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Alcohol dependence is a chronic disorder with frequent relapses. Even the most motivated individuals have difficulties in maintaining abstinence, and require pharmacotherapy, apart from psychotherapy. Current anti-craving medications (acamprosate, naltrexone, nalmefene, disulfiram) have only limited efficacy. The present paper aims to review both the agents developed within the last 10 years (novel opioid and vasopressin antagonist, dopamine, cannabinoid, glucocorticoid and orexin receptors modulators) and the drugs already prescribed for other uses (anticonvulsants, muscle relaxants, antihypertensives, antiemetics, and even neuroimmune modulators and antiparasitic drugs), which were proven beneficial for controlling heavy drinking. RezumatDependența alcoolică este o patologie cronică, recăderile fiind frecvente. Chiar și indivizii motivați mențin cu dificultate abstinența, necesitând psihoterapie, dar și terapie medicamentoasă. Medicația anti-craving actuală (acamprosat, naltrexonă, nalmefen, disulfiram) are eficacitate limitată. Prezentul articol își propune o trecere în revistă a compușilor descoperiți în ultimii 10 ani (noi antagonişti opioizi şi de vasopresină, modulatori ai sistemelor dopaminergic, canabinoid, corticoid şi orexinic), dar și a medicamentelor utilizate deja în practica clinică cu alte indicații (anticonvulsivante, antiparazitare, miorelaxante, antihipertensive, antiemetice şi chiar modulatoare neuroimune), care s-au dovedit utile în controlul consumului de alcool.

IntroductionThe core features of Borderline Personality Disorder (BPD), such as deliberate self-harm, suicide attempts and demandingness in interpersonal relationships persist with age, even though impulsivity decreases. Impairing progressive disease combined with affective instability and chronic feelings of emptiness can lead to a desire for death.ObjectivesTo present a case of BPD with severe chronic endocrine pathology and liver cirrhosis who refused to take his treatment as prescribed.MethodsA case report is presented and discussed.ResultsWe report the case of a 61-year-old man with BPD and liver cirrhosis, complex endocrine pathology (pituitary adenoma, diabetes insipidus and primary hypothyroidism), type 2 diabetes mellitus with insulin therapy, essential hypertension and alcohol use disorder. He had a history of 5 suicide attempts caused by marked feelings of rejection and emptiness and a pattern of unstable relationships and lack of commitment, thus his marriage lasted only 2 years. He idealized and was extremely familiar with his clinician and displayed marked affective instability (dysphoria, periods of anger and despair, affective ambivalence towards his parents and recurrent depressive symptoms). Because of his liver disease, the psychotropic medication was ceased by his physician. The patient refused to follow the rest of his treatment plan and diet as prescribed, resulting in the deterioration of his somatic status. The patient denied an active suicidal ideation, but did not explain his non-compliance.ConclusionThe impairment from BPD and the risk of suicide persist even in older age affecting the outcome of co-morbid somatic conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Contrary to the stigmatizing perception, alcohol dependence is not a mark of moral decay, but the result of combining environmental, social, cultural and especially biological factors, family studies finding that about 50% of the risk is due to heredity. Genetic linkage and association studies have failed to identify significant risk alleles, except for the alcohol-metabolizing enzyme genes. Thus, a new approach was needed - genome wide association studies (GWAS) that do not depend on a pre-existing hypothesis and highlighted new polymorphisms associated with susceptibility to alcoholism. A review of family, twin, linkage, candidate genes and GWAS will be briefly presented.