Alcoholics anonymous and relapse prevention as maintenance strategies after conjoint behavioral alcohol treatment for men: 18-month outcomes

Ninety men with alcohol problems and their female partners were randomly assigned to 1 of 3 outpatient conjoint treatments: alcohol behavioral couples therapy (ABCT), ABCT with relapse prevention techniques (RP/ABCT), or ABCT with interventions encouraging Alcoholics Anonymous (AA) involvement (AA/ABCT). Couples were followed for 18 months after treatment. Across the 3 treatments, drinkers who provided follow-up data maintained abstinence on almost 80% of days during follow-up, with no differences in drinking or marital happiness outcomes between groups. AA/ABCT participants attended AA meetings more often than ABCT or RP/ABCT participants, and their drinking outcomes were more strongly related to concurrent AA attendance. For the entire sample, AA attendance was positively related to abstinence during follow-up in both concurrent and time-lagged analyses. In the RP/ABCT treatment, attendance at posttreatment booster sessions was related to posttreatment abstinence. Across treatment conditions, marital happiness was related positively to abstinence in concurrent but not time-lagged analyses.     

Controlled drinking training with a female alcoholic

Controlled drinking training based upon an avoidance conditioning paradigm (Mills, Sobell & Schaefer, 1971) has previously been demonstrated to offer an alternative to abstinence for some alcoholics. This paper describes the treatment and outcome of controlled drinking training as applied to a 33 year old female who had previously attempted abstinence and who could engage in sexual intercourse only after drinking.     

Two inv dup(15) chromosomes in a woman with repeated abortions

A 40‐year‐old, phenotypically normal woman, with a history of two repeated abortions and no child, had two additional, small, bisatellited, and apparently metacentric chromosomes. Various banding and microsatellite analyses indicated that the additional chromosomes were inv dup(15)(q11q11) without the Prader‐Willi/Angelman syndromes critical region, and therefore without phenotypic effects. Her father had a single, identical additional inv dup(15) chromosome. Her husband was chromosomally normal, but sperm analysis indicated a reduced motility and a reduced frequency of morphologically normal sperm. In view of these findings, it was deduced that the inv dup(15) chromosome in the father was transmitted in duplicate to the woman. Individuals with two additional inv dup(15) chromosomes in the literature were reviewed, and possible correlation of the two additional inv dup(15) chromosomes in the woman and her repeated abortions was discussed. © 2001 Wiley‐Liss, Inc.     

The drinking partnership and marital satisfaction: The longitudinal influence of discrepant drinking

The objective was to determine whether discrepancies between husbands' and wives' past-year heavy drinking predicted decreased marital satisfaction over time. Participants (N = 634) were recruited at the time they applied for their marriage licenses. Couples completed questionnaires about their alcohol use and marital satisfaction at the time of marriage and again at their 1st and 2nd anniversaries. Generalized estimating equation models were used to evaluate the association between discrepancies in husbands' and wives' heavy drinking in the year prior to marriage and marital satisfaction at the 1st wedding anniversary and the association between discrepancies in heavy alcohol use in the 1st year of marriage and marital satisfaction at the 2nd wedding anniversary. In these prospective time-lagged analyses, discrepancies in husbands' and wives' heavy drinking predicted decreased marital satisfaction over time while controlling for heavy drinking. Over time, these couples may be at greater risk for decreased marital functioning that may lead to relationship dissolution.     

Cognitive‐Behavioral Treatment of Hoarding in Youth: A Case Illustration

Hoarding in children is associated with more severe ancillary psychopathology, and has poor treatment outcome. At present, there are no empirically established procedures for treating hoarding in youth. The present case illustration is of a 10‐year old child (“Grace”) who presented for treatment with significant hoarding related to academic concerns and additional unrelated symptoms of obsessive‐compulsive disorder (OCD). Grace was treated with cognitive behavior therapy (CBT) primarily comprising exposure with response prevention, behavioral experiments, and cognitive therapy, along with a program of reinforcement delivered by her parents to maintain her motivation for therapy. After 23 sessions and one booster session, Grace's symptoms improved significantly, with gains maintained at 1‐year follow‐up. In addition to the benefits of the specific interventions chosen, the role of therapist–patient/parent alliance as a contributory factor for good outcome is emphasized. As hoarding is underinvestigated in youth, suggestions for further investigation are offered.     

Discriminating neuropsychological sequelae of head injury from alcohol-ABUSE-induced deficits: A review and analysis

Alcohol abuse is linked strongly with neuropsychological deficits that may resemble deficits seen in head-injured individuals. Heavy daily drinking appears more damaging than episodic abusive consumption. Cognitive deficits associated with alcohol include abstraction, perceptuospatial, and problem- solving skills. Verbal abilities are spared. For alcoholics younger than 40, abstinence is associated with improved functioning. For those over 40, deficits may be permanent. Intelligence tests are unlikely to pick up alcohol-induced deficits. Points for neuropsychologists to consider in differentiating between head injury and alcohol-induced deficits include abstinence from drinking prior to testing, intactness of remote memory and verbal functions, and changes in tolerance for alcohol.     

