Alcohol Use and Associated Environmental Factors Among Middle and High School Students in Sfax (Tunisia)

Our objective was to investigate the prevalence and the environmental determinants of alcohol use among students in the region of Sfax in Tunisia. We carried out a cross-sectional study among 315 middle and high school students. We used the Alcohol Use Disorders Identification Test (AUDIT) to identify risky alcohol consumption, and we used the Parenting Styles and Dimensions Questionnaire (PSDQ) to assess the students’ perceptions of their parents’ parenting styles. The results show that 19.7% reported drinking alcohol at least once in their lifetime. Among them, 21% scored as dependent alcohol users, according to the AUDIT. Those who drank alcohol at least once were more likely to have parents with a permissive parenting style (p < 0.001; Cramer’s V = 0.287), and a father (p < 0.001; Cramer’s V = 0.258), a mother (p = 0.025; Cramer’s V = 0.158), or a friend (p < 0.001; Cramer’s V = 0.341) who drinks. Students perceiving their parents’ parenting style as permissive had the highest AUDIT score (p = 0.005; partial η² = 0.132). The authoritarian style score was significantly higher for students who were current alcohol users (p = 0.028; Cohen’s d = 0.57). Our study highlights the influence of peers, family drinking, and parenting styles on alcohol use among middle and high school students. Therefore, particular attention should be given to students that are at risk of having the abovementioned environmental determinants of alcohol use. And, prevention strategies should involve parents, as well as enhanced guidance and counseling for these students.

     

Hippocampal cerebral blood flow increased following low-pressure hyperbaric oxygenation in firefighters with mild traumatic brain injury and emotional distress

Background

Recent evidence suggests that hyperbaric oxygenation (HBO), which has been used as an effective treatment for certain types of tissue injury, may change neural activities in the human brain and subsequently improve symptoms of psychiatric disorders. To scrutinize the neural mechanism of HBO in the human brain, we investigated whether 20 sessions of HBO changed regional cerebral blood flow (rCBF) of the limbic system in firefighters with mild traumatic brain injury (mTBI) and subjective emotional distress.

Methods

Twenty firefighters with mTBI and mild emotional distress were treated with HBO at a relatively low pressure of 1.3 atmospheres absolute for 45 min a day for 20 consecutive days (the mild emotional distress group). The rCBF of the limbic system was measured using an arterial spin labeling perfusion magnetic resonance imaging before and after the HBO. Analyses were performed on the data from fourteen individuals who completed the study and 14 age- and sex-matched healthy firefighters (the comparison group).

Results

Firefighters in the mild emotional distress group showed increase rCBF following HBO in a cluster encompassing the right hippocampal and parahippocampal regions (peak t = 4.31; cluster size = 248 mm³)(post-hoc analysis, z = 5.92, p < 0.001) that had lower rCBF relative to the comparison group at baseline (post-hoc analysis, t = ?2.20, p = 0.04).

Conclusion

The current study demonstrated that low-pressure HBO might increase rCBF of the hippocampal and parahippocampal regions, suggesting a potential underpinning mechanism of HBO in the human brain.

     

Enhancing Access to Psychiatric Care for Posttraumatic Stress Disorder in Veterans with Mild Traumatic Brain Injury through Integrated Services

(i) To describe an integrated model of psychiatric care for the treatment of posttraumatic stress disorder (PTSD) in veterans with mild traumatic brain injury (mTBI). (ii) To evaluate access to and engagement in psychiatric care among veterans with comorbid PTSD and mTBI after implementation of an Integrated Care (IC) model compared to the previous Usual Care (UC). 100 randomly selected charts, 50 from each of UC and IC were reviewed in this non-concurrent case- control study. Polytrauma Network Site (PNS), an outpatient rehabilitation clinic, for veterans who suffered from brain and other traumatic injuries at an urban VA Polytrauma Rehabilitation Center. Veterans receiving treatment for mTBI symptoms by the rehabilitation team were referred for medication management for PTSD to UC and IC. Co-located access to psychiatric care for medication management as part of the interdisciplinary team with the goal of expediting rehabilitation and functional recovery. Number of consults for psychiatric care for medication management scheduled and completed within 30 days, and number of veterans offered, initiating, and completing evidence-based psychotherapies for PTSD in UC compared to IC. After implementation of IC there were significant improvements in timely completion of consults and patient engagement with a psychiatrist. There also were improvements in number of referrals, initiation, and completion of evidence-based psychotherapies for the treatment of PTSD. IC within the PNS shows promise as an effective care model for increasing access and engagement in care for veterans with comorbid PTSD/mTBI. Future research is needed to examine the utility of this model in other sites.

