酒依赖脱瘾维持期患者复饮相关因素分析

目的:探讨酒依赖患者脱瘾维持期复饮的相关因素。方法:回顾分析在本院进行认知行为治疗(CBT)的188例酒依赖脱瘾维持期患者的临床资料,发现复饮酒113例(复饮酒组),未复饮酒75例(未复饮组)。将两组的临床资料进行对照分析,非条件二项Logistic回归分析复饮相关因素。结果:患者治疗后复饮率为60.1%。两组平均年龄、性别、饮酒年限、日均饮酒量、文化程度差异均无统计学意义(P0.05)。两组婚姻状况不良、家族饮酒史阳性、酒精依赖严重程度问卷(SADQ-C)评分、Zung焦虑自评量表(SAS)评分、Zung抑郁自评量表(SDS)评分、人格障碍、肝脏异常、CBT例数差异均有统计学意义(P0.05)。复饮与婚姻状况不良、家族饮酒史阳性、SADQ-C评分、SAS评分、SDS评分、人格障碍呈正相关,与肝脏异常、CBT治疗呈负相关(P均0.01)。结论:婚姻状况不良、家族饮酒史阳性、SADQ-C高评分、焦虑、抑郁、人格障碍是酒依赖患者脱瘾维持期复饮危险因素,肝脏异常以及接受CBT治疗患者复饮率相对较低。     

肠道菌群与酒精使用障碍关系的研究进展

正酒精使用障碍(alcohol use disorder,AUD)是以精神和躯体损害为特征的慢性复发性脑病,包括酒精依赖和酒精滥用,患者表现为持续性或间断性酒精渴求、强迫性饮酒体验和停饮后戒断症状等。AUD由生物学因素和心理社会因素共同作用导致,其具体病因和发病机制尚不清楚。     

酒精依赖患者脑卒中后戒酒依从性影响因素分析

目的探讨及分析酒精依赖患者脑卒中后戒酒依从性的相关影响因素。方法对常德地区多中心卒中登记数据库中的134例酒精依赖患者在脑卒中1年后饮酒情况进行调查,根据受教育程度、脑卒中部位等进行分组,用SPSS20.0软件包进行数据统计分析其相关影响因素。结果在134例患者中戒酒率为56.7%;复饮组的离婚、丧偶或再婚率高于未复饮组(18/40∶9/67,χ2=7.531,P=0.006),居住地在农村的比例大于未复饮组(33/25∶7/49,χ2=6.067,P=0.014);每日饮酒量高于未复饮组[(510±187)ml∶(392±101)ml,t=3.93,P=0.000];HRSD-24评分均高于未复饮组[(19±6.1)ml∶(10±7.3)ml,t=4.37,P=0.000];小学及以下组戒酒率为46.2%,中学组为63.4%,大专及以上组为73.1%(χ2=6.563,P=0.038);Logistic回归分析显示受教育程度低、卒中后抑郁情绪、额叶卒中为酒精依赖患者脑卒中后戒酒依从性的危险因素,OR值分别为1.292、7.217和2.282。结论不良的婚姻、居住在农村、每日饮酒量高、较低的受教育程度、伴有抑郁情绪及额叶卒中的患者戒酒依从性差,医务人员应加强心理疏导及健康指导,家属应对出院后饮酒方面进行控制。     

高频重复经颅磁刺激对酒精使用障碍患者饮酒行为和认知功能的疗效

目的:探讨重复经颅磁刺激(rTMS)对酒精使用障碍(AUD)患者认知功能、饮酒行为和冲动水平的干预效果.方法:84例男性AUD患者,分为实验组(rTMS联合药物治疗组)42例和对照组(药物治疗组)42例.采用饮酒问卷(ADS)与临床酒精戒断状态评估量表(CIWA-Ar)评估患者治疗前酒精依赖水平与是否存在戒断症状;治疗...     