Effects of short-term abstinence from alcohol on subsequent drinking patterns of social drinkers

Previous research with both animals and humans has suggested that short-term abstinence from alcohol temporarily may increase subsequent alcohol consumption. To study this issue further, the present investigation evaluated the effect of voluntary, short-term abstinence on the subsequent drinking patterns of female social drinkers. Thirty-six subjects provided a baseline assessment of drinking patterns and then were assigned randomly to either a control group, which drank as usual, or to an experimental group, which abstained from alcohol for 3 weeks. All subjects monitored the frequency and quantity of their subsequent drinking for a 3-week follow-up period. The results showed that voluntary abstinence neither increased nor decreased subsequent alcohol consumption. This finding is discussed in relation to previous research.     

P450氧化还原酶缺陷症的临床表现和羊水穿刺产前诊断的意义

 目的 本研究旨在增加对P450氧化还原酶（POR）缺陷症发病机制和临床表现的认识,探讨羊水穿刺进行POR基因检测对产前诊断的重要意义。方法 对1例孕妇的既往异常妊娠史和胎儿的畸形进行描述;对孕妇及其配偶的POR基因进行检测;在本次妊娠时,对羊水细胞POR基因进行检测;对分娩胎儿的外生殖器和骨骼进行评价。结果 1）此孕妇在既往首次妊娠时出现声音低沉、痤疮增多等显著男性化表现;首次分娩双胎,均有肘关节骨融合、阴蒂肥大和脑瘫,经救治无效而死亡。2）此孕妇及其配偶的POR基因检测证实,男方存在POR基因的杂合突变（G1370A,Arg457His）。3）当此孕妇再次妊娠达20周时,对羊水细胞进行POR基因检测未发现突变。4）足月顺产1女婴,外生殖器和骨骼正常。 结论 羊水穿刺进行POR基因检测有助于获得此疾病相关的基因信息,指导妊娠决策。     

Moderate alcohol intake is related to increased heart rate variability in young adults: Implications for health and well‐being

Epidemiological literature indicates that the relationship between alcohol consumption and health outcomes reflects a J‐shaped curve such that moderate alcohol consumption confers a protective effect in comparison to abstinence, while heavy consumption is associated with poorer health. While heart rate variability (HRV) may underpin the relationship between drinking and poor health in heavy drinkers, it is unclear whether HRV is increased in moderate, habitual drinkers relative to nonhabitual drinkers. HRV and drinking habits were assessed in 47 volunteers. Results supported hypotheses suggesting that moderate, habitual drinking increases HRV. Although not supported by a significant interaction between drinking group and sex, planned follow‐up analysis also revealed that these findings may be specific to males. Regardless, results highlight HRV as a candidate mechanism for the findings reported in the epidemiological literature.     

The role of alcoholics' insight in abstinence from alcohol in male Korean alcohol dependents

This study was performed to examine the relationship between the abstinence results of alcohol dependents after discharge and the level of insight at the time of discharge. 117 male Korean alcohol dependents discharged from a community-based alcohol treatment center were followed up to determine the initial months of abstinence on a successive basis (IMA), total months of abstinence during 12-month period (TMA), and complete abstinence for one full year after discharge. Analyses of abstinence results with adjustment for the differences in baseline characteristics were performed for subjects' insight levels (poor, fair and good). The mean IMA of patients with good insight was significantly (p<0.01) longer than that of patients with poor insight and TMA of patients with good insight was significantly (p<0.001) longer than that of others. Using patients with good insight as the reference, patients with poor insight showed an adjusted odds ratio (OR) of 0.07 (95% confidence interval [CI]=0.01-0.75, p<0.05) for complete abstinence for one full year after discharge and patients with fair insight, adjusted OR of 0.17 (95% CI=0.03-0.81, p<0.05). These results suggest that alcohol dependents' insight could be regarded as a factor related with abstinence.     

Usefulness of immunohistochemical staining for MUC5AC in differentiating primary pancreatic cancer from pancreatic metastasis of breast cancer

Diagnosis of pancreatic ductal adenocarcinoma (PDAC) and its differentiation from metastases to the pancreas from other organs remains challenging. We report a case in which immunohistochemical staining for MUC5AC was useful in distinguishing primary pancreatic cancer from breast cancer metastasis. A 51‐year‐old Japanese woman who underwent curative resection of her breast cancer was referred to our hospital with a pancreatic head tumor. Although we surmised her pancreatic tumor to be metastatic breast cancer based on her past history and imaging studies, she was subsequently diagnosed with PDAC on the basis of immunohistochemical staining for MUC5AC using specimens obtained by endoscopic ultrasound‐fine‐needle aspiration. Thus, MUC5AC may be a useful diagnostic marker for discriminating PDAC from a secondary malignancy.     

