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Nishimura Y, Choi H, Colgan B, Kistler H, Mercado F. Current evidence and clinical utility of phenobarbital for alcohol withdrawal syndrome. Eur J Intern Med 2023; 112:52-61. [PMID: 36935249 DOI: 10.1016/j.ejim.2023.03.006] [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: 01/03/2023] [Revised: 02/28/2023] [Accepted: 03/06/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Phenobarbital (PB) has been acknowledged among clinicians as a potential alternative to benzodiazepines (BZD) to decrease the need for hospital length of stay and complications associated with alcohol withdrawal syndrome (AWS). However, the level of evidence, including appropriate dosing, is unclear. We aim to summarize the evidence regarding PB used in AWS and provide future agendas for research. METHODS Following the PRISMA guidelines, we searched MEDLINE, EMBASE, ClinicalTrials.gov, and WHO ICTRP for all peer-reviewed articles and clinical trials using keywords including"alcohol withdrawal", "delirium tremens", "phenobarbital," and "barbiturate" from their inception to September 18, 2022. RESULTS We included 20 articles, nine in the emergency department (ED) and 11 in the general floors or intensive care units (ICUs). Studies performed in the ED included two RCTs, although both suffered from a considerably small sample size. Six studies done in the general floors or ICUs compared PB and BZD monotherapy, while four compared the utility of adjunct PB in addition to BZD compared with BZD monotherapy and one was a database study without specific dosing information. Overall, there was considerable heterogeneity in PB dosing, measured outcomes, and AWS severity measurement scales. CONCLUSION This systematic review summarizes the current evidence related to PB use in AWS. While considerable heterogeneity exists among studies available, PB as monotherapy without BZD may be a safe and effective alternative in AWS treatment. Future prospective studies or trials should focus on the standardization of PB dosing and outcomes.
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Affiliation(s)
- Yoshito Nishimura
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, United States of America.
| | - Horyun Choi
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, United States of America
| | - Bridget Colgan
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, United States of America
| | - Harrison Kistler
- Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, United States of America
| | - Francisco Mercado
- Department of Medicine, John A. Burns School of Medicine, University of Hawai'i, Honolulu, HI, 96813, United States of America; Department of Medicine, Tripler Army Medical Center, Honolulu, HI 96859, United States of America
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Simpson TL, Kaysen DL, Fleming CB, Rhew IC, Jaffe AE, Desai S, Hien DA, Berliner L, Donovan D, Resick PA. Cognitive Processing Therapy or Relapse Prevention for comorbid Posttraumatic Stress Disorder and Alcohol Use Disorder: A randomized clinical trial. PLoS One 2022; 17:e0276111. [PMID: 36445895 PMCID: PMC9707793 DOI: 10.1371/journal.pone.0276111] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/12/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To compare a Posttraumatic Stress Disorder (PTSD) treatment (Cognitive Processing Therapy; CPT), an Alcohol Use Disorder (AUD) treatment (Relapse Prevention; RP), and assessment-only (AO) for those meeting diagnostic criteria for both PTSD and AUD. METHOD Participants with current PTSD/AUD (N = 101; mean age = 42.10; 56% female) were initially randomized to CPT, RP, or AO and assessed post-treatment or 6-weeks post-randomization (AO). AO participants were then re-randomized to CPT or RP. Follow-ups were at immediate post-treatment, 3-, and 12-months. Mixed effects intent-to-treat models compared conditions on changes in PTSD symptom severity, drinking days, and heavy drinking days. RESULTS At post-treatment, participants assigned to CPT showed significantly greater improvement than those in AO on PTSD symptom severity (b = -9.72, 95% CI [-16.20, -3.23], d = 1.22); the RP and AO groups did not differ significantly on PTSD. Both active treatment conditions significantly decreased heavy drinking days relative to AO (CPT vs. AO: Count Ratio [CR] = 0.51, 95% CI [0.30, 0.88]; RP vs. AO: CR = 0.34, 95% CI [0.19, 0.59]). After re-randomization both treatment conditions showed substantial improvements in PTSD symptoms and drinking between pre-treatment and post-treatment over the 12-month follow-up period, with RP showing an advantage on heavy drinking days. CONCLUSION Treatments targeting one or the other aspects of the PTSD/AUD comorbidity may have salutary effects on both PTSD and drinking outcomes. These preliminary results suggest that people with this comorbidity may have viable treatment options whether they present for mental health or addiction care. TRIAL REGISTRATION The trial is registered at clinicaltrials.gov (NCT01663337).
