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Bohnsack JP, Zhang H, Pandey SC. EZH2-dependent epigenetic reprogramming in the central nucleus of amygdala regulates adult anxiety in both sexes after adolescent alcohol exposure. Transl Psychiatry 2024; 14:197. [PMID: 38670959 PMCID: PMC11053082 DOI: 10.1038/s41398-024-02906-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Alcohol use and anxiety disorders occur in both males and females, but despite sharing similar presentation and classical symptoms, the prevalence of alcohol use disorder (AUD) is lower in females. While anxiety is a symptom and comorbidity shared by both sexes, the common underlying mechanism that leads to AUD and the subsequent development of anxiety is still understudied. Using a rodent model of adolescent intermittent ethanol (AIE) exposure in both sexes, we investigated the epigenetic mechanism mediated by enhancer of zeste 2 (EZH2), a histone methyltransferase, in regulating both the expression of activity-regulated cytoskeleton-associated protein (Arc) and an anxiety-like phenotype in adulthood. Here, we report that EZH2 protein levels were significantly higher in PKC-δ positive GABAergic neurons in the central nucleus of amygdala (CeA) of adult male and female rats after AIE. Reducing protein and mRNA levels of EZH2 using siRNA infusion in the CeA prevented AIE-induced anxiety-like behavior, increased H3K27me3, decreased H3K27ac at the Arc synaptic activity response element (SARE) site, and restored deficits in Arc mRNA and protein expression in both male and female adult rats. Our data indicate that an EZH2-mediated epigenetic mechanism in the CeA plays an important role in regulating anxiety-like behavior and Arc expression after AIE in both male and female rats in adulthood. This study suggests that EZH2 may serve as a tractable drug target for the treatment of adult psychopathology after adolescent alcohol exposure.
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Affiliation(s)
- John Peyton Bohnsack
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, 60612, USA
| | - Huaibo Zhang
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, 60612, USA
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL, 60612, USA
| | - Subhash C Pandey
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois Chicago, Chicago, IL, 60612, USA.
- Jesse Brown Veterans Affairs Medical Center, Chicago, IL, 60612, USA.
- Department of Anatomy and Cell Biology, University of Illinois Chicago, Chicago, IL, 60612, USA.
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2
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Bohnsack JP, Zhang H, Wandling GM, He D, Kyzar EJ, Lasek AW, Pandey SC. Targeted epigenomic editing ameliorates adult anxiety and excessive drinking after adolescent alcohol exposure. SCIENCE ADVANCES 2022; 8:eabn2748. [PMID: 35507645 PMCID: PMC9067919 DOI: 10.1126/sciadv.abn2748] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Adolescent binge drinking is a major risk factor for psychiatric disorders later in life including alcohol use disorder. Adolescent alcohol exposure induces epigenetic reprogramming at the enhancer region of the activity-regulated cytoskeleton-associated protein (Arc) immediate-early gene, known as synaptic activity response element (SARE), and decreases Arc expression in the amygdala of both rodents and humans. The causal role of amygdalar epigenomic regulation at Arc SARE in adult anxiety and drinking after adolescent alcohol exposure is unknown. Here, we show that dCas9-P300 increases histone acetylation at the Arc SARE and normalizes deficits in Arc expression, leading to attenuation of adult anxiety and excessive alcohol drinking in a rat model of adolescent alcohol exposure. Conversely, dCas9-KRAB increases repressive histone methylation at the Arc SARE, decreases Arc expression, and produces anxiety and alcohol drinking in control rats. These results demonstrate that epigenomic editing in the amygdala can ameliorate adult psychopathology after adolescent alcohol exposure.
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Affiliation(s)
- John Peyton Bohnsack
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Huaibo Zhang
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Gabriela M. Wandling
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Donghong He
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Evan J. Kyzar
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Amy W. Lasek
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, 60612 USA
| | - Subhash C. Pandey
- Center for Alcohol Research in Epigenetics, Department of Psychiatry, University of Illinois at Chicago, Chicago, IL 60612, USA
- Jesse Brown VA Medical Center, Chicago, IL 60612, USA
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, Chicago, IL, 60612 USA
- Corresponding author.