     

Aggression in a rural psychogeriatric outreach program

A rural, community-dwelling group of elders referred to a psychogeriatric outreach program were examined for presence of aggressive behaviors. Aggressive patients were compared to non-aggressive patients on the following variables: age, sex, presence of hallucinations and delusions, alcohol use, cognition score, score on Hamilton Depression Scale, physical and instrumental activity of daily living (ADL) scores, general health and quality of life. Of one hundred and fifty-eight patients, 19 (12%) exhibited aggressive behavior. Aggression was significantly associated with presence of hallucinations (p < 0.0001), delusions (p = 0.004), lower physical (p = 0.004), instrumental activity of daily living scores (p < 0.0001) and diagnosis of dementia versus other psychiatric diagnoses. However, lower cognitive score, depressive symptoms, age, gender, alcohol use, quality of life and general health did not differ between aggressive and non-aggressive patients. Aggression is not uncommon in community-dwelling elders in a rural psychogeriatric program. Careful evaluation for treatment of psychotic symptoms should be done in aggressive elders.     

Towards DSM‐V: considering other withdrawal‐like symptoms of pathological gambling disorder

Despite clinical reports of other withdrawal‐like symptoms, the DSM‐IV considers only restlessness/irritability as a withdrawal‐like criterion comprising pathological gambling disorder (PGD). We explored whether this criterion should be broadened to include other gambling withdrawal‐like symptoms. Community‐recruited adult gamblers (n = 312) participated in telephone interviews about gambling and related behaviors as a part of a larger psychometric study. Frequency and chi‐square analyses described the association of gambling withdrawal‐like symptoms by gambling disorder status. Multinomial forward selection logistic regression obtained a multivariate model describing the simultaneous relationship between these symptoms and gambling disorder status. One‐quarter of the sample experienced the DSM‐IV PGD criterion of restlessness/irritability. However, 41% experienced additional gambling withdrawal‐like symptoms when attempting to quit or control gambling. A model including restlessness/irritability and three additional non‐DSM‐IV withdrawal‐like symptoms (i.e. feelings of anger, guilt, and disappointment) is a stronger model of gambling disorder (χ² = 217.488; df = 8, p < 0.0001; R² = 0.5428; p < 0.0001) than restlessness/irritability alone (χ² = 151.278; df = 2, p < 0.0001; R² = 0.4133). The overlap of gambling withdrawal‐like symptoms with substance use withdrawal (11%) and depressive symptoms (34%) failed to fully account for these associations with gambling disorder status. Future PGD conceptualization and potential criteria revisions for DSM‐V may warrant a broader inclusion of gambling withdrawal‐like symptoms. Copyright © 2009 John Wiley & Sons, Ltd.     

Alcohol use predicts emergency psychiatric unit admission for non-fatal suicidal behaviour in the Western Cape (South Africa): a case–control study

Abstract

Objective: We aimed to describe patterns of substance use among patients admitted to an emergency psychiatric unit for non-fatal suicidal behaviour (NFSB) or another psychiatric reason and establish whether there were significant differences in patterns of substance use between the two groups.

Methods: We employed a case–control design (N?=?50) and collected data about participants' substance use in Cape Town, South Africa. Data were analysed using Chi-square and Mann–Whitney tests, factor analysis, and logistic regressions.

Results: Prevalence of lifetime Alcohol Use Disorder (AUD) was 60% in the NFSB group and 28% in the control group. 12% of the NFSB group and 20% of the control group had a lifetime Tobacco Use Disorder. Prevalence of lifetime illicit Substance Use Disorder was 44% in the NFSB group and 60% in the control group. Hospital admission for NFSB was associated with: any past 24-hour alcohol use; quantity of past 24-hour alcohol use; quantity of past-month alcohol use; lifetime AUD; past 12-month AUD; and current AUD; and was not associated with the use of any other substances (p<.05). Past 12-month AUD was the best predictor of hospital admission for NFSB, controlling for, respectively, any past 24-hour alcohol use (aOR = 13.33, p?=?.023) and quantity of past 24-hour alcohol use (aOR = 9.01, p?=?.022)

Conclusions: Patients admitted to emergency psychiatric units for NFSB have increased needs for the treatment of AUDs compared to patients admitted for another psychiatric emergency. Findings support calls for interventions to prevent NFSB among psychiatric patients with a history of AUD.

