Evidence of genetic predisposition to alcoholic cirrhosis and psychosis: twin concordances for alcoholism and its biological end points by zygosity among male veterans

Evidence for genetic mediation of alcoholism in women

This review focuses on the etiology of alcoholism in women, examining the role of genetic vulnerability. The review is organized with respect to (1) the genetic epidemiology of alcoholism in women; (2) genetic models that take gender into account; (3) further discussion of the genetic heterogeneity of alcoholism as it relates to gender; and (4) presentation of data obtained from the Pittsburgh family study. This review concludes that, although much evidence remains to be gathered concerning the question of whether or not alcoholism is genetically mediated to the same degree in women as it is in men, there is no reason to rule out this possibility at the present time.

Follow-up of a cohort of alcoholic patients through 12 months of comprehensive biobehavioral treatment

One hundred and eleven socially stable alcoholic patients were subjected to a comprehensive diagnostic and treatment protocol based on a biobehavioral model of alcoholism. Physical pathology, malnutrition, and toxicity were prevalent throughout the sample. After a period of inpatient care, subjects were treated for a period of 12 months with a combination of medical, nutritional, behavioral, and psychological support and care. At the end of the study period, 91 subjects (81.9%) remained in treatment contact. Sixty seven subjects (60.4%) were abstinent and physically stable at the 12-month date. Elevations of three scales of the MMPI were significantly predictive of treatment outcome.

Biological markers of alcoholism

Biological markers are biochemical or physiological characteristics which may help to classify a person according to the presence or absence of some disease or risk of disease, either with respect to their current status or future susceptibility. Many biological markers related to alcoholism have been described; this review suggests a classification of them and indicates areas where they are well-established and other areas where further investigation may be useful.

Alcohol and drug use by college males as a function of family alcoholism history

Family history of alcoholism increases the risk for development of alcoholism in male offspring. The present questionnaire study examined self-reported alcohol and drug use in 744 college males as a function of DSM-IIIR alcohol dependence diagnoses in first- and/or second-degree biological relatives. Substance use was most prevalent and most frequent in students with both first- and second-degree alcohol-dependent family members, was intermediate in students with only first-degree affected relatives, and was least in students with no affected relatives. Students with both first- and second-degree alcohol-dependent relatives reported: more alcohol, marijuana, sedative, and cocaine ingestion; a younger age at first alcohol intoxication and first marijuana use; experience with less commonly used drugs; and more personal substance-related problems as well as more family mental health care. These data have significant prevention implications for targeting at-risk youth.

Molecular genetics of chronic liver diseases

The molecular genetics of five common single gene and one polygenic chronic liver disease is discussed. In two of the single gene disorders, alpha 1-antitrypsin deficiency and cystic fibrosis, the gene responsible is now known and the repertoire of different mutations underlying the disease is being defined. In the other three single gene defects (haemochromatosis, polycystic liver disease and Wilson's disease) the chromosomal location of the disease allele is known. It is anticipated that recombinant DNA techniques will enable the genes responsible for these diseases to be cloned in the near future, thus allowing the biochemical abnormalities to be defined through reverse genetics. In many chronic liver diseases the relative contribution of genetic and environmental factors remains unclear. Evidence suggests there is a definite genetic component in predisposition to alcoholic cirrhosis; the role of putative candidate genes is discussed. It is hoped that the definition of a genetic locus linked to alcoholic cirrhosis will ultimately teach us more about the basic pathogenesis of this disease.

Psychopathological characteristics in alcohol hallucinosis and paranoid schizophrenia

In a retrospective study psychopathology, psychiatric family history and demographic data were studied in 53 patients with alcohol hallucinosis and an age- and sex-matched control group of 53 patients with paranoid schizophrenia who had been treated at the Psychiatric Hospital of the University of Munich between 1979 and 1986. The psychopathology was assessed by the AMDP system. The paranoid-hallucinatory symptoms in both conditions were very similar; verbal hallucinations and delusions of reference were most common in both groups. Disorders of ego were found in 87% of the schizophrenics, but only 30% of the alcoholic patients (P less than 0.001). Schizophrenics developed psychosis at a younger age than alcoholics and seemed to have poorer outcome. Patients with alcohol hallucinosis had more relatives with an alcohol history (P less than 0.001), and schizophrenics more relatives with schizophrenic psychosis (P less than 0.001).