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3
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Nordeck CD, Riehm KE, Smail EJ, Holingue C, Kane JC, Johnson RM, Veldhuis CB, Kalb LG, Stuart EA, Kreuter F, Thrul J. Changes in drinking days among United States adults during the COVID-19 pandemic. Addiction 2022; 117:331-340. [PMID: 34159674 PMCID: PMC8441933 DOI: 10.1111/add.15622] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/30/2020] [Accepted: 06/09/2021] [Indexed: 12/11/2022]
Abstract
AIMS To examine changes in drinking behavior among United States (US) adults between March 10 and July 21, 2020, a critical period during the COVID-19 pandemic. DESIGN Longitudinal, internet-based panel survey. SETTING The Understanding America Study (UAS), a nationally representative panel of US adults age 18 or older. PARTICIPANTS A total of 4298 US adults who reported alcohol use. MEASUREMENTS Changes in number of reported drinking days from March 11, 2020 through July 21, 2020 in the overall sample and stratified by sex, age, race/ethnicity, household structure, poverty status, and census region. FINDINGS Compared with March 11, the number of drinking days per week was significantly higher on April 1 by an average of 0.36 days (95% CI = 0.30, 0.43), on May 1 by an average of 0.55 days (95% CI = 0.47, 0.63), on June 1 by an average of 0.41 days (95% CI = 0.33, 0.49), and on July 1 by an average of 0.39 days (95% CI = 0.31, 0.48). Males, White participants, and older adults reported sustained increases in drinking days, whereas female participants and individuals living under the federal poverty line had attenuated drinking days in the latter part of the study period. CONCLUSIONS Between March and mid-July 2020, adults in the United States reported increases in the number of drinking days, with sustained increases observed among males, White participants, and older adults.
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Affiliation(s)
- Courtney D. Nordeck
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - Kira E. Riehm
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - Emily J. Smail
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - Calliope Holingue
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
- Department of Neuropsychology, Kennedy Krieger InstituteJohns Hopkins UniversityBaltimoreMDUSA
| | - Jeremy C. Kane
- Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Renee M. Johnson
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Luther G. Kalb
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
- Department of Neuropsychology, Kennedy Krieger InstituteJohns Hopkins UniversityBaltimoreMDUSA
| | - Elizabeth A. Stuart
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
| | - Frauke Kreuter
- Joint Program in Survey MethodologyUniversity of MarylandMDUSA
- Department of StatisticsLudwig Maximilian University of MunichMunichGermany
- Statistical Methods GroupInstitute for Employment ResearchNurembergGermany
| | - Johannes Thrul
- Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMDUSA
- Centre for Alcohol Policy ResearchLa Trobe UniversityBundooraVICAustralia
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4
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Saramago P, Gega L, Marshall D, Nikolaidis GF, Jankovic D, Melton H, Dawson S, Churchill R, Bojke L. Digital Interventions for Generalized Anxiety Disorder (GAD): Systematic Review and Network Meta-Analysis. Front Psychiatry 2021; 12:726222. [PMID: 34938209 PMCID: PMC8685377 DOI: 10.3389/fpsyt.2021.726222] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Generalized anxiety disorder is the most common mental health condition based on weekly prevalence. Digital interventions have been used as alternatives or as supplements to conventional therapies to improve access, patient choice, and clinical outcomes. Little is known about their comparative effectiveness for generalized anxiety disorder. Methods: We conducted a systematic review and network meta-analysis of randomized controlled trials comparing digital interventions with medication, non-digital interventions, non-therapeutic controls, and no intervention. Results: We included 21 randomized controlled trials with a total of 2,350 participants from generalized anxiety disorder populations. Pooled outcomes using analysis of Covariance and rankograms based on the surface under the cumulative ranking curves indicated that antidepressant medication and group therapy had a higher probability than digital interventions of being the "best" intervention. Supported digital interventions were not necessarily "better" than unsupported (pure self-help) ones. Conclusions: Due to very wide confidence intervals, network meta-analysis results were inconclusive as to whether digital interventions are better than no intervention and non-therapeutic active controls, or whether they confer an additional benefit to standard therapy. Future research needs to compare digital interventions with one-to-one therapy and with manualized non-digital self-help and to include antidepressant medication as a treatment comparator and effect modifier.
