酒依赖治疗药物研究进展

酒精是成瘾性或依赖性物质之一。酒精成瘾特征表现为对获得酒精的强迫性渴望,无节制地饮酒,并且发展为酒精耐受和酒依赖。     

停止信号任务在酒依赖中的研究进展

<正>目前,频繁的使用酒精或成瘾药物所导致的负面效果已得到全球的广泛关注和重视~([1])。在2012年,全球约有330万人因使用酒精而导致死亡,占全球死亡人数的5.9%。过度使用酒精对个人、家庭及社会产生大量的健康和经济负担,因酒精使用而     

胺类神经递质在酒依赖睡眠障碍中的研究进展

<正>睡眠是生物的本能,是指机体失去对周围环境知觉和反应的一种可逆行为,可以帮助生物体恢复体力和精力。生理性睡眠可分为非快眼动睡眠期(non-rapid eye movement,NREM)和快眼动睡眠期(rapid eye movement,REM),NREM期又可分为1、2、3、4期,其中3、4期合称慢波睡眠期(slow wake sleep,SWS)[1]。睡眠障碍是指从睡眠至觉醒的过     

电脑中频治疗在酒依赖治疗中的应用

目的：探讨电脑中频治疗对酒依赖病人恢复过程中肌肉关节疼痛的治疗效果。方法：对酒依赖急性戒断期治疗后出现主诉肌肉关节疼痛病例进行治疗,对疗效及不良反应进行评估,得出结论。结果：电脑中频治疗酒依赖者肌肉酸疼有效率89．66％,86．21％的病例无任何不良反应,12．07％病例局部起水疱现象。结论：电脑中频治疗对酒依赖戒断后肌肉关节酸疼有效,但治疗时需注意透热强度的调控以免局部烫伤。     

酒依赖的遗传学研究进展

酒依赖是一种慢性、复发性并受遗传因素影响的复杂疾病,也是重大的公共卫生问题。根据WHO的统计,全球估计有20亿饮酒者,13亿吸烟者,1．85亿非法物质使用者［1］。因而酒精是全球使用最为广泛的成瘾性物质。目前已有大量的动物实验和人类研究的结果表明,遗传学影响在物质滥用和依赖形成过程中起重要作用［2］。     

酒依赖的遗传学研究进展

酒依赖是一种慢性、复发性并受遗传因素影响的复杂疾病,也是重大的公共卫生问题.根据WHO的统计,全球估计有20亿饮酒者,13亿吸烟者,1. 85亿非法物质使用者[1].因而酒精是全球使用最为广泛的成瘾性物质.目前已有大量的动物实验和人类研究的结果表明,遗传学影响在物质滥用和依赖形成过程中起重要作用[2].     

国内呋喃唑酮在酒依赖治疗中的应用现状

饮酒所带来的问题及酒依赖、酒中毒在发达国家比较突出。据美国Ｓｃｈｕｃｋｉｔ等人报告，一生中出现酒精滥用或酒依赖的比率，在男性约为１５％，在女性约为５％〔１〕。在我国酒中毒患者在８０年代以前一直处于很低水平。但近十余年来随着酒类消费的显著上升，酒依赖患...     

家庭干预在酒依赖后期治疗中的应用

酒精引起的精神疾病以高复发率为特点,如何减少复发成为人们探索的问题。本文就我院在酒依赖后期治疗中采用家庭干预减少复发的方法,报告如下。 1 对象与方法 1.1 纳入标准及排除标准:纳入对象均符合     

乌灵胶囊在酒依赖治疗中的应用效果观察

目的：观察乌灵胶囊在酒依赖治疗过程中主诉睡眠差、疲乏无力、肌肉酸胀、记忆差等症状的改善情况。方法：将使用乌灵胶囊病例与不使用病例进行对照观察,时限1个月,对不适症状消除时间进行评估,得出改善状况。结果：观察组主诉症状改善明显快于对照组。睡眠障碍（P〈0．05）,疲乏无力（P〈0．01）,肌肉酸胀（P〈0．05）,记忆商数（MQ）（P〈0．05—0．01）,均有显著差异。结论：内含多种有效成份的纯中药制剂乌灵胶囊在酒依赖治疗中有明显缓解主诉不适症状之作用。     

The effect of acamprosate on alcohol and food craving in patients with alcohol dependence

Clinical variables that affect treatment outcome for marijuana-dependent individuals are not yet well understood, including the effects of cognitive functioning. To address this, level of cognitive functioning and treatment outcome were investigated. Twenty marijuana-dependent outpatients were administered a neuropsychological battery at treatment entry. All patients received 12 weekly individual sessions of combined motivational enhancement therapy and cognitive behavioral therapy. The Wilcoxon Exact Test was used to compare cognitive functioning test scores between completers and dropouts, and the Fisher Exact Test was used to compare proportion of negative urines between those with higher and lower scores on the cognitive tests. Marijuana abstinence was unrelated to cognitive functioning. However, dropouts scored significantly lower than completers on measures of abstract reasoning and processing accuracy, providing initial evidence that cognitive functioning plays a role in treatment retention of adult marijuana-dependent patients. If supported by further studies, the findings may help inform the development of interventions tailored for cognitively impaired marijuana-dependent patients.     