立体定向伏隔核毁损术对酒精心理依赖疗效的初步研究

目的研究立体定向手术对酒精依赖患者的影响。方法 12例有严重酒精心理依赖的患者(在不同康复中心接受了3~8次系统的脱酒治疗,但戒断两周后发生复饮)接受了立体定向双侧伏隔核毁损术的手术治疗。分别在术前和术后6个月对患者实施评估以分析该疗法的有效性和安全性。结果酒精戒断术后复饮率是:半年为16.7%(2/12),一年为25%(3/12)。12例患者中,1例发生了嗅觉障碍,但在术后4个月时恢复。与术前相比,患者的总智商和记忆商有显著的改善。这些患者酒精依赖严重程度量表和酒精渴求程度量表的评分均显著下降。患者的MMPI评分也显著下降,说明在抑郁、易怒性以及精神病理表现方面均有显著改善。结论本研究说明立体定向伏隔核毁损术是一项安全的并能缓解酒精心理依赖的的治疗方法,能够有效降低复饮率且提高患者术后的生活质量。     

慢性酒精中毒导致大脑损害及其相关因素

目的　探讨慢性酒精中毒导致大脑损害的程度及其相关因素。方法　采用神经心理测验和颅脑 Ｃ Ｔ 扫描的方法测量８８ 例慢性酒精中毒男性患者。结果　８８ 例患者大脑损伤指数（ Ｄ Ｑ） 为０５２ ±０２５ ，６３ 例（７２ ％ ） 大脑功能损害程度为中度及其以上，７１ 例（８０ ％ ） 大脑白质萎缩程度为中度及其以上。大脑萎缩度数（５３５ ±１２７） 与每日饮酒最多次数、首次住院戒酒年龄、酒精依赖期饮酒量、酒精依赖年数和 Ｄ Ｑ 呈正相关（ Ｐ＜ ００５ ～００１） 。结论　慢性酒精中毒会导致广泛性大脑损害。酒精依赖期较长、饮酒量较多、饮酒频率较高 、首次住院戒酒年龄较晚和住院戒酒次数较少等与大脑损害相关。     

酒精所致的精神和行为障碍患者复饮影响因素分析（英文）

背景:酒精所致精神行为障碍患者与不伴有精神行为障碍者相比,接受治疗后复饮率较高。目标:探讨酒精所致精神和行为障碍患者出现复饮的影响因素,为因物质使用障碍而接受治疗的患者提供康复干预的依据。方法:患者被分为研究组或对照组。采用卡方检验分析一般人口学资料、饮酒史和住院情况。患者复饮的影响因素采用logistic回归分析。结果:单因素分析显示酒精所致精神和行为障碍患者复饮的影响因素有民族、文化程度、职业、婚姻、出现精神症状的时限以及隐瞒酒精使用等;多因素分析显示上述患者复饮行为与其婚姻、出现精神症状时限以及是否有隐瞒酒精使用有关。结论:对单身患者而言,更容易在饮酒后5年内出现精神症状。隐瞒酒精使用情况者比不隐瞒者更容易复发。     

酒精所致的精神和行为障碍患者复饮影响因素分析

背景：酒精所致精神行为障碍患者与不伴有精神行为障碍者相比，接受治疗后复饮率较高。目标：探讨酒精所致精神和行为障碍患者出现复饮的影响因素，为因物质使用障碍而接受治疗的患者提供康复干预的依据。方法：患者被分为研究组或对照组。采用卡方检验分析一般人口学资料、饮酒史和住院情况。患者复饮的影响因素采用logistic回归分析。结果：单因素分析显示酒精所致精神和行为障碍患者复饮的影响因素有民族、文化程度、职业、婚姻、出现精神症状的时限以及隐瞒酒精使用等；多因素分析显示上述患者复饮行为与其婚姻、出现精神症状时限以及是否有隐瞒酒精使用有关。结论：对单身患者而言，更容易在饮酒后5年内出现精神症状。隐瞒酒精使用情况者比不隐瞒者更容易复发。     