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Affiliation(s)
- Pedro Saramago
- Centre for Health Economics, University of York, York, United Kingdom
| | - Lina Gega
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, University of York, Heslington, United Kingdom
- Tees, Esk and Wear Valleys NHS Trust, Darlington, United Kingdom
| | - David Marshall
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Georgios F. Nikolaidis
- Centre for Health Economics, University of York, York, United Kingdom
- IQVIA, London, United Kingdom
| | - Dina Jankovic
- Centre for Health Economics, University of York, York, United Kingdom
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
| | - Sarah Dawson
- Common Mental Disorders Group, Cochrane Collaboration, York, United Kingdom
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, United Kingdom
- Common Mental Disorders Group, Cochrane Collaboration, York, United Kingdom
| | - Laura Bojke
- Centre for Health Economics, University of York, York, United Kingdom
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5
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McEwan AR, Davidson C, Hay E, Turnbull Y, Erickson JC, Marini P, Wilson D, McIntosh AM, Adams MJ, Murgatroyd C, Barrett P, Delibegovic M, Clarke TK, MacKenzie A. CRISPR disruption and UK Biobank analysis of a highly conserved polymorphic enhancer suggests a role in male anxiety and ethanol intake. Mol Psychiatry 2021; 26:2263-2276. [PMID: 32203157 DOI: 10.1038/s41380-020-0707-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 02/20/2020] [Accepted: 02/27/2020] [Indexed: 02/06/2023]
Abstract
Excessive alcohol intake is associated with 5.9% of global deaths. However, this figure is especially acute in men such that 7.6% of deaths can be attributed to alcohol intake. Previous studies identified a significant interaction between genotypes of the galanin (GAL) gene with anxiety and alcohol abuse in different male populations but were unable to define a mechanism. To address these issues the current study analysed the human UK Biobank cohort and identified a significant interaction (n = 115,865; p = 0.0007) between allelic variation (GG or CA genotypes) in the highly conserved human GAL5.1 enhancer, alcohol intake (AUDIT questionnaire scores) and anxiety in men. Critically, disruption of GAL5.1 in mice using CRISPR genome editing significantly reduced GAL expression in the amygdala and hypothalamus whilst producing a corresponding reduction in ethanol intake in KO mice. Intriguingly, we also found the evidence of reduced anxiety-like behaviour in male GAL5.1KO animals mirroring that seen in humans from our UK Biobank studies. Using bioinformatic analysis and co-transfection studies we further identified the EGR1 transcription factor, that is co-expressed with GAL in amygdala and hypothalamus, as being important in the protein kinase C (PKC) supported activity of the GG genotype of GAL5.1 but less so in the CA genotype. Our unique study uses a novel combination of human association analysis, CRISPR genome editing in mice, animal behavioural analysis and cell culture studies to identify a highly conserved regulatory mechanism linking anxiety and alcohol intake that might contribute to increased susceptibility to anxiety and alcohol abuse in men.
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Affiliation(s)
- Andrew R McEwan
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Connor Davidson
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Elizabeth Hay
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Yvonne Turnbull
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Johanna Celene Erickson
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Pietro Marini
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Dana Wilson
- Rowett Institute of Nutrition and Health, School of Medicine, Medical Sciences and Nutrition, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Andrew M McIntosh
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, EH8 9YL, UK.,Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, EH8 9YL, UK
| | - Mark J Adams
- Division of Psychiatry, University of Edinburgh, Edinburgh, Scotland, EH8 9YL, UK
| | - Chris Murgatroyd
- School of Healthcare Sciences, John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - Perry Barrett
- Rowett Institute of Nutrition and Health, School of Medicine, Medical Sciences and Nutrition, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Mirela Delibegovic
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK
| | - Toni-Kim Clarke
- School of Healthcare Sciences, John Dalton Building, Manchester Campus, Manchester Metropolitan University, Manchester, M15 6BH, UK
| | - Alasdair MacKenzie
- School of Medicine, Medical Sciences and Nutrition, Institute of Medical Sciences, Foresterhill, University of Aberdeen, Aberdeen, Scotland, AB25 2ZD, UK.
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6
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Rawls E, Kummerfeld E, Zilverstand A. An integrated multimodal model of alcohol use disorder generated by data-driven causal discovery analysis. Commun Biol 2021; 4:435. [PMID: 33790384 PMCID: PMC8012376 DOI: 10.1038/s42003-021-01955-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/24/2021] [Indexed: 12/24/2022] Open
Abstract
Alcohol use disorder (AUD) has high prevalence and adverse societal impacts, but our understanding of the factors driving AUD is hampered by a lack of studies that describe the complex neurobehavioral mechanisms driving AUD. We analyzed causal pathways to AUD severity using Causal Discovery Analysis (CDA) with data from the Human Connectome Project (HCP; n = 926 [54% female], 22% AUD [37% female]). We applied exploratory factor analysis to parse the wide HCP phenotypic space (100 measures) into 18 underlying domains, and we assessed functional connectivity within 12 resting-state brain networks. We then employed data-driven CDA to generate a causal model relating phenotypic factors, fMRI network connectivity, and AUD symptom severity, which highlighted a limited set of causes of AUD. The model proposed a hierarchy with causal influence propagating from brain connectivity to cognition (fluid/crystalized cognition, language/math ability, & working memory) to social (agreeableness/social support) to affective/psychiatric function (negative affect, low conscientiousness/attention, externalizing symptoms) and ultimately AUD severity. Our data-driven model confirmed hypothesized influences of cognitive and affective factors on AUD, while underscoring that addiction models need to be expanded to highlight the importance of social factors, amongst others.