The effect of acamprosate on alcohol and food craving in patients with alcohol dependence

Introduction

The balance between inhibitory (gamma aminobutyric acid; GABAergic) and excitatory (glutamatergic) neurotransmission is thought to be associated with craving for alcohol and food. The anticraving effect of acamprosate is thought to be mediated through modifying the balance of GABA and glutamate. Recent studies in animals have suggested that acamprosate may have non-selective effects on craving for both alcohol and food.

Methods

The influence of acamprosate for reducing craving for alcohol and food was assessed in 204 in-patients with alcohol dependence (96 patients treated with acamprosate, PWA; 108 patients were not treated PNA) was assessed at baseline and following 1, 2, and 4 weeks of treatment.

Results

There was a significant reduction in craving for alcohol over 4 weeks of treatment in both PWA and PNA groups, but without significant group differences. In contrast, a reduction in food craving was observed only in the PWA group. In addition, there was a significant increase of body mass index (BMI) in the PNA group but not the PWA group over the 4-week period.

Discussion

These results demonstrate acamprosate nonselective effects on craving for drinking and eating in alcoholic patients.     

Initiating acamprosate within-detoxification versus post-detoxification in the treatment of alcohol dependence

ObjectivesThis trial compared the efficacy of acamprosate, started at the beginning of detoxification, to acamprosate started at the completion of detoxification, in the treatment of alcohol dependence.MethodsThis biphasic clinical trial consisted of a randomized, double-blind, placebo-controlled Detoxification Phase (DP), followed by a 10-week open-label Rehabilitation Phase (RP). Forty alcohol dependent patients were randomly assigned to receive either 1998 mg of acamprosate daily, or matching placebo, during the DP (5–14 days). After completing detoxification, all patients received open label acamprosate (1998 mg daily) in the RP. Outcome measures during the DP included: treatment retention, alcohol withdrawal, alcohol consumption, and oxazepam used. Outcome measures during the RP included: treatment retention and alcohol consumption.ResultsThere were no significant outcome differences between acamprosate and placebo-treated patients during the DP. Patients given acamprosate, compared to placebo, during the DP drank more alcohol in the RP.ConclusionsStarting acamprosate at the beginning of detoxification did not improve DP outcomes. Starting acamprosate after detoxification was completed was associated with better drinking outcomes during subsequent alcohol rehabilitation treatment.     

Effect of early and late compliance on the effectiveness of acamprosate in the treatment of alcohol dependence

Background

The aim of this study is to assess the influence of early and late compliance of acamprosate on attendance and abstinence duration in the treatment of alcohol dependence.

Methods

Individual patient data of 2,305 patients from 11 randomized controlled trials comparing acamprosate (n = 1,128) with placebo (n = 1,177) were used to predict early and late compliance and to study the effect of early and late compliance on attendance and abstinence duration using regression analysis and structural equation modeling.

Results

Early compliance was predicted by baseline motivation to become fully abstinent and baseline abstinence (R² = .26); late compliance was predicted by early compliance (R² = .13); treatment discontinuation was predicted by young age, marital status, compliance, and treatment condition (R² = .26); and abstinence duration was predicted by motivation to become fully abstinent early compliance and the interaction of early compliance and treatment condition (R² = .27). Structural equation modeling showed that abstinence duration was significantly associated with motivation at baseline, late compliance, and treatment condition (Goodness of Fit Index [GFI] χ²/df = 1.56; Parsimonious Goodness of Fit Index [PGFI] = 0.69).

Conclusions

Motivation to become fully abstinent and abstinence at the start of treatment are important for early compliance. Early compliance in turn predicts late compliance. Late compliance, in combination with motivation to become fully abstinent, and treatment condition (acamprosate vs. placebo) predict duration of abstinence. This suggests that motivational interventions directed toward full abstinence motivation and abstinence at the start of treatment are crucial for both compliance with acamprosate and successful treatment outcome.     

The neurobiology,clinical efficacy and safety of acamprosate in the treatment of alcohol dependence

Importance to the field: Acamprosate, marketed under the brand name Campral^®, (Forest Pharmaceuticals, Inc., Saint Louis, MO, USA; Merck Sante s.a.s., Lyon, France) is an orally administered drug approved in the US and throughout much of the world for treating alcohol dependence. Its safety and efficacy have been demonstrated in a number of clinical trials worldwide and as with all pharmacotherapies for alcoholism, it is used in conjunction with psychosocial interventions.

Areas covered in this review: This article reviews the mechanism of action, clinical efficacy and safety of acamprosate in Phase I, II and III randomized controlled trials involving healthy and alcohol-dependent populations using published reports from 1984 to 2009.

What the reader will gain: This review provides an update of the mechanism of action and the safety and efficacy profile of acamprosate.

Take home message: Acamprosate appears to act centrally to restore the normal activity of glutamatergic neurotransmission altered by chronic alcohol exposure. Acamprosate’s excellent safety profile along with several pharmacokinetic and pharmacodynamic characteristics make it well suited for treating a broad population of alcohol-dependent patients.     

