The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women

BACKGROUND: Patterns of comorbidity suggest that the common psychiatric and substance use syndromes may be divisible into 2 broad groups of internalizing and externalizing disorders. We do not know how genetic and environmental risk factors contribute to this pattern of comorbidity or whether the etiologic structure of these groups differ in men and women. METHODS: Lifetime diagnoses for 10 psychiatric syndromes were obtained at a personal interview in more than 5600 members of male-male and female-female twin pairs ascertained from a population-based registry. Multivariate twin modeling was performed using the program Mx. RESULTS: We first fit models to the following 7 syndromes: major depression, generalized anxiety disorder, phobia, alcohol dependence, drug abuse/dependence, adult antisocial behavior, and conduct disorder. The full model, which could be constrained to equality in male and female subjects, identified 2 genetic factors. The first had strongest loadings on alcohol dependence, drug abuse/dependence, adult antisocial behavior, and conduct disorder; the second, on major depression, generalized anxiety disorder, and phobia. Alcohol dependence and drug abuse/dependence had substantial disorder-specific genetic risk factors. Shared environmental factors were most pronounced for conduct disorder and adult antisocial behavior. No clear internalizing/externalizing structure was seen for the unique environmental common factors. We then fit models to 5 internalizing syndromes. The full model, which could also be constrained to equality in men and women, revealed one genetic factor loading most heavily on major depression and generalized anxiety disorder and another loading most strongly on animal and situational phobia. CONCLUSIONS: The underlying structure of the genetic and environmental risk factors for the common psychiatric and drug abuse disorders in men and women is very similar. Genetic risk factors predispose to 2 broad groups of internalizing and externalizing disorders. Within the internalizing disorders, 2 genetic factors are seen that predispose to disorders dominated by anxious-misery and fear. Substance use disorders have disorder-specific genetic risks. The externalizing disorders of conduct disorder and adult antisocial behavior are significantly influenced by the shared environment. The pattern of lifetime comorbidity of common psychiatric and substance use disorders results largely from the effects of genetic risk factors.     

Comorbidité des troubles anxieux avec l’alcoolisme

Alcohol dependence entrains psychological, physiological and toxic factors. Anxiety, depression and other emotional disorders may be a cause or a consequence of alcohol dependence. Although alcohol is known to have anxiolytic and anti-phobic properties, alcoholic patients have a higher prevalence of developing anxiety disorders. A prevalence of panic disorders is higher in an alcoholic population and similarly alcohol dependence is higher in a population suffering from panic disorders. The association of alcohol dependence with depression in panic disorders increases suicidal risks and ideation. The prevalence of alcohol dependence is also higher in phobias and OCD. Alcohol dependence and anxiety disorders seem to be genetically associated: Anxiety disorders are greater in first degree family members of alcoholic patients. Alcohol dependence can be a cause or a consequence of anxiety disorders; simple, social phobias and agoraphobias usually precede alcoholism, while GAD occurs simultaneously with it. Depending on dose intake alcohol can reduce or increase anxiety by causing a dysfunction of the neurotransmission of GABA, glutamate and noradrenalin receptors. Alcohol intake can have euphoric or depressive effects, depending on dose intake, psychological characteristics and patients’ expectations.     

Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions

OBJECTIVE: The purpose of this study was to provide nationally representative data on the prevalence, sociodemographic correlates, and comorbidity of antisocial syndromes across alcohol and 8 specific drug use disorders, including sedative, tranquilizer, opiate, stimulant, hallucinogen, cannabis, cocaine, and inhalant/solvent abuse and dependence. METHOD: This study is based on a nationally representative sample of adults. Lifetime prevalences of antisocial syndromes were estimated and logistic regression analyses were used to examine associations between antisocial syndromes and sociodemographic characteristics and substance use disorders. Diagnoses were made according to the criteria of the DSM-IV using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: The lifetime prevalences of antisocial personality disorder (APD), conduct disorder, and adult antisocial behavior were 3.6%, 1.1%, and 12.3%, respectively. Prevalences of alcohol use disorders and drug use disorders were 30.3% and 10.3%, respectively. In general, men and individuals who were younger, widowed/separated/divorced, of lower socioeconomic status, and living in urban areas or in the West were more likely to have antisocial syndromes. Native Americans were more likely and Asians and Hispanics were less likely to have APD and adult antisocial behavior. Virtually all of the associations between APD and adult antisocial behavior and specific substance use disorders were positive and statistically significant (p < .05). Significant associations between conduct disorder and substance use disorders were concentrated among women. CONCLUSION: Comorbidity of specific substance disorders with antisocial syndromes is very common in the U.S. population. Further work in many directions is indicated by the results of this study, including the factors that give rise to the associations and the treatment and prevention implications of these conditions when comorbid.     

An epidemiological survey of alcohol use disorders in a Tibetan population

We performed an epidemiological survey in order to detect the prevalence of alcohol use disorders in a sub-group of the population of Tibet. The Alcohol Use Disorders Identification Test (AUDIT) questionnaire, the Severity of Alcohol Dependence Questionnaire (SADQ), and a 12-item version of the General Health Questionnaire (GHQ12) were used to obtain epidemiological data on alcohol use disorders and to assess the severity of ‘problem drinking’ and general mental health status. The AUDIT is a reliable and valid screening tool for both alcohol abuse and dependence in the Tibetan population to identify individuals with alcohol use problems. The cut-off points were set to be 10 and 13 of the AUDIT scores as a diagnostic discriminator of alcohol abuse and alcohol dependence, respectively, with both sensitivity and specificity > 0.84. The prevalence of alcohol abuse, was 2.7% (female: 2.0%; male: 6.2%), alcohol dependence 13.5% (female: 7.6%; male: 25.4%) and alcohol use disorders 16.2% (female: 9.6%; male: 31.6%). Age and sex were the main factors affecting an individual's alcohol use and general mental health status. The epidemiological data on alcohol use disorders documented in this project may be helpful in future work seeking more valid causal inferences or interpretations related to this prevalent health problem in Tibet.     

Lifetime prevalence of specific mental disorders among people born in Iceland in 1931

The lifetime prevalence rates are presented for mental disorders in a random sample of people born in Iceland in 1931, interviewed at the age of 55-57 years. The diagnoses are made according to DSM-III, on the basis of the National Institute of Mental Health's diagnostic Interview Schedule (NIMH-DIS) used by trained lay interviewers. The most common diagnoses were alcohol abuse and dependence, generalized anxiety disorder, phobic disorders, dysthymic disorder and major depressive episode. Disorders more common in men were antisocial personality, alcohol abuse and alcohol dependence. Disorders more common among women were major depressive episode and generalized anxiety disorder. Alcohol abuse was more prevalent among those living in rural areas, but dependence was more prevalent in the urban area, where panic disorder is also more frequent. Widowed, separated and divorced people had most of the highest prevalences: tobacco-use disorder, alcohol abuse and dependence, dysthymia and generalized anxiety disorder. Except for a very high rate of alcohol abuse and dependence and a low rate of substance abuse disorders, the prevalence rates are similar to those obtained in North American studies using the NIMH-DIS as a survey instrument. The DSM-III criteria for alcohol abuse or dependence may be less applicable to Iceland than to North America, because of differences in what is culturally regarded as acceptable use of alcohol.     

Characteristics of suicide attempts preceded by alcohol consumption.

