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Psychiatric comorbidity in alcoholics treated at an institution with both coerced and voluntary admission. Eur Psychiatry 2020; 12:329-34. [DOI: 10.1016/s0924-9338(97)80001-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/1996] [Accepted: 11/19/1996] [Indexed: 11/18/2022] Open
Abstract
SummaryPsychiatric comorbidity in alcoholics admitted to a rehabilitation center on either a voluntary or a coerced basis were studied. A group of 104 alcoholics (37 coerced and 35 voluntarily admitted men; and 21 coerced and ten voluntarily admitted women) with a mean age (SD) of 43 ± 8 years were assessed by means of a Structural Clinical Interview in accordance with the Diagnostic and Statistical Manual (DSM)-III-R (SCID). The interview took place a mean of 7 days after admission. The frequencies of lifetime/current axis I psychiatric comorbidity (substance use disorders excluded) were 66 and 61%, respectively. Drug dependence was present in 41 and 39%, respectively, of the cases. Thirty-seven percent had a lifetime diagnosis, and 33% a current diagnosis of affective disorders, 27 and 23%, respectively, of anxiety disorders and 20 and 13%, respectively, of non-organic psychotic disorders. In a subsample of 20 subjects, depressive symptoms were found to be stable during the course of treatment. No differences in frequency of psychiatric comorbidity were found between coerced and voluntarily admitted patients (67 and 56%, respectively) or between men and women (65 and 52%, respectively). The combination of psychiatric comorbidity and drug dependence was overrepresented among the coerced patients (50 vs 16%). It was concluded that the frequencies of psychiatric comorbidity were high in the present group. The co-occurrence of alcohol dependence, drug dependence and psychiatric comorbidity was more frequent among subjects who were coercively treated.
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Patkar OL, Belmer A, Beecher K, Jacques A, Bartlett SE. Pindolol Rescues Anxiety-Like Behavior and Neurogenic Maladaptations of Long-Term Binge Alcohol Intake in Mice. Front Behav Neurosci 2019; 13:264. [PMID: 31849624 PMCID: PMC6895681 DOI: 10.3389/fnbeh.2019.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/20/2019] [Indexed: 12/30/2022] Open
Abstract
Long-term binge alcohol consumption alters the signaling of numerous neurotransmitters in the brain including noradrenaline (NE) and serotonin (5-HT). Alterations in the signaling of these neuronal pathways result in dysfunctional emotional states like anxiety and depression which are typically seen during alcohol withdrawal. Interestingly, studies have demonstrated that the development of alcohol-induced negative affective states is linked to disrupted neurogenesis in the dentate gyrus (DG) region of the hippocampus in alcohol-dependent animals. We have previously shown that modulation of NE and 5-HT activity by pharmacological targeting of β-adrenoreceptors (β-ARs) and 5-HT1A/1B receptors with pindolol reduces consumption in long-term alcohol-consuming mice. Since these receptors are also involved in emotional homeostasis and hippocampal neurogenesis, we investigated the effects of pindolol administration on emotional and neurogenic deficits in mice consuming long-term alcohol (18 weeks). We report that acute administration of pindolol (32 mg/kg) reduces anxiety-like behavior in mice at 24 h withdrawal in the marble-burying test (MBT) and the elevated plus-maze (EPM). We also show that chronic (2 weeks) pindolol treatment (32 mg/kg/day) attenuates alcohol-induced impairments in the density of immature neurons (DCX+) but not newborn cells (BrdU+) in the hippocampal DG. Pindolol treatment also restores the normal proportion of newborn proliferating cells (BrdU+/Ki67+/DCX−), newborn proliferating immature neurons (BrdU+/Ki67+/DCX+) and newborn non-proliferating immature neurons (BrdU+/Ki67−/DCX+) following long-term alcohol intake. These results suggest that pindolol, through its unique pharmacology may rescue some but not all deficits of long-term alcohol abuse on the brain, adding further value to its properties as a strong pharmaceutical option for alcohol use disorders (AUDs).