• Key points

• Rates of substance use among patients admitted to emergency psychiatric units in South Africa were high compared to the general population.

• Hazardous alcohol use was uniquely associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.

• Tobacco use and illicit substance use were not associated with hospital admission for non-fatal suicidal behaviour compared to another psychiatric emergency.

• The association between hazardous alcohol use and hospital admission for non-fatal suicidal behaviour did not appear to be affected by demographic variables.

• Patients admitted to hospital for non-fatal suicidal behaviour have increased needs for the treatment of alcohol use disorders compared to other psychiatric patients.

     

The impact of alcohol and tobacco use on in vivo glutathione in youth with bipolar disorder: An exploratory study

Risky alcohol consumption and tobacco smoking is highly prevalent in bipolar disorder (BD) and is associated with increased formation of neural reactive oxygen species. Proton magnetic resonance spectroscopy (¹H-MRS) is an in vivo imaging modality that allows quantification of glutathione (GSH) concentration, the brains primary antioxidant. Sixty-four patients with BD and 49 controls (18–30 years) completed self-report questionnaires regarding alcohol and tobacco use and underwent ¹H-MRS. Levels of GSH in the hippocampus and anterior cingulate cortex (ACC) were determined. Within-group Pearson's correlations were used to explore the relationship between alcohol use and GSH concentration for BD and controls, covarying for age, gender, family history of alcohol dependence and smoking status. Relationships between GSH and presence/severity of alcohol-induced blackouts were determined using Spearman's correlations. In BD, reduced hippocampal-GSH associated with higher alcohol use (R = −0.489, p < 0.021). Reduction of ACC-GSH with increased drinking was non-significant when controlling for tobacco use. Independent samples t-test revealed a significantly decreased ACC-GSH in smokers with BD (t (53) = 4.162, p < 0.001). In controls, alcohol use was not correlated to GSH in either region. In both patients and controls, reduced hippocampal-GSH was associated with blackout presence/severity, supporting a role for the hippocampus in the continuum of alcohol-induced memory impairments. Our preliminary findings suggest that in youth with BD reduced hippocampal-GSH is associated with risky alcohol use and alcohol and tobacco use is associated with reduced ACC-GSH, highlighting the role of these substances as modifiable risk factors for decreased anti-oxidant capacity in BD.     

Alcohol consumption in the elderly and risk of dementia related death - a Norwegian prospective study with a 17-year follow-up

Purpose: The aim of this study was to determine the association between alcohol intake and risk of dementia related death, taking into account relevant confounding and mediating factors. Materials and Methods: Data was obtained from a Norwegian prospective study with a 17-year follow-up. The study population comprised 25,635 participants aged between 60 and 80 years at the time of examination from the Cohort of Norway (CONOR). Cox regression was used to investigate the association between alcohol use and dementia related death. Results: Nearly half (12,139) of the study population died during follow-up, of which 1,224 had a diagnosis of dementia on their death certificate. The risk of dementia related death was significantly higher among abstainers than among individuals that drank alcohol once per month (HR = 1.33, 95% CI = 1.14–1.56, p < 0.001, in a fully adjusted model). Respondents with missing information regarding alcohol consumption (representing 5% of the study population) had the highest risk of dementia related death (HR = 1.60, 95% CI = 1.28–2.00, p < 0.001) and also significantly higher mortality rates due to alcohol-related causes (HR = 1.41, 95% CI = 1.03–1.93, p = 0.031) and other causes (HR = 1.32, 95% CI = 1.21–1.43, p < 0.001), all compared to those drinking alcohol no more than once per month. Conclusion: These findings suggest that the risk of dementia related death is significantly higher among elderly abstainers than among those who drink alcohol, after adjusting for relevant confounders. However, care should be taken in interpretation of data due to missing information on drinking frequency, as this missing-group might have a large share of the heavy drinkers in the study cohort.     

