, Vlkolinsky R, Polis I, Cates-Gatto C, Roberto M, Gruol DL. Increased IL-6 expression in astrocytes is associated with emotionality, alterations in central amygdala GABAergic transmission, and excitability during alcohol withdrawal. Brain Behav Immun 2019; 82:188-202. [PMID: 31437534 PMCID: PMC6800653 DOI: 10.1016/j.bbi.2019.08.185] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 01/14/2023] Open
Abstract
Accumulating evidence from preclinical and clinical studies has implicated a role for the cytokine IL-6 in a variety of CNS diseases including anxiety-like and depressive-like behaviors, as well as alcohol use disorder. Here we use homozygous and heterozygous transgenic mice expressing elevated levels of IL-6 in the CNS due to increased astrocyte expression and non-transgenic littermates to examine a role for astrocyte-produced IL-6 in emotionality (response to novelty, anxiety-like, and depressive-like behaviors). Our results from homozygous IL-6 mice in a variety of behavioral tests (light/dark transfer, open field, digging, tail suspension, and forced swim tests) support a role for IL-6 in stress-coping behaviors. Ex vivo electrophysiological studies of neuronal excitability and inhibitory GABAergic synaptic transmission in the central nucleus of the amygdala (CeA) of the homozygous transgenic mice revealed increased inhibitory GABAergic signaling and increased excitability of CeA neurons, suggesting a role for astrocyte produced IL-6 in the amygdala in exploratory drive and depressive-like behavior. Furthermore, studies in the hippocampus of activation/expression of proteins associated with IL-6 signal transduction and inhibitory GABAergic mechanisms support a role for astrocyte produced IL-6 in depressive-like behaviors. Our studies indicate a complex and dose-dependent relationship between IL-6 and behavior and implicate IL-6 induced neuroadaptive changes in neuronal excitability and the inhibitory GABAergic system as important contributors to altered behavior associated with IL-6 expression in the CNS.
Collapse
Affiliation(s)
- Amanda J. Roberts
- Animal Models Core Facility, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Sophia Khom
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Michal Bajo
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Roman Vlkolinsky
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Ilham Polis
- Animal Models Core Facility, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Chelsea Cates-Gatto
- Animal Models Core Facility, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Marisa Roberto
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA 92037 U.S.A
| | - Donna L. Gruol
- Neuroscience Department, The Scripps Research Institute, La Jolla, CA 92037 U.S.A,Corresponding Author: Dr. Donna L. Gruol, Neuroscience Department, SP30-1522, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, Phone: (858) 784-7060, Fax: (858) 784-7393,
| |
Collapse
|
28
|
Farooq H, Mohammad T, Farooq A, Mohammad Q. Alcohol Withdrawal Mimicking Neuroleptic Malignant Syndrome. Cureus 2019; 11:e4697. [PMID: 31338272 PMCID: PMC6639086 DOI: 10.7759/cureus.4697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Long-standing, heavy alcohol use can lead to alcohol dependence, which predisposes to alcohol withdrawal if alcohol consumption is suddenly decreased or stopped. Alcohol withdrawal syndrome is characterized by a hyperadrenergic response, with symptoms ranging from mild tremulousness to delirium tremens. We report a 55-year-old male presenting with hyperthermia, tachycardia, tachypnea, altered consciousness, tremors, rigidity, diaphoresis, elevated creatinine kinase, and myoglobinuria. The diagnosis of alcohol withdrawal was made due to a history of alcohol use disorder with the last drink two days ago and no history of any medication or drug intake prior to admission. He was treated with benzodiazepines with an improvement in his condition.
Collapse
Affiliation(s)
- Hafsa Farooq
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Tayyaba Mohammad
- Internal Medicine, Rutgers New Jersey Medical School, Newark, USA
| | - Amna Farooq
- Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, PAK
| | - Qasim Mohammad
- Internal Medicine, Windsor University School of Medicine, Boonton, USA
| |
Collapse
|
29
|
Nisavic M, Nejad SH, Isenberg BM, Bajwa EK, Currier P, Wallace PM, Velmahos G, Wilens T. Use of Phenobarbital in Alcohol Withdrawal Management - A Retrospective Comparison Study of Phenobarbital and Benzodiazepines for Acute Alcohol Withdrawal Management in General Medical Patients. PSYCHOSOMATICS 2019; 60:458-467. [PMID: 30876654 DOI: 10.1016/j.psym.2019.02.002] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/03/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Benzodiazepine-based protocols offer a standard of care for management of alcohol withdrawal, though they may not be safe or appropriate for all patients. Phenobarbital, a long-acting barbiturate, presents an alternative to conventional benzodiazepine treatment, though existing research offers only modest guidance to the safety and effectiveness of phenobarbital in managing alcohol withdrawal syndrome (AWS) in general hospital settings. METHODS To compare clinical effectiveness of phenobarbital versus benzodiazepines in managing symptoms of alcohol withdrawal, we conducted a retrospective chart review of 562 patients admitted over a 2-year period to a general hospital and treated for AWS. The development of AWS-related complications (seizures, alcoholic hallucinosis, and alcohol withdrawal delirium) post-treatment initiation was the primary outcome examined in both treatment groups. Additional outcomes measured included hospital length of stay, intensive care unit (ICU) admission rates/length of stay, medication-related adverse events, and discharge against medical advice. RESULTS Despite being significantly more likely to have a history of prior complications related to AWS (including seizures and delirium), patients initiated on phenobarbital (n = 143) had overall similar primary and secondary treatment outcomes to those in the benzodiazepine treatment protocol (n = 419). Additionally, a subset of patients (n = 16) initially treated with benzodiazepines displayed signs of treatment nonresponse, including significantly higher rates of AWS-related delirium and ICU admission rates, but were well-managed following transition to the phenobarbital protocol. CONCLUSION The data from this retrospective chart review lend further support to effectiveness and safety of phenobarbital for the treatment and management of AWS. Further randomized controlled trials are warranted.