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Affiliation(s)
- Omkar L Patkar
- Addiction and Obesity Laboratory, Department of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD, Australia
| | - Arnauld Belmer
- Addiction and Obesity Laboratory, Department of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD, Australia
| | - Kate Beecher
- Addiction and Obesity Laboratory, Department of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD, Australia
| | - Angela Jacques
- Addiction and Obesity Laboratory, Department of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD, Australia
| | - Selena E Bartlett
- Addiction and Obesity Laboratory, Department of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.,Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, QLD, Australia
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Fein G, Cardenas VA. P3b amplitude is not reduced in abstinent alcoholics with a current MDD. Alcohol 2017; 63:33-42. [PMID: 28847380 DOI: 10.1016/j.alcohol.2017.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS In two studies of long-term abstinent alcoholics (LTAAs), we found that about 17% had a current major depressive disorder (MDD). We tested the hypothesis that LTAAs with a current MDD diagnosis do not exhibit the reduced P3b event-related potential amplitude endophenotype for alcoholism. This is consistent with the majority of LTAAs with a current MDD having developed alcohol dependence via self-medication of their MDD rather than their alcohol dependence arising from the alcoholism endophenotype. We revisited the P3b data from the two LTAAs studies, comparing LTAAs with a current MDD vs. LTAAs without a current MDD to each other and to non-substance abusing controls (NSACs). In northern California, 48 LTAAs and 48 non-substance abusing controls were studied, while in Honolulu, 105 LTAAs and 77 NSACs were studied. A total of 26 LTAAs had a current MDD (10 in California and 16 in Honolulu). The difference in P3b amplitude and latency (measured in targets-standards) in a 3-condition visual oddball paradigm was compared to MDD diagnoses gathered using the computerized Diagnostic Interview Schedule. Across both study sites, LTAAs without a current MDD (either with no lifetime MDD or a lifetime, but not current MDD) had lower P3b amplitudes than NSACs. In contrast, P3b amplitudes in LTAAs with a current MDD did not differ from controls. We conclude that alcohol dependence in LTAAs with a current MDD did not derive from the alcoholism endophenotype. This group may not exhibit the externalizing diathesis characterized by impulsive, disinhibited behavior and may have developed alcohol dependence via excessive drinking in an attempt to self-medicate their MDD. These results have major implications for targeted treatments of alcoholism and comorbid MDD.
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Affiliation(s)
- George Fein
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, HI 96732, USA; Department of Medicine and Psychology, University of Hawaii, Honolulu, HI 96822, USA.
| | - Valerie A Cardenas
- Neurobehavioral Research, Inc., 77 Ho'okele Street, 3rd Floor, Kahului, HI 96732, USA
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Hunt SA, Kay-Lambkin FJ, Baker AL, Michie PT. Systematic review of neurocognition in people with co-occurring alcohol misuse and depression. J Affect Disord 2015; 179:51-64. [PMID: 25845750 DOI: 10.1016/j.jad.2015.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 03/06/2015] [Accepted: 03/12/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Alcohol misuse and depression represent two major social and health problems globally. These conditions commonly co-occur and both are associated with significant cognitive impairment. Despite this, few studies have examined the impact on cognitive functioning of co-occurring alcohol misuse and depression. This study aims to critically review findings from peer-reviewed published articles examining neuropsychological test performance among samples of people with co-occurring alcohol misuse and depression. METHOD A comprehensive literature search was conducted, yielding six studies reporting neuropsychological profiles of people with co-occurring alcohol misuse and depression. Results comparing cognitive functioning of people with this comorbidity to those with alcohol misuse alone, depression alone, healthy controls and published norms were examined as well as those describing the correlation between depressive symptoms and cognitive functioning in people with alcohol use disorders. RESULTS In the majority of instances, the comorbid groups did not differ significantly from those with depression only or alcohol misuse only, nor from healthy controls or published norms. In the cases where a difference in neuropsychological test scores between groups was found, it was not consistently identified across studies. However, visual memory was identified in two studies as being impaired in comorbid samples and is worthy of inclusion in future studies. LIMITATIONS Due to the small number of included studies and the large variation in inclusion criteria as well as differing assessment tools and methodologies between studies, the review did not include a quantitative synthesis. CONCLUSIONS Research into cognitive deficits among people with singly occurring versus co-occurring alcohol misuse and depression is accumulating. Evidence suggests that the neuropsychological performance among samples with this comorbidity is generally not severely impaired and is unlikely to preclude benefit from treatment.