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Affiliation(s)
- Tracy L. Simpson
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound Health Care, Seattle, WA, United States of America
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
- * E-mail:
| | - Debra L. Kaysen
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Charles B. Fleming
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Isaac C. Rhew
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Anna E. Jaffe
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, United States of America
| | - Sruti Desai
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Denise A. Hien
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, Center of Alcohol & Substance Use Studies, Piscataway, NJ, United States of America
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, University of Washington, Seattle, WA, United States of America
| | - Dennis Donovan
- Alcohol and Drug Abuse Institute, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, United States of America
| | - Patricia A. Resick
- Department of Psychiatry and Behavioral Sciences, Duke Health, Durham, NC, United States of America
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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.
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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.
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Executive Summary of the American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management. J Addict Med 2020; 14:376-392. [PMID: 32909985 DOI: 10.1097/adm.0000000000000732] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
: The American Society of Addiction Medicine (ASAM) Clinical Practice Guideline on Alcohol Withdrawal Management provides guidance on the identification and management of alcohol withdrawal in adults with varying degrees of syndrome severity. The guideline addresses both ambulatory and inpatient care and considers special patient populations. The Guideline was primarily developed following the RAND/UCLA Appropriateness Method (RAM), a process to determine the appropriateness of a set of clinical procedures. This process included a review of gray and empirical literature published between January 2012 and October 2017. Nineteen existing guidelines, 112 reviews, and 150 research studies were used to develop draft guideline statements that were assessed by a panel of physicians experienced in withdrawal management and representing a diverse range of settings and patient populations. Recommendations were included in the Guideline where consensus on appropriate clinical practice was identified by the panel. Areas where additional research would provide valuable information for determining best practices were highlighted.
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Wolf C, Curry A, Nacht J, Simpson SA. Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives. Open Access Emerg Med 2020; 12:53-65. [PMID: 32256131 PMCID: PMC7093658 DOI: 10.2147/oaem.s235288] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients' AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.
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Affiliation(s)
- Chelsea Wolf
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ashley Curry
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jacob Nacht
- Denver Health Medical Center, Denver, CO, USA
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Scott A Simpson
- Denver Health Medical Center, Denver, CO, USA
- Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Lee JA, Duby JJ, Cocanour CS. Effect of early and focused benzodiazepine therapy on length of stay in severe alcohol withdrawal syndrome. Clin Toxicol (Phila) 2019; 57:624-627. [PMID: 30729859 DOI: 10.1080/15563650.2018.1542701] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objective: Current evidence supports symptom-triggered therapy for alcohol withdrawal syndrome (AWS). Early, escalating therapy with benzodiazepines (BZD) appears to decrease ICU length of stay (LOS); however, the effect on hospital LOS remains unknown. The hypothesis of this study is that focused BZD treatment in the first 24 h will decrease hospital LOS. Design: Pre-post cohort study. Setting: Academic medical center. Patients: This study included patients with severe AWS. The pre-intervention cohort (PRE) was admitted between January and November 2015. The post-intervention cohort (POST) was admitted between April 2016 and March 2017. Severe AWS was defined as patients requiring diazepam doses of >30 mg. Focused treatment was defined as >50% of total diazepam usage within the first 24 h of recognition of AWS. Intervention: In the PRE group, patients received symptom-triggered, escalating doses of diazepam and phenobarbital based on their Richmond Agitation-Sedation Scale (RASS). In the POST group, patients received a revised, time-limited course of therapy: escalating doses of BZD and phenobarbital were given during a 24-h loading phase, and all therapy was discontinued after a 72-h tapering phase. The SHOT scale was used as an adjunct to RASS to assess non-agitation symptoms of AWS and guide additional diazepam doses. Measurements and main results: The primary outcome was hospital LOS; secondary outcomes included ICU LOS, BZD use, and ventilator-free days. Five hundred thirty-two patients were treated using the AWS protocol; 113 experienced severe AWS. The PRE (n = 75) and POST (n = 38) groups were evenly matched in age, sex, history of AWS, and severity of illness. There was a substantial difference in POST patients who received focused treatment (51.3% vs. 73.7%, p = .03). The POST group had a significant decrease in hospital LOS (14.0 vs. 9.8 days, p = .03) and ICU LOS (7.4 vs. 4.4 days, p = .03). Conclusion: Early, focused management of severe AWS was associated with a decrease in ICU and hospital LOS.