Early onset of nonalcoholic cirrhosis in patients with familial alcoholism

The etiology of many forms of liver disease is largely unknown. Recent research has identified certain immunogenetic factors which may play a role in the progression of alcoholic cirrhosis as well as autoimmune forms of cirrhosis. In this study we examined the role of familial alcoholism and HLA status in determining age of liver disease onset. Patients with biopsy-proven nonalcoholic autoimmune cirrhosis and having a history of familial alcoholism experience an earlier age of onset of liver disease than patients without a family history of alcoholism. The same result was true for patients with alcoholic liver disease. This effect may be more prominent in females. Subjects with HLA B-8 also had a younger age of onset of nonalcoholic autoimmune liver disease. The presence of a family history of alcoholism in conjunction with the presence of HLA B-8 and DR-3 also was related to an earlier age of disease onset. These findings suggest that the susceptibility to develop alcoholism and nonalcoholic autoimmune liver disease may be transmitted conjointly and point to potential fruitful areas of research for identifying individuals at risk for developing cirrhosis as well as detecting genetic markers for alcoholism.

The genetic epidemiology of alcoholism

Despite the variability in sampling and methodology, the majority of the family, twin and adoption studies suggest that alcoholism is familial, a significant proportion of which can be attributed to genetic factors. However, the specific components of alcoholism that may be inherited have yet to be identified. To date, there are no biological trait markers for which there is evidence for specificity for alcoholism. The three major levels of enquiry regarding possible mechanisms for the transmission of alcoholism and the involvement of genes and gene products in its development are factors related to exposure, metabolism, or pharmacological effects of ethanol. Exposure to ethanol is an obvious precondition for the development of tolerance and/or dependence. Therefore, identification of factors which enhance (or decrease) exposure are important goals of studies of the pathogenesis of alcoholism. It is likely that demographic, cultural and environmental factors (i.e. sex, age, religious affiliation, social group influences, income, availability of alcohol, etc.) play a crucial role in mediating exposure to alcohol. The key to alcoholism is likely to reside in the effects of alcohol on the brain. In contrast to nicotine, the opioids, and catecholamines, no specific receptor for ethanol has been found. Thus, one major focus of current research on possible central nervous system (CNS) mechanisms for the effect of alcohol includes assessment of the role of alcohol in the stimulation of brain reward or reinforcement systems. Alternately, alcohol may produce dependence by normalizing abnormal baseline states such as irritability, hyperexcitability, dysphoria, impulsiveness, or stress/tension level. The results of animal studies have yielded information on the central effects of alcohol including sensitivity of neuronal membranes, proteins, and ion channels to alcohol, and factors related to the binding and release of neurotransmitters and neuromodulators including dopamine, norepinephrine, gamma aminobutyric acid, pro-opiomelanocortin, glutamate receptors and the endorphin system (Institute of Medicine, 1987). In addition to possible genetic explanations for the strong degree of familial aggregation of alcoholism, alternative explanations need to be further evaluated. These include: modelling of parental behaviour; possible changes in the susceptibility of the foetus to alcohol as a result of in utero maternal ingestion of alcohol; results of negligent rearing manifested in dietary deficiency, exposure to toxic substances, or brain trauma, which so often characterize the homes of alcoholic parents; or damage to paternal germ cells from alcohol.

Genetic influences on tobacco use: a review of human and animal studies

This paper provides an overview of the literature which indicates that genetic factors regulate the use of alcohol and tobacco by humans. The methods used to make genetic assessments in humans and the results obtained are discussed. Studies using animals have been helpful in identifying simpler behavioral components of the dependence process that are regulated by genetic factors. An overview of the genetic methods used most often in animal studies is presented along with an in-depth discussion of how these methods have been useful in uncovering genetic influences on nicotine responses in animals. Data which indicate that genetic factors regulate brain nicotinic receptor numbers and response to nicotine are also included as examples of how genetic strategies have been useful in increasing our understanding of how genes may influence behavior.

