1
|
Rolko T, Rauks-Pärgmäe T, Aluoja A, Tõru I, Janno S. Reliability and validity of the Estonian version of the Clinical Institute of Withdrawal Assessment for Alcohol scale. Nord J Psychiatry 2024; 78:347-352. [PMID: 38436948 DOI: 10.1080/08039488.2024.2324061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
AIMS Our aim was to adapt the Clinical Institute of Withdrawal Assessment for Alcohol scale (CIWA-Ar) into Estonian and test its reliability and validity. METHODS A total of 72 patients with alcohol withdrawal syndrome participated in the study. In order to assess the interrater reliability, at first assessment the CIWA-Ar was simultaneously completed by two nurses. In order to assess the sensitivity of the CIWA-Ar to the changes in the severity of the withdrawal syndrome, as well as its correlations to several indices characterizing the subjects' current condition, the CIWA-Ar, the Clinical Global Impression Severity subscale (CGI-S), the visual analogue scales for the assessment of the general feeling of malaise, anxiety and depression were filled in and the vital signs were measured at inclusion, in 4 h and after the withdrawal syndrome had been resolved. RESULTS The intraclass correlation coefficient (ICC) for the Estonian version of the CIWA-Ar total score, used as an indicator of interrater reliability, was excellent. The CIWA-Ar had significant correlations with the psychiatrists' CGI-S ratings of the severity of the patient's condition at all assessment points. Significant correlations were also found between CIWA-Ar and patients' self-ratings, the highest correlations found with self-rated anxiety and general feeling of malaise. CIWA-Ar total score did not correlate with simultaneously measured heart rate, systolic and diastolic blood pressure at the first assessment. At the second assessment, heart rate had a significant correlation with the CIWA-Ar total score. CONCLUSION Our study provides confirmation that the CIWA-Ar tool is well applicable in the Estonian language and culture setting.
Collapse
Affiliation(s)
- Teelia Rolko
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
| | | | - Anu Aluoja
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Psychiatry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Innar Tõru
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Psychiatry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Sven Janno
- Psychiatry Clinic, Tartu University Hospital, Tartu, Estonia
- Department of Psychiatry, Faculty of Medicine, University of Tartu, Tartu, Estonia
| |
Collapse
|
2
|
Affiliation(s)
- Alexander Alexiou
- Barts Health NHS Trust, London, UK
- London's Air Ambulance, Royal London Hospital, London
| | - Thomas King
- Barts Health NHS Trust, London, UK
- London's Air Ambulance, Royal London Hospital, London
| |
Collapse
|
3
|
Rentrop M, Zwanzger P. [Anxiety, agitation, suicidality - Psychiatric emergencies in the general hospital]. Dtsch Med Wochenschr 2023; 148:406-422. [PMID: 36940692 DOI: 10.1055/a-1967-6310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Abstract
Psychiatric emergencies are encountered by every physician - regardless of specialty. Nevertheless, psychiatric emergencies in general hospitals are often a very significant challenge. In this article, the most important psychiatric emergency situations, diagnostic aspects as well as corresponding therapy options are presented.
Collapse
|
4
|
Suárez-Cuenca JA, Toledo-Lozano CG, Espinosa-Arroyo MD, Vázquez-Aguirre NA, Fonseca-González GT, Garro-Almendaro K, Melchor-López A, García-López VH, Ortiz-Matamoros A, Ortega-Rosas T, Alcaraz-Estrada SL, Mondragón-Terán P, García S. Diagnostic Performance of AST Scale in Mexican Male Population for Alcohol Withdrawal Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159208. [PMID: 35954565 PMCID: PMC9367724 DOI: 10.3390/ijerph19159208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/23/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Abstract
Alcohol withdrawal syndrome (AWS) represents an adverse consequence of chronic alcohol use that may lead to serious complications. Therefore, AWS requires timely attention based on its early recognition, where easy-to-apply diagnostic tools are desirable. Our aim was to characterize the performance of a short-scale AST (Anxiety, Sweats, Tremors) in patients from public general hospitals. We conducted a cross-sectional study of patients attended at the Emergency Department diagnosed with AWS. Three scales were applied: CIWA-Ar (Clinical Institute Retirement Assessment Scale-Revised), GMAWS (Glasgow Modified Alcohol Withdrawal Syndrome) and AST. Cronbach’s alpha and Cohen’s kappa tests were used for reliability and concordance. Factorial analysis and diagnostic performance including ROC curve were carried out. Sixty-eight males with a mean age of 41.2 years old, with high school education and robust alcohol consumption, were included. Mean scores for CIWA-Ar, GMWAS and AST were 17.4 ± 11.2, 3.9 ± 2.3 and 3.8 ± 2.6, respectively, without significant differences. The AST scale showed an acceptable reliability and concordance (0.852 and 0.439; p < 0.0001) compared with CIWA-Ar and GMAWS. AST component analysis evidenced tremor (77.5% variance), sweat (12.1% variance) and anxiety (10.4% variance). Diagnostic performance of the AST scale was similar to the GMAWS scale, evidencing a sensitivity of 84%, specificity of 83.3% and Area Under the Curve (AUC) of 0.837 to discriminate severe AWS, according to CIWA-Ar. The performance of the AST scale to evaluate AWS is comparable with the commonly used CIWA-Ar and GMAWS scales. AST further represents an easy-to-apply instrument.
Collapse
Affiliation(s)
- Juan Antonio Suárez-Cuenca
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | - Christian Gabriel Toledo-Lozano
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-551-956-2089 (C.G.T.-L.); +52-555-437-7491 (S.G.)
| | - Maryjose Daniela Espinosa-Arroyo
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | - Nallely Alejandra Vázquez-Aguirre
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | | | - Karen Garro-Almendaro
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | - Alberto Melchor-López
- Internal Medicine Department, Hospital General Xoco, SEDESA, Mexico City 03330, Mexico; (J.A.S.-C.); (M.D.E.-A.); (N.A.V.-A.); (K.G.-A.); (A.M.-L.)
| | | | - Abril Ortiz-Matamoros
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | - Tania Ortega-Rosas
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
| | | | - Paul Mondragón-Terán
- Coordination of Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico;
| | - Silvia García
- Department of Clinical Research, Centro Médico Nacional “20 de Noviembre”, ISSSTE, Mexico City 03229, Mexico; (A.O.-M.); (T.O.-R.)
- Correspondence: (C.G.T.-L.); (S.G.); Tel.: +52-551-956-2089 (C.G.T.-L.); +52-555-437-7491 (S.G.)
| |
Collapse
|
5
|
Hu X, Zhang T, Ma H, Zhou X, Wang H, Wang X, Cheng C, Li Y, Duan R, Zhang B, Wang H, Lu J, Kang C, Zhao N, Zhang Y, Tian L, Liu J, Shi J, Wang Z, Zhou X, Zhu S, Liu Q, Li X, Wang H, Nie M, Yang M, Yang J, Chi Y, Zhu X, Hu J, Jia Y, Peng Y, Liu L. Repetitive transcranial magnetic stimulation combined with cognitive behavioral therapy treatment in alcohol-dependent patients: A randomized, double-blind sham-controlled multicenter clinical trial. Front Psychiatry 2022; 13:935491. [PMID: 36299538 PMCID: PMC9590282 DOI: 10.3389/fpsyt.2022.935491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Alcohol dependence (AD) is a complex addictive disorder with a high relapse rate. Previous studies have shown that both repetitive transcranial magnetic stimulation (rTMS) and cognitive behavioral therapy (CBT) may be effective for AD, and we aim to explore more effective treatment options to reduce relapse rates for AD. MATERIALS AND METHODS A total of 263 AD patients were recruited. They were divided into six groups according to the location and the type of rTMS: left dorsolateral prefrontal cortex (DLPFC), right DLPFC, sham stimulation, and whether they received CBT treatment: with a fixed schedule (C1) and without a fixed plan (C0). There were included in sham rTMS + C0 group (n = 50), sham rTMS + C1 group (n = 37), right rTMS + C0 group (n = 45), right rTMS + C1 group (n = 42), left rTMS + C0 group (n = 49), left rTMS + C1 group (n = 40). We used obsessive compulsive drinking scale (OCDS), visual analogue scale (VAS), alcohol dependence scale (ADS), montreal cognitive assessment (MoCA), generalized anxiety disorder-7 (GAD-7), patient health questionnaire-9 items (PHQ-9), and Pittsburgh sleep quality index (PSQI) to assess alcohol cravings, alcohol dependence, cognition, anxiety, depression, and sleep quality. They were followed up and evaluated for relapse. RESULTS The sham rTMS + C0 group relapse rate was significantly higher than the right rTMS + C1 group (P = 0.006), the left rTMS + C0 group (P = 0.031), the left rTMS + C1 group (P = 0.043). The right rTMS + C0 group showed significantly higher relapse rate compared to the right rTMS + C1 group (P = 0.046). There was no significant difference in relapse rates between other groups. The repeated-measures ANOVA showed an interaction effect between group and time was significant in the rate of patient health questionnaire-9 items (PHQ-9) scale reduction (P = 0.020). Logistic analysis indicated that smoking and alcohol consumption were independent determinants of relapse (P < 0.05). At 24 weeks of follow-up, Kaplan-Meier survival analysis reveal that there is statistically significant relapse rate between six groups (P = 0.025), left rTMS + C1 group has the best treatment effect for alcohol dependent patients. Cox regression analysis confirmed that current smoking, total cholesterol, and total bilirubin (TBIL) level were risk factors of relapse (P < 0.05). CONCLUSION This study is the first to suggest that the combination of rTMS and CBT may be a potentially effective treatment for reducing relapse.
