Alcoholism and Depression

Intestinal dysbiosis and permeability: the yin and yang in alcohol dependence and alcoholic liver disease

Alcohol dependence and alcoholic liver disease represent a major public health problem with substantial morbidity and mortality. By yet incompletely understood mechanisms, chronic alcohol abuse is associated with increased intestinal permeability and alterations of the gut microbiota composition, allowing bacterial components, bacteria, and metabolites to reach the portal and the systemic circulation. These gut-derived bacterial products are recognized by immune cells circulating in the blood or residing in remote organs such as the liver leading to the release of pro-inflammatory cytokines which are considered important mediators of the liver-gut-brain communication. Although circulating cytokines are likely not the sole factors involved, they can induce liver inflammation/damage and reach the central nervous system where they favor neuroinflammation which is associated with change in mood, cognition, and drinking behavior. In this review, the authors focus on the current evidence describing the changes that occur in the intestinal microbiota with chronic alcohol consumption in conjunction with intestinal barrier breakdown and inflammatory changes sustaining the concept of a gut-liver-brain axis in the pathophysiology of alcohol dependence and alcoholic liver disease.

Disease recognition is related to specific autobiographical memory deficits in alcohol-dependence

The particularly high treatment gap in alcohol-dependence suggests the existence of important barriers to treatment decision and in particular difficulties in problem recognition. This study tested the relation between problem recognition and self-related memories. Forty-one recently detoxified alcohol-dependent individuals (AD) were compared to twenty alcoholic subjects that were abstinent for 6 months or more (recruited among alcoholics-anonymous (AA)), and to twenty controls on autobiographical memories elicited by pictures depicting or not alcohol using the autobiographical memory test. Autonoetic consciousness was measured with the Remember/Know paradigm. We tested whether memories performances were related with data obtained on the readiness to change questionnaire (RCQ) or with consciousness of the severity of drinking. AD subjects provided less specific memories than control and AA subjects, and fewer Remember responses than controls. The deficits in AD subjects were not specific for memories elicited by pictures depicting alcohol, suggesting a global deficit. Autobiographical memories specificity was negatively correlated to scores of consciousness of the severity of drinking but not to RCQ. Our results support potential recovery of autobiographical memory with abstinence. AD's deficits in autobiographical memory were related to capacities to recognize the severity and therefore may be a barrier to treatment decision.

Diabetes, depression, and OASIS-C: a guide for home healthcare clinicians

Depression is significantly higher among elderly adults receiving home healthcare, particularly among adults with Type 2 diabetes. Depression leads to greater medical illness, functional impairment, and chronic pain. Opportunities are often missed to improve mental health and general medical outcomes when mental illness is underrecognized and undertreated. This article discusses the mandate by the Centers for Medicare & Medicaid Services (CMS), Outcome and Assessment Information Set-C (OASIS-C) (2009) for the use of the Patient Health Questionnaire (PHQ-2) to screen for depression in home care patients, with special emphasis on the patient with diabetes.

The development of a behaviorally-based alcohol intoxication scale

INTRODUCTION

The ED and Behavioral Health (BH) department developed a behaviorally-based alcohol intoxication scale (AIS) to assess when patients can be transferred to the BH unit from the ED rather than using blood alcohol levels. The purpose of this study was to determine the reliability and validity of the scale. A secondary purpose was to determine whether there was any correlation between blood alcohol level and the alcohol intoxication scale.

METHODS

Inter-rater reliability was calculated by assessing the same patient at the same time by 2 people. To assess for criterion-related validity of the scale, the medical records of the subjects were reviewed in behavioral health to determine whether the patients being transferred to BH were medically stable.

RESULTS

Using Krippendorff's alpha to assess inter-rater reliability, the total score on the AIS yielded an alpha of 0.9396. To assess for criterion-related validity of the scale, the charts of the subjects were reviewed; data supported that the patients were medically stable after transfer. As expected, there was no correlation between the AIS and blood alcohol level. The results of this study show initial reliability and validity for the AIS.

DISCUSSION

This study showed preliminary support for using a behaviorally-based assessment as a basis for transferring patients to the BH unit. More studies are needed to further substantiate the reliability and validity of this measure as a tool to accurately assess stability for transfer to a BH unit.