The diagnosis of alcohol and cannabis dependence in cocaine dependents and alcohol dependence in their families

Genetic research in alcoholism has made major advances in recent decades. Twin, adoption, high-risk and familial studies have demonstrated an inheritance factor in alcoholism. Few studies have demonstrated a genetic predisposition to cocaine and cannabis dependence. Two hundred and sixty-three inpatients were given a structured psychiatric interview retrospectively (150) and prospectively (113) to obtain DSM-III-R diagnosis of cocaine, alcohol and cannabis dependence disorders in the inpatients and of alcohol dependence in family members. Our study reveals a large number of cocaine dependents with a positive family history for alcohol dependence. Approximately 50% of cocaine addicts had at least a first or second degree relative with a diagnosis of alcohol dependence when studied by the family history and study methods. As many as 89% of cocaine dependents diagnosed by DSM-III-R criteria for cocaine dependence qualified for other alcohol and drug dependence diagnoses. Our study finds a high prevalence of alcohol (67% and 89%) and cannabis dependence (51% and 46%) in patients with cocaine dependence. Previous reports regarding alcohol and other drug dependence among cocaine dependents and their families are few and inconclusive. The diagnosis of other drug and alcohol dependence in cocaine dependence and in family members of cocaine dependents has important impact on etiology, prognosis and treatment.

Alcoholism and the 'new genetics'

Molecular biology is transforming our view of psychiatry. For the first time methods are becoming available to detect directly the genetic abnormalities leading to psychiatric illness. This article examines the ways in which the new marker technology might bridge the gap between classical genetic knowledge of alcoholism and the precise identification and localization of specific genes implicated in its aetiology.

Twin concordance for dishonorable discharge from the military: with a review of the genetics of antisocial behavior

It has been hypothesized that there is a genetic component to antisocial behavior. To test this hypothesis, twin concordance for dishonorable discharge from the US military was examined among 15,924 twin pairs in the National Academy of Sciences-National Research Council (NAS-NRC) Twin Registry, all of whom served in the US military. Of 62 dizygotic (DZ) twin pairs, at least one of whom had received a dishonorable discharge, one pair (1.6%) was concordant for dishonorable discharge; of 47 monozygotic (MZ) twin pairs, seven (14.9%) were concordant for dishonorable discharge. Concordance rates for dishonorable discharge were significantly greater for MZ vDZ twin pairs. Concordances for dishonorable discharge were not confounded by co-diagnoses of alcoholism. The results are discussed in light of research findings suggesting a genetic component to antisocial behavior.

Family history and diagnosis of alcohol dependence in cocaine dependence

Genetic research in alcoholism has made major advances in recent decades. Twin, adoption, high-risk, and familial studies have demonstrated an inheritance factor in alcoholism. No studies have demonstrated a genetic or familial disposition to cocaine and marijuana dependence. Two hundred sixty-three inpatients were given a structured psychiatric interview retrospectively (150) and prospectively (113) to obtain a DSM-III-R diagnosis of substance dependence disorders in the probands and of alcohol dependence in family members. Our study reveals a large number of probands with cocaine dependence with a positive family history for alcohol dependence. Approximately 50% of probands with cocaine dependence had at least a first or second degree relative with a diagnosis of alcohol dependence when studied by the family history and study methods. As many as 89% of probands who met DSM-III-R criteria for cocaine dependence qualified for other substance dependence diagnoses. Our study finds a high prevalence of alcohol (68% and 89%) and cannabis dependence (53% and 46%) in patients with cocaine dependence. Furthermore, the age of onset of alcohol and other drug dependence is early for those with cocaine dependence and precedes the onset of cocaine dependence. The diagnoses of other alcohol and drug dependence in cocaine dependence and in family members of probands with cocaine dependence have important implications for etiology, prognosis, and treatment.

Alcohol and liver injury: dose-related or permissive effect?

Studies addressing the risk of development of cirrhosis of the liver in relation to alcohol consumption have been based on comparisons at the aggregate population level and, at the individual level, on case-control studies and cohort studies, and on retrospective and prospective assessment of alcohol consumption. The ideal, but unfeasible, study design for estimation of the risk function is a prospective monitoring of alcohol consumption and recording of the rate of development of cirrhosis per unit of time. Two recent studies, approaching this design, suggested that above a rather low, but not precisely determined, level of alcohol consumption the risk of development of cirrhosis is not further influenced by the amount of alcohol consumed. A critical analysis of previous studies suggests that this risk function is actually compatible with their findings. The contention that alcohol abuse has a permissive rather than a dose-dependent role in the development of alcoholic liver injury encourages research into the additional factors that must act before the liver injury occurs.