Collapse
Affiliation(s)
- Xiaorui Hu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Tian Zhang
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongkun Ma
- Department of Epidemiology and Health Statistics, Mudanjiang Medical University, Mudanjiang, China
| | - Xuhui Zhou
- Hunan Provincial Brain Hospital, Changsha, China
| | - Hongxuan Wang
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaohong Wang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chang Cheng
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanfei Li
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bo Zhang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Huaizhi Wang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jia Lu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chuanyi Kang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Na Zhao
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yingjie Zhang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Lu Tian
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jun Liu
- The First Psychiatric Hospital of Harbin, Harbin, China
| | - Jingjing Shi
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Zhe Wang
- The First Psychiatric Hospital of Harbin, Harbin, China
| | - Xinxin Zhou
- The First Psychiatric Hospital of Harbin, Harbin, China
| | - Shuang Zhu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Qingxia Liu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Xuemin Li
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Honghui Wang
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Mingxuan Nie
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Mei Yang
- Shenzhen Mental Health Center, Shenzhen Kangning Hospital, Shenzhen, China
| | - Jianzhong Yang
- The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yong Chi
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Zhu
- Department of Physiology and Neurobiology, Mudanjiang Medical University, Mudanjiang, China
| | - Jian Hu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Yanjie Jia
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Peng
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lei Liu
- Department of Psychiatry, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| |
Collapse
|
6
|
Melkonian AJ, Flanagan JC, Calhoun CD, Hogan JN, Back SE. Craving Moderates the Effects of Intranasal Oxytocin on Anger in Response to Social Stress Among Veterans With Co-Occurring Posttraumatic Stress Disorder and Alcohol Use Disorder. J Clin Psychopharmacol 2021; 41:465-469. [PMID: 34121063 DOI: 10.1097/jcp.0000000000001434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE/BACKGROUND Posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) commonly co-occur among US military veterans. Oxytocin may have therapeutic value in treating both conditions. The potential for oxytocin to augment affective features common to PTSD and AUD, such as anger, is relevant to inform emerging treatments. METHODS/PROCEDURES We examined the influence of intranasally administered oxytocin on connections between alcohol craving and stress-induced anger in a sample of 73 veterans (91.3% men) with co-occurring PTSD and AUD. Participants self-administered oxytocin (40 IU) or placebo (saline) 45 minutes before completing the Trier Social Stress Task (TSST). Self-reports of alcohol craving and anger were assessed pre- and post-TSST using a modified visual analog scale. Multiple regression analysis, including main effects for group, baseline craving, and their interaction, was used to predict post-TSST anger. FINDINGS/RESULTS A marginally significant interaction was observed, suggesting a positive association between baseline craving and anger for those in the oxytocin group (B = 0.65, P = 0.01). Among those reporting low craving, participants in the oxytocin group reported significantly lower post-TSST anger than those in the placebo group. IMPLICATIONS/CONCLUSIONS The current study is among the first to examine relevant psychosocial moderators that may influence the effects of oxytocin among veterans with comorbid PTSD and AUD. Although oxytocin attenuated ratings of anger after a stress task among those with low baseline craving, findings suggest that oxytocin may not be as effective at reducing anger, a highly salient factor in PTSD, for individuals experiencing high levels of craving. Findings are consistent with the social salience hypothesis and suggest that individual differences in alcohol craving should be considered when evaluating oxytocin as a potential treatment for individuals with comorbid PTSD and AUD.
Collapse
Affiliation(s)
| | | | - Casey D Calhoun
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC
| | - Jasara N Hogan
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | | |
Collapse
|
7
|
Riedel P, Wolff M, Spreer M, Petzold J, Plawecki MH, Goschke T, Zimmermann US, Smolka MN. Acute alcohol does not impair attentional inhibition as measured with Stroop interference scores but impairs Stroop performance. Psychopharmacology (Berl) 2021; 238:1593-1607. [PMID: 33660080 PMCID: PMC8139883 DOI: 10.1007/s00213-021-05792-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 02/04/2021] [Indexed: 11/24/2022]
Abstract
RATIONALE Inhibition is a core executive function and refers to the ability to deliberately suppress attention, behavior, thoughts, and/or emotions and instead act in a specific manner. While acute alcohol exposure has been shown to impair response inhibition in the stop-signal and Go/NoGo tasks, reported alcohol effects on attentional inhibition in the Stroop task are inconsistent. Notably, studies have operationalized attentional inhibition variably and there has been intra- and inter-individual variability in alcohol exposure. OBJECTIVE This study aimed to examine the acute effects of alcohol on attentional inhibition, considering previous limitations. METHODS In a single-blind, cross-over design, 40 non-dependent participants with a medium-to-high risk drinking behavior performed a Counting Stroop task (CST) under a baseline and an arterial blood alcohol concentration (aBAC) clamp at 80 mg%. Attentional inhibition was assessed as the alteration of reaction times (RT), error rates (ER), and inverse efficiency scores (IES) between incongruent and congruent trials (interference score). Stroop performance was also assessed regardless of trial-type. RESULTS Compared to saline, acute alcohol exposure via an aBAC clamp did not affect CST interference scores but increased RTs and IES in both incongruent and congruent trials. CONCLUSIONS Attentional inhibition (Stroop interference score) was not impaired by clamped moderate alcohol exposure. Acute alcohol impaired Stroop performance evidenced by a general increase in response times. Our findings suggest that response and attentional inhibition do not share the same neurocognitive mechanisms and are affected differently by alcohol. Results could also be explained by automated behaviors known to be relatively unaffected by acute alcohol.
Collapse
Affiliation(s)
- P Riedel
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - M Wolff
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of General Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany
| | - M Spreer
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - J Petzold
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
| | - M H Plawecki
- Department of Psychiatry, Indiana University School of Medicine, 355 West 16th Street, Indianapolis, IN, 46202, USA
| | - T Goschke
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany
- Department of General Psychology, Technische Universität Dresden, Zellescher Weg 17, 01069, Dresden, Germany
| | - U S Zimmermann
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany
- Department of Addiction Medicine and Psychotherapy, kbo-Isar-Amper-Klinikum München-Ost, Vockestraße 72, 85540, Haar, Germany
| | - M N Smolka
- Department of Psychiatry and Psychotherapy, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
- Neuroimaging Center, Technische Universität Dresden, Würzburger Straße 35, 01187, Dresden, Germany.
| |
Collapse
|
8
|
Pribék IK, Kovács I, Kádár BK, Kovács CS, Richman MJ, Janka Z, Andó B, Lázár BA. Evaluation of the course and treatment of Alcohol Withdrawal Syndrome with the Clinical Institute Withdrawal Assessment for Alcohol - Revised: A systematic review-based meta-analysis. Drug Alcohol Depend 2021; 220:108536. [PMID: 33503582 DOI: 10.1016/j.drugalcdep.2021.108536] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 12/11/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although the Clinical Institute Withdrawal Assessment for Alcohol - Revised (CIWA-Ar) is a gold standard tool for the clinical evaluation of alcohol withdrawal syndrome (AWS), a systematic analysis using the total scores of the CIWA-Ar as a means of an objective follow-up of the course and treatment of AWS is missing. The aims of the present study were to systematically evaluate scientific data using the CIWA-Ar, to reveal whether the aggregated CIWA-Ar total scores follow the course of AWS and to compare benzodiazepine (BZD) and non-benzodiazepine (nBZD) therapies in AWS. METHODS 1054 findings were identified with the keyword "ciwa" from four databases (PubMed, ScienceDirect, Web of Science, Cochrane Registry). Articles using CIWA-Ar in patients treated with AWS were incorporated and two measurement intervals (cumulative mean data of day 1-3 and day 4-9) of the CIWA-Ar total scores were compared. Subgroup analysis based on pharmacotherapy regimen was conducted to compare the effectiveness of BZD and nBZD treatments. RESULTS The random effects analysis of 423 patients showed decreased CIWA-Ar scores between the two measurement intervals (BZD: d = -1.361; CI: -1.829 < δ < -0.893; nBZD: d = -0.858; CI: -1.073 < δ < -0.643). Sampling variances were calculated for the BZD (v1 = 0.215) and the nBZD (v2 = 0.106) groups, which indicated no significant group difference (z = -1.532). CONCLUSIONS Our findings support that the CIWA-Ar follows the course of AWS. Furthermore, nBZD therapy has a similar effectiveness compared to BZD treatment based on the CIWA-Ar total scores.