慢性酒中毒者复饮的相关因素分析

目的：探讨影响慢性酒中毒者复饮的相关因素。方法：对已出院的慢性酒中毒患者随访，按结果分为未复饮组与复饮组，对两组情况进行对照研究?结果：未复饮组中高中及以上、脑力劳动者较多。复饮组中有酒依赖家族史、有社会的心理应激、起病年龄早、成瘾时间长、酒中毒性妄想症、酒中毒性人格改变者较多。结论：有某些情况的慢性酒中毒者戒断后易复饮。     

长期危险饮酒对酒精依赖者心血管功能的影响

目的探讨长期危险饮酒与心血管功能变化的关系,并分析长期危险饮酒对酒精依赖患者心血管意外发生的影响。方法纳入酒精依赖患者72例,按WHO饮酒分类标准将危险饮酒且超过10年的患者分为长期危险饮酒组(52例),其他患者为非长期危险饮酒组(20例);并纳入无习惯性饮酒嗜好的健康体检者75名为对照组。采用全自动生化分析仪检测被试血脂水平,彩色多普勒超声测量心脏功能以及颈、肱动脉内皮功能,并于患者出院后1年内电话随访其心血管意外发生情况。结果三组血脂各指标差异均无统计学意义(P0.05)。长期危险饮酒组患者左心射血分数低于对照组(P0.01),左房主动排空分数高于非长期危险饮酒组及对照组(P0.05),肱动脉内皮舒张功能、颈动脉内膜中层厚度低于对照组(P0.05)。所有患者饮酒年限与左房被动排空分数(r=-0.246,P=0.014)、左房主动排空分数(r=-0.239,P=0.016)呈负相关,平均每日饮酒量与左心射血分数呈正相关(r=0.256,P=0.010),与肱动脉内皮舒张功能呈负相关(r=-0.256,P=0.010)。多因素logistic回归分析示,酒精依赖患者发生心血管意外与年龄(OR=1.102,95%CI:1.020~1.191)、长期危险饮酒(OR=1.334,95%CI:1.060~1.678)有关联(P0.05)。结论长期危险饮酒可致酒精依赖患者的左室舒张功能及血管内皮功能受损,是导致酒精依赖患者发生心血管意外的独立危险因素。     

Motivation to change drinking behavior: comparison of alcohol-dependent individuals in a general hospital and a general population sample

The general hospital would be especially suited to initiate interventions if hospitalized alcohol-dependent individuals were particularly motivated to change their drinking behavior. This study compares the readiness to change of alcohol-dependent persons in the general hospital and the general population. Stages of change according to the model of Prochaska and DiClemente [6] are assessed using the Readiness to Change Questionnaire (RCQ) in two representative samples: 118 alcohol-dependent subjects admitted to a general hospital (sample 1) and 50 alcohol-dependent individuals in the general population (sample 2). In sample 1, alcohol-dependent persons were identified in 1167 consecutive admissions using screening questionnaires and a diagnostic interview (SCAN). In sample 2, alcohol dependence was assessed in 4075 individuals using a German version of CIDI. The distribution of stages of change differed significantly (p < 0.0001) between the groups, revealing a shift towards higher stages in the hospital subjects. Logistic regression analysis revealed that the stages of readiness to change and age contributed in predicting whether subjects belonged to the general hospital or the general population sample. Findings suggest that the general hospital is a suitable site to initiate interventions for alcohol-dependent individuals.     

Correlation of stable elevations in striatal mu-opioid receptor availability in detoxified alcoholic patients with alcohol craving: a positron emission tomography study using carbon 11-labeled carfentanil