Acute alcohol ingestion and alcohol dependence are known to increase the risk of impulsive suicide attempt even in non-depressed patients. The relation between alcohol and suicide risk needs, however, to be clarified. We assessed for this purpose prevalence of recent alcohol intake among suicide attempters and compared suicide attempts preceded ("Alcohol + ") or not by alcohol intake. We included 160 patients examined in the emergency service of a French general hospital after a suicide attempt. Psychiatric disorders were identified according to the DSM-IV criteria. Patients were rated for depression and alcohol use disorder (MAST). Prevalence of alcohol consumption was 40%. Patients from the "Alcohol + " group were significantly older (40 versus 34.8 years, p = 0.03). Alcohol abuse was more frequent among suicide attempters with prior alcohol ingestion (49% versus 12%,). Alcohol dependence was also more frequent in the "Alcohol + " group (43% versus 9%). Patients from the "Alcohol + " group drank more alcohol each day (6.1 versus 1.3 drinks) and more often during the week (3.6 days per week versus 1.4). They had a higher number of alcohol intoxications each week (0.9 versus 0.3). They drank more often alone (41% versus 12%, p < 0.005) and in the morning (21% versus 3%). They had higher scores on the Michigan Alcohol Screening test (14.8 versus 2.9). Prevalence of drug dependence was higher in the "Alcohol + " group (21% versus 3%, respectively). Suicide attempts must be asked about their recent alcohol intake. This alcohol intake is often the symptom of an alcohol abuse or dependence disorder.     

Alcohol and Marijuana: Effects on Epilepsy and Use by Patients with Epilepsy

We review the safety of alcohol or marijuana use by patients with epilepsy. Alcohol intake in small amounts (one to two drinks per day) usually does not increase seizure frequency or significantly affect serum levels of antiepileptic drugs (AEDs). Adult patients with epilepsy should therefore be allowed to consume alcohol in limited amounts. However, exceptions may include patients with a history of alcohol or substance abuse, or those with a history of alcohol-related seizures. The most serious risk of seizures in connection with alcohol use is withdrawal. Alcohol withdrawal lowers the seizure threshold, an effect that may be related to alcohol dose, rapidity of withdrawal, and chronicity of exposure. Individuals who chronically abuse alcohol are at significantly increased risk of developing seizures, which can occur during withdrawal or intoxication. Alcohol abuse predisposes to medical and metabolic disorders that can lower the seizure threshold or cause symptoms that mimic seizures. Therefore, in evaluating a seizure in a patient who is inebriated or has abused alcohol, one must carefully investigate to determine the cause. Animal and human research on the effects of marijuana on seizure activity are inconclusive. There are currently insufficient data to determine whether occasional or chronic marijuana use influences seizure frequency. Some evidence suggests that marijuana and its active cannabinoids have antiepileptic effects, but these may be specific to partial or tonic-clonic seizures. In some animal models, marijuana or its constituents can lower the seizure threshold. Preliminary, uncontrolled clinical studies suggest that cannabidiol may have antiepileptic effects in humans. Marijuana use can transiently impair short-term memory, and like alcohol use, may increase noncompliance with AEDs. Marijuana use or withdrawal could potentially trigger seizures in susceptible patients.     

The impact of substance abuse on the course of bipolar disorder.

BACKGROUND: Substance abuse occurs at high rates in bipolar disorder. The reasons for this co-occurrence are unknown. Alcohol use disorders have been associated with both earlier and later age of onset of bipolar disorder, in part based on the temporal associations of the two conditions. Both drug and alcohol use disorders are associated with impaired outcome of bipolar illness. This influence may involve both direct effects of alcohol or drugs on the initiation of affective symptoms and indirect effects on treatment compliance. To extend these previous findings we examined the temporal associations of substance abuse and affective symptoms in patients with new onset bipolar disorder. METHODS: Associations between affective symptoms and alcohol and cannabis use disorder symptoms were evaluated using regression and time-series correlative methods in 50 new-onset bipolar patients. RESULTS: The duration of alcohol abuse during follow-up was associated with the time patients experienced depression. The duration of cannabis abuse was associated with the duration of mania. Several subgroups could be identified with different temporal relationships among these disorders. CONCLUSIONS: Although the relationships among substance use and bipolar disorders are complex, systematic study of the courses of the disorders might clarify how these conditions interact longitudinally. As the numbers of subjects in specific subgroups are relatively small in this study, these results should be considered preliminary.     