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Affiliation(s)
- Sally A Hunt
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia.
| | - Frances J Kay-Lambkin
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Australia.
| | - Amanda L Baker
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia.
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Conner KR, Pinquart M, Gamble SA. Meta-analysis of depression and substance use among individuals with alcohol use disorders. J Subst Abuse Treat 2009; 37:127-37. [PMID: 19150207 PMCID: PMC4864601 DOI: 10.1016/j.jsat.2008.11.007] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 10/29/2008] [Accepted: 11/24/2008] [Indexed: 12/16/2022]
Abstract
The relationships of depression with alcohol and drug use and impairment were examined. Additional analyses were conducted to examine moderators of these associations. Empirical reports on adults with alcohol abuse or dependence published in English in peer-reviewed journals since 1986 that contained data on depression and substance use variable(s) were obtained using a systematic search. The search yielded 74 studies including 58 reports from clinical venues, 10 that were community based, and 6 with subjects from both settings. As hypothesized, the analyses showed that depression is associated with concurrent alcohol use and impairment and drug use and impairment. Effect sizes were small. Depression was also related to future alcohol use and impairment, an earlier age of onset of an alcohol use disorder, and higher treatment participation. Age moderated the association between depression and alcohol use and impairment such that the association was stronger in older samples.
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Affiliation(s)
- Kenneth R Conner
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY 14642, USA
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Abstract
AIM To review information relevant to the question of whether substance-induced mental disorders exist and their implications. DESIGN AND METHOD This paper utilized a systematic review of manuscripts published in the English language since approximately 1970 dealing with comorbid psychiatric and substance use disorders. FINDINGS The results of any specific study depended on the definitions of comorbidity, the methods of operationalizing diagnostic criteria, the interview and protocol invoked several additional methodological issues. The results generally support the conclusion that substance use mental disorders exist, especially regarding stimulant or cannabinoid-induced psychoses, substance-induced mood disorders, as well as substance-induced anxiety conditions. CONCLUSIONS The material reviewed indicates that induced disorders are prevalent enough to contribute significantly to rates of comorbidity between substance use disorders and psychiatric conditions, and that their recognition has important treatment implications. The current literature review underscores the heterogeneous nature of comorbidity.
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Shields AL, Hufford MR. Assessing motivation to change among problem drinkers with and without co-occurring major depression. J Psychoactive Drugs 2006; 37:401-8. [PMID: 16480167 DOI: 10.1080/02791072.2005.10399813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The University of Rhode Island Change Assessment Scale (URICA) is a widely used measure of readiness to change. To evaluate the URICA's ability to discriminate among alcohol abusers with and without co-occurring major depression, the authors administered it to 193 outpatients court-referred for alcohol treatment. Estimates of internal consistency suggest that scoring the URICA using its traditional factors, as well as using the newer Readiness to Change index, produced variable yet adequately reliable scores. Further, the URICA detected statistically significant differences in motivation to change an alcohol problem between an alcohol use disorder group (AD; n = 131) and an alcohol use disorder with co-occurring depression group (AD/D; n = 62) with the AD/D group showing greater readiness to change. For the AD/D group, separate URICAs were given for alcohol use and depressed mood. Confirming previous findings, results suggest the URICA may lack sensitivity to discriminate among two simultaneously occurring psychological disorders.
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Affiliation(s)
- Alan L Shields
- Department of Psychology, East Tennessee State University, Johnson City 37614, USA.
