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Psychiatry AND Alcohol withdrawal [keywords]
- The relation of autonomic function to physical fitness in patients suffering from alcohol dependence. [JOURNAL ARTICLE]
- Drug Alcohol Depend 2013 May 9.
BACKGROUND:Reduced cardio-vascular health has been found in patients suffering from alcohol dependence. Low cardio-respiratory fitness is an independent predictor of cardio-vascular disease.
METHODS:We investigated physical fitness in 22 alcohol-dependent patients 10 days after acute alcohol withdrawal and compared results with matched controls. The standardized 6-min walk test (6 MWT) was used to analyze the relationship of autonomic dysfunction and physical fitness. Ventilatory indices and gas exchanges were assessed using a portable spiroergometric system while heart rate recordings were obtained separately. We calculated walking distance, indices of heart rate variability and efficiency parameters of heart rate and breathing. In addition, levels of exhaled carbon monoxide were measured in all participants to account for differences in smoking behaviour. Multivariate analyses of variance (MANOVA) were performed to investigate differences between patients and controls with regard to autonomic and efficiency parameters.
RESULTS:Patients walked a significantly shorter distance in comparison to healthy subjects during the 6 MWT. Significantly decreased heart rate variability was observed before and after the test in patients when compared to controls, while no such difference was observed during exercise. The efficiency parameters indicated significantly reduced efficiency in physiological regulation when the obtained parameters were normalized to the distance.
DISCUSSION:The 6 MWT is an easily applied instrument to measure physical fitness in alcohol dependent patients. It can also be used during exercise interventions. Reduced physical fitness, as observed in our study, might partly be caused by autonomic dysfunction, leading to less efficient regulation of physiological processes during exercise.
- Association between Craving and Attention Deficit/Hyperactivity Disorder Symptoms among Patients with Alcohol Use Disorders. [Journal Article]
- Am J Addict 2013 May; 22(3):292-6.
Adult Alcohol Use Disorders (AUD) patients with Attention Deficit/Hyperactivity Disorder (ADHD) symptoms may suffer more from craving than patients who only have AUD. However, craving may be even more strongly related to withdrawal and psychiatric symptoms; therefore, the association between craving and ADHD may be misinterpreted. The purpose of this study is to examine the association between craving and ADHD symptoms among AUD patients in more detail.In a multisite study, 385 patients with and without ADHD symptoms who were attending treatment for alcohol dependence were compared in terms of craving, withdrawal, and psychiatric symptoms. The contribution of ADHD symptoms to craving was estimated in a hierarchical regression analysis by controlling for psychiatric and withdrawal symptoms.Patients with probable adult ADHD showed higher craving, more withdrawal and psychiatric symptoms, and rated withdrawal symptoms as more severe than did patients without ADHD symptoms. In the regression model, only about 3% of variance in alcohol craving was explained by ADHD symptomatology, whereas 23% of the variance was explained when withdrawal and psychiatric symptoms were added to the model.Alcohol craving is likely related to withdrawal and psychiatric symptoms more strongly than to ADHD symptoms. (Am J Addict 2013; 22:292-296).
- Comment on "intranasal oxytocin blocks alcohol withdrawal in human subjects" by pedersen and colleagues (). [Journal Article]
- Alcohol Clin Exp Res 2013 May; 37(5):720-1.
- Acute alcohol withdrawal accompanied by posterior reversible encephalopathy syndrome. [Letter]
- Psychiatry Clin Neurosci 2013 Apr; 67(3):189.
- iPhone® applications as versatile video tracking tools to analyze behavior in zebrafish (Danio rerio). [JOURNAL ARTICLE]
- Pharmacol Biochem Behav 2013 Apr 2.:137-142.
Zebrafish (Danio rerio) are emerging as a promising model organism for experimental studies relevant to biological psychiatry. The objective of this study was to develop a novel video-based movement tracking and analysis system to quantify behavioral changes following psychoactive drug exposure in zebrafish. We assessed the effects of withdrawal from chronic ethanol exposure, and subsequent administration of fluoxetine (Prozac®), buspirone (Buspar®), and diazepam (Valium) using two behavioral paradigms; the Novel Tank Diving Test and the Light/Dark Choice Assay. A video tracking system was developed using two Apple® applications (Apps) to quantify these behaviors. Data from zebrafish exposed to the above treatments are presented in this paper not only to exemplify behavioral alterations associated with chronic exposure, but also more importantly, to validate the video tracking system. Following withdrawal from chronic ethanol exposure, zebrafish exhibited dose/time-dependent anxiogenic effects; including reduced exploration and freezing behavior in the Novel Tank Diving Test, and preference for the dark area for the Light/Dark Choice Assay. In contrast, the above drug treatments had significant anxiolytic effects. We have developed a simple and cost-effective method of measuring zebrafish behavioral responses. The iPhone® Apps outlined in this study offer numerous flexible methods of data acquisition; namely, ease of identification and tracking of multiple animals, tools for visualization of the tracks, and calculation of a range of analysis parameters. Furthermore, the limited amount of time required for interpretation of the video data makes this a powerful high-throughput tool with potential applications for pre-clinical drug development.