Effects of co-occurring alcohol abuse on the course of bipolar disorder following a first hospitalization for mania

CONTEXT: Alcohol-use disorders are common co-occurring conditions affecting bipolar patients, and this co-occurrence is negatively associated with outcome. OBJECTIVE: The primary goal of this study was to identify how the relative onsets of alcohol-use and bipolar disorders affect the subsequent courses of illness in patients with both conditions. DESIGN AND SETTING: Inception cohort at an academic medical center. PATIENTS: Patients meeting criteria for type I bipolar disorder, manic or mixed, with ages of 12 to 45 years, no prior hospitalizations, and minimal prior treatment. We enrolled 144 subjects who were followed up for up to 5 years, including 27 subjects in whom the onset of an alcohol-use disorder preceded the onset of bipolar disorder (Alcohol First), 33 subjects in whom bipolar disorder onset preceded or was concurrent with the onset of alcohol abuse (Bipolar First), and 83 subjects with bipolar disorder only (No Alcohol). MAIN OUTCOME MEASURES: Symptomatic recovery and recurrence of both conditions and percentage of follow-up with affective episodes and affective and alcohol-use disorder symptoms. RESULTS: The Alcohol First group was older and more likely to recover and recover more quickly than the other groups. Affective symptomatic recurrence curves were similar among groups. The Bipolar First group spent more time with affective episodes and symptoms of an alcohol-use disorder during follow-up than the Alcohol First group. Hospitalization was associated with a period of decreased alcohol abuse, although recurrence of the alcohol-use disorder was common. CONCLUSIONS: The relative age at onset of alcohol-use and bipolar disorders is associated with differences in the course of both conditions. A first hospitalization for mania is associated with a period of recovery from comorbid alcohol abuse, suggesting this posthospital time may provide an opportunity to treat this co-occurring condition.     

Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

CONTEXT: Epidemiologic information is important to inform etiological research and service delivery planning. However, current information on the epidemiology of alcohol use disorders in the United States is lacking. OBJECTIVES: To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, and treatment of DSM-IV alcohol abuse and dependence. Design, Setting, and PARTICIPANTS: Face-to-face interviews with a representative US adult sample (N = 43 093). MAIN OUTCOME MEASURES: Lifetime and 12-month DSM-IV alcohol abuse and dependence. RESULTS: Prevalence of lifetime and 12-month alcohol abuse was 17.8% and 4.7%; prevalence of lifetime and 12-month alcohol dependence was 12.5% and 3.8%. Alcohol dependence was significantly more prevalent among men, whites, Native Americans, younger and unmarried adults, and those with lower incomes. Current alcohol abuse was more prevalent among men, whites, and younger and unmarried individuals while lifetime rates were highest among middle-aged Americans. Significant disability was particularly associated with alcohol dependence. Only 24.1% of those with alcohol dependence were ever treated, slightly less than the treatment rate found 10 years earlier. Strong associations between other substance use disorders and alcohol use disorders (odds ratios, 2.0-18.7) were lower but remained strong and significant (odds ratios, 1.8-7.5) when controlling for other comorbidity. Significant associations between mood, anxiety, and personality disorders and alcohol dependence (odds ratios, 2.1-4.8) were reduced in number and magnitude (odds ratios, 1.5-2.0) when controlling for other comorbidity. CONCLUSIONS: Alcohol abuse and dependence remain highly prevalent and disabling. Comorbidity of alcohol dependence with other substance disorders appears due in part to unique factors underlying etiology for each pair of disorders studied while comorbidity of alcohol dependence with mood, anxiety, and personality disorders appears more attributable to factors shared among these other disorders. Persistent low treatment rates given the availability of effective treatments indicate the need for vigorous education efforts for the public and professionals.     