Collapse
Affiliation(s)
- Ildikó Katalin Pribék
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary.
| | - Ildikó Kovács
- Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bettina Kata Kádár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Csenge Sára Kovács
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Mara J Richman
- Department of Psychiatry and Psychotherapy, Semmelweis University, Balassa Street 8, H-1085, Budapest, Hungary; Endeavor Psychology, 10 Newbury Street, Boston, MA, 02116, USA
| | - Zoltán Janka
- Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bálint Andó
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary
| | - Bence András Lázár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 8-10 Korányi fasor, Szeged, H-6720, Hungary.
| |
Collapse
|
9
|
Maschke M. S1-Leitlinie: Delir und Verwirrtheitszustände inklusive Alkoholentzugsdelir. ACTA ACUST UNITED AC 2021. [DOI: 10.1007/s42451-021-00302-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
10
|
The Relevance of Dual Diagnoses among Drug-Dependent Patients with Sleep Disorders. J Clin Med 2020; 9:jcm9092862. [PMID: 32899692 PMCID: PMC7565704 DOI: 10.3390/jcm9092862] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Sleep disorders are often associated with drug use. Nearly 70% of patients admitted for detoxification report sleep problems. Dual disorder (DD) is the comorbidity between mental disorders in general and disorders related to psychoactive substance use. The association between substance use and sleep disorders (SD) appears to be bidirectional. Our objective is to analyze the association between sleep disturbance history and drug use pattern (alcohol, cannabis, opioids, and cocaine). METHODS Analysis of data in the first interview at the Addictions Unit of the Department of Psychiatry at the University of Salamanca Health Care Complex between October 2017 and January 2020. The sample consists of 398 patients. We studied the association between different variables: origin of patients (Inpatient Dual Diagnosis Detoxification Unit (IDDDU) vs. Outpatient Drug Clinic (ODC), presence of affective disorder, psychotic disorder, type of drug used, and treatment. RESULTS Of patients with DD, 62% had more delayed sleep induction, sleep fragmentation, early awakening, and nightmares. Outpatients had more difficulty falling asleep because, in many cases, they had not previously sought any medical assistance. On the other hand, 67% of the patients with insomnia presented depression. CONCLUSIONS There is evidence of a harmful association between DD and SD.
Collapse
|
11
|
Mühle C, Weinland C, Gulbins E, Lenz B, Kornhuber J. Peripheral Acid Sphingomyelinase Activity Is Associated with Biomarkers and Phenotypes of Alcohol Use and Dependence in Patients and Healthy Controls. Int J Mol Sci 2018; 19:ijms19124028. [PMID: 30551571 PMCID: PMC6320816 DOI: 10.3390/ijms19124028] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 11/30/2018] [Accepted: 12/04/2018] [Indexed: 01/04/2023] Open
Abstract
By catalyzing the hydrolysis of sphingomyelin into ceramide, acid sphingomyelinase (ASM) changes the local composition of the plasma membrane with effects on receptor-mediated signaling. Altered enzyme activities have been noted in common human diseases, including alcohol dependence. However, the underlying mechanisms remain largely unresolved. Blood samples were collected from early-abstinent alcohol-dependent in-patients (n[♂] = 113, n[♀] = 87) and matched healthy controls (n[♂] = 133, n[♀] = 107), and analyzed for routine blood parameters and serum ASM activity. We confirmed increased secretory ASM activities in alcohol-dependent patients compared to healthy control subjects, which decreased slightly during detoxification. ASM activity correlated positively with blood alcohol concentration, withdrawal severity, biomarkers of alcohol dependence (liver enzyme activities of gamma-glutamyl transferase, alanine aminotransferase, aspartate aminotransferase; homocysteine, carbohydrate-deficient transferrin; mean corpuscular volume, and creatine kinase). ASM activity correlated negatively with leukocyte and thrombocyte counts. ASM and gamma-glutamyl transferase were also associated in healthy subjects. Most effects were similar for males and females with different strengths. We describe previously unreported associations between ASM activity and markers of liver damage and myelosuppression. Further research should investigate whether this relationship is causal, or whether these parameters are part of a common pathway in order to gain insights into underlying mechanisms and develop clinical applications.
Collapse
Affiliation(s)
- Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany.
| | - Christian Weinland
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany.
| | - Erich Gulbins
- Department of Molecular Biology, University of Duisburg-Essen, D-45259 Essen, Germany.
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45267-0558, USA.
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany.
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), D-91054 Erlangen, Germany.
| |
Collapse
|
12
|
Seizure on a Benzodiazepine-Sparing Alcohol-Detoxification Protocol: A Case Report. PSYCHOSOMATICS 2018; 60:513-518. [PMID: 30528859 DOI: 10.1016/j.psym.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/29/2018] [Accepted: 10/30/2018] [Indexed: 11/21/2022]
|
13
|
OPRM1 A118G and serum β-endorphin interact with sex and digit ratio (2D:4D) to influence risk and course of alcohol dependence. Eur Neuropsychopharmacol 2018; 28:1418-1428. [PMID: 30322771 DOI: 10.1016/j.euroneuro.2018.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 08/06/2018] [Accepted: 09/05/2018] [Indexed: 01/15/2023]
Abstract
Activation of mesolimbic mu-opioid receptors by their endogenous ligand, β-endorphin, can mediate the rewarding effects of alcohol. However, there is conflicting evidence on the relationship between the mu-opioid receptor (OPRM1) A118G single nucleotide polymorphism (SNP) and alcohol dependence risk. Preclinical evidence suggests that sex and sex hormone-dependent prenatal brain organization may interact with the opioid system to influence alcohol drinking behavior. We genotyped 200 alcohol-dependent patients and 240 healthy individuals for the OPRM1 A118G SNP and measured serum β-endorphin level at recruitment and after acute withdrawal. We then determined the association between these factors and alcohol dependence risk and 24-month outcome in the context of both sex and second-to-fourth digit lengths ratio (2D:4D) - a biomarker of prenatal sex hormone levels. The OPRM1 A118G AA genotype associated with elevated risk of alcohol-related hospital readmission, more readmissions, and fewer days until first readmission in male patients only. After normalizing patient 2D:4D against control 2D:4D, we found that normalized 2D:4D ratios were lower in male 118G patients than male AA patients, suggesting prenatal androgens interact with OPRM1 to influence alcohol dependence risk. In addition, β-endorphin levels after acute withdrawal correlated negatively with withdrawal severity in females but not in males, which may indicate β-endorphin protects against withdrawal-induced stress in a sex-specific manner.
Collapse
|
14
|
Plawecki MH, White K, Kosobud A, Grahame N, Zimmermann US, Crabb D, O’Connor S. Sex Differences in Motivation to Self-Administer Alcohol After 2 Weeks of Abstinence in Young-Adult Heavy Drinkers. Alcohol Clin Exp Res 2018; 42:1897-1908. [PMID: 30080254 PMCID: PMC6167142 DOI: 10.1111/acer.13860] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Studies in animal models document that forced abstinence from usual consumption of alcohol changes subsequent seeking and consumption, with increases or decreases depending on the species, duration of abstinence, number of deprivations, and sex. Human laboratory-based alcohol deprivation studies are rare. METHODS We conducted a 2-session, within-participant, randomized-order comparison of intravenous, progressive ratio, alcohol self-administration during 2.5 hours of progressive work for alcohol and/or vehicle; once while the participants pursued their usual drinking habits and once after 2 weeks of closely monitored, voluntary outpatient abstinence from alcohol. The schedule of work for rewards and the incremental increases in breath alcohol concentration following completion of an alcohol work-set were identical across participants. Fifty young-adult (27 men), heavy-drinking participants completed both sessions. Our primary hypothesis was that motivation to work for alcohol after 2 weeks of abstinence would be greater in participants with a weekly binge pattern of drinking, compared to those who regularly drink heavily, and we intended to explore associations with biological family history of alcoholism and sex. RESULTS We detected no change in work for alcohol associated with recent drinking history. However, females, on average, increased their work for alcohol upon resumption after 2 weeks of abstinence (mean ± SEM = +16.3 ± 9.6%), while males decreased that work (-24.8 ± 13.8%). The sex difference was substantial and significant (p < 0.03), with a medium effect size (Cohen's d = 0.63). CONCLUSIONS We believe a more comprehensive study of mechanisms underlying the sex differences in the human postabstinence response is warranted.