Collapse
Affiliation(s)
- Mladen Nisavic
- Addiction Consult Service, Avery D. Weismann, Psychiatry Consultation Service, Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA.
| | - Shamim H Nejad
- Division of Psychosocial Oncology - Swedish Cancer Institute, Swedish Medical Center, Seattle, WA
| | - Benjamin M Isenberg
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA
| | - Ednan Khalid Bajwa
- Pulmonary & Critical Care Unit, Massachusetts General Hospital, Boston, MA
| | - Paul Currier
- Pulmonary & Critical Care Unit, Massachusetts General Hospital, Boston, MA
| | | | - George Velmahos
- Trauma, Emergency Surgery and Surgical Critical Care Service, Massachusetts General Hospital, Boston, MA
| | - Timothy Wilens
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD Massachusetts General Hospital, Boston, MA; Department of Psychiatry, Harvard Medical School, Boston, MA
| |
Collapse
|
30
|
Jung ME, Mallet RT. Intermittent hypoxia training: Powerful, non-invasive cerebroprotection against ethanol withdrawal excitotoxicity. Respir Physiol Neurobiol 2018; 256:67-78. [PMID: 28811138 PMCID: PMC5825251 DOI: 10.1016/j.resp.2017.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/24/2017] [Accepted: 08/08/2017] [Indexed: 12/12/2022]
Abstract
Ethanol intoxication and withdrawal exact a devastating toll on the central nervous system. Abrupt ethanol withdrawal provokes massive release of the excitatory neurotransmitter glutamate, which over-activates its postsynaptic receptors, causing intense Ca2+ loading, p38 mitogen activated protein kinase activation and oxidative stress, culminating in ATP depletion, mitochondrial injury, amyloid β deposition and neuronal death. Collectively, these mechanisms produce neurocognitive and sensorimotor dysfunction that discourages continued abstinence. Although the brain is heavily dependent on blood-borne O2 to sustain its aerobic ATP production, brief, cyclic episodes of moderate hypoxia and reoxygenation, when judiciously applied over the course of days or weeks, evoke adaptations that protect the brain from ethanol withdrawal-induced glutamate excitotoxicity, mitochondrial damage, oxidative stress and amyloid β accumulation. This review summarizes evidence from ongoing preclinical research that demonstrates intermittent hypoxia training to be a potentially powerful yet non-invasive intervention capable of affording robust, sustained neuroprotection during ethanol withdrawal.
Collapse
Affiliation(s)
- Marianna E Jung
- Center for Neuroscience Discovery, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699, USA.
| | - Robert T Mallet
- Institute for Cardiovascular and Metabolic Diseases, University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107-2699, USA.
| |
Collapse
|
31
|
Abstract
Thirty percent of emergency department admissions are related to an alcohol misuse. Eighty percent of acute intoxications admitted in emergency departments concern patients with alcohol addiction. Care protocols validated in all of emergency departments are necessary for prevention of alcohol withdrawal syndrome. Risky uses require ultra-brief interventions, situations of abuse (light use disorders) require brief interventions and situations of dependence (moderate to severe use disorders) require motivational interviews to promote the emergence of a process of change. The key word for alcohol intervention in emergencies is: empathy. Search addictive comorbidities (tobacco and cannabis) and psychiatric comorbidities (depression and suicidal risk) must be systematic. The coordination between emergency departments and addictology departments is essential. In the emergency department, the goal is to optimise patient care path for all addictive behaviors.
Collapse
Affiliation(s)
- Georges Brousse
- Université Clermont Auvergne 1, UFR médecine, EA7280, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, psychiatrie addictologie B, 63003 Clermont-Ferrand, France.
| | | | - Julien Cabe
- Université Clermont Auvergne 1, UFR médecine, EA7280, 63001 Clermont-Ferrand, France; CHU Clermont-Ferrand, psychiatrie addictologie B, 63003 Clermont-Ferrand, France
| | | |
Collapse
|
32
|
Liu X, Qin Z, Zhu X, Yao Q, Liu Z. Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome. Acupunct Med 2018; 36:275-283. [PMID: 30030272 PMCID: PMC6176524 DOI: 10.1136/acupmed-2016-011283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/20/2022]
Abstract
Background Acupuncture has been used as a potential therapy for alcohol withdrawal syndrome (AWS), but evidence for its effects on this condition is limited. Objective To assess the effects and safety of acupuncture for AWS. Data sources Central Register of Controlled Trials (CENTRAL), PubMed, Embase, the Cochrane Library, PsycINFO, Chinese Biomedicine Literature (CBM), China National Knowledge Infrastructure (CNKI) and Wan-Fang Database were searched from their inception to August 2016. Study eligibility criteria Randomised controlled trials (RCTs) of drug plus acupuncture or acupuncture alone for the treatment of AWS were included. Data collection and analysis Continuous data were expressed as mean difference (MD) with 95% confidence intervals (95% CI). Dichotomous data were expressed as risk ratio (RR) with 95% CI. Results Eleven RCTs with 875 participants were included. In the acute phase, two trials reported no difference between drug plus acupuncture and drug plus sham acupuncture in the reduction of craving for alcohol; however, two positive trials reported that drug plus acupuncture was superior to drug alone in the alleviation of psychological symptoms. In the protracted phase, one trial reported acupuncture was superior to sham acupuncture in reducing the craving for alcohol, one trial reported no difference between acupuncture and drug (disulfiram), and one trial reported acupuncture was superior to sham acupuncture for the alleviation of psychological symptoms. Adverse effects were tolerable and not severe. Conclusion There was nosignificant difference between acupuncture (plus drug) and sham acupuncture (plus drug) with respect to the primary outcome measure of craving for alcohol among participants with AWS, and no difference in completion rates (pooled results). There was limited evidence from individual trials that acupuncture may reduce alcohol craving in the protracted phase and help alleviate psychological symptoms; however, given concerns about the quantity and quality of included studies, further large-scale and well-conducted RCTs are needed. Protocol registration PROSPERO CRD42016039862.