Psychiatric complications of alcoholism: alcohol withdrawal syndrome and other psychiatric disorders

Alcohol withdrawal syndrome is an acute condition secondary to total or partial reduction of alcohol consumption, characterized by self limited signs and symptoms and different degrees of severity. It can be complicated by several clinical and/or other psychiatric related problems. The objective of this article is to review the most important psychiatric complications to alcohol withdrawal syndrome as well as other psychiatric disorders associated with alcohol dependence as Wernicke Korsakoff and Marchiava Bignami syndromes. We aim to promote early diagnosis and treatment of these conditions, minimizing morbidity and mortality associated with them.     

Prospective analysis of the relation between DSM-III anxiety disorders and alcohol use disorders.

OBJECTIVE: Cross-sectional studies show a robust association between anxiety disorders and alcohol use disorders (comorbidity); however, this methodology does not allow for the testing of causal models. The authors attempted to overcome this limitation by examining comorbid relationships prospectively. METHOD: Male and female college students were assessed as freshmen (year 1), and then again at years 4 and 7, for selected 12-month anxiety disorders (generalized anxiety disorder, agoraphobia, and social phobia or panic) diagnosed according to the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and DSM-III and for 12-month DIS/DSM-III alcohol use disorders (alcohol dependence alone and alcohol abuse or dependence). RESULTS: Cross-sectionally, the odds of having either an anxiety disorder or an alcohol use disorder were two- to fivefold greater when the other condition was present. Prospectively, the odds of developing a new alcohol dependence diagnosis at year 7 increased from 3.5 to five times for those diagnosed with an anxiety disorder at years 1 or 4. Conversely, the odds of developing a new anxiety disorder at year 7 increased by about four times for those diagnosed with alcohol dependence at years 1 or 4. When alcohol abuse and dependence were combined, the pattern of findings was similar, albeit weaker. Multivariate path models provide similar results and highlight the reciprocal influence of alcohol use disorders and anxiety disorders. CONCLUSIONS: Alcohol use disorders (especially alcohol dependence) and anxiety disorders demonstrate a reciprocal causal relationship over time, with anxiety disorders leading to alcohol dependence and vice versa.     

Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, mood and anxiety disorders: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

The objective of this study was to present nationally representative findings on sociodemographic and psychopathologic predictors of first incidence of Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) substance, mood and anxiety disorders using the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. One-year incidence rates of DSM-IV substance, mood and anxiety disorders were highest for alcohol abuse (1.02), alcohol dependence (1.70), major depressive disorder (MDD; 1.51) and generalized anxiety disorder (GAD; 1.12). Incidence rates were significantly greater (P<0.01) among men for substance use disorders and greater among women for mood and anxiety disorders except bipolar disorders and social phobia. Age was inversely related to all disorders. Black individuals were at decreased risk of incident alcohol abuse and Hispanic individuals were at decreased risk of GAD. Anxiety disorders at baseline more often predicted incidence of other anxiety disorders than mood disorders. Reciprocal temporal relationships were found between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. Borderline and schizotypal personality disorders predicted most incident disorders. Incidence rates of substance, mood and anxiety disorders were comparable to or greater than rates of lung cancer, stroke and cardiovascular disease. The greater incidence of all disorders in the youngest cohort underscores the need for increased vigilance in identifying and treating these disorders among young adults. Strong common factors and unique factors appear to underlie associations between alcohol abuse and dependence, MDD and GAD, and GAD and panic disorder. The major results of this study are discussed with regard to prevention and treatment implications.     

Alcohol use disorders in geriatrics

Alcohol use disorders cause significant morbidity and mortality in the geriatric population. This review article begins with a hypothetical case for illustration, asking what the primary care physician could do for a geriatric patient with alcohol abuse over a course of four office visits. Various aspects of alcohol use disorders in the geriatric population are reviewed, such as range of alcohol use, epidemiology, medical/psychiatric impact, detection, comprehensive treatment planning, modalities of psychotherapy, medication management, and resources for clinicians/patients.     