The differential effects of PTSD,MDD, and dissociation on CRP in trauma-exposed women

ObjectiveC-reactive protein (CRP), a marker of systemic inflammation, has been associated with psychiatric disorders including major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Some research suggests that exposure to trauma can trigger increased activity in the inflammatory system. Dissociation is associated with chronic trauma exposure and may be an important factor in understanding the risk for psychiatric outcomes associated with inflammation. The main objective of the current study was to understand how CRP was related to trauma, dissociation, PTSD and MDD in a sample of 55 traumatized African American women with type 2 diabetes mellitus recruited from an urban hospital.MethodHigh sensitivity CRP (hsCRP) was assayed through blood samples; psychiatric disorders were assessed with structured clinical interviews, dissociation was assessed with the Multiscale Dissociation Inventory, and exposure to trauma in childhood and adulthood was assessed with the Childhood Trauma Questionnaire and the Traumatic Events Inventory, respectively.ResultsCorrelational results showed a significant association between higher concentrations of hsCRP and child abuse (p < 0.05), overall dissociation severity (p < 0.001), and PTSD symptoms (p < 0.01). ANOVA results showed significantly higher levels of hsCRP in those with current MDD, current PTSD, and remitted PTSD. A hierarchical linear regression model demonstrated a significant association between dissociation symptoms and greater hsCRP levels independent of childhood abuse, PTSD, and MDD (R²∆ = 0.11, p = 0.001) and independent of emotion dysregulation (p < 0.05).ConclusionThese findings suggest that dissociation symptoms among those with a history of trauma may be particularly associated with higher levels of inflammation.     

The contributions of self-reported injury characteristics and psychiatric symptoms to cognitive functioning in OEF/OIF veterans with mild traumatic brain injury

Mild traumatic brain injury (mTBI) affects a significant number of combat veterans returning from Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF). Although resolution of mTBI symptoms is expected over time, some individuals continue to report lingering cognitive difficulties. This study examined the contributions of self-reported mTBI injury characteristics (e.g., loss of consciousness, post-traumatic amnesia) and psychiatric symptoms to both subjective and objective cognitive functioning in a sample of 167 OEF/OIF veterans seen in a TBI clinic. Injury characteristics were not associated with performance on neuropsychological tests but were variably related to subjective ratings of cognitive functioning. Psychiatric symptoms were highly prevalent and fully mediated most of the relationships between injury characteristics and cognitive ratings. This indicates that mTBI characteristics such as longer time since injury and loss of consciousness or post-traumatic amnesia can lead to increased perceived cognitive deficits despite having no objective effects on cognitive performance. Psychiatric symptoms were associated with both cognitive ratings and neuropsychological performance, illustrating the important role that psychiatric treatment can potentially play in optimizing functioning. Finally, subjective cognitive ratings were not predictive of neuropsychological performance once psychiatric functioning was statistically controlled, suggesting that neuropsychological assessment provides valuable information that cannot be gleaned from self-report alone.     

Psychometric evaluation of the alcohol use disorders identification test and short drug abuse screening test with psychiatric patients in India

BACKGROUND: The Alcohol Use Disorders Identification Test (AUDIT) and the short Drug Abuse Screening Test (DAST-10) are brief self-report screens for alcohol and drug problems that have not been evaluated for use with psychiatric patients in developing countries. This study was designed to evaluate the factor structure, reliability, validity, and utility of the AUDIT and the DAST-10 in an Indian psychiatric hospital. METHOD: Consecutive inpatient admissions from April to December 2001 were sampled. Patients were diagnosed with substance use disorders or psychiatric disorders according to ICD-10 criteria. All patients completed both the AUDIT and the DAST-10 during their intake evaluation. RESULTS: Of the 2286 admissions to the hospital, 1349 were enrolled in the study (30% women); 361 patients (27%) had primary substance use disorders and 988 patients (73%) had primary psychiatric disorders. Both the AUDIT and the DAST-10 were unidimensional and internally consistent. Total scores significantly differentiated the subsamples with primary substance use from those with primary psychiatric disorders (p <.0001). Using cutoff scores of >/= 8 on the AUDIT and >/= 3 on the DAST-10, only 10% (N = 100) of the psychiatric subsample exceeded either cutoff, whereas 99% (N = 358) of the addiction treatment subsample exceeded 1 or both cutoffs. Within the psychiatric subsample, 77% (N = 65) of the patients who were identified as high risk on the AUDIT did not receive an additional alcohol use disorder diagnosis at discharge, and 59% (N = 16) of those identified as high risk on the DAST-10 did not receive an additional discharge diagnosis of drug use disorder. CONCLUSION: The AUDIT and the DAST-10 demonstrate strong psychometric properties when used in an Indian psychiatric hospital. Routine use of these brief screens can facilitate detection of substance use disorders among psychiatric patients.     