Effects of naltrexone alone and in combination with acamprosate on the alcohol deprivation effect in rats.

Previous research in our laboratory has shown that responding for ethanol increases after a period of imposed deprivation during which no ethanol is available (the alcohol deprivation effect). This selective increase in responding for ethanol was blocked by chronic administration of acamprosate. In the present study the effects of naltrexone and the combination of naltrexone+acamprosate on oral ethanol self-administration were examined following an imposed period of abstinence. Male Wistar rats were trained to respond for ethanol (10% w/v) or water in a two-lever free-choice condition. After training, separate groups of rats received chronic injections (2 x /day) of saline, naltrexone, or naltrexone+acamprosate during a 5-day period of abstinence. Ethanol self-administration was tested in all groups of rats on the last day of abstinence, 30 min after the last drug injection. Responding for ethanol increased significantly following the deprivation period in animals treated with saline. Chronic administration of naltrexone and the combination naltrexone+acamprosate blocked the increased ethanol consumption following the imposed abstinence period on post-deprivation Day 1. On post-deprivation Day 2, the combination of acamprosate with naltrexone blocked the rebound increase in ethanol consumption observed in animals treated with a low dose of naltrexone. These results support the hypothesis that naltrexone and acamprosate are effective in modulating aspects of alcohol-seeking behavior, and under certain situations may be more effective in combination.     

地西泮联合小剂量阿立哌唑治疗酒依赖患者的疗效观察

目的：观察地西泮联合小剂量阿立哌唑治疗酒依赖患者的临床效果。方法将144例酒依赖患者随机分为治疗组和对照组各72例。2组均接受常规治疗,治疗组在常规治疗基础上加服阿立哌唑治疗,对比2组治疗前后戒断症状评分。结果2组治疗前戒断症状评分差异无统计学意义（P＞0．05）。治疗后2组戒断症状评分均低于治疗前,且观察组低于对照组,差异均有统计学意义（P＜0．05）。结论地西泮联合小剂量阿立哌唑治疗酒依赖患者疗效较好,且起效时间短,不良反应轻微,值得推广应用。     

酒精依赖综合征治疗药物的研究进展

当今社会生活中酒精滥用现象普遍存在,已成为危害人类健康与公共安全的医学和社会难题。目前研发的多种活性物质能够影响中脑边缘多巴胺神经通路以降低酒精引起的奖赏效应,从而有效改善或治疗酒精依赖综合征。该文综述了近期酒精依赖干预药物的研究进展,旨在为相关机制研究和药物开发提供参考。     

Oxidative damage to plasma proteins in patients with chronic alcohol dependence: the effect of smoking

BACKGROUND: Accumulating evidence implicates oxidative stress in ethanol-induced toxicity. Ethanol has been reported to be involved in oxidative damage, mostly in vitro, or in post mortem tissues, while biochemical abnormalities in the blood or serum are scanty or lacking. The aim of the present study was to examine the oxidative status of plasma proteins as markers of oxidative stress in subjects with chronic alcohol dependence (CAD). Since smoking has also been associated with oxidative stress this factor was also considered. PATIENTS AND METHODS: A total of 71 patients with CAD and 61 healthy volunteers of comparable age were included in the study. The protein carbonyl assay was carried out in plasma, as a reliable measure of general oxidative protein damage, in these two groups. RESULTS: Increased plasma protein carbonyls (PCs) were found in patients with CAD as compared with the control group [mean values (nmollmg protein): 4.73+/-1.46 and 3.62+/-0.91 respectively, p<0.000001]. Within the control group, smokers had higher PCs than the non-smokers, however this difference was of marginal significance [mean values (nmol/mg protein): 3.93+/-1.32 and 3.47+/-0.63, respectively]. The CAD group had significantly increased PCs compared with both the smoker and the non-smoker subgroups of the controls (p<0.001 and p<0.0001, respectively). Duration of alcohol consumption, daily alcohol intake, smoke load, folic acid and vitamin B12 levels did not correlate significantly with PC levels. CONCLUSION: The above results support the evidence for systemic oxidative stress in CAD, which must be attributed mainly to alcohol consumption, while smoking may act synergistically.     

喹硫平对酒依赖预防复饮作用的meta分析

目的:使用meta分析的方法探索喹硫平对酒依赖患者预防复饮的作用。方法:在Pubmed、Embase、The Cochrane Library、Web of Science、Ovid和中国知网、万方数据库、维普中文科技期刊数据库进行中英文文献的检索,对检索到的文献进行系统文献筛查,将符合入组标准的文献进行meta分析。结果:最终纳入3篇文献,总样本量341人,meta分析结果显示,服用喹硫平的酒依赖患者与安慰剂组的复饮率差异无统计学意义(OR=0.707, 95%CI=0.707～2.209,P=0.551>0.05)。结论:临床使用喹硫平作为预防酒依赖患者复饮的治疗措施仍需谨慎,需要更大样本量、更高质量的研究进一步提供支持证据。