Alcohol and liver injury: dose-related or permissive effect?

The studies addressing the risk of development of cirrhosis of the liver in relation to alcohol consumption have been based on comparisons at the aggregate population level and at the individual level, on case-control studies and cohort studies, and on retrospective and prospective assessment of alcohol consumption. The ideal, but unfeasible, study design for estimation of the risk function is a prospective monitoring of alcohol consumption and recording of rate of development of cirrhosis per unit of time. Two recent studies, approaching this design, suggested that above a rather low, but not precisely determined, level of alcohol consumption, the risk of development of cirrhosis is not further influenced by the amount of alcohol consumed. A critical analysis of previous studies suggests that this risk function actually is compatible with their findings. The contention that alcohol abuse has a permissive rather than a dose-dependent role in the development of alcoholic liver injury encourages research into the additional factors that must act before the liver injury occurs.

Alcoholic hallucinosis: a psychiatric enigma--2. Follow-up studies

This paper reviews the contribution of natural history and genetic studies to the understanding of the syndrome called alcoholic hallucinosis. Critical analysis of research methodology demonstrates that the diversity of fundamental definitions and assessment techniques challenge the interpretations derived from the data. Important questions for future research are outlined.

Acetylation phenotype in abstinent alcoholics

No association between acetylation phenotype and alcoholism was discovered. Fifty-four percent of both the alcoholic patients and healthy volunteers were rapid acetylators. Acetylation phenotyping is not helpful to the investigation of the genetics of alcoholism.

Risk for alcoholism: a comparison between two different groups of sons of alcoholics on cardiovascular reactivity and sensitivity to alcohol

Two groups of sons of alcoholic fathers of differing family pedigrees for alcoholism [multigenerational (MGH) versus unigenerational (UGH)] were compared on measures of cardiovascular reactivity to unavoidable shock under alcohol and no alcohol consumption conditions. The MGH subjects were significantly more reactive than UGH subjects to the shock procedure on a measure of peripheral vasoconstriction (digital blood volume amplitude) with a similar trend on heart rate. The MGH subjects were significantly more sensitive to the reactivity dampening effects of alcohol than the UGH subjects on both cardiovascular measures. MGH subjects were also significantly more alexithymic than UGH subjects. The results are discussed in terms of the potential etiological significance of these characteristics in MGH males, and the importance of delineating the family history for at least two generations when assigning risk status to potential subjects.

Genetically determined response of hepatic aldehyde dehydrogenase activity to ethanol exposures may be associated with alcohol sensitivity in mouse genotypes

Mice (Mus musculus) from four genetic strains (BALB/c, C57BL/6J, 129/ReJ, and SW) and their F1 hybrids (SWxBALB/c, C57BL/6JxBALB/c, and C57BL/6Jx129/ReJ) were used to evaluate the effect of ethanol on the activity of the two primary enzymes, alcohol dehydrogenase (ADH; E.C.1.1.1.1) and aldehyde dehydrogenase (ALDH; E.C. 1.2.1.3), of alcohol metabolism. Three week-old male mice (12-16 g) were placed on liquid diet (5% ethanol) while a weight-matched littermate control was fed isocaloric maltose-dextrin in place of ethanol. Animals were sacrificed after 3 weeks and the liver and stomach were excised for biochemical analysis. Although the ethanol feeding did not influence the stomach ADH and ALDH activity levels, these enzymes in the liver were affected. The liver ADH activity was depressed to varying degrees in all mouse genotypes studied. Also, the ethanol feeding altered the liver-ALDH activity, which was highly variable and genotype specific. The mice of C57BL/6J and F1 C57BL/6JxBALB/c, both relatively resistant genotypes, exhibited significant increase in liver ALDH-(cytosolic and whole liver homogenate) activity. The response in the other genotypes were not significantly different from their matched controls. The relative resistance of the C57BL/6J strain may be associated with the increase in liver ALDH activity which is expected to facilitate the elimination of acetaldehyde, the toxic metabolite. The results from the selected F1 crosses indicate a multigene system regulating the inducibility of the liver ALDH. The relative sensitivity of different genotypes may be attributed to inducibility components regulating the liver enzyme activity, particularly liver ALDH following challenges with ethanol. These observations may offer a new approach in explaining extensive variability in response to alcohols in most populations.