Why do we climb mountains? An exploration of features of behavioural addiction in mountaineering and the association with stress-related psychiatric disorders

Common knowledge implies that individuals engaging in outdoor sports and especially in regular and extreme mountaineering are exceptionally healthy and hardened. Physical activity in outdoor environments has a positive effect on physical and mental health. However, regular and/or extreme mountaineering might share similarities with behavioural addictions and could thus also have a negative impact on health. In this cross-sectional web-based questionnaire study, we collected data on exercise and mountaineering addiction (Exercise Addiction Inventory; original and adapted version for mountaineering; Exercise Dependence Scale adapted version for mountaineering). Further surveyed parameters included mountaineering habits, Risk-Taking Inventory, Sensation-Seeking/Emotion Regulation/Agency Scale (SEAS), resilience, self-perceived stress, physical activity in metabolic units and mental health. Comparisons were performed between individuals with symptoms of addiction to mountaineering (MA) and individuals without symptoms of addiction to mountaineering or sports in general (CO) using non-parametric analyses. We analysed data from 335 participants, n = 88 thereof with addiction to mountaineering (MA) and n = 247 control participants (CO). The MA group scored significantly higher with regards to self-perceived stress (p < 0.001) and included a significantly higher number of individuals affected by symptoms of depression (p < 0.001), symptoms of anxiety (p < 0.001), symptoms of eating disorders (p < 0.001), alcohol abuse or dependence (p < 0.001), illicit drug abuse (p = 0.050), or current and history of psychiatric disorders (p < 0.001). Individuals with MA showed higher values in all SEAS subscales as well as increased risk-taking (p < 0.001). Regular and extreme mountaineering can display features of a behavioural addiction and is associated with psychiatric disorders. Behavioural addiction in mountaineering is associated with higher levels of sensation-seeking, emotion regulation, and agency, as well as increased risk-taking.

     

Repetitive Transcranial Magnetic Stimulation for Depression and Posttraumatic Stress Disorder in Veterans With Mild Traumatic Brain Injury

ObjectivesMild traumatic brain injury (mTBI) is a signature injury of military conflicts and is prevalent in veterans with major depressive disorder (MDD) and posttraumatic stress disorder (PTSD). Although therapeutic transcranial magnetic stimulation (TMS) can reduce symptoms of depression and PTSD, whether traumatic brain injury (TBI) affects TMS responsiveness is not yet known. We hypothesized mTBI would be associated with higher pretreatment symptom burden and poorer TMS response.Materials and MethodsWe investigated a registry of veterans (N = 770) who received TMS for depression across the US Veterans Affairs system. Of these, 665 (86.4%) had data on TBI and lifetime number of head injuries while 658 had complete data related to depression outcomes. Depression symptoms were assessed using the nine-item Patient Health Questionnaire and PTSD symptoms using the PTSD Checklist for DSM-5. Linear mixed effects models and t-tests evaluated whether head injuries predicted symptom severity before treatment, and how TBI status affected clinical TMS outcomes.ResultsOf the 658 veterans included, 337 (50.7%) reported previous mTBI, with a mean of three head injuries (range 1–20). TBI status did not predict depressive symptom severity or TMS-associated changes in depression (all p’s > 0.1). TBI status was associated with a modest attenuation of TMS-associated improvement in PTSD (in patients with PTSD Checklist for DSM-5 scores > 33). There was no correlation between the number of head injuries and TMS response (p > 0.1).ConclusionsContrary to our hypothesis, presence of mTBI did not meaningfully change TMS outcomes. Veterans with mTBI had greater PTSD symptoms, yet neither TBI status nor cumulative head injuries reduced TMS effectiveness. Limitations include those inherent to retrospective registry studies and self-reporting. Although these findings are contrary to our hypotheses, they support the safety and effectiveness of TMS for MDD and PTSD in patients who have comorbid mTBI.     