Collapse
Affiliation(s)
- Xiaoxu Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Zongshi Qin
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoming Zhu
- Department of Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qin Yao
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
33
|
Kirsten A, Linder S, Olbrich S. [Perspectives for the Electroencephalogram in Psychiatry]. PRAXIS 2018; 107:837-843. [PMID: 30043707 DOI: 10.1024/1661-8157/a003028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Perspectives for the Electroencephalogram in Psychiatry Abstract. The electroencephalogram (EEG) is a non-invasive and cost-effective method to monitor spontaneous neuronal activity over time. Pathologies in EEG recordings indicate with high sensitivity but low specificity abnormal functional brain states. The main psychiatric indications for EEG recordings include atypical clinical symptoms of a neuropsychiatric syndrome or atypical reactions to medication as well as a baseline diagnostic before starting treatment with specific drugs or stimulation modalities. In recent research the EEG continues to be a valuable tool not only in diagnostics but also for the prediction of treatment success. The following paper focuses on basic electrophysiological understanding of EEG recordings, the diagnostic value of EEG recordings in different clinical entities, and new research attempts in diagnostic and treatment prediction.
Collapse
|
34
|
An alcohol withdrawal test battery measuring multiple behavioral symptoms in mice. Alcohol 2018; 68:19-35. [PMID: 29427828 DOI: 10.1016/j.alcohol.2017.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/30/2017] [Accepted: 08/31/2017] [Indexed: 12/30/2022]
Abstract
Despite acceptance that risk for alcohol-use disorder (AUD) has a large genetic component, the identification of genes underlying various components of risk for AUD has been hampered in humans, in part by the heterogeneity of expression of the phenotype. One aspect of AUD is physical dependence. Alcohol withdrawal is a serious consequence of alcohol dependence with multiple symptoms, many of which are seen in multiple species, and can be experienced over a wide-ranging time course. In the present three studies, we developed a battery of withdrawal tests in mice, examining behavioral symptoms from multiple domains that could be measured over time. To permit eventual use of the battery in different strains of mice, we used male and female mice of a genetically heterogeneous stock developed from intercrossing eight inbred strains. Withdrawal symptoms were assessed using commonly used tests after administration of ethanol in vapor for 72 continuous hours. We found significant effects of ethanol withdrawal versus air-breathing controls on nearly all symptoms, spanning 4 days following ethanol vapor inhalation. Withdrawal produced hypothermia, greater neurohyperexcitability (seizures and tremor), anxiety-like behaviors using an apparatus (such as reduced transitions between light and dark compartments), anhedonia (reduced sucrose preference), Straub tail, backward walking, and reductions in activity; however, there were no changes in thermal pain sensitivity, hyper-reactivity to handling, or anxiety-like emergence behaviors in other apparatus. Using these data, we constructed a refined battery of withdrawal tests. Individual differences in severity of withdrawal among different tests were weakly correlated at best. This battery should be useful for identifying genetic influences on particular withdrawal behaviors, which should reflect the influences of different constellations of genes.