Blood markers of alcoholic liver disease

Not all heavy drinkers develop severe alcoholic liver disease. Genetic factors are probably involved, but no corresponding useful markers have been developed thus far. Of greater practical applicability is the recognition of early changes in the liver that may indicate that the process of scarring or fibrosis has been initiated. Measurement of breakdown products of collagen, the protein of the fibrotic tissue, have been found to be useful for detecting these early stages. Assessment of glutamic dehydrogenase activity in the serum also provides some indication of the degree of inflammation and necrosis present in the liver, but not of the alcohol intake. The severity of the latter can be assessed with a variety of biological markers, to which circulating antibodies against acetaldehyde adducts have recently been added.

Schizoaffective disorder: a dimensional approach

The current categorical approach has not proved successful in resolving the problem of classifying patients with both affective and schizophrenic features. A dimensional approach is suggested; postulating two interacting factors; "dissociotaxia", a neurointegrative abnormality; and "hyperactivation", an abnormality in activation regulation. The latter factor can convert dissociotaxia to associative dyscontrol and produce mixed schizoaffective features. Clinical-phenomenological, prognostic, genetic-familial, treatment response and biological evidence is reconsidered from this standpoint; and the preferability of the dimensional approach is suggested, both for understanding the underlying psychopathology, and for constructing a different classification system, extensible to other areas of psychiatry.

Risk factors for alcohol hepatotoxicity among male alcoholics

Alcoholic liver cirrhosis is a leading cause of morbidity and mortality in alcohol dependence. A common precursor to cirrhosis is alcoholic hepatotoxicity evident clinically by elevated serum liver enzymes. In this study 50 male patients with significant (greater than two times upper limits of normal) elevation of liver enzymes attending a veterans inpatient alcohol treatment center were matched by age and time since last drink to 50 male veterans without elevated liver enzymes. Patients with elevated liver enzymes were found to be more likely to be daily drinkers, less likely to indulge in binge drinking patterns or have alcoholic blackouts, and showed a trend towards a less severe pattern of alcoholism. Significant gamma glutamyl transferase (GGT) elevations were found in patients consuming an average of 7 beers/day for 5 years, and significant aspartate aminotransferase (AST) elevations were found in patients consuming a threshold of 12 beers/day for 10 years. These findings are consistent with current research suggesting alcoholic cirrhosis is a result of a threshold exposure to alcohol in alcoholics with an additional environmental or genetic risk factor.

Neurogenetic adaptive mechanisms in alcoholism

Clinical, genetic, and neuropsychopharmacological studies of developmental factors in alcoholism are providing a better understanding of the neurobiological bases of personality and learning. Studies of the adopted-away children of alcoholics show that the predisposition to initiate alcohol-seeking behavior is genetically different from susceptibility to loss of control after drinking begins. Alcohol-seeking behavior is a special case of exploratory appetitive behavior and involves different neurogenetic processes than do susceptibility to behavioral tolerance and dependence on the antianxiety or sedative effects of alcohol. Three dimensions of personality have been described that may reflect individual differences in brain systems modulating the activation, maintenance, and inhibition of behavioral responses to the effects of alcohol and other environmental stimuli. These personality traits distinguish alcoholics with different patterns of behavioral, neurophysiological, and neuropharmacological responses to alcohol.

Presence of nonoxidative ethanol metabolism in human organs commonly damaged by ethanol abuse

Acetaldehyde, the end product of oxidative ethanol metabolism, contributes to alcohol-induced disease in the liver, but cannot account for damage in organs such as the pancreas, heart, or brain, where oxidative metabolism is minimal or absent; nor can it account for the varied patterns of organ damage found in chronic alcoholics. Thus other biochemical mediators may be important in the pathogenesis of alcohol-induced organ damage. Many human organs were found to metabolize ethanol through a recently described nonoxidative pathway to form fatty acid ethyl esters. Organs lacking oxidative alcohol metabolism yet frequently damaged by ethanol abuse have high fatty acid ethyl ester synthetic activities and show substantial transient accumulations of fatty acid ethyl esters. Thus nonoxidative ethanol metabolism in addition to the oxidative pathway may be important in the pathophysiology of ethanol-induced disease in humans.

