Central pontine and extrapontine myelinolysis after alcohol withdrawal

Central pontine myelinolysis (CPM) and extrapontine myelinolysis (EPM) are well-recognized syndromes that are related to various conditions such as rapid correction of hyponatremia and chronic alcoholism. We report a very case of a patient with dysarthria, dysphagia and psychiatric symptoms including abnormal behavior starting after alcohol withdrawal, with radiological evidence of CPM and EPM. There was little improvement in the dysarthria or psychiatric symptoms in the first month.     

Relation between psychiatric syndromes and behaviorally defined sexual orientation in a sample of the US population

Most surveys of the prevalence of psychiatric disorders among lesbians and gay men find no increased risk in comparison with heterosexuals. However, the majority of this work has relied on convenience samples drawn from the visible lesbian and gay community. The authors examined differences in 1-year prevalence of six psychiatric syndromes among sexually active individuals in the 1996 National Household Survey of Drug Abuse who reported either exclusive heterosexuality (n = 9,714) or having any same-gender sex partners (n = 194) in the prior year. Although nearly three quarters of homosexually active individuals did not meet criteria for any of the six syndromes assessed, in multivariate logistic regression analyses, homosexually active men were more likely than other men to evidence major depression and panic attack syndromes. In contrast, homosexually active women were more likely than other women to be classified with alcohol or drug dependency syndromes. Both men and women reporting any same-gender sex partners were more likely than others to have used mental health services in the year prior to interview. These findings suggest a small increased risk among homosexually active populations in 1-year psychiatric morbidity and use of mental health care services.     

Dual diagnosis in the Walter B. Jones Alcohol and Drug Treatment Center

The identification and management of substance abusers admitted with dual diagnosis problems or subsequently diagnosed during treatment with psychiatric syndromes, presents a therapeutic challenge to the hospital staff. This task becomes increasingly difficult because of the time constraints imposed by the length of the program (28 days) in our institution. An ongoing effort is in place to discover independent psychiatric illness in our population. If it exists, it is treated as effectively as possible within the constraints of time, with the expectation of enhancing aftercare treatment. The difficulties that arise in identifying psychiatric symptoms secondary to alcohol and drug use, from independent co-existing psychiatric illness will be described.     

Psychiatric distress in incarcerated women with recent cocaine and alcohol abuse.

PURPOSE: Women frequently abuse cocaine and alcohol before incarceration. Research indicates that women in criminal justice settings also suffer high rates of psychiatric distress. This study aimed to determine how preincarceration abuse of alcohol and cocaine affected current psychiatric distress among female jail detainees held for 10-14 days. METHODS: A probability sample of women in a large urban jail (n = 469) were assessed for use of alcohol and cocaine during the 6 months before incarceration and for their current psychiatric distress. They were grouped based on their level of alcohol consumption and cocaine use: high cocaine/high alcohol; high cocaine/low alcohol; low cocaine/high alcohol; and low cocaine/low alcohol. Profile analysis was used to examine the relation of psychiatric distress, as measured by the Brief Symptom Inventory, to levels of recent alcohol and cocaine use. RESULTS: Psychiatric distress is highest (and similar) among women in the high cocaine groups, regardless of alcohol use, and psychiatric distress is lowest among those who used both substances infrequently. Characteristics of psychiatric distress differed based on level of alcohol use, but only when cocaine use was low. High alcohol and cocaine use alone and together also predict the likelihood of psychiatric distress reaching a diagnosable level of severity. CONCLUSIONS: High cocaine, alcohol, or combined use is related to higher levels of psychiatric distress among incarcerated women in this jail. Women should be screened at the time of incarceration, and women who have alcohol and other drug problems should receive treatment that includes mental health services.     

Women and cross-dependence

Most scientific researches on drug abuse and dependence suffer from "gender bias" being male dominated with the assumption that men are the main users of drugs. In reality, women use mind-altering drugs in the same way as men. This paper focus on alcohol, drugs use/abuse and dependence amongst females on public treatment Services, on recreational settings as well as at school. Problem related to alcohol and cocaine are discussed the most. Findings on aggressive behavior, psychological aspects, younger age of abuse, traumatic events, patterns of use, subset of gender specific symptoms manifestation (depression, mood swings, paranoia) the vicious circle of anxiety and alcoholism, the cross-dependence on legal and illegal drugs, comorbidity between drug abuse and psychiatric syndromes are treated in relation to academic literature.     