Collapse
Affiliation(s)
- Martin Henry Plawecki
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kurt White
- Indiana University School of Epidemiology, Bloomington, IN, USA
| | - Ann Kosobud
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas Grahame
- Indiana University Purdue University Indianapolis, School of Psychology
| | - Ulrich S. Zimmermann
- Technische Universitat Dresden, Germany, School of Medicine, Department of Psychiatry
| | - David Crabb
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean O’Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| |
Collapse
|
15
|
Wolitzky-Taylor K, Niles AN, Ries R, Krull JL, Rawson R, Roy-Byrne P, Craske M. Who needs more than standard care? Treatment moderators in a randomized clinical trial comparing addiction treatment alone to addiction treatment plus anxiety disorder treatment for comorbid anxiety and substance use disorders. Behav Res Ther 2018; 107:1-9. [DOI: 10.1016/j.brat.2018.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/26/2018] [Accepted: 05/04/2018] [Indexed: 11/27/2022]
|
16
|
Liu X, Qin Z, Zhu X, Yao Q, Liu Z. Systematic review of acupuncture for the treatment of alcohol withdrawal syndrome. Acupunct Med 2018; 36:275-283. [PMID: 30030272 PMCID: PMC6176524 DOI: 10.1136/acupmed-2016-011283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 11/20/2022]
Abstract
Background Acupuncture has been used as a potential therapy for alcohol withdrawal syndrome (AWS), but evidence for its effects on this condition is limited. Objective To assess the effects and safety of acupuncture for AWS. Data sources Central Register of Controlled Trials (CENTRAL), PubMed, Embase, the Cochrane Library, PsycINFO, Chinese Biomedicine Literature (CBM), China National Knowledge Infrastructure (CNKI) and Wan-Fang Database were searched from their inception to August 2016. Study eligibility criteria Randomised controlled trials (RCTs) of drug plus acupuncture or acupuncture alone for the treatment of AWS were included. Data collection and analysis Continuous data were expressed as mean difference (MD) with 95% confidence intervals (95% CI). Dichotomous data were expressed as risk ratio (RR) with 95% CI. Results Eleven RCTs with 875 participants were included. In the acute phase, two trials reported no difference between drug plus acupuncture and drug plus sham acupuncture in the reduction of craving for alcohol; however, two positive trials reported that drug plus acupuncture was superior to drug alone in the alleviation of psychological symptoms. In the protracted phase, one trial reported acupuncture was superior to sham acupuncture in reducing the craving for alcohol, one trial reported no difference between acupuncture and drug (disulfiram), and one trial reported acupuncture was superior to sham acupuncture for the alleviation of psychological symptoms. Adverse effects were tolerable and not severe. Conclusion There was nosignificant difference between acupuncture (plus drug) and sham acupuncture (plus drug) with respect to the primary outcome measure of craving for alcohol among participants with AWS, and no difference in completion rates (pooled results). There was limited evidence from individual trials that acupuncture may reduce alcohol craving in the protracted phase and help alleviate psychological symptoms; however, given concerns about the quantity and quality of included studies, further large-scale and well-conducted RCTs are needed. Protocol registration PROSPERO CRD42016039862.
Collapse
Affiliation(s)
- Xiaoxu Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Zongshi Qin
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoming Zhu
- Department of Surgery, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qin Yao
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Beijing University of Chinese Medicine, Beijing, China
| | - Zhishun Liu
- Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
17
|
The "Forgotten" Treatment of Alcohol Withdrawal Delirium With Electroconvulsive Therapy: Successful Use in a Very Prolonged and Severe Case. Clin Neuropharmacol 2018. [PMID: 28622209 DOI: 10.1097/wnf.0000000000000224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Alcohol withdrawal delirium (AWD) is a notorious complication in alcohol withdrawal. Usually, the symptomatic treatment is efficacious; however, some patients show treatment resistance or a prolonged course of AWD. METHOD We report the case of a patient with a prolonged and severest form of AWD. Even 11 weeks after admission, he received approximately 100 mg diazepam per week to manage the symptoms of withdrawal delirium. RESULTS A treatment course of electroconvulsive therapy was initiated, which allowed a complete tapering off of benzodiazepines during electroconvulsive therapy without adverse effects. CONCLUSIONS The reported case might contribute to alternative approaches reserved for severest forms of prolonged AWD.
Collapse
|
18
|
Eloma AS, Tucciarone JM, Hayes EM, Bronson BD. Evaluation of the appropriate use of a CIWA-Ar alcohol withdrawal protocol in the general hospital setting. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:418-425. [PMID: 28981333 DOI: 10.1080/00952990.2017.1362418] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Clinical Institute Withdrawal Assessment-Alcohol, Revised (CIWA-Ar) is an assessment tool used to quantify alcohol withdrawal syndrome (AWS) severity and inform benzodiazepine treatment for alcohol withdrawal. OBJECTIVES To evaluate the prescribing patterns and appropriate use of the CIWA-Ar protocol in a general hospital setting, as determined by the presence or absence of documented AWS risk factors, patients' ability to communicate, and provider awareness of the CIWA-Ar order. METHODS This retrospective chart review included 118 encounters of hospitalized patients placed on a CIWA-Ar protocol during one year. The following data were collected for each encounter: patient demographics, admitting diagnosis, ability to communicate, and admission blood alcohol level; and medical specialty of the clinician ordering CIWA-Ar, documentation of the presence or absence of established AWS risk factors, specific parameters of the protocol ordered, service admitted to, provider documentation of awareness of the active protocol within 48 h of initial order, total benzodiazepine dose equivalents administered and associated adverse events. RESULTS 57% of patients who started on a CIWA-Ar protocol had either zero or one documented risk factor for AWS (19% and 38% respectively). 20% had no documentation of recent alcohol use. 14% were unable to communicate. 19% of medical records lacked documentation of provider awareness of the ordered protocol. Benzodiazepine associated adverse events were documented in 15% of encounters. CONCLUSIONS The judicious use of CIWA-Ar protocols in general hospitals requires mechanisms to ensure assessment of validated alcohol withdrawal risk factors, exclusion of patients who cannot communicate, and continuity of care during transitions.
Collapse
Affiliation(s)
- Amanda S Eloma
- a Stony Brook University , School of Pharmacy and Pharmaceutical Sciences , Stony Brook , NY , USA
| | | | - Edmund M Hayes
- a Stony Brook University , School of Pharmacy and Pharmaceutical Sciences , Stony Brook , NY , USA
| | - Brian D Bronson
- c Department of Psychiatry , Stony Brook University, School of Medicine , Stony Brook , NY , USA
| |
Collapse
|
19
|
Lenz B, Mühle C, Braun B, Weinland C, Bouna-Pyrrou P, Behrens J, Kubis S, Mikolaiczik K, Muschler MR, Saigali S, Sibach M, Tanovska P, Huber SE, Hoppe U, Eichler A, Heinrich H, Moll GH, Engel A, Goecke TW, Beckmann MW, Fasching PA, Müller CP, Kornhuber J. Prenatal and adult androgen activities in alcohol dependence. Acta Psychiatr Scand 2017; 136:96-107. [PMID: 28383757 DOI: 10.1111/acps.12725] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Alcohol dependence is more prevalent in men than in women. The evidence for how prenatal and adult androgens influence alcohol dependence is limited. We investigated the effects of prenatal and adult androgen activity on alcohol dependence. Moreover, we studied how the behaviours of pregnant women affect their children's prenatal androgen load. METHOD We quantified prenatal androgen markers (e.g., second-to-fourth finger length ratio [2D : 4D]) and blood androgens in 200 early-abstinent alcohol-dependent in-patients and 240 controls (2013-2015, including a 12-month follow-up). We also surveyed 134 women during pregnancy (2005-2007) and measured the 2D : 4D of their children (2013-2016). RESULTS The prenatal androgen loads were higher in the male alcohol-dependent patients compared to the controls (lower 2D : 4D, P = 0.004) and correlated positively with the patients' liver transaminase activities (P < 0.001) and alcohol withdrawal severity (P = 0.019). Higher prenatal androgen loads and increasing androgen levels during withdrawal predicted earlier and more frequent 12-month hospital readmission in alcohol-dependent patients (P < 0.005). Moreover, stress levels (P = 0.002), alcohol (P = 0.010) and tobacco consumption (P = 0.017), and lifetime stressors (P = 0.019) of women during pregnancy related positively to their children's prenatal androgen loads (lower 2D : 4D). CONCLUSION Androgen activities in alcohol-dependent patients and behaviours of pregnant women represent novel preventive and therapeutic targets of alcohol dependence.