健康教育路径在酒依赖厌恶治疗中的对照研究

目的 探讨路径健康教育在酒依赖厌恶治疗中的作用及效果.方法 将酒依赖住院患者随机分为两组,实验组在厌恶治疗基础上,按健康教育路径进行宣教,而对照组予以常规健康教育.两组分别于4周末,采用自行设计的护理服务满意度调查袁及健康教育知识测试卷进行评定;随访12周末对出院后的累加戒酒时间和复饮率进行评定.结果 实施健康教育4周...     

对一例恐怖症的综合心理治疗

1　病历摘要患者 ,女 ,52岁 ,山东某厂职工学校语文教师 ,已婚。主诉为害怕洗衣粉、肥皂和洗发液等洗涤品五年。 1995年下半年起 ,患者开始反感洗衣粉 ,一旦接触 ,要反复清洗。后反感范围扩展到肥皂、洗发液等一切洗涤品 ,且程度加重 ,不能接触 ,否则有头昏、大汗、心跳加剧、两腿酸软、颤抖 ,甚至小便失禁等明显的植物神经反应。五年来 ,患者只用清水洗发、洗澡 ;不洗衣 ,也不敢买新衣 ,怕新衣沾有洗衣粉 ,只穿多年前旧衣 ,认为没有洗衣粉 ;上街见了洗衣粉便绕着走 ,看一眼都难受。同时 ,也不许丈夫、儿子接触。明知没道理 ,但无法控制。每…     

Treating Trichotillomania (Hair‐Pulling Disorder) in a Child

Although cognitive behavioral treatments (CBTs) have been recommended as first‐line interventions for trichotillomania (hair‐pulling disorder [HPD]), research on CBT for young children with HPD is limited. We illustrate the use of family‐based CBT for HPD in an 8‐year‐old boy. The client had a 5‐year history of chronic HPD and several large bald spots on the crown of his head. Treatment primarily comprised habit reversal training (HRT) and function‐based interventions. The child showed significant improvement in HPD severity and impairment after 8 weekly sessions, although complete abstinence was not achieved. The findings underscore the importance of parental involvement in the treatment and show that children as young as 8 years of age can successfully use strategies taught in HRT.     

A Tape Recorder as a Therapeutic “Witness” in the Treatment of an 8‐Year‐Old Girl

A tape‐recorded session of an early moment in an 8‐year‐old girl's psychotherapy experience is presented. The use of the recording device is immediately taken up by the child as a means of creating a “witness” for her depiction of both intensely distorted experiences of her therapist and poignant portrayals of her life as miserable and despairing. A discussion of both the process and the content generated from the use of the tape recorder is described, with implications drawn as to its effectiveness in the therapeutic process.     

Mammary hamartoma: immunohistochemical study of two adenolipomas and one variant with cartilage, smooth muscle and myoepithelial proliferation

Three cases of mammary hamartoma were investigated immunohistochemically and are described. Case 1 was a 42 year old woman with an elastic hard tumor, 1.5 cm in diameter, in her left breast. Case 2 was a 49 year old woman with a semisoft tumor, 5 x 2 cm, in her right breast. Case 3 was a 47 year old woman with a hard tumor, 5 cm in diameter, in her left breast. In each case, mammography and ultrasonography revealed a benign-looking, well-circumscribed mass without calcification. Histologically, the tumors were composed of adipose tissue, mammary glands, and fibrous and/or fibromuscular tissue. The tumor in case 3 also contained small islands of hyaline cartilage. Immunohistochemical analysis was performed, and epithelial and mesenchymal components were discretely and differentially immunostained except that the smooth muscle component seemed to be derived from myoepithelial cells. Cartilage formation might be the result of metaplasia, and 'metaplastic variant of the mammary hamartoma' or 'choristoma' may be an appropriate term for cartilage-containing mammary hamartoma. Using proliferating cell nuclear antigen (PCNA)-immunostaining, we observed that each component of the tumors had an individual growth rate. This finding may reflect one aspect of the biological characteristics of hamartoma.     