Wernicke's encephalopathy following reduced food intake due to depressive disorders

Wernicke's encephalopathy (WE) is an unexpected common neurological disorder caused by thiamine deficiency often due to alcohol abuse, but WE-not alcohol related is also frequent. A prolonged reduction of food intake can cause WE. This condition can arise in depression disorders, especially in the early stages of these psychiatric syndromes. WE is characterized by the triad of signs: ataxia, ocular dysfunctions and confusional state. However, they rarely appear together and this makes the diagnosis particularly difficult, especially when there is not a history of alcohol abuse. Electroencephalography, since in the early stage of the disease, can be helpful in detecting pattern of metabolic encephalopathy. We describe three cases of thiamine deficiency responsible of WE, caused by a decrease in appetite and food intake due to the onset of a depressive disorder. In our series, the most frequent symptom observed at the onset of the disease was the motor incoordination. We recommend to perform quickly thiamine infusion in all depressed patients with a history of reduced food intake, presenting to Emergency Department with recent onset of motor incoordination, with or without alterations in eyes’ movements and confusional state, after exclusion of other neurological conditions.     

Decreased risk of alcohol dependence and/or misuse in women with high self-assertiveness and leadership abilities

AIMS: To analyse dimensions of gender identity and its association to psychiatric disorders and alcohol consumption. METHODS: The study was performed in two stages: an initial screening (n = 8335) for alcohol consumption, followed by a structured psychiatric interview (n = 1054). The Masculinity/Femininity-Questionnaire was used as an indicator of gender identity. The final study group included 836 women. RESULTS: Leadership, caring, self-assertiveness and emotionality were dimensions of gender identity found in a factor analysis. Low self-assertiveness, high emotionality and to some extent low leadership were associated with increased odds for having bipolar disorders, severe anxiety disorders and alcohol dependence and misuse. Low self-assertiveness and high emotionality were not only associated with alcohol dependence and misuse, but also with high episodic drinking. CONCLUSIONS: There was an association between some of the dimensions of gender identity and psychiatric disorders and alcohol consumption. Further attention is needed in both clinical work and research.     

Mental health and related disability among workers: a population-based study

BACKGROUND: In past decades, the nature of work has undergone significant changes including increased psychological demands and job instability. A stressful psychosocial work environment has been shown to have adverse effects on workers' mental and physical health. This goal of this study is to estimate the prevalence of psychiatric syndromes and related disability in a population-based sample of employed adults and investigate associations between psychiatric syndromes and related disability. METHODS: A random-digit dial provincial wide mental health survey was conducted in Alberta, Canada (n = 5,383). The telephone interview included the Mini International Neuropsychiatric Interview (MINI) and the World Health Organization's Disability Assessment Schedule (WHO-DAS-II). In this analysis, participants who were currently employed were included (n = 4,149). RESULTS: In this population, 6.2% had had at least one MINI-defined psychiatric diagnosis with clinically significant interference. Without consideration of the clinical interference criterion, the prevalence of psychiatric syndromes was higher (33.5%). Psychiatric syndromes were strongly associated with disability. A dose-response relationship between the number of diagnoses and disability was found. CONCLUSIONS: Interventional strategies in the workplace should focus on mental disorders at both the clinical and sub-clinical levels.     

Neurological or psychiatric symptoms in patients with systemic lupus erythematosus (SLE): terminological problems, pathogenesis, diagnosis and therapy

The nomenclature of the American College of Rheumatology leads to misunderstandings in multidisciplinary discussions on patients with systemic lupus erythematosus (SLE) who also have neurological or psychiatric symptoms. These proposed neuropsychiatric syndromes are rarely syndromes and the symptoms are rarely neuropsychiatric. It is better first of all to determine whether the SLE patients have neurological or psychiatric symptoms, and if these symptoms are present, the first question is what is the cause. Vasculitis of the cerebral blood vessels should be considered as a possible explanation only if ischaemic lesions in the brain have been demonstrated, other causes of cerebral ischaemia in SLE are unlikely, and the clinical signs are consistent with cerebral vasculitis. These other causes of cerebral ischaemia include: antiphospholipid antibodies, atherosclerosis, heart valve disorders and thrombotic thrombocytopenic purpura.     

Psychiatric disorders in Parkinson's disease.

Parkinson's disease is associated with a wide variety of psychiatric syndromes. Advances in the neuropathology and neuropharmacology have not been applied to the associated psychiatric disorders due to complex interactions between social, psychological and pathological variables.     