Effect of chronic ethanol administration on enzyme and lipid properties of liver plasma membranes in long and short sleep mice

Mechanisms of alcoholic liver disease are still ill defined. We evaluated in two outbred lines of mice whether chronic ingestion of ethanol alters the lipid composition and/or enzyme activity of liver plasma membranes. Two mouse lines with different sensitivities towards the hypnotic effect of ethanol, designated long sleep and short sleep, were fed a liquid diet containing ethanol for 30 days. Ethanol intake reached 30 gm per kg per day in both lines, and serum ethanol levels were similar. In addition, hepatic triglyceride levels were similarly increased 2-fold with ethanol feeding. The following effects of ethanol treatment were observed in liver plasma membrane fractions: (i) Na+,K+-ATPase was significantly increased to 26% above control in long sleep only; (ii) alkaline phosphatase activity was 2-fold increased in both lines; (iii) 5'-nucleotidase, leucine aminopeptidase and Mg2+-ATPase activities remained unchanged in both lines; (iv) unesterified cholesterol and total phospholipid contents were unaltered in both lines, and (v) cholesteryl esters were increased in both lines, but to a greater extent in short sleep (1.5 vs. 4-fold). Thus, chronic ethanol ingestion induces specific alterations in liver plasma membrane structure and function, suggesting that adaptive responses to ethanol may be determined in part by inherited factors.

A twin study of individuals with both schizophrenia and alcoholism

Substantial evidence suggests that genetic factors contribute to the aetiology of both schizophrenia and alcoholism, when they occur alone. To examine the role of genetic factors in schizophrenia and alcoholism when they occur together in the same individual, the frequency of both conditions was investigated in the co-twins of 34 monozygotic (MZ) and 47 dizygotic (DZ) index twins with a diagnosis of both schizophrenia and alcoholism. Both disorders alone were significantly more common in the MZ than in the DZ co-twins, suggesting that individuals suffering from schizophrenia and alcoholism have a genetic predisposition to both disorders, which is of the same nature as that which causes the two when they occur alone. In the co-twins of the MZ index twins, the diagnoses of schizophrenia and alcoholism were uncorrelated, indicating that the specific environmental factors of causal importance in the two disorders are not closely related.

A family study of psychotic symptomatology in schizophrenia, schizoaffective disorder, unipolar depression, and bipolar disorder

An evaluation was made of schizophrenics (140), schizoaffectives (40), unipolar depressives (59), and bipolars (30), and their relatives who had a chart diagnosis of psychosis or depressive neurosis. The purpose was to determine whether the psychosis (delusions and hallucinations) was transmitted independently of the illness itself. If this were true, there would be an excess of pairs of probands and relatives both positive for psychosis and pairs of relatives and probands both negative for psychosis when compared to relatives and probands who were not concordant for the variable. This was found to be true in schizophrenia and schizoaffective disorder and is probably the result of the simple transmission of an illness which includes the presence of psychotic symptoms in the definition. Thus, this would be a manifestation of the genetic propensity in schizophrenia. For the affective disorders there was no evidence that psychotic probands were more likely than the nonpsychotic to have psychotic relatives. So far the reason why some patients have psychosis and others not in the affective disorders remains unexplained.

Depression, criminality and psychopathology associated with alcoholism: evidence from a twin study

A study of 74 twin pairs with alcoholic probands from the Maudsley Hospital is reported. Pairwise concordance for alcoholism as categorised by the SADS-L Research Diagnostic Criteria is similar in MZ twins (29%, 8/22) and DZ twins (33%, 13/39). Concordance for all diagnoses other than alcoholism is however significantly greater in MZ twins (48%, 13/27) than DZ twins (21%, 8/39, P less than 0.001). Concordance in MZ and DZ twins for all diagnoses other than alcoholism, including depression, did not coincide with concordance for alcoholism. Data on criminality revealed that 21% (32/148) of the twin sample had non-alcohol, non-traffic offences on record at the UK Home Office. Of the 32 with criminal records, 28 were alcoholic probands and pairwise concordance for criminality was found in only 1 MZ and 2 DZ pairs.