Pilot study of interpersonal psychotherapy versus supportive psychotherapy for dysthymic patients with secondary alcohol abuse or dependence

Interpersonal psychotherapy (IPT) has demonstrated efficacy for depression but yielded negative results for substance disorders. Alcohol abuse frequently complicates mood disorders. This pilot study compared IPT with brief supportive psychotherapy (BSP) for dysthymic disorder and alcohol abuse. We hypothesized that effect sizes would suggest greater IPT efficacy for both diagnoses, despite limited statistical power. Subjects with primary DSM-IV dysthymic disorder and secondary alcohol abuse/dependence were randomly assigned 16 weeks of IPT (N = 14) or BSP (N = 12). Patients in both treatments reported improved depressive symptoms and alcohol abstinence. IPT had a large and BSP a moderate effect size in depression, whereas BSP had a moderate and IPT a small effect size in percentage of days abstinent. This pilot study offers initial data on IPT and BSP for comorbid chronic depression and alcohol abuse/dependence. Results suggest IPT may have specific antidepressant benefits for dysthymic alcoholic patients but not in treating alcoholism.     

Variables associated with alcohol, drug, and daily smoking cessation in patients with severe mental illnesses

BACKGROUND: Co-occurrence of substance use disorders and severe mental illnesses (SMIs) is a major U.S. public health issue, although the role of tobacco is usually neglected. This study explored variables associated with alcohol, drug, and smoking cessation in a naturalistic setting. METHOD: Logistic regression was used to study variables associated with cessation of alcohol and drug use disorder and daily smoking in 560 SMI inpatients and outpatients from central Kentucky facilities. Patients with a lifetime history of alcohol or drug use disorder were considered to be in cessation if they had not suffered from abuse or dependence during the last year. Alcohol and drug use disorder diagnoses were determined using the Clinician Rating of Alcohol and Drug Use Disorder. Patients were recruited from July 2000 to March 2003. RESULTS: The cessation rates for alcohol and drug use disorders were, respectively, 44% (95% CI = 39% to 49%) and 46% (CI = 40% to 51%); these were higher than the daily cigarette smoking cessation rate of 10% (CI = 7% to 13%). Drug use disorders (p < or = .02), outpatient status (p < .001), and having a medical complication of obesity (diabetes mellitus, hypertension, or hyperlipidemia; p < .001) were significantly associated with alcohol cessation. Alcohol use disorder (p < .001), starting treatment with psychiatric medications after 33 years of age (p < .001), taking these medications for 14 years or more (p = .02), schizophrenia diagnosis (p < .001), outpatient status (p = .03), and obesity (p = .04) were significantly associated with drug cessation. Cessation of daily smoking was associated with hypertension (p = .02), late start of treatment with psychiatric medications (> 33 years old; p = .01), and lack of lifetime drug abuse (p < .001). CONCLUSIONS: These results are limited by the cross-sectional and naturalistic design but suggest that public health experts, researchers, and clinicians need to mindfully address smoking cessation in patients with SMIs. Clinicians may want to consider that medical illnesses may motivate patients with SMIs to stop substance abuse and that patients with SMIs who abuse both alcohol and drugs rarely stop abusing just one of them.     