Collapse
|
35
|
Lappin JM, Ayub MH, Rogers D, Morgan M, Kanyamibwa JY, Shakeshaft A. Routine screening and related interventions significantly improve the effectiveness of emergency department detection and management of alcohol withdrawal syndrome. Emerg Med Australas 2018. [DOI: 10.1111/1742-6723.12959] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
- School of Psychiatry; The University of New South Wales; Sydney New South Wales Australia
| | - Muhammad H Ayub
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
| | - David Rogers
- Drug and Alcohol Services; Mid North Coast Local Health District; Port Macquarie New South Wales Australia
| | - Madeleine Morgan
- Drug and Alcohol Services; Kempsey District Hospital; Kempsey New South Wales Australia
| | - Jean-Yves Kanyamibwa
- Drug and Alcohol Services; Kempsey District Hospital; Kempsey New South Wales Australia
| | - Anthony Shakeshaft
- National Drug and Alcohol Research Centre; The University of New South Wales; Sydney New South Wales Australia
| |
Collapse
|
36
|
Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, Naudet F. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta-analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction 2018; 113:220-237. [PMID: 28940866 DOI: 10.1111/add.13974] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/16/2017] [Accepted: 07/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders (AUDs) is an emerging concept. Our objective was to explore the comparative effectiveness of drugs used in this indication. DESIGN Systematic review with direct and network meta-analysis of double-blind randomized controlled trials (RCTs) assessing the efficacy of nalmefene, naltrexone, acamprosate, baclofen or topiramate in non-abstinent adults diagnosed with alcohol dependence or AUDs. Two independent reviewers selected published and unpublished studies on Medline, the Cochrane Library, Embase, ClinicalTrials.gov, contacted pharmaceutical companies, the European Medicines Agency and the Food and Drug Administration, and extracted data. SETTING Thirty-two RCTs. PARTICIPANTS A total of 6036 patients. MEASUREMENTS The primary outcome was total alcohol consumption (TAC). Other consumption outcomes and health outcomes were considered as secondary outcomes. FINDINGS No study provided direct comparisons between drugs. A risk of incomplete outcome data was identified in 26 studies (81%) and risk of selective outcome reporting in 17 (53%). Nalmefene [standardized mean difference (SMD) = -0.19, 95% confidence interval (CI) = -0.29, -0.10; I2 = 0%], baclofen (SMD = -1.00, 95% CI = -1.80, -0.19; one study) and topiramate (SMD = -0.77, 95% CI = -1.12, -0.42; I2 = 0%) showed superiority over placebo on TAC. No efficacy was observed for naltrexone or acamprosate. Similar results were observed for other consumption outcomes, except for baclofen (the favourable outcome on TAC was not reproduced). The number of withdrawals for safety reasons increased under nalmefene and naltrexone. No treatment demonstrated any harm reduction (no study was powered to explore health outcomes). Indirect comparisons suggested that topiramate was superior to nalmefene, naltrexone and acamprosate on consumption outcomes, but its safety profile is known to be poor. CONCLUSIONS There is currently no high-grade evidence for pharmacological treatment to control drinking using nalmefene, naltrexone, acamprosate, baclofen or topiramate in patients with alcohol dependence or alcohol use disorder. Some treatments show low to medium efficacy in reducing drinking across a range of studies with a high risk of bias. None demonstrates any benefit on health outcomes.
Collapse
Affiliation(s)
| | - Renan Duprez
- Fondation Saint Jean de Dieu, Centre Hospitalier Dinan/St Brieuc, Dinan, France
| | | | - Clara Locher
- Inserm, CIC 1414 Clinical Investigation Centre, Rennes, France.,Rennes University Hospital, Department of Biological and Clinical Pharmacology and Pharmacovigilance, Rennes, France.,Rennes 1 University, Laboratory of Experimental and Clinical Pharmacology, Rennes, France
| | - Rémy Boussageon
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, Poitiers, France
| | - Bruno Laviolle
- Inserm, CIC 1414 Clinical Investigation Centre, Rennes, France.,Rennes University Hospital, Department of Biological and Clinical Pharmacology and Pharmacovigilance, Rennes, France.,Rennes 1 University, Laboratory of Experimental and Clinical Pharmacology, Rennes, France
| | - Florian Naudet
- Inserm, CIC 1414 Clinical Investigation Centre, Rennes, France.,Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Palo Alto, CA, USA
| |
Collapse
|
37
|
Dencker D, Molander A, Thomsen M, Schlumberger C, Wortwein G, Weikop P, Benveniste H, Volkow ND, Fink-Jensen A. Ketogenic Diet Suppresses Alcohol Withdrawal Syndrome in Rats. Alcohol Clin Exp Res 2017; 42:270-277. [PMID: 29160944 DOI: 10.1111/acer.13560] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/14/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use disorder is underdiagnosed and undertreated, and up to 50% of alcohol-abstinent patients diagnosed with alcohol dependence relapse within the first year of treatment. Current treatments for the maintenance of alcohol abstinence in patients with alcohol use disorder have limited efficacy, and there is an urgent need for novel treatment strategies. Decreased cerebral glucose metabolism and increased brain uptake of acetate were recently reported in heavy drinkers, relative to controls. Given the switch of metabolic fuel from glucose to acetate in the alcohol-dependent brain, we investigated the potential therapeutic benefit of a ketogenic diet in managing alcohol withdrawal symptoms during detoxification. METHODS Male Sprague Dawley rats fed either ketogenic or regular diet were administered ethanol or water orally, twice daily for 6 days while the diet conditions were maintained. Abstinence symptoms were rated 6, 24, 48, and 72 hours after the last alcohol administration. RESULTS Maintenance on a ketogenic diet caused a significant decrease in the alcohol withdrawal symptoms' "rigidity" and "irritability." CONCLUSIONS Our preclinical pilot study suggests that a ketogenic diet may be a novel approach for treating alcohol withdrawal symptoms in humans.