Event-related brain potentials in boys at risk for alcoholism

Recent neurophysiological findings have demonstrated that abstinent chronic alcoholics manifest deficits in event-related brain potentials. To explore possible biological antecedents of alcoholism the present study examined boys at high risk for alcoholism. Event-related brain potentials were recorded from biological sons of alcoholic fathers and matched control boys. Differences in the P3 component of the potentials were obtained between the high-risk and control subjects.

Psychosis in bipolar and unipolar affective illness with special reference to schizo-affective disorder

Bipolar and unipolar patients respectively were separated into psychotic and non-psychotic sub-types. The bipolar psychotic patients were more likely to have certain severe symptoms, such as hallucinations and motor abnormalities, than were the unipolar patients, but the family histories of the four sub-groups were identical. The psychotic sub-groups had a different course of illness, in that they were less likely to have had a history of multiple episodes on admission and were more likely to show chronicity for a period of time on discharge. The data are interpreted as being opposed to the concept of a continuum of vulnerability in the affective disorders, and as not favouring either psychotic unipolar or psychotic bipolar illnesses or schizo-affective disorder being considered autonomous. One possible interpretation of the findings is that a trait or propensity to psychosis is transmitted totally independently of the major affective illness, and that this propensity is silent or not observed when the patient is in remission.

Acetaldehyde stimulates collagen and noncollagen protein production by human fibroblasts

The mechanisms responsible for the increased hepatic collagen deposition in alcoholic cirrhosis remain unknown. The question of whether ethanol or acetaldehyde has a direct effect on collagen and noncollagen protein production was investigated in human fibroblasts with no detectable activity of alcohol dehydrogenase to distinguish the effects of these metabolites. To eliminate environmental factors, protein production by confluent human skin, fetal and hepatic fibroblasts was studied after three passages. Cells were labeled with [5-3H]proline for 4 hr in the presence of 0.2 mM ascorbate alone or with addition of either ethanol (50 mM) or acetaldehyde (0 to 300 microM). Rates of protein production were calculated from the radioactivities of collagenase-sensitive and collagenase-resistant proteins. Skin fibroblasts from alcoholic individual either with cirrhosis or without liver disease have comparable rates of collagen and noncollagen protein production. Acetaldehyde, in a concentration found in the liver during ethanol abuse, significantly increased collagen production by human skin fibroblasts (up to 140%), fetal fibroblasts (up to 240%) and hepatic fibroblasts (up to 70%) but the addition of ethanol had no significant effect on basal collagen production. The effect of acetaldehyde was dose-related and affected noncollagen protein production in a similar manner. Acetaldehyde did not cause changes in either proline transport or the specific activity of the proline precursor pool. This newly recognized stimulation of collagen production by acetaldehyde may be a possible mechanism of fibrogenesis in alcoholic individuals.

Genetic and biochemical factors relevant to alcoholism

Important biochemical clues from animal and human studies as well as epidemiologic studies of twins and adoptees suggest that genetic factors may predispose to alcohol addiction. This paper critically examines the epidemiology and biochemistry literature to assess the strength of the evidence supporting a genetic element in alcohol addiction. Then, a biochemical hypothesis is presented that involves the identification of specific metabolic pathways, pathway controls, and metabolites that may be unique to alcoholics, and which has been tested by experiment.

Arylsulfatase A variants in patients with alcoholism

Leukocytes from 200 mentally ill patients and 100 normal controls were analyzed for electrophoretic variants of arylsulfatase A. Four different variant forms were found in 15 subjects. There is a relatively high occurrence of the arylsulfatase A variants in patients with alcoholism. Twenty-one per cent (12/56) of patients with alcoholism have a variant enzyme. Only one of the 100 normal controls has a variant enzyme. (This single subject was considered normal by the criteria of the study, namely, a self-report of no current medical problem or psychiatric history. However, upon further testing, it was found that this subject has neurological and neuropsychological deficits). The hypothesis is presented that chronic alcohol intake and abnormal arylsulfatase A act in concert to elevate sulfatide levels which results in abnormalities of brain function. If this hypothesis is correct, persons in whom abnormal arylsulfatase A is expressed may be at risk to the neuropathological effects of alcohol.