Two cases of mosaic RhD blood‐group phenotypes and paternal isodisomy for chromosome 1

We encountered a 22‐year‐old man (case 1) and a 23‐year‐old woman (case 2), both unrelated and healthy. They were mosaic for the Rh blood group phenotype: one erythrocyte population was D‐positive and the other was D‐negative. Flow cytometric analysis of density profile of RhD antigen in their erythrocytes, and cytogenetic analysis including in situ hybridization using an RHD/RHCE‐containing PAC clone, excluded a deletion of the RHD/RHCE gene complex, but suggested the presence of cells with uniparental disomy for chromosome 1 (UPD1). Microsatellite marker analysis was performed in both probands and their family members. In case 1, the analysis with markers spanning the chromosome 1 revealed both maternal and paternal alleles in his peripheral blood leukocytes (PBL), Epstein‐Barr virus‐transformed lymphoblastoid cells (EBL), and buccal mucosal cells. However, only paternal alleles were detected in all of 50 individual pieces of his hair or hair‐roots and all of five monoclonal cell lines cloned from his established EBL. There was no direct evidence of heterozygous, biparental alleles in these two tissues. The presence of maternal isodisomy 1 was not absolutely ruled out in other tissues examined in case 1. Similar results were obtained in case 2, showing biparental, disomic patterns in her PBL and in 15 of 20 pieces of her hair roots, and showing monoallelic patterns in the remaining five pieces of hair roots. Analysis with markers for other autosomes confirmed their biparental inheritance. These findings indicated that both cases had at least two cell populations, one population having paternal UPD1 (isodisomy 1), and another heterozygous, biparental disomy 1. We emphasize that isodisomy for chromosome 1 is not infrequent and may cause unusual RhD phenotype, as seen in cases we described. © 2001 Wiley‐Liss, Inc.     

Coping skills and treatment outcomes in cognitive-behavioral and interactional group therapy for alcoholism

In the present study 128 alcohol dependent men and women received 26 weeks of group treatment in one of two modalities: Cognitive-behavioral treatment (CBT) intended specifically to develop coping skills or interactional therapy intended to examine interpersonal relationships. Coping skills and drinking were assessed prior to and after treatment and up to 18 months after intake. Results indicated that both treatments yielded very good drinking outcomes throughout the follow-up period. Increased coping skills was a significant predictor of outcome. However, neither treatment effected greater increases in coping than the other. Specific coping-skills training was not essential for increasing the use of coping skills. The results raise questions about the efficacy of specific treatment elements of CBT in treatment of alcohol dependence.     

Behavior Therapy for Youth With Tourette Disorder

Persistent tic disorders and Tourette disorder (TD) are neuropsychiatric conditions that commonly co‐occur among youth with obsessive‐compulsive disorder. Although historically managed with pharmacological agents such as antipsychotics and alpha‐2 agonists, behavioral interventions like habit reversal training (HRT) and the comprehensive behavioral intervention for tics have demonstrated considerable efficacy in reducing tic symptom severity. This case study illustrates the implementation of behavior therapy in reducing tic symptom severity of an adolescent with TD. Arlene was a 14‐year‐old girl with TD who presented with moderate tic symptom severity that caused her physical, academic, and social impairment. In addition to concurrent pharmacotherapy, Arlene completed a 20‐session weekly course of HRT, and experienced a clinically meaningful reduction in tic symptom severity and tic‐related impairment. This example provides further evidence of the benefit of behavior therapy in reducing tic symptom severity and highlights key considerations for treatment of youth with TD.     

Hybrid Mice as Genetic Models of High Alcohol Consumption

We showed that F1 hybrid genotypes may provide a broader variety of ethanol drinking phenotypes than the inbred progenitor strains used to create the hybrids (Blednov et al. in Alcohol Clin Exp Res 29:1949–1958, 2005). To extend this work, we characterized alcohol consumption as well as intake of other tastants (saccharin, quinine and sodium chloride) in five inbred strains of mice (FVB, SJL, B6, BUB, NZB) and in their reciprocal F1 hybrids with B6 (FVBxB6; B6xFVB; NZBxB6; B6xNZB; BUBxB6; B6xBUB; SJLxB6; B6xSJL). We also compared ethanol intake in these mice for several concentrations before and after two periods of abstinence. F1 hybrid mice derived from the crosses of B6 and FVB and also B6 and SJL drank higher levels of ethanol than their progenitor strains, demonstrating overdominance for two-bottle choice drinking test. The B6 and NZB hybrid showed additivity in two-bottle choice drinking, whereas the hybrid of B6 and BUB demonstrated full or complete dominance. Genealogical origin, as well as non-alcohol taste preferences (sodium chloride), predicted ethanol consumption. Mice derived from the crosses of B6 and FVB showed high sustained alcohol preference and the B6 and NZB hybrids showed reduced alcohol preference after periods of abstinence. These new genetic models offer some advantages over inbred strains because they provide high, sustained, alcohol intake, and should allow mapping of loci important for the genetic architecture of these traits.