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Rehm J, Room R, Graham K, Monteiro M, Gmel G, Sempos CT. The relationship of average volume of alcohol consumption and patterns of drinking to burden of disease: an overview. Addiction 2003; 98:1209-28. [PMID: 12930209 DOI: 10.1046/j.1360-0443.2003.00467.x] [Citation(s) in RCA: 606] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS As part of a larger study to estimate the global burden of disease attributable to alcohol: to quantify the relationships between average volume of alcohol consumption, patterns of drinking and disease and injury outcomes, and to combine exposure and risk estimates to determine regional and global alcohol-attributable fractions (AAFs) for major disease and injury categories. DESIGN, METHODS, SETTING: Systematic literature reviews were used to select diseases related to alcohol consumption. Meta-analyses of the relationship between alcohol consumption and disease and multi-level analyses of aggregate data to fill alcohol-disease relationships not currently covered by individual-level data were used to determine the risk relationships between alcohol and disease. AAFs were estimated as a function of prevalence of exposure and relative risk, or from combining the aggregate multi-level analyses with prevalence data. FINDINGS Average volume of alcohol consumption was found to increase risk for the following major chronic diseases: mouth and oropharyngeal cancer; oesophageal cancer; liver cancer; breast cancer; unipolar major depression; epilepsy; alcohol use disorders; hypertensive disease; hemorrhagic stroke; and cirrhosis of the liver. Coronary heart disease (CHD), unintentional and intentional injuries were found to depend on patterns of drinking in addition to average volume of alcohol consumption. Most effects of alcohol on disease were detrimental, but for certain patterns of drinking, a beneficial influence on CHD, stroke and diabetes mellitus was observed. CONCLUSIONS Alcohol is related to many major disease outcomes, mainly in a detrimental fashion. While average volume of consumption was related to all disease and injury categories under consideration, pattern of drinking was found to be an additional influencing factor for CHD and injury. The influence of patterns of drinking may be underestimated because pattern measures have not been included in many epidemiologic studies. Generalizability of the results is limited by methodological problems of the underlying studies used in the present analyses. Future studies need to address these methodological issues in order to obtain more accurate risk estimates.
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Affiliation(s)
- Jürgen Rehm
- Addiction Research Institute, Zurich, Switzerland.
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Burns L, Teesson M. Alcohol use disorders comorbid with anxiety, depression and drug use disorders. Findings from the Australian National Survey of Mental Health and Well Being. Drug Alcohol Depend 2002; 68:299-307. [PMID: 12393224 DOI: 10.1016/s0376-8716(02)00220-x] [Citation(s) in RCA: 232] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this paper is to report the prevalence of 12-month comorbidity between DSM-IV alcohol use disorders (abuse or dependence) and anxiety, affective and drug use disorders in the adult Australian general population and to examine the disability and health service utilisation associated with this comorbidity. The study uses data from the National Survey of Mental Health and Well Being (NSMH&WB). The NSMH&WB is a cross-sectional survey of 10,641 Australian adults conducted in 1997 that measured the prevalence of DSM-IV mental disorders in the previous 12 months and associated disability and health service utilisation. Results show approximately one-third of respondents with an alcohol use disorder (abuse or dependence) met criteria for at least one comorbid mental disorder in the previous 12 months. They were 10 times more likely to have a drug use disorder, four times more likely to have an affective disorder and three times more likely to have an anxiety disorder. Respondents with an alcohol use disorder and a comorbid mental disorder were significantly more disabled and higher users of health services than respondents with an alcohol disorder and no comorbid mental disorders. These results reinforce the need for both mental health and drug and alcohol professionals to be provided with education to assist with appropriate identification, management and referral of clients presenting with this complex range of disorders.
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Affiliation(s)
- Lucy Burns
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW 2052, Australia.