Collapse
Affiliation(s)
- B Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - B Braun
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C Weinland
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - P Bouna-Pyrrou
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - J Behrens
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Kubis
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - K Mikolaiczik
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M-R Muschler
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S Saigali
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - M Sibach
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - P Tanovska
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - S E Huber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - U Hoppe
- Department of Audiology, ENT Clinic, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Eichler
- Department of Child and Adolescent Mental Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - H Heinrich
- Department of Child and Adolescent Mental Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,kbo-Heckscher-Klinikum, Munich, Germany
| | - G H Moll
- Department of Child and Adolescent Mental Health, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - A Engel
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - T W Goecke
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.,Department of Perinatal Medicine and Obstetrics, University Hospital RWTH Aachen, Aachen, Germany
| | - M W Beckmann
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - C P Müller
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - J Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| |
Collapse
|
20
|
Zois E, Vollstädt-Klein S, Hoffmann S, Reinhard I, Bach P, Charlet K, Beck A, Treutlein J, Frank J, Jorde A, Kirsch M, Degenhardt F, Walter H, Heinz A, Kiefer F. GATA4 variant interaction with brain limbic structure and relapse risk: A voxel-based morphometry study. Eur Neuropsychopharmacol 2016; 26:1431-1437. [PMID: 27397865 DOI: 10.1016/j.euroneuro.2016.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 05/25/2016] [Accepted: 06/18/2016] [Indexed: 01/08/2023]
Abstract
Atrial natriuretic peptide (ANP) receptors are highly expressed in the amygdala, caudate and hypothalamus. GATA4 gene encodes a transcription factor of ANP associated with the pathophysiology of alcohol dependence. We have previously demonstrated that the GATA4 single nucleotide polymorphism (SNP) rs13273672 revealed stronger alcohol-specific amygdala activation associated with lowered relapse risk to heavy drinking at 90 days in the AA-homozygotes. Our understanding however with respect to GATA4 variation on gray matter (GM) regional amygdala, caudate and hypothalamus volume is limited. We investigated GM differences specific to GATA4 and hypothesized that GM alterations will be predictive of heavy relapse. Eighty-three recently detoxified alcohol dependent patients were included. Neuroimaging data was analyzed using Voxel Based Morphometry (VBM). The main effects of GM volume and genotype as well as their interaction effect on time to heavy relapse (60 and 90 days) were analyzed using cox regression. Significant higher GM volume was found for the AA-genotype group compared with AG/GG-genotype in the hypothalamus and caudate. A significant interaction was revealed between caudate and amygdala GM volume and GATA4 genotype on time to heavy relapse. The interaction was expressed by means of higher GM in the AA genotype group to be associated with reduced risk to relapse whereas in the AG/GG group higher GM was associated with increased risk to relapse. This is the first report on GM regional volume alterations specific to GATA4 genotype [(SNP) rs13273672] and its association with relapse in alcohol dependence. Current findings further support the role of GATA4 in alcoholism.
Collapse
Affiliation(s)
- Evangelos Zois
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
| | - Sabine Vollstädt-Klein
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Sabine Hoffmann
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Patrick Bach
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Katrin Charlet
- Department of Psychiatry and Psychotherapy, Charité, University Medicine, Campus Mitte, Berlin, Germany
| | - Anne Beck
- Department of Psychiatry and Psychotherapy, Charité, University Medicine, Campus Mitte, Berlin, Germany
| | - Jens Treutlein
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/University Heidelberg, Mannheim, Germany
| | - Josef Frank
- Department of Genetic Epidemiology in Psychiatry, Central Institute of Mental Health, Medical Faculty Mannheim/University Heidelberg, Mannheim, Germany
| | - Anne Jorde
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Martina Kirsch
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | | | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Charité, University Medicine, Campus Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité, University Medicine, Campus Mitte, Berlin, Germany
| | - Falk Kiefer
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| |
Collapse
|
21
|
Mumtaz W, Vuong PL, Xia L, Malik AS, Rashid RBA. Automatic diagnosis of alcohol use disorder using EEG features. Knowl Based Syst 2016. [DOI: 10.1016/j.knosys.2016.04.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
22
|
Association of testosterone and BDNF serum levels with craving during alcohol withdrawal. Alcohol 2016; 54:67-72. [PMID: 27514572 DOI: 10.1016/j.alcohol.2016.06.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/22/2022]
Abstract
Preclinical and clinical studies show associations between testosterone and brain-derived neurotrophic growth factor (BDNF) serum levels. BDNF and testosterone have been independently reported to influence alcohol consumption. Therefore, we aimed to investigate a possible interplay of testosterone and BDNF contributing to alcohol dependence. Regarding possible interplay of testosterone and BDNF and the activity of the hypothalamic pituitary axis (HPA), we included cortisol serum levels in our research. We investigated testosterone and BDNF serum levels in a sample of 99 male alcohol-dependent patients during alcohol withdrawal (day 1, 7, and 14) and compared them to a healthy male control group (n = 17). The testosterone serum levels were significantly (p < 0.001) higher in the patients' group than in the control group and decreased significantly during alcohol withdrawal (p < 0.001). The decrease of testosterone serum levels during alcohol withdrawal (days 1-7) was significantly associated with the BDNF serum levels (day 1: p = 0.008). In a subgroup of patients showing high cortisol serum levels (putatively mirroring high HPA activity), we found a significant association of BDNF and testosterone as well as with alcohol craving measured by the Obsessive and Compulsive Drinking Scale (OCDS). Our data suggest a possible association of BDNF and testosterone serum levels, which may be relevant for the symptomatology of alcohol dependence. Further studies are needed to clarify our results.
Collapse
|
23
|
|
24
|
Alkoholentzugsdelir und akute Komplikationen. Notf Rett Med 2016. [DOI: 10.1007/s10049-015-0108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
25
|
Saylor JL, Schell KA, Mendell MF, Graber JS. Development of a Clinical Competency Checklist for Care of Patients Experiencing Substance Withdrawal Delirium or Delirium: Use of a Delphi Technique and Expert Panel. J Psychosoc Nurs Ment Health Serv 2015; 53:29-36. [DOI: 10.3928/02793695-20150526-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 05/05/2015] [Indexed: 11/20/2022]
|
26
|
Manning S, Gilmour M, Weatherall M, Robinson GM. Refeeding syndrome is uncommon in alcoholics admitted to a hospital detoxification unit. Intern Med J 2015; 44:512-4. [PMID: 24816312 DOI: 10.1111/imj.12408] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
Abstract
The refeeding syndrome is increasingly recognised. It is a serious change in electrolytes when nutrition is reintroduced to malnourished patients. Alcohol dependence is a risk factor for the refeeding syndrome. We report a prospective cohort study of 36 alcoholics hospitalised for withdrawal management. We found no evidence of refeeding syndrome in any patient after 3 days of hospitalisation, despite hypomagnesaemia, a risk factor for the refeeding syndrome being prevalent (44% of subjects). Low thiamine levels were infrequent affecting 3/29 (10%). We recommend that in alcoholics admitted for managed withdrawal, risk of refeeding syndrome appears to be low, and routine testing of repeat electrolytes appears unnecessary.
Collapse
Affiliation(s)
- S Manning
- Capital and Coast District Health Board, Wellington, New Zealand
| | | | | | | |
Collapse
|
27
|
Genetic variation in the atrial natriuretic peptide transcription factor GATA4 modulates amygdala responsiveness in alcohol dependence. Biol Psychiatry 2014; 75:790-7. [PMID: 24314346 DOI: 10.1016/j.biopsych.2013.10.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Two genome-wide association studies recently showed alcohol dependence to be associated with a single-nucleotide polymorphism (rs13273672) located on a gene (GATA4) that encodes a transcription factor of atrial natriuretic peptide (ANP). A growing body of evidence suggests that ANP might be involved in the symptomology of alcohol dependence. This study examined whether reactivity to alcohol cues in the ANP target region amygdala, a key area implicated in addictive behavior, differs depending on the GATA4 genotype of a patient. We also investigated potential associations between these differences in amygdala activation and relapse behavior. METHODS Eighty-one abstinent, alcohol-dependent patients completed a functional magnetic resonance imaging cue-reactivity task in a 3-Tesla scanner and provided blood samples for DNA extraction. RESULTS The results showed significantly lower alcohol-cue-induced activations in G-allele carriers as compared with AA-homozygotes in the bilateral amygdala. A survival analysis revealed that a stronger alcohol-specific amygdala response predicted a lowered risk for relapse to heavy drinking in the AA-homozygotes, whereas this effect could not be observed in G-allele carriers. CONCLUSIONS These results illuminate potential underlying mechanisms of the involvement of the GATA4 gene in the etiology of alcohol dependence via its influence on ANP and amygdala processing.
Collapse
|
28
|
Krienke UJ, Nikesch F, Spiegelhalder K, Hennig J, Olbrich HM, Langosch JM. Impact of alcohol-related video sequences on functional MRI in abstinent alcoholics. Eur Addict Res 2014; 20:33-40. [PMID: 23921439 DOI: 10.1159/000349909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Accepted: 02/07/2013] [Indexed: 11/19/2022]
Abstract
The object of this study was the identification of brain areas that were significantly more connected than other regions with a previously identified reference region, the posterior cingulate cortex, during the presentation of visual cues in alcoholics. Alcohol-related and neutral video sequences were presented to 30 alcoholics who had been abstinent for at least 4 days. Participants underwent a psychometric assessment before and after the presentation of the video sequences. Functional MRI data were acquired. Psychophysiological interaction analyses were carried out. Participants reported a significant increase in craving and arousal after the presentation of alcohol-related video sequences. The simple contrast alcohol versus neutral was found not to be significantly different in the present study. The brain regions that were found to correlate significantly more with the posterior cingulate cortex under the alcohol-related condition were the inferior parietal lobe, the medial temporal lobe, the inferior frontal gyrus, the postcentral gyrus, and the precuneus. The involvement of these regions in processes of memory, self-control, and self-reflection with a particular focus on alcohol dependence and craving will be discussed.