BACKGROUND: The pleasant effects of food and alcohol intake are partially mediated by mu-opiate receptors in the ventral striatum, a central area of the brain reward system. Blockade of mu-opiate receptors with naltrexone reduces the relapse risk among some but not all alcoholic individuals. OBJECTIVE: To test the hypothesis that alcohol craving is pronounced among alcoholic individuals with a high availability of mu-opiate receptors in the brain reward system. DESIGN: Patients and comparison sample. The availability of central mu-opiate receptors was measured in vivo with positron emission tomography (PET) and the radioligand carbon 11-labeled carfentanil in the ventral striatum and compared with the severity of alcohol craving as assessed by the Obsessive Compulsive Drinking Scale (OCDS). SETTING: Hospitalized care. PARTICIPANTS: Volunteer sample of 25 male alcohol-dependent inpatients assessed after detoxification of whom 12 underwent PET again 5 weeks later. Control group of 10 healthy men. MAIN OUTCOME MEASURES: After 1 to 3 weeks of abstinence, the availability of mu-opiate receptors in the ventral striatum, including the nucleus accumbens, was significantly elevated in alcoholic patients compared with healthy controls and remained elevated when 12 alcoholic patients had these levels measured 5 weeks later (P<.05 corrected for multiple testing). Higher availability of mu-opiate receptors in this brain area correlated significantly with the intensity of alcohol craving as assessed by the OCDS. CONCLUSIONS: Abstinent alcoholic patients displayed an increase in mu-opiate receptors in the ventral striatum, including the nucleus accumbens, which correlated with the severity of alcohol craving. These findings point to a neuronal correlate of alcohol urges.     

Resumption of Direct Oral Anticoagulants in Patients with Acute Spontaneous Intracerebral Hemorrhage

Background: Decisions regarding whether and when to resume direct oral anticoagulants (DOAC) after acute intracerebral hemorrhage (ICH) are challenging. We examined the timing of DOAC resumption and factors that influence decision-making in DOAC resumption. Methods: We retrospectively analyzed 43 patients with ICH who were treated with DOAC for nonvalvular atrial fibrillation before ICH onset. All patients were divided into 2 groups (resumption of DOAC and no resumption of DOAC) during hospitalization. Clinical backgrounds, laboratory data, and stroke severity were compared between the groups. Results: DOAC were resumed in 19 of 39 (49%) acute ICH survivors and were not resumed in 24 patients, including 4 deceased patients. The National Institutes of Health Stroke Scale score at admission tended to be higher in the no resumption group (median, 17) than in the resumption group (median, 6) (P = .119). The modified Rankin Scale score was slightly poorer in the no resumption group (median, 4) than in the resumption group (median, 3) (P = .070). In the resumption group, DOAC were resumed at a median of 11 days (interquartile range, 5-21 days) after ICH onset. The modified Rankin Scale score at discharge was positively correlated with the days of DOAC resumption (R² = .31, P = .013). Conclusions: In half of patients, DOAC were resumed relatively early after ICH onset. Early resumption of DOAC for ICH in patients with nonvalvular atrial fibrillation is considered to be safe. The functional outcome was associated with not only resumption of DOAC but also the timing of resumption.     

Mu-opioid receptor binding measured by [11C]carfentanil positron emission tomography is related to craving and mood in alcohol dependence.

BACKGROUND: The endogenous opioid system has been linked to alcohol dependence through animal and human studies. We investigated the relationship between alcohol craving and brain mu opioid receptors (mu-OR) in alcohol-dependent subjects. METHODS: Regional brain mu-OR binding potential (BP) was measured using [(11)C]carfentanil positron emission tomography in eight male alcohol-dependent subjects undergoing alcohol withdrawal and eight matched control subjects. Self-reported alcohol craving, withdrawal, and mood were measured. RESULTS: Lower mu-OR BP was associated with higher craving in the right dorsal lateral prefrontal cortex, the right anterior frontal cortex, and right parietal cortex. In these regions, alcoholics showed lower mean mu-OR BP compared with control subjects. Mu-OR BP in four other brain regions also correlated with craving, but there were no group differences in receptor binding potential. Mu-OR BP also correlated with depressive symptoms in five brain regions, three of which were identified in the craving analyses. CONCLUSIONS: Results show a strong functional relationship between alcohol craving, mood, and mu-OR binding in specific brain regions of recently abstinent, alcohol-dependent men.     