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Kalman D, Longabaugh R, Clifford PR, Beattie M, Maisto SA. Matching alcoholics to treatment. Failure to replicate finding of an earlier study. J Subst Abuse Treat 2000; 19:183-7. [PMID: 10963930 DOI: 10.1016/s0740-5472(00)00096-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of the present study was to investigate whether sociopathic alcoholics respond differentially to different types of treatment. An earlier study found that alcoholics with antisocial personality disorder had somewhat better outcomes if treated in individually focused versus relationship-focused cognitive-behavioral treatment. The present study was designed to attempt to replicate these findings. One hundred and forty-nine alcoholics (42 of whom scored high on a measure of sociopathy) were randomly assigned to receive either individually focused cognitive-behavioral treatment or a relationship-focused community reinforcement approach. Follow-up evaluations were conducted every 4 months for 2 years. Results failed to support the study hypothesis. Drinking outcomes were similar for sociopathic alcoholics in both treatment conditions. Directions for future research are identified.
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Affiliation(s)
- D Kalman
- Center for Alcohol and Addiction Studies, Brown University, 02912, Providence, RI, USA.
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Farren CK, O'Malley SS. Occurrence and management of depression in the context of naltrexone treatment of alcoholism. Am J Psychiatry 1999; 156:1258-62. [PMID: 10450269 DOI: 10.1176/ajp.156.8.1258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C K Farren
- Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., USA.
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Abstract
This paper reviews recent literature on the prevalence of alcohol dependence and affective disorders (major depression, dysthymia), the comorbidity of these conditions and the effects of comorbid affective disorders on the outcome of treatment for alcohol dependence. Alcohol dependence and affective disorders co-occur at significantly higher rates than would be expected by chance within the general population. This comorbidity is further elevated in samples of people seeking treatment for alcohol dependence, suggesting that the co-occurrence of affective disorders may be an important determinant of treatment seeking. The results of a number of recent placebo-controlled studies have suggested that pharmacological treatment with anti-depressants may enhance the efficacy of treatment for alcohol dependence in individuals with comorbid affective disorders.
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Affiliation(s)
- M T Lynskey
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia
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Abstract
This article explores the complex relationships between alcohol dependence and mood disorders. Although many alcoholics present with substance-induced depressions, once appropriate methodological controls are used, there does not appear to be a significant relationship between independent unipolar depression and alcohol dependence. However, the data support a small, but significant, relationship between bipolar manic-depressive disease and alcoholism. The literature does not support the relevance of self-medication as a course of alcoholism, unless one includes the use of alcohol to alleviate alcohol-induced psychological and neurochemical perturbations. The clinical importance of distinguishing between substance-induced and independent mood disorders is reviewed.
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Affiliation(s)
- E B Raimo
- University of California, San Diego, USA
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Sullivan JM, Evans K. Trauma and chemical dependence: A summary overview of the issues and an integrated treatment approach. ACTA ACUST UNITED AC 1996. [DOI: 10.1080/10720169608400114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Powell BJ, Campbell JL, Landon JF, Liskow BI, Thomas HM, Nickel EJ, Dale TM, Penick EC, Samuelson SD, Lacoursiere RB. A double-blind, placebo-controlled study of nortriptyline and bromocriptine in male alcoholics subtyped by comorbid psychiatric disorders. Alcohol Clin Exp Res 1995; 19:462-8. [PMID: 7625583 DOI: 10.1111/j.1530-0277.1995.tb01532.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
This double-blind, placebo-controlled, 6-month follow-up treatment study investigated the efficacy of bromocriptine and nortriptyline in attenuating drinking behavior and psychiatric symptoms in 216 male alcoholic patients subtyped by comorbid psychiatric disorder(s). Three well-defined subtypes were examined: alcoholism only, alcoholism + affective/anxiety disorder, and alcoholism + antisocial personality disorder. It was hypothesized that both medications would relieve negative affective symptoms associated with alcohol use and would be particularly effective for the affective/anxiety subgroup. Contrary to our predictions, the only significant effects found were with the antisocial personality disorder patients who were receiving nortriptyline. One interpretation of the results was that nortriptyline may have reduced impulsive drinking in the antisocial personality disorder subgroup by actions on serotonergic neurotransmission.