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Affiliation(s)
- Jin A Lee
- a Department of Pharmacy Services, University of California, Davis Medical Center , Sacramento , CA, USA
| | - Jeremiah J Duby
- a Department of Pharmacy Services, University of California, Davis Medical Center , Sacramento , CA, USA
| | - Christine S Cocanour
- b Department of Surgery , University of California, Davis Medical Center , Sacramento , CA, USA
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Norouzi N, Carver S, Dear T, Bromberg S, Gray S, Kahan M, Aarabi P, Borgundvaag B. Evaluation of alcohol intoxication and withdrawal syndromes based on analysis of tremor signals. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aarabi P, Norouzi N, Dear T, Carver S, Bromberg S, Gray S, Kahan M, Borgundvaag B. A quantitative evaluation of alcohol withdrawal tremors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6215-8. [PMID: 26737712 DOI: 10.1109/embc.2015.7319812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This paper evaluates the relation between Alcohol Withdrawal Syndrome tremors in the left and right hands of patients. By analyzing 122 recordings from 61 patients in emergency departments, we found a weak relationship between the left and right hand tremor frequencies (correlation coefficient of 0.63). We found a much stronger relationship between the expert physician tremor ratings (on CIWA-Ar 0-7 scale) of the two hands, with a correlation coefficient of 0.923. Next, using a smartphone to collect the tremor data and using a previously developed model for obtaining estimated tremor ratings, we also found a strong correlation (correlation coefficient of 0.852) between the estimates of each hand. Finally, we evaluated different methods of combining the data from the two hands for obtaining a single tremor rating estimate, and found that simply averaging the tremor ratings of the two hands results in the lowest tremor estimate error (an RMSE of 0.977). Looking at the frequency dependence of this error, we found that higher frequency tremors had a much lower estimation error (an RMSE of 1.102 for tremors with frequencies in the 3-6Hz range as compared to 0.625 for tremors with frequencies in the 7-10Hz range).
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McDonell MG, Nepom JR, Leickly E, Suchy-Dicey A, Hirchak K, Echo-Hawk A, Schwartz SM, Calhoun D, Donovan D, Roll J, Ries R, Buchwald D. A culturally-tailored behavioral intervention trial for alcohol use disorders in three American Indian communities: Rationale, design, and methods. Contemp Clin Trials 2016; 47:93-100. [PMID: 26706667 PMCID: PMC4818164 DOI: 10.1016/j.cct.2015.12.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 12/10/2015] [Accepted: 12/14/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Disproportionately high rates of alcohol use disorders are present in many American Indian/Alaska Native (AI/AN) communities, yet little information exists regarding the effectiveness of alcohol treatments in AI/AN populations. Contingency management is an intervention for illicit drug use in which tangible reinforcers (rewards) are provided when patients demonstrate abstinence as assessed by urine drug tests. Contingency management has not been widely studied as an intervention for alcohol problems because until recently, no alcohol biomarker has been available to adequately verify abstinence. AIMS The HONOR Study is designed to determine whether a culturally-tailored contingency management intervention is an effective intervention for AI/AN adults who suffer from alcohol use disorders. METHODS Participants include 400 AI/AN alcohol-dependent adults residing in one rural reservation, one urban community, as well as a third site to be decided, in the Western U.S. Participants complete a 4-week lead-in phase prior to randomization, then 12 weeks of either a contingency management intervention for alcohol abstinence, or a control condition where participants receive reinforcers for attending study visits regardless of alcohol use. Participants are then followed for 3-more months post-intervention. The primary study outcome is urinary ethyl glucuronide-confirmed alcohol abstinence; secondary outcomes include self-reported alcohol and drug use, HIV risk behaviors, and self-reported cigarette smoking. DISCUSSION This will be the largest randomized, controlled trial of any alcohol for AI/ANs and the largest contingency management study targeting alcohol use disorders, thus providing important information to AI/AN communities and the alcohol treatment field in general.
