Neurological soft signs in schizophrenia: Assessment and correlates

A German version of the Neurological Evaluation Scale (NES) was administered to 143 schizophrenic patients, 45 of them being severly chronic and disabled. Seventy-eight alcohol-dependent inpatients and 57 healthy volunteers were tested as control groups. Neurological soft signs (NSS) were rated with convincing agreement. Schizophrenic patients are more impaired on all scales than healthy controls. The chronic, severly disabled schizophrenic patients are more impaired compared with the main group of schizophrenic patients and both control groups. A significant patients and alcohol-dependent patients was only found for the subscale Motor Coordination. Compared with healthy controls the alcohol-dependent patients show a higher NES total score. The NES total score was related to the relative width of the third ventricle. Total score and subscales were correlated consistently with the level of cognitive functioning as measured by the Raven Standard Progressive Matrices and various neuropsychological tests presumably sensitive to dysfunctions of the prefrontal cortex. The NSS were related to positive as well as to negative symptoms, the correlations with negative symptoms being confined to items of Cognitive Disorganization. This close association of psychomotor and cognitive dysfunctions may be seen as related to the frequently discussed dysfunctions of the prefrontal cortex or the neurointegrative deficit postulated by Meehl.     

L’alcoolisme est-il toujours une maladie au XXIe siècle ?

ContextAlcohol is the first psychoactive substance in our cultures, the use of which has been closely linked to the history of the European societies. As the easiest accessible psychotropic in France, alcoholic beverages can be consumed for simple use or misused. This necessary distinction without amalgam or shortcut, let us consider the alcohol use disorders (DSM-5) through the prism of different paradigms, such as alcoholism, alcoholic sickness or alcohol addiction. If alcohol use disorders are mainly addressed in care device, this means that they are considered as a sickness. But is alcoholism really a sickness? And if so, is it a sickness like any other?MethodA subjective review of the literature has considered the emergence of the concept of alcoholic sickness, in order to determine how along the twentieth century, it seems to have been erased in favor of the concept of addiction, without solving the fundamental question of whether alcoholism is a sickness and if so, in whose interest?ResultsThe notion of alcoholic sickness, operative or alienating, needs to be taken in account. This conditions the adequacy or not of the welcome of persons with these disorders as patients by health professionals, at hospital, or at any place of the care device. This article reviews the various advantages or disadvantages associated with the concept of alcoholic disease, questioning the need to have a medicalization of alcoholism and for the benefit of who? Beyond this interrogation, the fundamental question of knowing if alcohol use disorders are rather a sickness, a problem or an improvised solution, failing a better way of feeling better. As an alternative to the concept of alcoholic sickness, that of alcoholic addiction, advent of recent decades, requires carefulness to try to clarify its benefits, limitations, or excesses, failing to solve the interrogations about the concept of alcoholic sickness. Is the concept of alcoholic addiction worth more than the notion of alcoholic sickness? If the addiction allows a global approach of substance use disorder, it seems to have replaced and relegated the concept of dependence on a psychoactive substance. Even more than only nosological difficulties, the embarrassment that appears quickly to name the disorder and more to designate the user, is a first illustration of possible difficulty speaking of alcohol with people misusing of it.ConclusionQuestioning oneself about the notion of alcoholic sickness, allows to query the legitimacy of the place given in the care device to people misuse of alcohol. Secondly, it becomes possible to think about the place of cares in the approach and therapy of addictions.     

低频重复经颅磁刺激对酒依赖患者急性戒断后焦虑、抑郁和复饮的效果

目的探讨低频重复经颅磁刺激(rTMS)对酒依赖急性戒断后焦虑、抑郁和复饮的疗效,为改善酒依赖患者预后提供参考。方法选取在绵阳市第三人民医院住院的、符合《国际疾病分类(第10版)》(ICD-10)酒精依赖诊断标准的急性戒断后的102例患者为研究对象。采用随机数字表法分为研究组(n=50)和对照组(n=52)。两组患者均接受常规治疗,研究组加用rTMS,对照组应用伪刺激,治疗共8周。于治疗前和治疗第2、4、8周末进行汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表17项版(HAMD-17)评定,在患者出院后3、6月末评定其复饮情况。结果治疗第2、4、8周末,研究组HAMA和HAMD-17评分均低于治疗前(P均0. 01),且研究组均低于对照组,差异均有统计学意义(P均0. 01);在患者出院后3、6月末,研究组复饮率均低于对照组(P均0. 05)。结论低频rTMS可能有助于改善酒依赖患者急性戒断后的焦虑、抑郁情绪和复饮情况。     

酒精依赖患者的风险决策功能损害和危险因素分析

目的：探讨酒精依赖患者的实验室决策功能特点及其影响因素。方法：对30例酒精依赖患者和30例健康对照进行宗氏焦虑自评量表（SAS）、宗氏焦虑自评量表（SDS）评估和爱荷华赌博试验（IGT）、骰子博弈试验测试（GDT）。结果：1）酒依赖组在SAS、SDS量表评分中的得分高于对照组,差异具有统计学意义（P<0.05）;2）在IGT的第五模块测试中,酒依赖组的冒险得分高于对照组,两组有统计差异（P<0.05）;酒依赖组的GDT结果显示,安全选项的得分低于对照组,风险选项的得分高于对照组,两组存在统计学差异（P<0.05）;3）IGT净分数的影响因素是SDS总分、受教育年限、SAS总分（P<0.001）;IGT冒险分数的影响因素是年龄、受教育年限和入院次数（P<0.001）;GDT风险选项的影响因素是成瘾时间（P=0.011）。结论：本研究发现酒精依赖患者存在风险决策功能损伤,其危险因素包括焦虑、抑郁情绪,年龄、受教育年限、入院次数和成瘾时间。     

Heart rate correlates of utilitarian moral decision-making in alcoholism

Background

Recent studies of moral reasoning in patients with alcohol use disorders have indicated a ‘utilitarian’ bias, whereby patients are more likely to endorse emotionally aversive actions in favor of aggregate welfare (e.g., to kill a person in order to save a group of people). The aim of the present study was to examine psychophysiological correlates of this tendency indexed by heart rate.

Methods

The sample was composed by 31 alcohol-dependent individuals and 34 healthy controls without alcohol use disorders. Electrocardiogram was recorded at rest and during execution of a validated moral judgment task, including non-moral scenarios, and moral dilemmas that were either high in emotional salience (“personal scenarios”) or low in emotional salience (“impersonal scenarios”).

Results

Alcohol-dependent individuals showed a blunted response to moral dilemmas. Furthermore, healthy controls displayed decreased heart rate to the personal vs. impersonal or non-moral scenarios, while alcohol-dependent individuals failed to differentiate dilemmas in terms of heart rate both prior decision-making and its post appraisal. These deficits were not related to baseline differences in Heart Rate.

Conclusion

Our findings indicate that alcohol-dependent individuals failed to engage emotional aversive reactions to personal moral violations in terms of heart rate response.     

酒依赖患者乙醇脱氢酶不同基因型与认知功能受损关系的研究

目的：研究酒依赖患者乙醇脱氢酶2不同基因型（ADH2＊1／ADH2＊1（野生型）、ADH2＊1／ADH2＊2（杂合型）、ADH2＊2／ADH2＊2（突变型））患者认知功能受损状况。方法：分别应用韦氏成人智力量表和韦氏记忆量表对107例酒依赖患者进行智力和记忆功能评定,对不同基因型患者认知受损的状况进行比较。结果：突变型患者智商、记忆商均显著低于野生型及杂合型。结论：突变型酒依赖患者认知功能受损更加严重。