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Affiliation(s)
- B J Powell
- Kansas City Veterans Administration Medical Center (151), Kansas City 64128, USA
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Penick EC, Powell BJ, Nickel EJ, Bingham SF, Riesenmy KR, Read MR, Campbell J. Co-morbidity of lifetime psychiatric disorder among male alcoholic patients. Alcohol Clin Exp Res 1994; 18:1289-93. [PMID: 7695019 DOI: 10.1111/j.1530-0277.1994.tb01425.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The lifetime co-morbidity of major psychiatric disorders among male alcoholics was examined with the structured Psychiatric Diagnostic Interview (PDI), which was administered to 928 patients undergoing alcoholism treatment at six Veterans Administration Medical Centers. Thirty-eight percent were positive for alcoholism only; 62% fulfilled inclusive lifetime diagnostic criteria for at least one other additional psychiatric syndrome. Thirty percent satisfied criteria for one additional syndrome; 16% for two additional syndromes; 12% for three; and 4% for four or more disorders in addition to alcoholism. Depression and antisocial personality were the most frequently identified co-occurring syndromes (36% and 24%, respectively) followed by drug abuse and mania (17% each). The additional psychiatric syndromes in this sample were clearly not randomly distributed; instead, certain disorders tended to cluster together such as: drug abuse and antisocial personality; mania and depression; depression and anxiety disorder; and schizophrenia and affective disorder. Implications for classification and treatment are discussed.
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Affiliation(s)
- E C Penick
- Department of Psychiatry, Kansas University Medical Center, Kansas City
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O'Connor S, Bauer L, Tasman A, Hesselbrock V. Reduced P3 amplitudes are associated with both a family history of alcoholism and antisocial personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 1994; 18:1307-21. [PMID: 7863018 DOI: 10.1016/0278-5846(94)90095-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
1. Previous research has demonstrated that the amplitude of the P3 component of the event-related electroencephalographic potential (ERP) is influenced by the presence/absence of a family history of alcoholism (FHA). The present study extended this line of research by examining the P3 effects of both FHA and antisocial personality disorder (ASP) in a 2 x 2 factorial design. 2. The task required subjects to judge the orientation of an infrequently-occurring outline drawing, representing an aerial view of a human head. 3. Analyses of P3 amplitudes elicited by this drawing revealed reductions attributable to the effects of both FHA and ASP, but not their interaction. These effects were most apparent at frontal electrode sites. Analyses of P3 latency revealed no consistent pattern of findings. However, the interval between P3 and manual reaction time was shorter in the ASP+ group relative to the ASP-group.
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Affiliation(s)
- S O'Connor
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis
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Sullivan JM, Evans K. Integrated treatment for the survivor of childhood trauma who is chemically dependent. J Psychoactive Drugs 1994; 26:369-78. [PMID: 7884599 DOI: 10.1080/02791072.1994.10472457] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A substantial percentage of individuals who are chemically dependent also suffer from posttraumatic stress disorder and other survivor syndromes related to childhood abuse. The synergism of these multiple conditions creates unique treatment challenges. An enhanced, integrated treatment approach increases the chances of a successful clinical outcome. This article discusses a treatment model for chemical dependence and trauma-related syndromes that blends mental health and 12-Step and other chemical dependence treatment notions into an integrated approach that treats both disorders simultaneously and comprehensively. The model uses the strategic principle of "safety first" to drive all interventions and has five stages to organize the selection and timing of treatment tactics: crisis, skills, education, integration, and maintenance. This article also presents specific therapeutic tactics for each stage and a composit case example blending the history and recovery process of a survivor to illustrate the model in action.