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Affiliation(s)
- Eric Rawls
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.
| | - Erich Kummerfeld
- Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Anna Zilverstand
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
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7
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Agabio R, Baldwin DS, Amaro H, Leggio L, Sinclair JMA. The influence of anxiety symptoms on clinical outcomes during baclofen treatment of alcohol use disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2021; 125:296-313. [PMID: 33454289 DOI: 10.1016/j.neubiorev.2020.12.030] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/17/2020] [Accepted: 12/27/2020] [Indexed: 12/22/2022]
Abstract
Given the high coexistence of anxiety symptoms in people with alcohol use disorder (AUD), we aimed to determine the influence of anxiety symptoms on outcomes in patients with AUD treated with the GABAB receptor agonist baclofen. A meta-analysis of 13 comparisons (published 2010-2020) including baseline and outcome data on alcohol consumption and anxiety after 12 weeks was undertaken. There were significantly higher rates of abstinent days in patients treated with baclofen compared to placebo (p = 0.004; high certainty evidence); specifically in those with higher baseline anxiety levels (p < 0.00001; high certainty evidence) compared to those with lower baseline anxiety levels (p = 0.20; moderate certainty evidence). The change in anxiety ratings over 12 weeks did not differ between those treated with baclofen or placebo (p = 0.84; moderate certainty evidence). This may be due to different anxiety constructs being measured by scales not validated in this patient group, or that anxiety is not a biobehavioral mechanism by which baclofen may reduce alcohol drinking. Given the prevalence of anxiety symptoms in AUD all these factors warrant further research.
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Affiliation(s)
- Roberta Agabio
- Department of Biomedical Sciences, Section of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy.
| | - David S Baldwin
- Faculty of Medicine, University of Southampton, Southampton, UK; University Department of Psychiatry and Mental Health, University of Cape Town, South Africa.
| | - Hugo Amaro
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Lorenzo Leggio
- Clinical Psychoneuroendocrinology and Neuropsychopharmacology Section, Translational Addiction Medicine Branch, National Institute on Drug Abuse Intramural Research Program and National Institute on Alcohol Abuse and Alcoholism Division of Intramural Clinical and Biological Research, National Institutes of Health, Baltimore and Bethesda, MD, United States; Medication Development Program, National Institute on Drug Abuse Intramural Research Program, National Institutes of Health, Baltimore, MD, United States; Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States; Division of Addiction Medicine, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States; Department of Neuroscience, Georgetown University Medical Center, Washington DC, United States.
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8
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Müller M, Ajdacic-Gross V, Vetrella AB, Preisig M, Castelao E, Lasserre A, Rodgers S, Rössler W, Vetter S, Seifritz E, Vandeleur C. Subtypes of alcohol use disorder in the general population: A latent class analysis. Psychiatry Res 2020; 285:112712. [PMID: 31837815 DOI: 10.1016/j.psychres.2019.112712] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 02/04/2023]
Abstract
Alcohol use disorders (AUD) are often comorbid with other disorders with high levels of impairment, which is of relevance for the development and the progression of the disease. Evidence shows that AUD varies greatly with regard to its aetiology, which might lead to distinct clinical representations with important implications for treatment. The current study aimed to apply latent class analysis (LCA) techniques to investigate how comorbidity patterns in AUD vary with regard to specific explanatory factors. A Swiss community sample of N=439 individuals with AUD was subjected to LCA in order to find empirical AUD subtypes of comorbid psychiatric conditions. The subtypes were further validated based on a range of external criteria, including clinical and psycho-social factors as well as treatment variables. A three-class solution of empirical subtypes of AUD comorbidity (low, depressive-anxious, and drug-dependent antisocial) provided the best fit to the data. The three AUD subtypes showed homogeneous comorbidity patterns but varied along dimensions of psycho-social risk factors, consumption patterns and consequences as well as treatment history. Our findings provide strong evidence that AUD in non-treated samples can be described as a multidimensional disorder in terms of its comorbidity structure with distinct etiological factors and important consequences for treatment.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Antonio Besi Vetrella
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Aurélie Lasserre
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stephanie Rodgers
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland
| | - Wulf Rössler
- Zurich Programme for Sustainable Development of Mental Health Services, Zurich, Switzerland; Institute of Psychiatry, Laboratory of Neuroscience (LIM 27), University of Sao Paulo, Sao Paulo, Brazil; Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité - University Medicine Berlin, Germany