Collapse
Affiliation(s)
- Ditte Dencker
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Anna Molander
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Morgane Thomsen
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Chantal Schlumberger
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Gitta Wortwein
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Pia Weikop
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Helene Benveniste
- Department of Anesthesiology, Yale University, New Haven, Connecticut
| | - Nora D Volkow
- Laboratory for Neuroimaging, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, Maryland
| | - Anders Fink-Jensen
- Laboratory of Neuropsychiatry, Psychiatric Centre Copenhagen, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
38
|
Mendoza RL. Is medical treatment of Alcohol Withdrawal Syndrome a Stag Hunt? Challenges and opportunities in managing risk and uncertainty in addiction cessation. Risk Manag Healthc Policy 2017; 11:1-14. [PMID: 29317849 PMCID: PMC5743126 DOI: 10.2147/rmhp.s144831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE While the individual and social costs of alcoholism or alcohol use disorder are well established, few are aware that medical problems can arise during detoxification, some of which can be life-threatening. This study determines if sustained treatment for Alcohol Withdrawal Syndrome (AWS) might be based on the strategic choices and expectations of patients and health care providers alike, as well as the risk mitigation options available to them. DESIGN/APPROACH AWS was modeled as a Stag Hunt to explain both risk and decision-making in medical treatments for detoxification, since it can deduce a set of equilibrium strategies available to both patient and provider. Modeling was based on a review of juried literature gathered from search engines with the use medical subject heading terms. MAIN FINDINGS While there is little evidence that decision-making is shared between patient and physician in AWS treatments, the outcomes of their interactions depend on utility-maximizing choices each makes in anticipation of the other. Payoff-dominant and risk-dominant treatment outcomes are equally likely and equally cost-efficient, as conditioned by the presence (or absence) of mutual trust and assurance in reciprocal transactions. CONCLUSION/VALUE Simulation games, such as the Stag Hunt, offer a viable framework to understand patient and provider incentives and health-affecting behaviors during treatments for addiction cessation. If both anticipate indefinitely interacting in the absence of any predetermined or foreseeable final visit, they can maximize future payoffs from mutual cooperation and accountability, which fosters health promotion. However, this study suggests that the effect of cooperation is distinct from the effect of time in AWS and other addiction-cessation programs.
Collapse
|
39
|
Eloma AS, Tucciarone JM, Hayes EM, Bronson BD. Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:418-425. [PMID: 28981333 DOI: 10.1080/00952990.2017.1362418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is an assessment tool used to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treatment for alcohol withdrawal. OBJECTIVES To evaluate the prescribing patterns and appropriate use of the CIWA-Ar protocol in a general hospital setting, as determined by the presence or absence of documented AWS risk factors, patients' ability to communicate, and provider awareness of the CIWA-Ar order. METHODS This retrospective chart review included 118 encounters of hospitalized patients placed on a CIWA-Ar protocol during one year. The following data were collected for each encounter: patient demographics, admitting diagnosis, ability to communicate, and admission blood alcohol level; and medical specialty of the clinician ordering CIWA-Ar, documentation of the presence or absence of established AWS risk factors, specific parameters of the protocol ordered, service admitted to, provider documentation of awareness of the active protocol within 48 h of initial order, total benzodiazepine dose equivalents administered and associated adverse events. RESULTS 57% of patients who started on a CIWA-Ar protocol had either zero or one documented risk factor for AWS (19% and 38% respectively). 20% had no documentation of recent alcohol use. 14% were unable to communicate. 19% of medical records lacked documentation of provider awareness of the ordered protocol. Benzodiazepine associated adverse events were documented in 15% of encounters. CONCLUSIONS The judicious use of CIWA-Ar protocols in general hospitals requires mechanisms to ensure assessment of validated alcohol withdrawal risk factors, exclusion of patients who cannot communicate, and continuity of care during transitions.
Collapse
Affiliation(s)
- Amanda S Eloma
- a Stony Brook University , School of Pharmacy and Pharmaceutical Sciences , Stony Brook , NY , USA
| | | | - Edmund M Hayes
- a Stony Brook University , School of Pharmacy and Pharmaceutical Sciences , Stony Brook , NY , USA
| | - Brian D Bronson
- c Department of Psychiatry , Stony Brook University, School of Medicine , Stony Brook , NY , USA
| |
Collapse
|
40
|
Maldonado JR. Novel Algorithms for the Prophylaxis and Management of Alcohol Withdrawal Syndromes–Beyond Benzodiazepines. Crit Care Clin 2017; 33:559-599. [DOI: 10.1016/j.ccc.2017.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
41
|
Impact of an Alcohol Withdrawal Treatment Pathway on Hospital Length of Stay: A Retrospective Observational Study Comparing Pre and Post Pathway Implementation. J Psychiatr Pract 2017; 23:233-241. [PMID: 28492463 DOI: 10.1097/pra.0000000000000229] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine if the implementation of a hospital-specific alcohol withdrawal treatment pathway used in a medical-surgical patient population decreased hospital length of stay (LOS) compared with the standard of care. METHODS This retrospective observational study, conducted in a large academic tertiary care hospital, involved 582 subjects who met criteria for study inclusion, with 275 subjects in the 2010 cohort and 307 in the 2012 cohort. The Alcohol Withdrawal Project Team was formed with the goal of creating a standardized approach to the recognition and treatment of alcohol withdrawal at Duke University Hospital. The group created a computerized physician order entry alcohol withdrawal treatment pathway with 4 possible treatment paths chosen on the basis of current withdrawal symptoms, vital signs, and alcohol withdrawal history. The 4 treatment paths are 1 prophylaxis; 2 mild-to-moderate withdrawal; 3 moderate-to-severe withdrawal, and 4 severe withdrawal/alcohol withdrawal delirium. Each treatment path corresponds to a different lorazepam dose and dose schedule and symptom assessment. This pathway was implemented in the hospital at the end of 2011. RESULTS Using a Cox proportional hazards model and adjusting for covariates, there was a 1 day [95% confidence interval (CI), 1-2 d] reduction in median hospital LOS between the 2010 and 2012 cohorts, 5 versus 4 days, respectively. The average ratio in hospital LOS between the 2 cohorts was 1.25 (95% CI, 1.25-1.67). The CI was estimated by bootstrapping and indicated a significantly longer LOS in the 2010 cohort compared with the 2012 cohort. Nonsignificant changes were found in the proportion of subjects admitted to the intensive care unit (24% in 2010 vs. 29.3% in 2012), LOS in the intensive care unit (7.1±8 d in 2010 vs. 5.6±6.9 d in 2012), and proportion of patients discharged with a diagnosis of delirium tremens (17.8% in 2010 vs. 15.3% in 2012). CONCLUSIONS This study demonstrates the successful implementation of an alcohol withdrawal treatment pathway in a medical-surgical population hospitalized in a large tertiary care facility with significant impact on hospital LOS.