War & military mental health: the US psychiatric response in the 20th century

Involvement in warfare can have dramatic consequences for the mental health and well-being of military personnel. During the 20th century, US military psychiatrists tried to deal with these consequences while contributing to the military goal of preserving manpower and reducing the debilitating impact of psychiatric syndromes by implementing screening programs to detect factors that predispose individuals to mental disorders, providing early intervention strategies for acute war-related syndromes, and treating long-term psychiatric disability after deployment. The success of screening has proven disappointing, the effects of treatment near the front lines are unclear, and the results of treatment for chronic postwar syndromes are mixed. After the Persian Gulf War, a number of military physicians made innovative proposals for a population-based approach, anchored in primary care instead of specialty-based care. This approach appears to hold the most promise for the future.     

Recognition of alcoholism among patients with psychiatric problems in a family practice clinic

The prevalence of psychiatric disorders associated with alcoholism is reported to be as high as 65 percent. A retrospective chart study was performed to determine whether physicians in a primary care center were adequately evaluating for alcoholism their patients with psychiatric problems. Thirty-five percent of the patients with psychiatric problems seen over a six-month period were not questioned about alcohol use. Younger patients and those with a nonspecific psychiatric diagnosis were questioned even less frequently. In a review of the charts for signs of alcohol abuse, 23 percent of the psychiatric patients had signs of possible alcoholism, and 6 percent were definite alcoholics. Since the presence of alcoholism may significantly alter the approach to therapy, primary care physicians should fully evaluate all patients for this problem, especially if they present with a psychiatric disorder.     

Drug testing welfare recipients--false positives, false negatives, unanticipated opportunities.

Substance abuse and dependence are among the most common psychiatric disorders among pregnant and parenting women. These disorders among welfare recipients have attracted special concern. Chemical testing has been proposed to identify illicit drug use in this population. This analysis scrutinizes the potential value of drug testing, using recent data from the Women's Employment Study and the National Household Survey of Drug Abuse. One-fifth of recipients reported illicit substance use during the previous year. However, less than 5% satisfied diagnostic screening criteria for illicit drug dependence. Most recipients with psychiatric disorders or alcohol dependence reported no recent illicit drug use, and, thus, would not be detected through chemical tests. Although illicit drug users are rarely dependent, many face barriers to self-sufficiency. Screening and assessment programs should distinguish use from dependence, and should also identify alcohol dependence and psychiatric disorders. States should provide a range of treatment services to address these concerns.     

Alcohol-related disorders in a psychiatric emergency service. Ribeirão Preto, Brazil

This study reports the results of a survey carried out in the psychiatric emergency service of the University Hospital of Ribeir?o Preto, Brazil (1988-1990) with the purpose of characterizing psychiatric disorders related to the consumption of alcohol. The sample included data on a total of 1,082 patients diagnosed during this period. A total of 576 cases were diagnosed with "alcohol dependency syndrome", 379 with "alcohol psychosis", and 127 patients with "alcohol without dependency". The majority of patients were male and the age group most affected was 25-44 years for both sexes. The study calls attention for the importance of alcohol abuse as a public health problem.     

Progressive multifocal leukoencephalopathy in a patient following long-term immunosuppressive therapy for systemic lupus erythematosus

A 41-year-old woman who had suffered from systemic lupus erythematosus (SLE) for 22 years presented with signs of neurological deficits. CT-scanning of the brain revealed hypodense lesions that suggested cerebral infarction due to vasculitis in SLE. However, in spite of intensified immunosuppressive therapy, she showed rapid neurological deterioration. After extensive, additional examinations and tests, the diagnosis was finally changed to progressive multifocal leukoencephalopathy, caused by an opportunistic infection by the JC polyomavirus. Neurological and psychiatric symptoms frequently occur in patients with SLE. The differential diagnosis of these symptoms in SLE is extensive and includes, on the one hand, primary neurological and psychiatric diseases related to direct involvement of the nervous system by SLE, and on the other hand, secondary syndromes arising as a result of complications of the SLE or the immunosuppressive treatment. Opportunistic infections are often an important secondary cause of neurological and psychiatric syndromes in patients with SLE. The clinical symptoms and radiological cerebral signs are non-specific and usually do not suffice to differentiate between the various syndromes. Since each syndrome requires its own specific clinical approach and treatment, extensive diagnostics are mandatory before the diagnosis 'cerebral lupus' can be made and immunosuppressive therapy can be started or intensified.     