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland; Centre for Disaster and Military Psychiatry, University of Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Zurich University Hospital of Psychiatry, Zurich, Switzerland
| | - Caroline Vandeleur
- Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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9
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Barbosa C, Dowd WN, Aldridge AP, Timko C, Zarkin GA. Estimating Long-Term Drinking Patterns for People with Lifetime Alcohol Use Disorder. Med Decis Making 2019; 39:765-780. [PMID: 31580211 DOI: 10.1177/0272989x19873627] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background. There is a lack of data on alcohol consumption over time. This study characterizes the long-term drinking patterns of people with lifetime alcohol use disorders who have engaged in treatment or informal care. Methods. We developed multinomial logit models using the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to estimate short-term transition probabilities (TPs) among the 4 World Health Organization drinking risk levels (low, medium, high, and very high risk) and abstinence by age, sex, and race/ethnicity. We applied an optimization algorithm to convert 3-year TPs from NESARC to 1-year TPs, then used simulated annealing to calibrate TPs to a propensity-scored matched set of participants derived from a separate 16-year study of alcohol consumption. We validated the resulting long-term TPs using NESARC-III, a cross-sectional study conducted on a different cohort. Results. Across 24 demographic groups, the 1-year probability of remaining in the same state averaged 0.93, 0.81, 0.49, 0.51, and 0.63 for abstinent, low, medium, high, and very high-risk states, respectively. After calibration to the 16-year study data (N = 420), resulting TPs produced state distributions that hit the calibration target. We find that the abstinent or low-risk states are very stable, and the annual probability of leaving the very high-risk state increases by about 20 percentage points beyond 8 years. Limitations. TPs for some demographic groups had small cell sizes. The data used to calibrate long-term TPs are based on a geographically narrow study. Conclusions. This study is the first to characterize long-term drinking patterns by combining short-term representative data with long-term data on drinking behaviors. Current research is using these patterns to estimate the long-term cost effectiveness of alcohol treatment.
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Affiliation(s)
- Carolina Barbosa
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| | - William N Dowd
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| | - Arnie P Aldridge
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
| | - Christine Timko
- Health Services Research & Development Center for Innovation to Implementation, Department of Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Gary A Zarkin
- Behavioral Health Research Division, RTI International, Chicago, IL, USA
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10
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Chou PH, Koenen KC. Associations between childhood maltreatment and risk of myocardial infarction in adulthood: Results from the National Epidemiologic Survey on alcohol and Related Conditions. J Psychiatr Res 2019; 116:172-177. [PMID: 30553535 DOI: 10.1016/j.jpsychires.2018.12.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/21/2018] [Accepted: 12/03/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Although childhood maltreatment has been reported to be associated with the incidence of cardiovascular diseases, its association with specific major cardiovascular events remains unclear. This study aimed to examine the relationship between different types of childhood maltreatment (CM) and myocardial infarction (MI) occurrence in a nationally representative sample. METHODS We used data from the National Epidemiologic Survey of Alcohol and Related Conditions, a nationally representative US sample of adults aged 20 years and older (N = 34, 653). Logistic regression models were constructed to investigate the associations between five types of CMs including physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse and the risk of MI adjusting for sociodemographic variables. RESULTS After adjusting for sociodemographic variables, childhood sexual abuse was significantly associated with increased odds of MI occurrence (adjusted odds ratio [aOR] = 1.85, 95%CI = 1.24-2.76, p = 0.003). Additionally, childhood physical abuse was significantly associated with increased odds of MI occurrence in men (aOR = 2.45, 95%CI = 1.35-4.44, p = 0.004) but this association was not observed in women (aOR = 0.72, 95%CI = 0.32-1.66, p = 0.440). Compared to those who did not experience CM, those who experienced more than three types of CMs showed increased odds of MI occurrence (adjusted OR = 2.08-3.05, all p < 0.05). CONCLUSIONS Using data from a nationally representative US sample of adults, we found significant positive associations between CM and odds of MI occurrence in adulthood. Future longitudinal prospective studies are needed to confirm our findings.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, 40447, Taiwan; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, 40402, Taiwan.