Collapse
|
42
|
Heba M, Faraz S, Banerjee S. Effect of Shankhpushpi on Alcohol Addiction in Mice. Pharmacogn Mag 2017; 13:S148-S153. [PMID: 28479740 PMCID: PMC5407107 DOI: 10.4103/0973-1296.203976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/24/2016] [Indexed: 12/02/2022] Open
Abstract
Alcohol addiction is a worldwide problem. It has mainly two components: dependence and withdrawal. Characteristic properties of most anti-addictive compounds include anti-anxiety, anticonvulsant, antidepressant, and nootropic actions. Shankhpushpi (Convolvulus pluricaulis. Convolvulaceae), known ethnopharmacologically as brain tonic, possess all the properties mentioned above. Here, we screen shankhpushpi for possible anti-addictive potential. Effect of shankhpushpi churna was measured on ethanol withdrawal anxiety using elevated plus maze. The role of shankhpushpi on chronic ethanol consumption (21 days) was measured using two bottle choice protocol of voluntary drinking. We also measured the effect of the above herb on cortico-hippocampal GABA levels. Shankhpushpi was found to reduce alcohol withdrawal anxiety in a dose-dependent manner. The herb also decreased ethanol intake and increased water intake significantly (P < 0.001) after 4 days of administration. Both these effects were blocked (P < 0.001) by GABAA antagonist suggesting the role of GABAA receptor. Chronic administration of shankhpushpi also significantly (P < 0.01) increased cortico-hippocampal GABA levels in mice. Shankhpushpi reduced both alcohol dependence and withdrawal in a GABAA-dependent manner, thus showing anti-addictive potential.
Collapse
Affiliation(s)
- Mahi Heba
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Sana Faraz
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| | - Sugato Banerjee
- Department of Pharmaceutical Science and Technology, Birla Institute of Technology, Mesra, Ranchi, Jharkhand, India
| |
Collapse
|
43
|
Abstract
Alcohol withdrawal syndrome has a high clinical prevalence. Severe cases must be treated in an intensive care unit and are associated with a high mortality rate, depending on patient comorbidities. Clinical requirements include sedation, control of vegetative symptoms, treatment of hallucinations and, when necessary, anticonvulsive therapy. Currently, there is no single substance that fulfills these requirements. National and international guidelines recommend a combination of various substances. The central α2-adrenergic receptor agonist clonidine is used as a therapeutic adjuvant. In consideration of its pharmacological characteristics, dexmedetomidine is assumed to be more advantageous compared to clondine. Case studies with dexmedetomidine in alcohol withdrawal syndrome show the safety of its application and a benzodiazepine-sparing effect. Its incorporation in escalating intensive care therapy of severe cases could be appropriate.
Collapse
|
44
|
Hammond CJ, Gray KM. Pharmacotherapy for Substance Use Disorders in Youths. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2016; 25:292-316. [PMID: 28082828 DOI: 10.1080/1067828x.2015.1037517] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Despite recent advances in psychosocial treatments targeting adolescent substance use disorders (SUD), effect sizes generally remain small to modest, and few treatment-enrolled youth achieve sustained abstinence. Among adults, SUD-targeted pharmacotherapies have emerged as viable options to complement psychosocial treatments and enhance outcomes. Developmental differences exist in pharmacodynamics and treatment-response, and comparatively little research has focused on SUD-targeted pharmacotherapies for youth. This article provides a review and synthesis of relevant published clinical trials focusing on youth SUDs and co-occurring/comorbid psychiatric and substance use disorders. It offers recommendations for clinical practice and further research based on the limited findings to date.
Collapse
Affiliation(s)
| | - Kevin M Gray
- Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
45
|
Kumar J, Hapidin H, Get Bee YT, Ismail Z. The effects of acute ethanol administration on ethanol withdrawal-induced anxiety-like syndrome in rats: A biochemical study. Alcohol 2016; 50:9-17. [PMID: 26626323 DOI: 10.1016/j.alcohol.2015.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/20/2015] [Indexed: 01/13/2023]
Abstract
Withdrawal from long-term ethanol consumption results in overexcitation of glutamatergic neurotransmission in the amygdala, which induces an anxiety-like syndrome. Most alcoholics that suffer from such symptoms frequently depend on habitual drinking as self-medication to alleviate their symptoms. Metabotropic glutamate receptor subtype 5 (mGlu5) and protein kinase C (PKC) epsilon have been reported to mediate acute and chronic effects of ethanol. This study explores the changes in mGlu5 and PKC epsilon in the amygdala following acute administration of ethanol during ethanol withdrawal (EW) induced anxiety. Male Wistar rats were fed a modified liquid diet containing low-fat cow milk, sucrose, and maltodextrin, with a gradual introduction of 2.4%, 4.8% and 7.2% ethanol for 20 days. Six hours into EW, the rats were intraperitoneally injected with normal saline and ethanol (2.5 g/kg, 20% v/v), and exposed to open-field and elevated plus maze tests. Then, amygdala tissue was dissected from the rat brain for Western blot and gene expression studies. EW-induced anxiety was accompanied by a significant increase in mGlu5, total PKC epsilon, and phosphorylated PKC epsilon protein levels, and also of mRNA of mGlu5 (GRM5) in the amygdala. Acute administration of ethanol significantly attenuated EW-induced anxiety as well as an EW-induced increase in GRM5. The acute challenge of ethanol to EW rats had little effect on the phosphorylated and total protein levels of PKC epsilon in the amygdala. Our results demonstrate that amygdala PKC epsilon may not be directly involved in the development of anxiety following EW.