Cholinergic receptor system as a target for treating alcohol abuse and dependence

Alcohol dependence and other alcohol use disorders are major public health problems. Due to the limitations in efficacy with current medications for the management of alcohol abuse and dependence, there is a need for alterantive pharmacotherapies. Emerging preclinical and clinical data indicate that brain nicotinic acetylcholine receptors (nAChRs), a heterogeneous family of ion channels expressed in the mammalian brain, are critical targets for the development of pharmacotherapies for alcohol abuse and dependence. Evidence suggests that the effects of nAChR partial agonists and antagonists have promise for the management of alcohol dependence and other alcohol use disorders. The present review summarizes information on the most recent pharmacotherapies targeting nAChRs, including cytisine, sazetidine A, varenicline, lobeline mecamylamine, PF-4575180 and CP-601932, that are able to treat alcohol dependence. The role of α4β2*, α3β4* and/or other subtypes associated effects in reducing voluntary alcohol consumption or modulate alcohol drinking behavior in animal models and humans are reviewed. Patents discussed include those targeting α4β2* and α7 subtypes as well as cholinesterase inhibitors. Future research indicating the ability of nAChR based compounds to reduce alcohol consumption or modulate alcohol drinking behavior in preclinical and clinical studies, are also discussed.     

Alcohol, nicotine, caffeine, and mental disorders

Alcohol, nicotine, and caffeine are the most widely consumed psychotropic drugs worldwide. They are largely consumed by normal individuals, but their use is even more frequent in psychiatric patients, Thus, patients with schizophrenia tend to abuse all three substances. The interrelationships between depression and alcohol are complex. These drugs can all create dependence, as understood in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Alcohol abuse is clearly deleterious to the brain, provoking acute and chronic mental disorders, ranging from intoxication with impairment of cognition, to delirium tremens, halluosis, and dementia. In contrast, the main health consequences of nicotine, notably cancer and cardiovascular disases, lie outside the realm of psychiatry However, the mes of nicotine dependence and motivation to smoke or quit are of concern to psychiatrists.     

Suicidal behaviour in the elderly

In a retrospective study of 69 elderly (65 years and over) cases of attempted suicide (deliberate self-harm) referred for psychiatric assessment in southern Sydney, 81% of took overdoses, 64% involving benzodiazepines. Depressive illness was present in 87% of cases, alcohol/substance abuse in 32%, organic syndromes in 29% and personality dysfunction in 26%. Multiple psychosocial, psychological, medical and psychiatric risk factors for suicide were identified. ‘Major’ functional psychiatric disorders (41%) were found predominantly in females and were associated with higher levels of suicidal intent, psychosis and fewer chronic physical illnesses. ‘Minor’ functional disorders (30%) were associated with lower degrees of suicidal intent, personality dysfunction and higher numbers of psychosocial stressors. Organic brain syndromes were associated with males over 75 years, chronic physical illness, and were often comorbid with depression. These findings indicate that there are several patterns of suicidal behaviour in the elderly that require further prospective research.     

Transcription profiling reveals mitochondrial,ubiquitin and signaling systems abnormalities in postmortem brains from subjects with a history of alcohol abuse or dependence

Alcohol abuse is a common human disorder with high rate of comorbidity with other psychiatric disorders. To identify candidate mechanisms for alcohol abuse, the expression of 12,626 genes was measured in postmortem temporal cortex from 11 subjects with a history of alcohol abuse or dependence, with or without other psychiatric diagnoses and compared pairwise with the expression in 11 nonalcoholic subjects matched for the other psychiatric diagnoses and demographics. Genes were defined to have altered expression in alcohol abuse if: 1) the gene showed decreased expression in at least 10 of 11 subjects with alcohol abuse, or showed increased expression in at least 10 of 11 subjects with this diagnosis compared to matched non-abusers (P < 0.007, chi(2)test); or 2) the difference in the mean abuser/non-abuser ratio for the gene from value of 1.0 was significant at P < 0.05 (one sample t-test). In subjects with a history of alcohol abuse or dependence, 163 genes were changed significantly. The most abundant and consistent changes were in gene families encoding mitochondrial proteins, the ubiquitin system, and signal transduction. These alterations indicate disturbances in energy metabolism and multiple signaling mechanisms in the temporal cortex of subjects with a history of alcohol abuse or dependence. We hypothesize that these mechanisms may be related to alcohol abuse traits or long-term effects of alcohol.