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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11
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Lemyre A, Gauthier-Légaré A, Bélanger RE. Shyness, social anxiety, social anxiety disorder, and substance use among normative adolescent populations: A systematic review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 45:230-247. [DOI: 10.1080/00952990.2018.1536882] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Alexandre Lemyre
- School of Psychology, Université Laval, Québec, QC, Canada
- Population Health and Optimal Health Practices Branch, CHU de Québec Research Centre, Québec, QC, Canada
| | - Audrey Gauthier-Légaré
- School of Psychology, Université Laval, Québec, QC, Canada
- University Center for Research on Youth and Families, Québec, QC, Canada
| | - Richard E. Bélanger
- Population Health and Optimal Health Practices Branch, CHU de Québec Research Centre, Québec, QC, Canada
- Department of Paediatrics, Centre mère-enfant Soleil, CHU de Québec, CHU de Québec-Université Laval, Québec, QC, Canada
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12
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Ivanovs R, Kivite A, Ziedonis D, Mintale I, Vrublevska J, Rancans E. Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study. BMC Public Health 2018; 18:328. [PMID: 29510681 PMCID: PMC5840840 DOI: 10.1186/s12889-018-5238-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiovascular (CV) diseases (CVDs) are the leading cause of mortality worldwide. Globally, there is a growing interest in understanding and addressing modifiable psychosocial risk factors, particularly depression and anxiety, to prevent CVDs and to reduce morbidity and mortality. Despite the high premature mortality rate from CVDs in Latvia, this is the first Latvian study to examine the association of depression and anxiety with CVD morbidity in a primary care population. METHODS This cross-sectional study was carried out in 2015 within the framework of the National Research Program BIOMEDICINE at 24 primary care facilities throughout Latvia. Consecutive adult patients during a one-week time period at each facility were invited to join the study. Assessments onsite included a 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7) followed by a socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, and total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to the general practitioner. A multivariate model was developed using binary logistic regression. RESULTS From the 1565 subjects (31.2% male), CVD was detected in 17.1%. Depression screening was positive (PHQ-9 ≥ 10) for 14.7%, and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% of the study subjects. According to the MINI, 10.3% had current and 28.1% had lifetime depressive episode, and 16.1% had an anxiety disorder. Depression, not anxiety, was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI). CONCLUSIONS Current depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity. Therefore, CV patients should be screened and treated for depression to potentially improve the prognosis of CVDs. Enhanced training and integration of mental health treatment in Latvian primary care settings may improve clinical outcomes.
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Affiliation(s)
- R Ivanovs
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia.
| | - A Kivite
- Department of Public Health and Epidemiology, Riga Stradins University, 9 Kronvalda Ave, Riga, LV-1010, Latvia
| | - D Ziedonis
- Associate Vice Chancellor for Health Sciences, University of California San Diego, Biomedical Sciences Building, Room 1310, 9500 Gilman Drive #0602, La Jolla, CA, 92093, USA
| | - I Mintale
- Department of Cardiology, University Clinic of Paul Stradins, 13 Pilsonu Str, Riga, LV-1002, Latvia
| | - J Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia
| | - E Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia
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13
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Domenico LH, Lewis B, Hazarika M, Nixon SJ. Characterizing Anxiety Among Individuals Receiving Treatment for Alcohol and Substance Use Disorders. J Am Psychiatr Nurses Assoc 2018; 24:343-351. [PMID: 29126358 PMCID: PMC5930139 DOI: 10.1177/1078390317739106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite high prevalence of generalized anxiety disorder (GAD) substance use disorder (SUD) comorbidity, little is known regarding demographic characteristics associated with GAD in SUD treatment seekers. OBJECTIVE To characterize demographic differences between inpatient SUD treatment seekers reporting varying levels of GAD symptomatology. DESIGN General linear models, chi-square test, t test, and correlational analyses were utilized to assess group differences. Groups included those with no history of significant anxiety (No GAD; n = 256), subclinical anxiety (Subclinical; n = 85), and those meeting GAD diagnostic criteria (GAD; n = 61). RESULTS The No GAD group differed substantially from Subclinical and GAD individuals. With the exception of polysubstance use, no differences were found regarding Subclinical and GAD groups. CONCLUSION Individuals with subclinical GAD symptoms and those meeting diagnostic criteria were nearly identical regarding precursors to problematic substance use, severity of use, and key mental health indicators. Findings suggest subclinical levels of GAD should not be overlooked when assessing and treating SUDs.