Temperament and character profiles are associated with depression outcome in psychiatric secondary care patients with harmful drinking

BackgroundTemperament and character profiles have been associated with depression outcome and alcohol abuse comorbidity in depressed patients. How harmful alcohol use modifies the effects of temperament and character on depression outcome is not well known. Knowledge of these associations could provide a method for enhancing more individualized treatment strategies for these patients.MethodsWe screened 242 depressed patients with at least moderate level of depressive symptoms. The Alcohol Use Disorders Identification Test (AUDIT) was used for identifying patients with marked alcohol use problems (AUP, AUDIT≥11). After 6 weeks of antidepressive treatment 173 patients were assessed using the Montgomery-Åsberg Depression Rating Scale (MADRS), and the Temperament and Character Inventory (TCI-R). Outcome of depression (MADRS scores across three follow-up points at 6 weeks, 6 months and 24 months) was predicted with AUP, gender, and AUP x Gender and AUP x Time interactions together with temperament and character dimension scores in a linear mixed effects model.ResultsPoorer outcome of depression (MADRS scores at 6 weeks, 6 months and 24 months) was predicted by AUP × Time interaction (p = 0.0002) together with low Reward Dependence (p = 0.003). Gender and all other temperament and character traits were non-significant predictors of the depression outcome in the mixed effects model.ConclusionsPossibly due to the modifying effect of alcohol use problems, high Reward Dependence was associated with better depression treatment outcome at 6 months. Harm Avoidance and Self-Directedness did not predict depression outcome when alcohol use problems were controlled.     

Brief Interventions for Patients Presenting to the Psychiatric Emergency Service (PES) with Major Mental Illnesses and At-risk Drinking

The presentation for care in psychiatric emergency setting provides an opportunity to assist individuals with mental health disorders and problems related to alcohol use. The purpose of this pilot study was to determine whether clinician-administered brief alcohol interventions are effective in reducing alcohol consumption in patients who screen positive for at-risk drinking in the psychiatric emergency setting. A total of 390 PES patients were screened; 87 (schizophrenia/bipolar disorder, n = 34; depression/anxiety, n = 53) met criteria for the study and received a brief alcohol intervention. Both groups dropped their drinking by ~7 drinks/week over the 6-months of the study (P < .05). The results of this study suggest that individuals with mental illnesses who drink at risk levels may benefit from a short, targeted brief alcohol intervention directed at changing their alcohol-related behavior and that, delivery of these interventions is feasible in a psychiatric emergency setting.     

Alcohol and its relationship to offence variables in a cohort of offenders with intellectual disability

Abstract

Background Alcohol use and misuse may be lower in people with intellectual disability (ID) than in the general population but may be related to offending.

Method Alcohol-related crime and history of alcohol use was recorded in 477 participants with ID referred to forensic ID services and related to offending.

Results Level of alcohol-related crime and history of alcohol misuse was lower than in some previous studies at 5.9% and 20.8%, respectively. History of alcohol abuse was associated with alcohol-related offences and theft. Higher rates of alcohol problem history were associated with histories of a number of offences, psychiatric disturbance in adulthood, psychiatric disturbance in childhood, and experiences of childhood adversity. Most effect sizes were weak or moderate.

Conclusions The convergence of childhood adversity, psychiatric problems in childhood and adulthood, and alcohol abuse is consistent with studies that have found these as risk markers for offending.     

An open-label trial of duloxetine in patients with irritable bowel syndrome and comorbid generalized anxiety disorder