The development of medications for alcohol-use disorders targeting the GABAB receptor system

The present paper summarizes experimental and clinical data suggesting the therapeutic potential of the prototypic GABAB receptor agonist, baclofen, for the treatment of alcohol-use disorders (AUDs). Numerous studies have reported baclofen-induced suppression of alcohol drinking, relapse-like drinking, and alcohol reinforcing, rewarding, stimulating, and motivational properties in rats and mice. The majority of clinical surveys conducted to date have demonstrated the capacity of baclofen to suppress alcohol consumption, craving for alcohol, and alcohol withdrawal symptomatology in alcohol-dependent patients. More recently, the discovery of a positive allosteric modulatory binding site, together with the synthesis of in vivo effective ligands, provided a new tool for pharmacological manipulations of the GABAB receptor. Accumulating lines of preclinical evidence suggest that positive allosteric modulators of the GABAB receptor (GABAB PAMs), such as GS39783, display a high therapeutic index and retain baclofen's capacity to suppress alcohol consumption and alcohol reinforcing and motivational properties. The present paper also summarizes the most relevant patents on GABAB receptor agonists and GABAB PAMs as possible pharmacotherapies for AUDs.     

Suppression of craving for gamma-hydroxybutyric acid by naltrexone administration: three case reports

Gamma-hydroxybutyric acid (GHB) is currently used to induce and maintain abstinence from alcohol. Cases of craving and desire to increase doses of GHB have been reported in both clinical trials and nonclinical self-administration. The enhancement of dopamine activity induced by GHB receptor activation might play a role in the euphoric effect and potential craving and the consequent abuse of this drug. Naltrexone (NTX), a mu-opioid antagonist, is effective in inducing and maintaining abstinence from alcohol, reducing relapses in heavy drinking and craving for alcohol in alcohol-dependent outpatients. Taking into account the alcohol antireward property of NTX, we tested its activity in reducing craving for GHB in 3 consecutive cases of alcoholics who manifested craving for this drug. In all patients the combination with NTX suppressed the craving for GHB. The antireward effect of NTX likely results from its interference with the GHB-induced dopamine release, leading to a partial blockade of the GHB reinforcing effect responsible of the craving for the drug. A combined therapy with GHB and NTX seems to be able to suppress craving for the former, thus improving the manageability and safety of treatment.     

Prolactin serum levels and alcohol craving - an analysis using Lesch's typology

BACKGROUND: Prolactin secretion is closely connected to dopaminergic transmission that is known to play a crucial role in mediating reinforcement and craving in alcoholism. OBJECTIVES: The study was performed to analyze the association between prolactin serum levels and alcohol craving during withdrawal differentiating alcohol-dependent patients using Lesch's typology. METHODS: We assessed 115 male patients with the Obsessive Compulsive Drinking Scale at early alcohol withdrawal. In addition, serum was obtained to measure prolactin concentration and the patients were classified according to Lesch's typology into one of four subgroups. RESULTS:Correlation analysis showed a significant association between prolactin serum levels and the extent of craving in Lesch's type 2 patients (r=0.32, p=0.015; n=57); however, no association was found for any other subgroup. The results were confirmed comparing patients with low and high craving (Mann-Whitney U test: Z=-2.805, p=0.005). CONCLUSIONS: In patients of Lesch's type 2, who are characterized to suffer from anxiety and to use alcohol because of its anxiolytic effects, prolactin is associated with craving during early alcohol withdrawal.     

Use of laboratory tests to monitor heavy drinking by alcoholic men discharged from a treatment program

Changes in blood test values from the time of discharge from an alcohol treatment program to 3-month follow-up were studied in two consecutive series of alcoholic men. The parallel combination of a percent increase in gamma-glutamyltransferase (GGT) of greater than or equal to 20%, in aspartate aminotransferase (SGOT) of greater than or equal to 40%, and in alanine aminotransferase (SGPT) of greater than or equal to 20% over discharge values was developed as a rule and then cross-validated to identify those alcoholic men who had resumed drinking at follow-up. Serial determination of these three test values in combination can be used to distinguish recovering alcoholics who remain abstinent from those who resume drinking.     