- Concerns about pregabalin: further experience with its potential of causing addictive behaviors. [Journal Article]
- J Addict Med 2013 Mar-Apr; 7(2):147-9.
Pregabalin (PRG) is approved for the treatment of neuropathic pain, partial seizures, and generalized anxiety disorder in many countries. Supported by case reports and a few studies there is an ongoing debate on PRG's potential to cause addictive behaviors. Considering that PRG is currently under investigation for the treatment of benzodiazepine dependence and withdrawal as well as relapse prevention in alcohol dependence, assessment of PRG's abuse and dependence potential is indispensable. We report the case of a 38-year-old female patient with borderline personality disorder and past alcohol abuse who developed PRG abuse. The patient took up to 800 mg PRG per day, initially administered to treat unspecific anxiety, and experienced euphoric feelings after PRG intake. In the further course, she increased the daily PRG dosage and consulted other physicians to receive additional PRG prescriptions. During reduction of PRG, the patient developed a moderate withdrawal syndrome with vegetative symptoms. Because of the early detection of the developing PRG abuse (4 months after first application of PRG), the development of PRG dependence was prevented. This case illustrates the possibility of PRG to trigger the development of addictive behaviors and should encourage physicians to be very careful when administering PRG to patients with current or past substance-related disorders.
- Predictability of alcohol relapse by hippocampal volumetry and psychometric variables. [Journal Article, Research Support, Non-U.S. Gov't]
- Psychiatry Res 2013 Apr 30; 212(1):14-8.
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.
- [Why benzodiazepines are still in wide use?]. [English Abstract, Journal Article]
- Acta Med Croatica 2012 May; 66(2):137-40.
The advent of benzodiazepines in the 1960s provided their wide use in neurology and psychiatry. They proved to be myorelaxant and anticonvulsive therapy in neurology; their anxiolytic and hypnotic properties have made them the treatment of choice for insomnia and anxiety problems; they have also been used in alcohol withdrawal and in anesthesia, and for a wide range of treatments in other clinical branches. However, reports giving rise to a prescription controversy including abuse, harmful effects, intoxication and dependence toward addiction appeared soon. On the other hand, the revolutionary appearance of selective serotonin reuptake inhibitors (SSRIs) overshadowed benzodiazepines. According to recommendations of many scientific and professional institutions, the use of benzodiazepines has been gradually excluded or reduced or limited to short-term use. However, clinical experience showed that benzodiazepines are frequently used for long-term treatment, and there are many reasons for this, e.g., prescribing tradition, patient preference, difficulties associated with benzodiazepine withdrawal (even in patients taking low doses) because they have a rapid clinical onset of action, and good efficacy with few initial adverse effects. Moreover, SSRIs as alternative drugs are associated with incomplete therapeutic response and more uncomfortable adverse effects. Some authors therefore point out that the rationale for the shift from benzodiazepines to SSRIs is inappropriate.
- Craving in Alcohol-Dependent Patients After Detoxification Is Related to Glutamatergic Dysfunction in the Nucleus Accumbens and the Anterior Cingulate Cortex. [JOURNAL ARTICLE]
- Neuropsychopharmacology 2013 Feb 12.
The upregulation of glutamatergic excitatory neurotransmission is thought to be partly responsible for the acute withdrawal symptoms and craving experienced by alcohol-dependent patients. Most physiological evidence supporting this hypothesis is based on data from animal studies. In addition, clinical data show that GABAergic and anti-glutamatergic drugs ameliorate withdrawal symptoms, offering indirect evidence indicative of glutamatergic hyperexcitability in alcohol-dependent subjects. We used proton magnetic resonance spectroscopy to quantify the glutamate (Glu) levels in healthy control subjects and in alcohol-dependent patients immediately after detoxification. The volumes of interest were located in the nucleus accumbens (NAcc) and the anterior cingulate cortex (ACC), which are two brain areas that have important functions in reward circuitry. In addition to Glu, we quantified the levels of combined Glu and glutamine (Gln), N-acetylaspartate, choline-containing compounds, and creatine. The Glu levels in the NAcc were significantly higher in patients than in controls. Craving, which was measured using the Obsessive Compulsive Drinking Scale, correlated positively with levels of combined Glu and Gln in the NAcc and in the ACC. The levels of all other metabolites were not significantly different between patients and controls. The increased Glu levels in the NAcc in alcohol-dependent patients shortly after detoxification confirm the animal data and suggest that striatal glutamatergic dysfunction is related to ethanol withdrawal. The positive correlation between craving and glutamatergic metabolism in both key reward circuitry areas support the hypothesis that the glutamatergic system has an important role in the later course of alcohol dependence with respect to abstinence and relapse.Neuropsychopharmacology advance online publication, 13 March 2013; doi:10.1038/npp.2013.45.
- Effects of a GABA-ergic medication combination and initial alcohol withdrawal severity on cue-elicited brain activation among treatment-seeking alcoholics. [JOURNAL ARTICLE]
- Psychopharmacology (Berl) 2013 Feb 7.