Collapse
Affiliation(s)
- Jaya Kumar
- Department of Physiology, Faculty of Medicine, Pre-Clinical Building, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
| | - Hermizi Hapidin
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Yvonne-Tee Get Bee
- School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zalina Ismail
- BRAINetwork Centre for Neurocognitive Science, School of Health Sciences, Health Campus, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| |
Collapse
|
46
|
Kissler JL, Walker BM. Dissociating Motivational From Physiological Withdrawal in Alcohol Dependence: Role of Central Amygdala κ-Opioid Receptors. Neuropsychopharmacology 2016; 41:560-7. [PMID: 26105136 PMCID: PMC5130131 DOI: 10.1038/npp.2015.183] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 05/30/2015] [Accepted: 06/19/2015] [Indexed: 11/09/2022]
Abstract
Chronic intermittent alcohol vapor exposure leads to increased dynorphin (DYN) A-like peptide expression and heightened kappa-opioid receptor (KOR) signaling in the central nucleus of the amygdala (CeA) and these neuroadaptive responses differentiate alcohol-dependent from non-dependent phenotypes. Important for therapeutic development efforts is understanding the nature of the stimulus that drives dependence-like phenotypes such as escalated alcohol self-administration. Accordingly, the present study examined the impact of intra-CeA KOR antagonism on escalated operant alcohol self-administration and physiological withdrawal symptoms during acute withdrawal and protracted abstinence in rats previously exposed to chronic intermittent alcohol vapor. Following operant training, rats were implanted with intra-CeA guide cannula and exposed to long-term intermittent alcohol vapor exposure that resulted in escalated alcohol self-administration and elevated physiological withdrawal signs during acute withdrawal. Animals received intra-CeA infusions of the KOR antagonist nor-binaltorphimine (nor-BNI; 0, 2, 4, or 6 μg) prior to operant alcohol self-administration sessions and physiological withdrawal assessment during acute withdrawal and protracted abstinence. The results indicated that site-specific KOR antagonism in the CeA ameliorated escalated alcohol self-administration during both acute withdrawal and protracted abstinence test sessions, whereas KOR antagonism had no effect on physiological withdrawal scores at either time point. These results dissociate escalated alcohol self-administration from physiological withdrawal symptoms in relation to KOR signaling in the CeA and help clarify the nature of the stimulus that drives escalated alcohol self-administration during acute withdrawal and protracted abstinence.
Collapse
Affiliation(s)
- Jessica L Kissler
- Laboratory of Alcoholism and Addictions Neuroscience, Translational Addiction Research Center, Department of Psychology, Washington State University, Pullman, WA, USA
| | - Brendan M Walker
- Laboratory of Alcoholism and Addictions Neuroscience, Translational Addiction Research Center, Department of Psychology, Washington State University, Pullman, WA, USA,Laboratory of Alcoholism and Addictions Neuroscience, Department of Psychology, Washington State University, 100 Dairy Road, Mail code: 644820, Pullman, WA 99164-4820 USA, Tel: +1 509 335 8526, Fax: +1 509 335 5324, E-mail:
| |
Collapse
|
47
|
Rolland B, Paille F, Gillet C, Rigaud A, Moirand R, Dano C, Dematteis M, Mann K, Aubin H. Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies. CNS Neurosci Ther 2016; 22:25-37. [PMID: 26768685 PMCID: PMC6492872 DOI: 10.1111/cns.12489] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Revised: 10/30/2015] [Accepted: 11/03/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence. METHODS A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system. RESULTS The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B).