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Affiliation(s)
- Lisa H Domenico
- 1 Lisa H. Domenico, PhD, University of Florida, Gainesville, FL, USA
| | - Ben Lewis
- 2 Ben Lewis, PhD, University of Florida, Gainesville, FL, USA
| | - Mythili Hazarika
- 3 Mythili Hazarika, PhD, Gauhati Medical College Hospital, Guwahati, Assam, India
| | - Sara Jo Nixon
- 4 Sara Jo Nixon, PhD, University of Florida, Gainesville, FL, USA
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14
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Anker JJ, Forbes MK, Almquist ZW, Menk JS, Thuras P, Unruh AS, Kushner MG. A network approach to modeling comorbid internalizing and alcohol use disorders. JOURNAL OF ABNORMAL PSYCHOLOGY 2017; 126:325-339. [PMID: 28182444 PMCID: PMC5388354 DOI: 10.1037/abn0000257] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Internalizing disorders co-occur with alcohol use disorder (AUD) at a rate that exceeds chance and compromise conventional AUD treatment. The "vicious cycle" model of comorbidity specifies drinking to cope (DTC) as a link between these disorders that, when not directly addressed, undermines the effectiveness of conventional treatments. Interventions based on this model have proven successful but there is no direct evidence for how and to what extent DTC contributes to the maintenance of comorbidity. In the present study, we used network analysis to depict associations between syndrome-specific groupings of internalizing symptoms, alcohol craving, and drinking behavior, as well as DTC and other extradiagnostic variables specified in the vicious cycle model (e.g., perceived stress and coping self-efficacy). Network analyses of 362 individuals with comorbid anxiety and AUD assessed at the beginning of residential AUD treatment indicated that while internalizing conditions and drinking elements had only weak direct associations, they were strongly connected with DTC and perceived stress. Consistent with this, centrality indices showed that DTC ranked as the most central/important element in the network in terms of its "connectedness" to all other network elements. A series of model simulations-in which individual elements were statistically controlled for-demonstrated that DTC accounted for all the relationships between the drinking-related elements and internalizing elements in the network; no other variable had this effect. Taken together, our findings suggest that DTC may serve as a "keystone" process in maintaining comorbidity between internalizing disorders and AUD. (PsycINFO Database Record
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Affiliation(s)
| | | | | | - Jeremiah S Menk
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute
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15
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The FKBP5 Gene Affects Alcohol Drinking in Knockout Mice and Is Implicated in Alcohol Drinking in Humans. Int J Mol Sci 2016; 17:ijms17081271. [PMID: 27527158 PMCID: PMC5000669 DOI: 10.3390/ijms17081271] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/21/2016] [Accepted: 07/25/2016] [Indexed: 12/12/2022] Open
Abstract
FKBP5 encodes FK506-binding protein 5, a glucocorticoid receptor (GR)-binding protein implicated in various psychiatric disorders and alcohol withdrawal severity. The purpose of this study is to characterize alcohol preference and related phenotypes in Fkbp5 knockout (KO) mice and to examine the role of FKBP5 in human alcohol consumption. The following experiments were performed to characterize Fkpb5 KO mice. (1) Fkbp5 KO and wild-type (WT) EtOH consumption was tested using a two-bottle choice paradigm; (2) The EtOH elimination rate was measured after intraperitoneal (IP) injection of 2.0 g/kg EtOH; (3) Blood alcohol concentration (BAC) was measured after 3 h limited access of alcohol; (4) Brain region expression of Fkbp5 was identified using LacZ staining; (5) Baseline corticosterone (CORT) was assessed. Additionally, two SNPs, rs1360780 (C/T) and rs3800373 (T/G), were selected to study the association of FKBP5 with alcohol consumption in humans. Participants were college students (n = 1162) from 21–26 years of age with Chinese, Korean or Caucasian ethnicity. The results, compared to WT mice, for KO mice exhibited an increase in alcohol consumption that was not due to differences in taste sensitivity or alcohol metabolism. Higher BAC was found in KO mice after 3 h of EtOH access. Fkbp5 was highly expressed in brain regions involved in the regulation of the stress response, such as the hippocampus, amygdala, dorsal raphe and locus coeruleus. Both genotypes exhibited similar basal levels of plasma corticosterone (CORT). Finally, single nucleotide polymorphisms (SNPs) in FKBP5 were found to be associated with alcohol drinking in humans. These results suggest that the association between FKBP5 and alcohol consumption is conserved in both mice and humans.