Collapse
Affiliation(s)
- Ute J Krienke
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical Center, Freiburg, Germany
| | | | | | | | | | | |
Collapse
|
29
|
Gross CM, Spiegelhalder K, Mercak J, Feige B, Langosch JM. Predictability of alcohol relapse by hippocampal volumetry and psychometric variables. Psychiatry Res 2013; 212:14-8. [PMID: 23473987 DOI: 10.1016/j.pscychresns.2012.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 08/08/2012] [Accepted: 09/28/2012] [Indexed: 11/16/2022]
Abstract
We examined the relationship between relapse risk/duration of abstinence and hippocampal volume as well as the moderating role of various psychological factors in 34 patients who fulfilled the diagnostic criteria for alcohol dependence according to ICD-10 and DSM-IV and 16 healthy controls (9 females and 7 males). This study is part of a single-blind, placebo-controlled, parallel-group treatment trial with the anticraving substance acamprosate administered for 3 months. Patients underwent a psychometric evaluation and a measurement of the hippocampus with magnetic resonance imaging before beginning medication (T0). At 2, 4, 8, and 12 weeks after treatment, abstinence was evaluated by phone. Afterwards all patients switched to a long-term open label study with acamprosate. Hippocampal volume did not constitute a predictive factor for relapse probability in abstinent alcoholics. Furthermore, stress level, depressivity, gender, and treatment with the anticraving substance acamprosate did not show a significant correlation with relapse probability. The current investigation could not identify significant risk factors for relapses after successful alcohol withdrawal. Further studies are required to identify crucial factors which are responsible for successful or unsuccessful relapse prevention.
Collapse
Affiliation(s)
- Claus M Gross
- University of Freiburg Medical Center, Department of Psychiatry and Psychotherapy, Hauptstraße 5, Freiburg 79104, Germany
| | | | | | | | | |
Collapse
|
30
|
The impact of acamprosate on cue reactivity in alcohol dependent individuals: a functional magnetic resonance imaging study. J Clin Psychopharmacol 2012; 32:661-5. [PMID: 22926600 DOI: 10.1097/jcp.0b013e318267b586] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Alcohol cue-induced brain activation has been studied extensively in alcoholics. However, little is known about the impact of standard treatment protocols on this phenomenon. The current study aimed at investigating the impact of the anticraving substance acamprosate on alcohol cue-related brain activity. Patients underwent a functional magnetic resonance imaging investigation before the beginning of medication with acamprosate or placebo (T0) and 2 weeks later (T1). All patients also received psychiatric inpatient treatment including psychotherapeutic interventions. Twenty-nine patients were included in the T0 analysis and 22 patients in the T1 analysis. At T0, a cluster in the left and right posterior cingulate cortex, covering parts of the retrosplenial cortex, was significantly associated with alcohol versus neutral cue exposure. At T1, no significant cluster was found for the alcohol-versus-neutral contrast. The analysis of the impact of acamprosate on cue-related activity in the posterior cingulate cortex cluster revealed no significant difference to placebo. These results provide further evidence for the involvement of the posterior cingulate cortex in alcohol cue exposure. However, in comparison with psychiatric inpatient treatment alone, there was no additional effect of acamprosate on cue-related brain activity.
Collapse
|
31
|
Stein LAR, Lebeau R, Clair M, Martin R, Bryant M, Storti S. Preliminary web-based measures development for GHB: expectancies, functions, and withdrawal. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 38:121-9. [PMID: 22175869 DOI: 10.3109/00952990.2011.643970] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Much of what is understood regarding gamma hydroxybutyrate (GHB) treatment is based on hospital case studies for overdose and withdrawal, and there are currently no measures developed specifically for GHB or its analogs (e.g., gamma butyrolactone and 1,4-butanediol) to assess drug effect expectancies, reasons for starting use, withdrawal effects, and knowledge and opinions about use. OBJECTIVES This pilot study (N = 61) was conducted to begin measures development to assess experiences, functions of use, and opinions regarding use as indicated by respondents taking a Web-based survey. METHODS Minimum average partial correlation and parallel analysis procedures are employed to create scales. RESULTS Scales were developed to assess expectancies, reasons for use, withdrawal, and knowledge/opinions of use with median α = .79 and that account for 8.69-24.17% of the variance. CONCLUSION Scales have relatively good psychometric properties and replication is needed. SCIENTIFIC SIGNIFICANCE GHB-specific measures may greatly assist in furthering our understanding of protective and risk factors for use, and withdrawal phenomena.
Collapse
Affiliation(s)
- L A R Stein
- Social Sciences Research Center, University of Rhode Island, Kingston, 02881, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Bayerlein K, Kraus T, Leinonen I, Pilniok D, Rotter A, Hofner B, Schwitulla J, Sperling W, Kornhuber J, Biermann T. Orexin A expression and promoter methylation in patients with alcohol dependence comparing acute and protracted withdrawal. Alcohol 2011; 45:541-7. [PMID: 21621370 DOI: 10.1016/j.alcohol.2011.02.306] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/11/2011] [Accepted: 02/21/2011] [Indexed: 12/29/2022]
Abstract
The orexins (hypocretins) are neuropeptides deriving from the lateral hypothalamus and may be of importance within the context of drug craving, withdrawal, and relapse. Therefore, the orexin A expression and promoter methylation in peripheral blood cells of 68 patients (41 male and 27 female patients at three different time points during withdrawal and 27 patients during stationary dehabituation therapy) suffering from alcohol dependence were assessed by quantitative reverse transcription-polymerase chain reaction and bisulfite sequencing. There was a statistically significant difference of orexin A expression between the three time points of withdrawal and long-term (LT) abstinence (F=4.16, P=.011). This difference was most prominent in comparison with LT abstinence (t=-3.08, P=.0032). Expression was significantly associated with the severity of withdrawal symptoms measured with the Withdrawal Syndrome Scale for Alcohol and Related Psychoactive Drugs (WSA) (t=2.17, P=.0356). The stronger the withdrawal symptoms, the lower the orexin A expression (F=4.69, P=.036). Body mass index (t=2.15, P=.041), the severity of withdrawal measured with the WSA (t=2.595, P=.0133), craving measured either by the Obsessive Compulsive Drinking Scale (t=2.77, P=.0085) or the Lübecker Craving Questionnaire (t=-2.23, P=.0314) had a significant influence on orexin A expression taking into account mean methylation of the CpG island of the orexin A promoter during withdrawal. Orexin A may be a possible candidate to further elucidate mechanisms of alcohol withdrawal taking into account energy homoeostasis in the circuit of reward and motivation.
Collapse
Affiliation(s)
- Kristina Bayerlein
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Stein LAR, Lebeau R, Clair M, Martin R, Bryant M, Storti S, Monti P. A web-based study of gamma hydroxybutyrate (GHB): patterns, experiences, and functions of use. Am J Addict 2010; 20:30-9. [PMID: 21175918 DOI: 10.1111/j.1521-0391.2010.00099.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
GHB (gamma hydroxybutyrate) was developed as a general anesthetic. Due to dosing difficulty and side effects, regular use was discontinued. Medical uses include treating sleep and alcohol disorders. In the 1990s, it was promoted as a supplement and taken to improve mood and sex. GHB and its analogs (gamma butyrolactone and butanediol) were widely available until federal regulations were put into effect with mounting evidence of adverse events. This survey (N = 61) study was conducted to assess patterns, experiences, and functions of use. Much of what is understood regarding GHB treatment is based on hospital case studies for overdose and withdrawal. Not enough is known about prevention, reducing use and associated problems, or relapse. We know little about specific drug effect expectancies, triggers, coping skills, and consequences of use (positive/negative). While the drug treatment literature has a wealth of information to draw upon, GHB-specific information may greatly assist relapse prevention.