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Affiliation(s)
- J M Sullivan
- Evans & Sullivan Clinic, Beaverton, Oregon 97005
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Abstract
The prevalence of anxious and phobic symptoms in 97 alcohol-dependent and alcohol abuse patients, and that of alcohol abuse and dependence in 90 patients with panic/agoraphobia (PAG), were respectively determined in out-patients attending alcoholism and anxiety clinics in a university psychiatric hospital. The clinical and socio-demographic data of both the phobics and non-phobics of the alcoholic sample, and the alcohol dependents and non-dependent of the PAG sample, were compared. Panic attacks and phobias were associated with increased severity and worse prognosis for alcoholism. The infrequent instances of alcohol use to cope with anxiety in the PAG sample were associated with symptoms of social phobia. Alcohol abuse and dependence were more frequent in PAG men who used alcohol to cope with anxiety. Finally, the frequency and intensity of the panic and phobic symptoms of the alcoholic and PAG samples were contrasted. The alcoholism clinic patients with anxiety had less frequent and milder panic attacks. The predominant diagnosis of this group was agoraphobia, which was infrequent in the anxiety disorders clinic.
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Affiliation(s)
- F Lotufo-Neto
- Instituto de Psiquiatria, Hospital das Clínicas/FMUSP, Brazil
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Abstract
This study examines the importance of Subjective Staff Ratings as predictors of the 3- and 12- month outcomes in 375 male primary alcoholic inpatients. For short-term outcome, while combinations of more usual predictors including two aspects of the pretreatment drinking history, evidence of a stable personal relationship, prior alcoholic hospitalizations, employment status, and posttreatment recovery home placement explained up to 5% of the variance on three measures of short-term outcome, Subjective Ratings alone explained up to 6%. The combination of Subjective Ratings and objective historical data explained up to 9% of the variance. The data indicate that it is difficult to accurately predict short term outcome among primary alcoholics, that the Subjective Ratings of prognosis by the treatment staff are important predictors of short-term outcome which do not overlap greatly with more traditional predictors, but that these ratings appear to add little to the longer term outcome prediction.
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Affiliation(s)
- M A Schuckit
- School of Medicine, University of California, San Diego
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Abstract
The combination of PTSD and substance abuse is both common and problematic. In this chapter we review the following questions: 1) What is the relationship between PTSD, Alcoholism, and Drug Abuse? 2) Can the general "dual diagnosis" literature be of help? 3) Is the phenomenology of PTSD combined with alcoholism and/or drug abuse either unique or specific? 4) Does current pathophysiologic data allow conceptualization of a neurobiological model of PTSD, alcoholism, and drug abuse? 5) Drawing on these ideas, on the limited treatment literature, and the "dual diagnosis" literature, can we develop rational assessment and treatment approaches? Available literature suggests that diagnoses can be validly applied to these patients; that the illnesses must be treated simultaneously as co-primary illnesses; that extreme psychological symptoms reduce the efficacy of alcoholism or drug abuse treatment; and that effective control of these symptoms improves treatment outcome.
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Affiliation(s)
- L Kofoed
- Psychiatry Service (116A), VA Medical Center, Sioux Falls, SD 57117
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22
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Abstract
A relationship between depression and alcoholism has long been postulated. A review of prior research studies reveals that though patients with depression do not appear to develop alcoholism to any great extent, recently detoxified alcoholics have a depressive syndrome about 20% of the time. This cannot be accounted for readily from data on family studies or genetic studies, which generally suggest that alcoholism and depression are two independent illnesses, albeit both quite common. Clinically, depressed alcoholics resemble alcoholics more than they resemble depressives. The clinical course of depression when it coexists with alcoholism is generally benign and self-limited, with most patients becoming euthymic over the course of 2-4 weeks without specific antidepressant treatment. In some depressed alcoholics, however, a more chronic depression persists, and may predict a worse outcome for the alcoholism. Treatment of depression in alcoholics should be initially conservative. Tricyclic and other antidepressants should be used with extreme care as they may potentiate toxic effects of alcohol.