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Affiliation(s)
- Michael G McDonell
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Elson S Floyd College of Medicine, Washington State University, USA
| | - Jenny R Nepom
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Emily Leickly
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Astrid Suchy-Dicey
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Kait Hirchak
- Department of Health Policy and Administration, Washington State University, Spokane, WA 99210-1495, USA
| | - Abigail Echo-Hawk
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA
| | - Stephen M Schwartz
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109-1024, USA
| | - Darren Calhoun
- Med Star Health Research Institute, 1616 E. Indian School Rd., Phoenix, AZ 85016, USA
| | - Dennis Donovan
- Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - John Roll
- Washington State University, Spokane, WA 99210-1495, USA
| | - Richard Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, 325 Ninth Ave, Box 359911, Seattle, WA 98195, USA
| | - Dedra Buchwald
- Partnerships for Native Health, Department of Epidemiology, University of Washington, 1100 Olive Way, Suite 1200, Box 357236, Seattle, WA 98101, USA; Elson S Floyd College of Medicine, Washington State University, USA
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Du A, Jiang H, Xu L, An N, Liu H, Li Y, Zhang R. Damage of hippocampal neurons in rats with chronic alcoholism. Neural Regen Res 2014; 9:1610-5. [PMID: 25368648 PMCID: PMC4211203 DOI: 10.4103/1673-5374.141787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2014] [Indexed: 01/08/2023] Open
Abstract
Chronic alcoholism can damage the cytoskeleton and aggravate neurological deficits. However, the effect of chronic alcoholism on hippocampal neurons remains unclear. In this study, a model of chronic alcoholism was established in rats that were fed with 6% alcohol for 42 days. Endogenous hydrogen sulfide content and cystathionine-beta-synthase activity in the hippocampus of rats with chronic alcoholism were significantly increased, while F-actin expression was decreased. Hippocampal neurons in rats with chronic alcoholism appeared to have a fuzzy nuclear membrane, mitochondrial edema, and ruptured mitochondrial crista. These findings suggest that chronic alcoholism can cause learning and memory decline in rats, which may be associated with the hydrogen sulfide/cystathionine-beta-synthase system, mitochondrial damage and reduced expression of F-actin.
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Affiliation(s)
- Ailin Du
- Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China ; Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Hongbo Jiang
- Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China ; Department of Neurology, the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Lei Xu
- Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Na An
- Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Hui Liu
- Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China ; Department of Neurology, the Third Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Yinsheng Li
- Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China
| | - Ruiling Zhang
- Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan Province, China ; Department of Physiology and Neurobiology, Xinxiang Medical University, Xinxiang, Henan Province, China ; Henan Provincial Key Laboratory of Bio-psychiatry, Xinxiang, Henan Province, China
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Carver S, Norouzi N, Bromberg S, Gray S, Kahan M, Aarabi P, Borgundvaag B. Time-frequency visualization of alcohol withdrawal tremors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2014; 2014:5474-5477. [PMID: 25571233 DOI: 10.1109/embc.2014.6944865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this paper, we propose a signal processing method of assessing the severity tremors caused by alcohol withdrawal (AW) syndrome. We have developed an iOS application to calculate the Clinical Institute Withdrawal Assessment (CIWA) score which captures iPod movements using the built-in accelerometer in order to reliably estimate the tremor severity component of the score. We report on the characteristics of AW tremor, the accuracy of electronic assessment of tremor compared to expert clinician assessment, and the potential for using signal processing assessment to differentiate factitious from real tremor in patients seen in the emergency department, as well as in nurses mimicking a tremor. Our preliminary results are based on 84 recordings from 61 subjects (49 patients, 12 nurses). In general we found a linear relationship between energy measured by the accelerometer (in the 4.4-10 Hz range) and the expert rating of tremor severity. Additionally, we demonstrate that 75% of the recordings from patients with actual AW syndrome had a mean peak frequency higher than 7 Hz whereas only 17% of the nurses' factitious tremors were above 7 Hz, suggesting that tremor above 7 Hz could be a potential discriminator of real versus factitious tremors.
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12
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Phenobarbital for Acute Alcohol Withdrawal: A Prospective Randomized Double-blind Placebo-controlled Study. J Emerg Med 2013; 44:592-598.e2. [DOI: 10.1016/j.jemermed.2012.07.056] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 04/03/2012] [Accepted: 07/02/2012] [Indexed: 11/19/2022]
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Livshits V, Rella J. The SHOT scale and measuring the severity of alcohol withdrawal in the emergency department. Acad Emerg Med 2011; 18:447; author reply 448. [PMID: 21496153 DOI: 10.1111/j.1553-2712.2011.01022.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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