Cortisol awakening response in abstinent alcohol-dependent patients as a marker of HPA-axis dysfunction

Hypothalamo-pituitary-adrenocorticoid (HPA)-axis reactivity to psychosocial or pharmacological stimulants is diminished in alcohol-dependent patients during early abstinence but recovers after several months of abstention. In order to assess the physiological reactivity in the morning we used the cortisol awakening response (CAR) in saliva to compare 24 early abstainers (mean 21.9+/-7.6, range 10-36 days) with 12 alcohol-dependent patients with longer abstention periods (mean 116.8+/-45.7, range 59-230 days) and looked for an association with sleep, especially rapid eye movement (REM) sleep of the preceding night. Both groups did not differ with respect to age, duration of alcohol dependence, daily drinking dosage before detoxification, body mass index, depressivity, level of anxiety, daily cigarette consumption or sleep quality during the preceding 14 days. Sleep in the night before cortisol assessment did not differ with respect to total sleep time (412.4+/-35.9 vs. 407.0+/-38.7 min). Immediately upon awakening and 15, 30, 45 and 60 min later, specimens of salivary cortisol were collected. While starting from equal levels upon awakening longer abstaining patients with alcohol dependence showed a stronger CAR (ANOVA with repeated measurement, time x group effect: F=4.33, p<0.01) with distinctly higher cortisol levels 45 and 60 min after awakening (T=3.79, p<0.001 and T=3.06, p<0.005, respectively). Across both groups the time spent in REM-sleep only correlated with cortisol levels upon awakening (r=0.33, p<0.05). Our data indicate that CAR is a useful tool for investigating alterations in the HPA-axis regulation in abstaining alcohol-dependent patients.     

Role of GABAB receptor in alcohol dependence: Reducing effect of baclofen on alcohol intake and alcohol motivational properties in rats and amelioration of alcohol withdrawal syndrome and alcohol craving in human alcoholics

The present paper describes the results of recent preclinical and clinical studies conducted in this laboratory in order to characterize the anti-alcohol properties of the GABA(B) receptor agonist, baclofen. At a preclinical level, the repeated administration of non-sedative doses of baclofen dose-dependently suppressed the acquisition and maintenance of alcohol drinking behavior in selectively bred Sardinian alcohol-preferring (sP) rats tested under the homecage, 2-bottle "alcohol vs water" choice regimen. Acute injection of baclofen completely blocked the temporary increase in voluntary alcohol intake occurring after a period of alcohol abstinence (the so-called alcohol deprivation effect, which models alcohol relapses in human alcoholics). Acute treatment with baclofen also dose-dependently suppressed extinction responding for alcohol (an index of motivation to consume alcohol) in sP rats trained to lever-press for oral alcohol self-administration. Taken together, these results suggest the involvement of the GABA(B) receptor in the neural substrate mediating alcohol intake and alcohol motivational properties in an animal model of excessive alcohol consumption. Further, acutely administered baclofen dose-dependently reduced the severity of alcohol withdrawal signs in Wistar rats made physically dependent upon alcohol. Preliminary clinical surveys suggest that the anti-alcohol properties of baclofen observed in rats may generalize to human alcoholics. Indeed, a double-blind survey demonstrated that repeated daily treatment with baclofen was associated, when compared to placebo, with a higher percentage of subjects totally abstinent from alcohol and a higher number of days of total abstinence. Treatment with baclofen also suppressed the number of daily drinks and decreased the obsessive and compulsive components of alcohol craving. Finally, a single non-sedative dose of baclofen resulted in the rapid disappearance of alcohol withdrawal symptomatology, including delirium tremens, in alcohol-dependent patients. In both clinical studies, baclofen was well tolerated with minimal side effects. These results suggest that baclofen may represent a potentially effective medication in the treatment of alcohol-dependent patients.