Collapse
Affiliation(s)
- L A R Stein
- Social Sciences Research Center, University of Rhode Island, Kingston, 02881, USA.
| | | | | | | | | | | | | |
Collapse
|
34
|
Kahl KG, Greggersen W, Schweiger U, Cordes J, Correll CU, Ristow J, Burow J, Findel C, Stoll A, Balijepalli C, Göres L, Lösch C, Hillemacher T, Bleich S, Moebus S. Prevalence of the metabolic syndrome in men and women with alcohol dependence: results from a cross-sectional study during behavioural treatment in a controlled environment. Addiction 2010; 105:1921-7. [PMID: 20735365 DOI: 10.1111/j.1360-0443.2010.03059.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Prevalence of metabolic syndrome (MetS) in men and women who use alcohol has been inconsistent in the literature. The aim of this study is to compare the prevalence of MetS in patients with a diagnosis of alcohol dependence who are currently abstinent in a controlled environment, and in control subjects followed in primary care from a similar region in Northern Germany. DESIGN Cross-sectional study. SETTING In-patient cognitive behavioural therapy. PARTICIPANTS One hundred and ninety-seven men and women with alcohol dependence during behavioural treatment in a controlled environment were compared to 1158 subjects from primary care from a similar region in northern Germany. MEASUREMENTS We used the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHBLI) criteria to determine the rate of MetS and each single criterion of MetS in both groups. FINDINGS The prevalence of MetS was almost twice as high in men and women with alcohol dependence compared to control subjects (30.6% versus 17.0%). With respect to the single criteria, elevations were found for fasting glucose and blood pressure in both genders and for triglycerides in women only. High density lipoprotein (HDL)-cholesterol was higher in men and women with alcohol dependence. CONCLUSIONS Our results demonstrate an increased rate of MetS, increased blood pressure and dysregulation of glucose and lipid metabolism in alcohol-dependent patients. Whether high HDL-cholesterol has cardioprotective effects in this context remain doubtful.
Collapse
Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Easton CJ, Sacco KA, Neavins TM, Wupperman P, George TP. Neurocognitive Performance Among Alcohol Dependent Men With and Without Physical Violence Toward Their Partners: A Preliminary Report. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:29-37. [DOI: 10.1080/00952990701764326] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
36
|
Nava F, Premi S, Manzato E, Campagnola W, Lucchini A, Gessa GL. Gamma-Hydroxybutyrate Reduces both Withdrawal Syndrome and Hypercortisolism in Severe Abstinent Alcoholics: An Open Study vs. Diazepam. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:379-92. [PMID: 17613965 DOI: 10.1080/00952990701315046] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 42 alcoholic inpatients we performed an open randomized study to compare the effects of diazepam and gamma-hydroxybutyrate (GHB) on the suppression of severe alcohol withdrawal syndrome and hypercortisolism. Both diazepam (.5 mg/kg bodyweight, q.i.d.) and GHB (50 mg/kg bodyweight, q.i.d.) were orally administered for three weeks. During all study period, GHB was more able than diazepam in reducing both withdrawal syndrome and hypercortisolism. These effects were evident during the first week of treatment and persisted throughout the study period. The results confirm a strict correlation between high levels of plasma cortisol and alcohol withdrawal symptoms and they show a slight superiority of GHB over diazepam in the suppression of both ethanol withdrawal and hypercortisolism. Taken together, our data suggest that GHB may act as potent anti-withdrawal agent in severe abstinent alcoholics.
Collapse
Affiliation(s)
- Felice Nava
- Italian Society of Addiction Medicine FederSerD, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
37
|
Tetrault JM, O'Connor PG. Substance Abuse and Withdrawal in the Critical Care Setting. Crit Care Clin 2008; 24:767-88, viii. [DOI: 10.1016/j.ccc.2008.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
38
|
Collins ED, Horton T, Reinke K, Amass L, Nunes EV. Using buprenorphine to facilitate entry into residential therapeutic community rehabilitation. J Subst Abuse Treat 2006; 32:167-75. [PMID: 17306725 DOI: 10.1016/j.jsat.2006.03.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2005] [Revised: 02/03/2006] [Accepted: 03/13/2006] [Indexed: 10/23/2022]
Abstract
For opioid-dependent patients, the need for detoxification has been a barrier to entry into long-term residential treatment. This report describes a retrospective observational cohort study with the first 38 opioid-dependent patients entering First Step, a 14-day buprenorphine-naloxone (Suboxone) detoxification regimen integrated into a long-term residential therapeutic community (TC) program. Eighty-nine percent (34 of 38) of First Step patients completed a 14-day buprenorphine taper protocol, 50% (19 of 38) completed an initial 3- to 4-week stay, and 39% (15 of 38) completed at least 3 months of residential treatment at the TC. Retention did not differ significantly in a demographically matched concurrently admitted control group without impending opioid withdrawal, in which 65% (24 of 37) completed an initial 3- to 4-week stay (p = .20) and 57% (21 of 37) completed at least 3 months of treatment (p = .14). Withdrawal symptoms were mild, and there were no instances of precipitated withdrawal. The findings suggest the potential for buprenorphine to serve as a bridge, improving the viability of long-term residential treatment for managing opioid dependence.
Collapse
Affiliation(s)
- Eric D Collins
- Department of Psychiatry, New York State Psychiatric Institute, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
| | | | | | | | | |
Collapse
|
39
|
Soyka M, Schmidt P, Franz M, Barth T, de Groot M, Kienast T, Reinert T, Richter C, Sander G. Treatment of alcohol withdrawal syndrome with a combination of tiapride/carbamazepine: results of a pooled analysis in 540 patients. Eur Arch Psychiatry Clin Neurosci 2006; 256:395-401. [PMID: 16917685 DOI: 10.1007/s00406-006-0644-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2005] [Accepted: 01/17/2006] [Indexed: 10/24/2022]
Abstract
This was a retrospective study to examine the efficacy, practicability and medical safety of a combination of tiapride and unretarded (fast acting formula) carbamazepine in the treatment of alcohol withdrawal syndrome. In five hospitals using this combination for treatment of alcohol withdrawal, 540 patients who had been treated with this combination were identified. An intensive evaluation of patients files and charts was performed. Details of alcohol history and comorbid disorders were extracted from patient files. Severity of alcohol withdrawal had been assessed using the CIWA-A-Score. Gender differences and differences between patients in their first and at least second withdrawal were computed by means of variance analyses (GLM). At baseline (day 1) mean dosage given was 796 for tiapride and 543 mg for carbamazepine. A pooled analysis of the results showed that, in general, medication was well tolerated. Withdrawal symptomatology as indicated by CIWA-A scores clearly decreased over time. Although a significant number of patients had a history of alcohol withdrawal delirium (103) and epileptic seizures (151), few patients suffered from them during treatment (8 and 5, respectively). Only 24 (4.4%) patients dropped out because of lack of efficacy or change of medication, 15 (2.8%) because of side effects. No case of malignant neuroleptic syndrome was recorded. Data analysis showed gender differences and differences between patients in their first and at least second withdrawal for side effects, complications, and in some CIWA-A-scores. In general, severe complications of withdrawal syndrome were more frequent in men compared to women and in patients with repeated inpatient treatment. In line with previous research, the results from this study give further evidence that a combination of the anticonvulsant carbamazepine and tiapride is an effective and safe treatment for alcohol withdrawal treatment.
Collapse
Affiliation(s)
- Michael Soyka
- Psychiatric Hospital, University of Munich, Nussbaumstr. 7, 80336, München, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Feige B, Gann H, Brueck R, Hornyak M, Litsch S, Hohagen F, Riemann D. Effects of Alcohol on Polysomnographically Recorded Sleep in Healthy Subjects. Alcohol Clin Exp Res 2006; 30:1527-37. [PMID: 16930215 DOI: 10.1111/j.1530-0277.2006.00184.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND After studying the sleep of alcohol-dependent patients at the beginning and over the course of abstinence in earlier studies, our interest in the current study focused on the direct effect of 2 doses of alcohol [0.03 and 0.1% blood alcohol level (BAL)] on healthy sleep. This is the first polysomnographic study testing the impact of 2 doses of alcohol ingestion (thus reflecting "normal" social drinking and alcohol abuse) in a single-blind randomized design in healthy volunteers. The study evaluated a short-term acute drinking period for 3 and 2 days of withdrawal from alcohol not only for polysomnographic variables but also for subjective estimates of sleep quality. METHODS In a crossover design with a 1-week interval, healthy subjects received alcohol to raise their blood alcohol to either 0.03 or 0.1% BAL at bedtime for 3 consecutive nights after an alcohol-free baseline night. Objective (polysomnography) and subjective sleep (questionnaires) was recorded each night. During the following 2 days, alcohol was discontinued with simultaneous measurements of sleep to gauge withdrawal effects. RESULTS At a dose of alcohol leading to BAL of 0.03%, no clear effects could be detected. Following an evening BAL of 0.1%, a hypnotic-like effect (shortened sleep latency, reduced number of wake periods, decreased stage 1 sleep) occurred primarily during the first half of the night with signs of rebound effects being already present during the second half of the night (increased stage 1 sleep). At this dose, alcohol significantly increased slow-wave sleep (SWS) in the first half of the night and reduced REM density in the beginning of the night. After discontinuation of the higher alcohol dose, REM sleep amount increased. No significant withdrawal or rebound effects could be observed for parameters of sleep continuity during the 2 nights after discontinuation from alcohol at a BAL of 0.1%. CONCLUSIONS Owing to the small sample size, the results of this study need to be interpreted with caution. Short-term moderate alcohol consumption (BAL 0.03%) did not significantly alter objective or subjective parameters of sleep. Higher doses of alcohol resulting in a BAL level of 0.10% immediately before going to bed mainly influenced sleep in the first half of the night, resembling the effects of a short-acting hypnotic drug, including a suppression of phasic aspects of REM sleep (REM density). Interestingly, analysis of the latter part of these nights indicated the immediate presence of withdrawal effects (increased light sleep). No statistically significant effects on sleep parameters were observable during the 2 nights of withdrawal from alcohol at the higher BAL. Interpreted carefully, our data indicate that negative effects on sleep occur already with short-term use of alcohol at doses of BAL of 0.10%, despite hypnotic-like effects during the first hours of sleep, especially during the latter part of the night.