Mental disorders as risk factors for the development of cocaine abuse/dependence: case-control study

OBJECTIVE: To evaluate the role of psychiatric disorders and alcohol dependence as possible risk factors for cocaine abuse/dependence. METHODS: The case-control study used the "snowball" technique in order to select untreated cocaine users (cases) and to match sex, age and friendship. Information was gathered using the Composite International Diagnostic Interview (CIDI), and computer diagnosis were generated according to the DSM-III-R criteria. The analysis was performed through the logistic conditional regression. RESULTS: The study included 208 subjects. The main results showed that having a history of alcohol dependence was independently associated with an increased risk of cocaine abuse/dependence (OR=15,1; 95% CI 3,8-60, 2); no other psychiatric disorder was significantly associated with an increase in this risk after the multivariate analysis. An increased risk of cocaine abuse/dependence was also found for those who related suicide thoughts (OR=3,1; 95% CI 0,91-10,8), suggesting an association between more severe manifestations of depression and cocaine abuse. CONCLUSIONS: These findings suggest that programs directed towards the treatment and prevention of cocaine abuse must be prepared to address issues related to comorbidity of drug abuse with alcohol and other psychiatric disorders     

Functional Gastrointestinal Disorders

An overwhelming majority of patients with these syndromes have an identifiable psychiatric disorder, which can often be diagnosed and treated by the primary physician. Guidelines for evaluation and management are offered.     

Generalized anxiety disorder is under-recognized in clinical practice in patients with alcohol dependence in France

Generalized Anxiety Disorder (GAD) is a frequent disabling disorder that often occurs with alcohol dependence. However comorbidity between substance use disorders and psychiatric disorders is often under-diagnosed. This study tried to evaluate an under-recognition of GAD by clinicians in alcoholic inpatients. Two groups of alcohol-dependent inpatients, hospitalized in the same non-academic psychiatric hospital in France, were included. The first group (Group 1) (n = 205) was included retrospectively within all patients hospitalized for alcohol dependence from may to November 2007. A record review was performed to determine the number of GAD (and other psychiatric disorders) diagnosis which was reported on these files by the clinicians. The second group (Group 2) (n = 199) was included prospectively from May to November 2008. GAD diagnosis was screened with the Worry and Anxiety Questionnaire and then confirmed with the Mini International Neurodiagnostic Interview. The two groups were similar in terms of social and demographic variables. GAD prevalence rate was significantly higher in Group 2 (30.7% with Confidence Interval [0.242; 0.371]) than in Group 1 (2.4% with Confidence Interval [0.003; 0.045]). This study confirms our hypothesis of an under-recognition of GAD by clinicians in alcohol dependant inpatients. It also confirms the high prevalence rate of comorbidity between alcohol dependence and GAD.     

Adolescent depression, alcohol and drug abuse.

The Diagnostic Interview Schedule was employed to ascertain the prevalence of major depressive disorder (MDD), alcohol and substance abuse in a sample of 424 college students aged 16 to 19 years. Applying DSM III criteria, the prevalence of MDD was 6.8 per cent; of alcohol abuse, 8.2 per cent; and of substance abuse 9.4 per cent. Alcohol abuse was associated with MDD, but not with other psychiatric diagnoses. Substance abuse was associated both with MDD and with other psychiatric diagnoses as well. The onset of MDD almost always preceded alcohol or substance abuse suggesting the possibility of self-medication as a factor in the development of alcohol or substance abuse.     

Gamma-hydroxybutyric acid and alcohol-related syndromes

We report on the effectiveness and safety of gamma-hydroxybutyric acid in the therapy of overt alcohol withdrawal syndromes, their prevention, and the prevention of relapses in formerly detoxified alcoholics. We studied 321 patients (236 men, 85 women), divided into two open-study groups for the treatment and prevention of alcohol withdrawal syndromes and one double-blind study group to evaluate the effects of gamma-hydroxybutyric acid versus placebo on alcoholic craving and relapses in detoxified patients. Gamma-hydroxybutyric acid treatment promptly reduced withdrawal symptoms in all patients and prevented alcohol withdrawal syndromes in 55% of cases. The attenuation of craving in detoxified patients was significantly greater in the gamma-hydroxybutyric acid-treated group in comparison with the placebo-treated group. The therapeutic use of gamma-hydroxybutyric acid was not accompanied by serious side effects. Gamma-hydroxybutyric acid diversion was poorly represented: gamma-hydroxybutyric acid-induced abuse was reported in 4 (1.1%) of 345 treated patients, and only 9 cases of gamma-hydroxybutyric acid acute poisoning were reported in the years 1992–1995. Our results suggest that gamma-hydroxybutyric acid, with a favorable risk/benefit ratio, is a clinically useful drug in the treatment of alcohol dependence.