Collapse
Affiliation(s)
- Benjamin Rolland
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHRU de LilleINSERM U1171Univ LilleLilleFrance
| | - François Paille
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHU de NancyVandœuvre‐lès‐NancyNancyFrance
| | - Claudine Gillet
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Centre d'AddictologieHôpital VilleminNancyFrance
| | - Alain Rigaud
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Pôle d'addictologieEPSM MarneChâlons‐en‐Champagne et ReimsReimsFrance
- Association Nationale de Prévention en Alcoologie et Addictologue (ANPAA)ParisFrance
| | - Romain Moirand
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- CHU de RennesUnité d'AddictologieRennesFrance
- INSERMUMR 991RennesFrance
| | - Corine Dano
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Service d'AddictologieCHU d'AngersAngersFrance
| | - Maurice Dematteis
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- Clinique d'AddictologieCHU de GrenobleUniversité Grenoble AlpesGrenobleFrance
| | - Karl Mann
- Central Institute of Mental HealthMedical Faculty MannheimUniversity of HeidelbergMannheimGermany
- EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD)Clinic Hospital of BarcelonaAddictive Behaviors UnitBarcelonaSpain
| | - Henri‐Jean Aubin
- Société Française d'AlcoologieIssy‐les‐MoulineauxFrance
- EUFAS Scientific Secretariat Professor Antoni Gual (MD; PhD)Clinic Hospital of BarcelonaAddictive Behaviors UnitBarcelonaSpain
- Département de Psychiatrie et d'AddictologieINSERM U1178Hôpital Paul BrousseAPHP VillejuifVillejuifFrance
| |
Collapse
|
48
|
Sachdeva A, Choudhary M, Chandra M. Alcohol Withdrawal Syndrome: Benzodiazepines and Beyond. J Clin Diagn Res 2015; 9:VE01-VE07. [PMID: 26500991 DOI: 10.7860/jcdr/2015/13407.6538] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 07/03/2015] [Indexed: 11/24/2022]
Abstract
Alcohol dependence is an increasing and pervasive problem. Alcohol withdrawal symptoms are a part of alcohol dependence syndrome and are commonly encountered in general hospital settings, in most of the departments. Alcohol withdrawal syndrome ranges from mild to severe. The severe complicated alcohol withdrawal may present with hallucinations, seizures or delirium tremens. Benzodiazepines have the largest and the best evidence base in the treatment of alcohol withdrawal, and are considered the gold standard. Others, such as anticonvulsants, barbiturates, adrenergic drugs, and GABA agonists have been tried and have evidence. Supportive care and use of vitamins is essential in the management. Symptom triggered regime is favoured over fixed tapering dose regime, although monitoring through scales is cumbersome. This article aims to review the evidence base for appropriate clinical management of the alcohol withdrawal syndrome. We searched Pubmed for articles published in English on 'Alcohol withdrawal syndrome' in humans during the last 10 years. A total of 1182 articles came up. Articles not relevant to clinical utility and management were excluded based on the titles and abstract available. Full text articles, meta-analyses, systematic reviews and randomized controlled trials were obtained from this list and were considered for review.
Collapse
Affiliation(s)
- Ankur Sachdeva
- Assistant Professor, Department of Psychiatry, ESIC Medical College and Hospital , Faridabad, Haryana, India
| | - Mona Choudhary
- Senior Resident, Department of Psychiatry and Drug De-addiction, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital , New Delhi, India
| | - Mina Chandra
- Chief Medical Officer (NFSG), Department of Psychiatry and Drug De-addiction, Post Graduate Institute of Medical Education and Research, Dr Ram Manohar Lohia Hospital , New Delhi, India
| |
Collapse
|
49
|
Perez EE, De Biasi M. Assessment of affective and somatic signs of ethanol withdrawal in C57BL/6J mice using a short-term ethanol treatment. Alcohol 2015; 49:237-43. [PMID: 25817777 DOI: 10.1016/j.alcohol.2015.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/16/2022]
Abstract
Alcohol is one of the most prevalent addictive substances in the world. Withdrawal symptoms result from abrupt cessation of alcohol consumption in habitual drinkers. The emergence of both affective and physical symptoms produces a state that promotes relapse. Mice provide a preclinical model that could be used to study alcohol dependence and withdrawal while controlling for both genetic and environmental variables. The use of a liquid ethanol diet offers a reliable method for the induction of alcohol dependence in mice, but this approach is impractical when conducting high-throughput pharmacological screens or when comparing multiple strains of genetically engineered mice. The goal of this study was to compare withdrawal-associated behaviors in mice chronically treated with a liquid ethanol diet vs. mice treated with a short-term ethanol treatment that consisted of daily ethanol injections containing the alcohol dehydrogenase inhibitor, 4-methylpyrazole. Twenty-four hours after ethanol treatment, mice were tested in the open field arena, the elevated plus maze, the marble burying test, or for changes in somatic signs during spontaneous ethanol withdrawal. Anxiety-like and compulsive-like behaviors, as well as physical signs, were all significantly elevated in mice undergoing withdrawal, regardless of the route of ethanol administration. Therefore, a short-term ethanol treatment can be utilized as a screening tool for testing genetic and pharmacological agents before investing in a more time-consuming ethanol treatment.
Collapse
Affiliation(s)
- E E Perez
- Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - M De Biasi
- Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA; Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
| |
Collapse
|
50
|
Abstract
Alcohol use disorders (AUDs) are less prevalent in pregnant women than in nonpregnant women, but these disorders can create a host of clinical challenges when encountered. Unfortunately, little evidence is available to guide clinical decision making in this population. Drinking alcohol during pregnancy can have negative consequences on both fetus and mother, but it remains controversial as to the volume of alcohol consumption that correlates with these consequences. Likewise, little evidence is available to support the use of particular pharmacologic interventions for AUDs during pregnancy or to guide the management of alcohol detoxification in pregnant women. The use of benzodiazepines (the mainstay of most alcohol detoxification protocols) in pregnant women is controversial. Nevertheless, despite the lack of robust data to guide management of AUDs in pregnancy, clinicians need to make management decisions when confronted with these challenging situations. In that context, this article reviews the epidemiology of AUDs in pregnancy and the pharmacologic management of both AUDs and alcohol withdrawal in pregnant women, with the goal of informing clinicians about what is known about managing these co-occurring conditions.
Collapse
Affiliation(s)
- Jeffrey DeVido
- University of California, San Francisco, Department of Psychiatry, San Francisco, CA
- McLean Hospital, Division of Alcohol and Drug Abuse, Harvard Medical School, Belmont, MA
| | - Olivera Bogunovic
- McLean Hospital, Division of Alcohol and Drug Abuse, Harvard Medical School, Belmont, MA
| | - Roger D. Weiss
- McLean Hospital, Division of Alcohol and Drug Abuse, Harvard Medical School, Belmont, MA
| |
Collapse
|