2,3-butanediol: an unusual metabolite in the serum of severely alcoholic men during acute intoxication

In a controlled experiment 15 (79%) of 19 severely alcoholic men but only 1 of 22 controls had a serum concentration of greater than or equal to 5 mumol/l 2,3-butanediol after ingestion of distilled spirits. Another diol, 1,2-propanediol, was found in a concentration of greater than or equal to 5 mumol/l in all patients' specimens after drinking; but it was also present in lower concentrations in the reference specimens of most of the patients. These data are consistent with the experimental evidence that ethanol can be metabolised in rats to produce 2,3-butanediol and with the epidemiological hypothesis that severely alcoholic men metabolise ethanol by a different pathway than do control subjects.

Selective breeding for a multivariate index of ethanol dependence in mice: results from the first five generations

Starting with a population of genetically heterogeneous mice (HS/lbg), selection for a multivariate index of the ethanol withdrawal syndrome has been initiated. The study uses within-litter selection to minimize inbreeding and includes replicate high, low, and control lines. After five generations, results indicate that selection is proceeding successfully. There is evidence of asymmetry in the selection, i.e., selection is proceeding more rapidly for signs of severe withdrawal than for mild withdrawal signs. The realized heritability after five generations of within-family selection is approximately 0.15. These selected lines should eventually prove useful in determining some of the underlying genetic, physiological, and biochemical mechanisms involved in ethanol dependence.

Event-related brain potentials are different in individuals at high and low risk for developing alcoholism

Event-related brain potentials (ERPs) from normal drinkers with and without a family history of alcoholism were compared. Three separate groups of 10 subjects each (5 with and 5 without a family history of alcoholism) ingested either a placebo or ethanol at 0.56 or 0.94 g/kg. In each comparison, ERP components elicited in conjunction with subjects' decisions about task-relevant stimuli were of significantly reduced amplitude in individuals with a family history of alcoholism. Additionally, both the latency of the positive component and reaction times to correctly detected targets were significantly later in individuals with a positive history of alcoholism than in those without such a history. These group differences were apparent both with and without a challenge of alcohol. The data suggest that brain functions are different in individuals at high and low risk for the development of alcoholism (i.e., those with and without a family history of alcoholism, respectively).

Risk of alcoholism and parental history: gender differences and a possible reporting bias

INTRODUCTION

Using data from a population-based study, we examined the association of parental history of heavy drinking and depressed mood with the occurrence of alcohol abuse and dependence in the participants, stratified on gender. We hypothesized that a parental history of heavy drinking or depressed mood would have a stronger association with the occurrence of alcohol abuse or dependence among women than among men.

METHODS

In 1981, collaborators in the National Institute of Mental Health Epidemiologic Catchment Area Program recruited 3,481 adult participants after probability sample selection of census tracts and households in Baltimore, Maryland. To assess the occurrence of psychiatric conditions over time, the Diagnostic Interview Schedule was administered soon after sampling and again at follow-up, roughly 1 year later. At the follow-up interview, parental history of psychiatric conditions was assessed. Individuals who did not complete either the baseline or follow-up interview, or who used a proxy informant were excluded from these analyses. These exclusions left 2,588 household residents who comprised the complete study sample, of which 384 had alcohol abuse or dependence.

RESULTS

The degree of association of alcoholism with parental history of heavy drinking or depressed mood is greater for women than for men. Men have an increased risk for alcohol abuse and dependence if they report that father has a history of heavy drinking (OR = 1.6, P < .01). For women, an alcohol disorder is associated with heavy drinking in fathers and in mothers (OR = 2.1, P < .01; OR = 2.6, P < .01, respectively). A similar pattern is found for a parental history of depressed mood. In addition, there is evidence of a possible reporting bias: Men and women with alcohol abuse or dependence are less likely to provide family information than participants without alcohol abuse or dependence. Among men, the presence of missing parental history information is significantly associated with alcohol abuse and dependence.

CONCLUSION

The current report shows evidence for a gender difference in the relationship of parental history of heavy drinking and depression with the risk of alcoholism in offspring, and suggests that the effect of missing information should be considered when analyzing family data.