Collapse
Affiliation(s)
- Bernd Feige
- Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | | | | | | | | | | | | |
Collapse
|
41
|
Olbrich HM, Valerius G, Paris C, Hagenbuch F, Ebert D, Juengling FD. Brain activation during craving for alcohol measured by positron emission tomography. Aust N Z J Psychiatry 2006; 40:171-8. [PMID: 16476136 DOI: 10.1080/j.1440-1614.2006.01765.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Craving for alcohol is probably involved in acquisition and maintenance of alcohol dependence to a substantial degree. However, the brain substrates and mechanisms that underlie alcohol craving await more detailed elucidation. METHOD Positron emission tomography was used to map regional cerebral blood flow (CBF) in 21 detoxified patients with alcohol dependence during exposure to alcoholic and non-alcoholic beverages. RESULTS During the alcohol condition compared with the control condition, significantly increased CBF was found in the ventral putamen. Additionally, activated areas included insula, dorsolateral prefrontal cortex and cerebellum. Cerebral blood flow increase in these regions was related to self-reports of craving assessed in the alcoholic patients. CONCLUSIONS In this investigation, cue-induced alcohol craving was associated with activation of brain regions particularly involved in brain reward mechanisms, memory and attentional processes. These results are consistent with studies on craving for other addictive substances and may offer strategies for more elaborate studies on the neurobiology of addiction.
Collapse
Affiliation(s)
- Hans M Olbrich
- Department of Psychiatry and Psychotherapy, University of Freiburg Medical School, Germany.
| | | | | | | | | | | |
Collapse
|
42
|
Bostwick JM, Lapid MI. False Positives on the Clinical Institute Withdrawal Assessment for Alcohol—Revised: Is This Scale Appropriate for Use in the Medically Ill? PSYCHOSOMATICS 2004; 45:256-61. [PMID: 15123853 DOI: 10.1176/appi.psy.45.3.256] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
43
|
Seifert J, Peters E, Jahn K, Metzner C, Ohlmeier M, te Wildt B, Emrich HM, Schneider U. Treatment of alcohol withdrawal: chlormethiazole vs. carbamazepine and the effect on memory performance--a pilot study. Addict Biol 2004; 9:43-51. [PMID: 15203438 DOI: 10.1080/13556210410001674086] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although relatively little attention has been paid to the question how acute alcohol withdrawal might affect cognitive functions, this factor remains of particular interest because it influences psychotherapeutic treatment during detoxification. The clinical outcome and neuropsychological state of 37 inpatients with alcohol withdrawal was investigated in a randomized single-blind approach. Two different medical strategies [chlormethiazole (CMZ) vs. carbamazepine (CBZ)] in the treatment of inpatients with alcohol withdrawal syndrome were compared. Among comparable groups (related to gender, age, initial alcohol level, severity of abuses, severity of initial withdrawal symptoms such as tremor, perspiration, psychomotor agitation, hallucinations, orientation, intelligence, patient demographics), CBZ is just as potent as CMZ in therapy of withdrawal symptoms (circulatory function, vegetative function, psychomotor activity). Patients in both groups showed initial impairments in some neuropsychological tests (d2, Zahlen-Verbundings test, Beck Depression Inventory, Anxiety Sensitivity Index) with significant improvement during detoxification. Additionally, CBZ-treated patients showed significantly better verbal memory performance during the first days of treatment. Without any addictive potential, CBZ therapy could be very supportive in alcohol detoxification. In addition a higher verbal memory performance state could be favourable for a psychotherapeutic approach.
Collapse
Affiliation(s)
- J Seifert
- Department of Clinical Psychiatry and Psychotherapy, Medical School Hannover, Hannover, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Rupp CI, Kurz M, Kemmler G, Mair D, Hausmann A, Hinterhuber H, Fleischhacker WW. Reduced olfactory sensitivity, discrimination, and identification in patients with alcohol dependence. Alcohol Clin Exp Res 2003; 27:432-9. [PMID: 12658108 DOI: 10.1097/01.alc.0000057945.57330.2c] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Various olfactory deficits have been reported in the alcohol-induced amnestic syndrome (Korsakoff's syndrome). Less is known about olfactory functioning in nonamnesic and nondemented alcoholic patients. METHODS Olfactory performance of 30 alcohol-dependent patients was assessed unirhinally using the Sniffin' Sticks (threshold, discrimination, identification, composite TDI score) and compared with that of 30 healthy controls, matched for sex, age, and smoking status. RESULTS Patients showed significantly reduced olfactory sensitivity (higher threshold), discrimination, and identification compared with controls. No group differences were observed in laterality. Identification and discrimination group differences remained significant after controlling for differences in sensitivity. Olfactory deficits in patients were present independent of age, gender, and duration of abstinence (<3 months) and were not attributable to smoking or general cognitive abilities. More than half of the patients (56.7%) could be classified as hyposmic. Lower overall olfactory functioning (TDI) was associated with longer duration of a regular alcohol intake and higher values of gamma-glutamyltransferase (GGT). CONCLUSIONS Olfactory dysfunction is common in nonamnesic and nondemented patients with alcohol dependence. Results suggest a detrimental effect of alcohol on central olfactory processing.
Collapse
Affiliation(s)
- Claudia I Rupp
- University Clinics of Innsbruck, Department of General Psychiatry, Anichstrasse 35, 6020 Innsbruck, Austria.
| | | | | | | | | | | | | |
Collapse
|
45
|
Pestka EL, Billman RR, Alexander JM, Rosenblad MK. Acute medical crises masquerading as psychiatric illness. J Emerg Nurs 2002; 28:531-5. [PMID: 12509730 DOI: 10.1067/men.2002.128438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
46
|
Olbrich HM, Maes H, Valerius G, Langosch JM, Gann H, Feige B. Assessing cerebral dysfunction with probe-evoked potentials in a CNV task -- a study in alcoholics. Clin Neurophysiol 2002; 113:815-25. [PMID: 12048041 DOI: 10.1016/s1388-2457(02)00060-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Contrary to event-related potential (ERP) components N1, N2 and P3, slow ERPs have rarely been used in assessing cerebral dysfunction in mental disorders. Focussing on slow waves (SWs) and on patients with mild cerebral dysfunction, we recorded ERPs in alcoholics using a dual task design. METHODS ERPs to auditory probes presented either 1s before the warning or 1s before the imperative stimulus of a visual contingent negative variation (CNV) paradigm were recorded from 33 scalp electrodes in 27 alcoholics following detoxification and 12 healthy controls. Independent component analysis (ICA) was used to separate potentially overlapping spatial components. RESULTS In alcoholics compared to controls, probe ERPs showed increased N2, decreased P3 and increased negative SWs of two types appearing pre- and post-P3, respectively. Both negative SWs significantly correlated with neuropsychological indices reflecting verbal intelligence and memory functions. The increase in probe-evoked N1 and P3 potentials during CNV, putatively associated with enhanced cortical excitability, significantly correlated with clinical features of protracted alcohol withdrawal syndrome in alcoholics. CONCLUSIONS Our experimental approach revealed two types of negative SWs which strongly correlated with neuropsychological deficits of mildly impaired patients. It is suggested that our methods might enhance diagnostic efficiency of ERPs. An electrophysiological measure of protracted alcohol withdrawal might be useful for managing central nervous system dysfunction in alcoholics.
Collapse
Affiliation(s)
- Hans M Olbrich
- Department of Psychiatry and Psychotherapy, Albert-Ludwigs-University Freiburg, Hauptstrasse 5, 79104 Freiburg, Germany.
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Alcohol is a ubiquitous drug which is responsible for a substantial amount of ill health and approximately 20% of patients in a general hospital will have alcohol-related problems, although only 4% will be admitted with alcohol-caused conditions. Eight per cent of patients, however, can be expected to have sufficient neuroadaptation to be at risk of withdrawal. This level of prevalence of alcoholism in general hospital patients requires that hospitals must become expert at providing good quality care for alcohol-related problems in all areas including obstetrics, but particularly in the management of intoxication, withdrawal and the various alcohol-related diseases. This paper provides some suggested benchmarks for acceptable standards of care for alcohol problems in the acute hospital.
Collapse
|