Objective. Irritable bowel syndrome (IBS) is commonly comorbid with generalized anxiety disorder (GAD). We evaluated whether duloxetine would lead to improvement in symptoms and quality of life in patients with both conditions. Method. A 12-week, open-label trial of duloxetine was conducted in 13 subjects with IBS and GAD. The primary outcome measure was the Clinical Global Impression (CGI) Scale. Secondary measures included the Hamilton Anxiety Rating Scale, IBS Quality of Life (IBS-QOL) Scale, and IBS Symptom Severity Scale (IBS-SSS). Results. Repeated measures ANOVA was used to examine the effect of treatment with duloxetine on ratings of anxiety and IBS. Significant improvement was observed on the CGI-Improvement (F = 14.19, df = 1,12, p < 0.001) and Severity scales (F = 16.16, df = 1,12, p < 0.001). Secondary measures revealed significant reduction in symptoms of anxiety (F = 11.66, df = 1,12, p < 0.01), η_p² = 0.56, and IBS-SSS (F = 6.05, df = 1,12, p < 0.001), η_p² = 0.34, in addition to IBS-QOL improvements (F = 11.66, df = 1,12, p < 0.01), η_p² = 0.56. Conclusion. Results of this pilot study support the efficacious use of duloxetine in comorbid IBS and GAD. Participants reported significant reductions in IBS components, as well as improvement in GAD.     

Risky use and misuse of alcohol and cigarettes in psychiatric inpatients: a screening questionnaire study

BackgroundMental disorders are associated with an increased prevalence of substance use disorders (SUDs). Despite this comorbidity being firmly established, alcohol and nicotine risky use and misuse are not routinely and systematically assessed in clinical practice.ObjectiveThe aim of this study is to examine the prevalence of risky use of alcohol, alcohol use disorder (AUD), smoking, and nicotine use disorder in people with psychiatric diagnoses and their association with age, gender, and occupational functioning.MethodParticipants were 210 patients from an inpatient psychiatric ward. Three self-reporting questionnaires were used: the Alcohol Use Disorders Identification Test (AUDIT), the Lübeck Alcoholism Screening Test (LAST), and the Fagerström Test for Nicotine Dependence (FTND).ResultsRisky alcohol use or AUD was found in more than one third of patients and was more common in males than in females (p < 0.01) and in young people as compared to older adults (p = 0.04). Current nicotine consumption concerned over a half participants and was significantly associated with risky alcohol use and AUD (p < 0.01). Patients with current SUD had the highest prevalence of both smoking (80%) and alcohol misuse (80%). Low occupational functioning was associated with both alcohol use (p = 0.02) and concurrent alcohol and SUDs (p = 0.03).ConclusionsBoth alcohol and nicotine risky use and misuse are highly prevalent in people with psychiatric disorders and their concurrent abuse is common. The simultaneous use of different screening questionnaires allows the identification not only of people with frank use disorders, but also those with harmful use, facilitating early detection of people at risk.     

Apolipoprotein E (APOE) ε4 genotype is associated with reduced neuropsychological performance in military veterans with a history of mild traumatic brain injury

Introduction: The purpose of this study was to investigate the effect of the apolipoprotein E (APOE) ε4 allele on neuropsychological functioning in military Veterans with a remote history of mild traumatic brain injury (mTBI).

Method: This cross-sectional study included 99 Veterans (mTBI = 53; military controls, MC = 46) who underwent neuropsychological assessment and APOE genotyping. Three neurocognitive composite scores—memory (α = .84), speed (α = .85), and executive functioning (α = .76)—were computed from 24 norm-referenced variables, and the total number of impaired scores (>1.5 SDs below mean) for each participant was calculated.

Results: Analyses of covariance adjusting for ethnicity and posttraumatic stress disorder (PTSD) symptoms revealed that although no significant differences were observed between mTBI ε4 allele groups on the executive functioning composite (p > .05), mTBI ε4+ Veterans performed more poorly than ε4? Veterans on the memory (p = .045, η_p² = .083) and speed (p = .023, η_p² = .106) composites. Furthermore, Mann–Whitney U tests showed that ε4+ mTBI Veterans displayed a significantly greater number of impaired scores than did ε4? mTBI Veterans (p = .010, r = .355). In contrast, there were no significant differences across any of the cognitive variables between ε4+ and ε4? MCs (all p > .05).

Conclusions: Results suggest that APOE ε4 genotype is related to reduced memory and processingspeed performance, as well as overall cognitive impairment, in those with a history of mTBI, but does not appear to have the same negative effects on cognition in the absence of neurotrauma. Although results are preliminary, the present study advances understanding of genetic influences on cognitive functioning in Veterans with remote mTBIs. Future longitudinal work is needed to elucidate the underlying brain-based mechanisms of ε4 allelic effects on cognitive and clinical outcomes following TBI.