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16
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Mangueira SDO, Lopes MVDO. Clinical validation of the nursing diagnosis of dysfunctional family processes related to alcoholism. J Adv Nurs 2016; 72:2401-12. [DOI: 10.1111/jan.12999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2016] [Indexed: 11/30/2022]
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17
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Hasin DS, Grant BF. The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1609-40. [PMID: 26210739 PMCID: PMC4618096 DOI: 10.1007/s00127-015-1088-0] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 06/28/2015] [Indexed: 01/12/2023]
Abstract
PURPOSE The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. METHOD NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. RESULT The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. CONCLUSIONS Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, New York, NY, 10032, USA
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5635 Fishers Lane, Room 3077, Rockville, MD, 20852, USA.
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Birrell L, Newton NC, Teesson M, Tonks Z, Slade T. Anxiety disorders and first alcohol use in the general population. Findings from a nationally representative sample. J Anxiety Disord 2015; 31:108-13. [PMID: 25795078 DOI: 10.1016/j.janxdis.2015.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 02/19/2015] [Accepted: 02/24/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine how early onset anxiety disorders are related to age of first alcohol use in a general population sample. METHOD Discrete time survival analysis was used to model the odds of first alcohol use among those with, vs without, early onset anxiety disorders. Data came from the 2007 Australian National Survey of Mental Health and Wellbeing. RESULTS After adjusting for the effects of family history of alcohol/drug use, sex, age cohort and education, people who experienced an early onset anxiety disorder had a 27% increased odds of first alcohol use in any given year, when compared to those with no anxiety disorder. This effect was particularly strong for transitions to first alcohol use that occurred after the age of 13 years. CONCLUSIONS Early onset anxiety disorders significantly predict first alcohol use in the general population and this relationship appears to be related to change over time. These results point to the need for developmentally appropriate and integrated prevention programs that target anxiety and alcohol use together.
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Affiliation(s)
- Louise Birrell
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney 2052, NSW, Australia.
| | - Nicola C Newton
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney 2052, NSW, Australia.
| | - Maree Teesson
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney 2052, NSW, Australia.
| | - Zoe Tonks
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney 2052, NSW, Australia.
| | - Tim Slade
- NHMRC Centre of Research Excellence in Mental Health and Substance Use (CREMS), National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney 2052, NSW, Australia.
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Altamura AC, Caldiroli A, Buoli M. Pharmacokinetic evaluation of fluvoxamine for the treatment of anxiety disorders. Expert Opin Drug Metab Toxicol 2015; 11:649-60. [DOI: 10.1517/17425255.2015.1021331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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20
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Di Lorenzo R, Galliani A, Guicciardi A, Landi G, Ferri P. A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services. Neuropsychiatr Dis Treat 2014; 10:1479-88. [PMID: 25143738 PMCID: PMC4136981 DOI: 10.2147/ndt.s65896] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To highlight which demographic, familial, premorbid, clinical, therapeutic, rehabilitative, and assistance factors were related to dual diagnosis, which, in psychiatry, means the co-occurrence of both mental disorder and substance use in the same patient. METHODS Our sample (N=145) was chosen from all outpatients with a dual diagnosis treated from January 1, 2012 to July 31, 2012 by both the Mental Health Service and the Substance Use Service of Modena and Castelfranco Emilia, Italy. Patients who dropped out during the study period were excluded. Demographic data and variables related to familial and premorbid history, clinical course, rehabilitative programs, social support and nursing care, and outcome complications were collected. The patients' clinical and functioning conditions during the study period were evaluated. RESULTS Our patients were mostly men suffering from a cluster B personality disorder. Substance use was significantly more likely to precede psychiatric disease (P<0.001), and 60% of the sample presented a positive familial history for psychiatric or addiction disease or premorbid traumatic factors. The onset age of substance use was related to the period of psychiatric treatment follow-up (P<0.001) and the time spent in rehabilitative facilities (P<0.05), which, in turn, was correlated with personality disorder diagnosis (P<0.05). Complications, which presented in 67% of patients, were related to the high number of psychiatric hospitalizations (P<0.05) and professionals involved in each patient's treatment (P<0.05). Males more frequently presented familial, health, and social complications, whereas females more frequently presented self-threatening behavior (P<0.005). CONCLUSION It was concluded that the course of dual diagnosis may be chronic, severe, and disabling, requiring many long-term therapeutic and rehabilitative programs to manage various disabilities.
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Affiliation(s)
| | - Agnese Galliani
- School of Nursing, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Guicciardi
- Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Giulia Landi
- Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Ferri
- School of Nursing, University of Modena and Reggio Emilia, Modena, Italy
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