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Affiliation(s)
- F Petty
- Dallas Veterans Affairs Medical Center, Texas
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23
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Arndt S, Tyrrell G, Flaum M, Andreasen NC. Comorbidity of substance abuse and schizophrenia: the role of pre-morbid adjustment. Psychol Med 1992; 22:379-388. [PMID: 1615105 DOI: 10.1017/s0033291700030324] [Citation(s) in RCA: 133] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Co-morbid substance use and abuse is common in schizophrenic patients, and the role of substance abuse in initiating and maintaining psychosis has important definitional and aetiological implications. We investigated the issue in a cohort of 131 schizophrenic patients. We found non-users (N = 67) were similar to pathological users (N = 64) in current symptomatology and clinical history. The pathological users did, however, have better pre-morbid adjustment levels. Only alcohol use and to some extent cannabis use contributed to this effect; use of stimulants or hallucinogens did not. These results indicate the importance of evaluating the various types of substance used when attempting to explore the significance of co-morbidity. The results also suggest that co-morbidity of substance abuse and schizophrenia may be explained by a common factor antecedent to both: better pre-morbid adjustment. A two-stage model is proposed to explain these findings: increased sociability increases exposure to opportunities of substance use in a subset of patients; subsequent onset of psychotic illness accelerates the use to a pathological level as the individual attempts to cope with the stress of the developing mental illness.
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Affiliation(s)
- S Arndt
- Department of Preventive Medicine and Environmental Health, University of Iowa, Iowa City 52242
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24
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Benishek LA, Bieschke KJ, Stöffelmayr BE, Mavis BE, Humphreys KA. Gender differences in depression and anxiety among alcoholics. JOURNAL OF SUBSTANCE ABUSE 1992; 4:235-45. [PMID: 1458041 DOI: 10.1016/0899-3289(92)90032-s] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent research suggests that psychopathology, in particular depression and anxiety, differentially affects the substance abuse treatment response of men and women. This study explores the relationship between global psychopathology, depression, anxiety, and alcoholism treatment outcome. These variables were assessed in a sample of 507 (373 men; 134 women) substance abuse clients at intake and at a 6-month follow-up. With the exception of alcohol dependence, there were significant differences in the levels of alcohol problems, depression, anxiety, and global psychopathology for men and women at both intake and follow-up. For the whole sample and for men, initial levels of alcohol problems and alcohol dependence were the best predictors of alcohol problems at follow-up. For women, the initial levels of alcohol dependence and a global measure of psychological functioning were predictive of outcome at follow-up. These findings are compared with past research, and suggestions for further investigation are proposed.
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25
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Kofoed L. Assessment of comorbid psychiatric illness and substance disorders. NEW DIRECTIONS FOR MENTAL HEALTH SERVICES 1991:43-55. [PMID: 1886549 DOI: 10.1002/yd.23319915006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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26
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27
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Penick EC, Powell BJ, Nickel EJ, Read MR, Gabrielli WF, Liskow BI. Examination of Cloninger's type I and type II alcoholism with a sample of men alcoholics in treatment. Alcohol Clin Exp Res 1990; 14:623-9. [PMID: 2221292 DOI: 10.1111/j.1530-0277.1990.tb01213.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cloninger's clinical method of classifying alcoholics into two groups (Types I and II) was examined with data obtained from 360 VA hospitalized male alcoholic patients. For operational criteria, the Cloninger clinical method of subtyping alcoholics employs age-of-onset of problem drinking and symptom-clusters supposedly associated with each subtype. Marked overlap was found between the symptom-clusters used to define the two subtypes. Ninety-one percent of the entire sample satisfied criteria for both symptom-clusters. Dividing the sample by early-onset (Type II, less than or equal to 25 years) and late-onset (Type I, greater than 26 years) alcoholism did not substantially reduce the overlap between symptom-clusters; i.e., 96% of the early-onset and 83% of the late-onset subgroups were positive for both symptom-clusters. Only 21 men (6%) could be classified when both age-of-onset and the type-appropriate symptom-cluster were used to separate patients. In hospital settings, at least, these findings suggest that the two-group clinical alcoholism typology proposed by Cloninger basically reflects the age-of-onset of problem drinking.
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Affiliation(s)
- E C Penick
- Department of Psychiatry, Kansas University Medical Center, Kansas City 66103
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