The psychiatric management of patients with alcohol dependence

Ritvo, Jonathan I.; Park, Charles

doi:10.1007/bf02938545

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…Since anxiolytics are primary medications employed in alcohol detoxification regardless of gender, the use of antidepressants may be of added benefit. This contention is further supported by the fact that anxiolytics are effective in dampening the immediate autonomic hyperactivity following alcohol cessation whereas depression may be a lingering mood state that would facilitate later relapse (Carpenter and Hasin, 1999;Koob and Le Moal, 2004;Ritvo and Park, 2007).…”

Section: Discussionmentioning

confidence: 99%

Desipramine blocks alcohol-induced anxiety- and depressive-like behaviors in two rat strains☆

Getachew¹,

Hauser²,

Taylor³

et al. 2008

Pharmacology Biochemistry and Behavior

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Epidemiological studies indicate significant co-morbid expression of alcoholism, anxiety, and depression. These symptoms are often under-diagnosed and under-treated and can worsen prognostic and treatment outcome for alcoholism. Nonetheless, a causal relationship between alcoholism and these conditions is yet to be established. In this study we sought to determine the effects of daily alcohol administration on the indices of anxiety and depression in two rat strains, one of which exhibits inherent depressive-like characteristics. Moreover, it was of relevance to examine the effects of a clinically useful antidepressant on alcohol-induced behavioral changes. Wistar-Kyoto (WKY) rats derived from Wistar stock show low levels of locomotor activity in an open field and high levels of immobility in the forced swim test (FST) which is considered a measure of their helplessness and hence are considered a putative animal model of depression. Adult female WKY and Wistar rats were exposed for 3 hrs daily to 95% ethanol vapor to achieve a mean blood alcohol level (BAL) of approximately 150 mg/dL. Controls were exposed to air in similar inhalation chambers. Sixteen to 18 hrs following 7 or 14 days of exposure to alcohol, locomotor activity (LCA) in open field, duration of time spent in the open arm of the elevated plus-maze (EPM), reflective of anxiety-like behavior and immobility in FST were evaluated. Alcohol exposure for 7 or 14 days reduced LCA only in Wistar rats but enhanced FST immobility in both strains at both time points. Only 14 day alcohol exposure reduced EPM open arm time in both WKY and Wistar rats. Daily treatment with desipramine (8 mg/kg) blocked all the changes induced by alcohol in both strains. Thus, subchronic (7 day) exposure to alcohol induces depressive-like characteristics in Wistar rats and exacerbates that of WKY rats. Chronic (14 day) exposure, however, also induces an anxiety-like effect in both strains. The depressive-and anxietylike behaviors induced by alcohol were blocked by daily treatment with a tricyclic antidepressant. It may be suggested that prophylactic treatment of alcoholics with an antidepressant prior to detoxification may improve treatment outcome for alcoholism.

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Section: Discussionmentioning

confidence: 99%

Desipramine blocks alcohol-induced anxiety- and depressive-like behaviors in two rat strains☆

Getachew¹,

Hauser²,

Taylor³

et al. 2008

Pharmacology Biochemistry and Behavior

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“…However, a significant portion of those with AUD do not return to a chronically relapsing/remitting course after treatment (15–18), suggesting variable individual vulnerability to relapse. Psychological, psychiatric and sociodemographic correlates of relapse have been investigated in previous work (17, 19–28). However, the neurobiological underpinnings associated with relapse and sustained abstinence after treatment for AUD are not well understood.…”

Section: Introductionmentioning

confidence: 99%

Brain Morphology at Entry into Treatment for Alcohol Dependence Is Related to Relapse Propensity

Cardenas

Durazzo

Gaździński

et al. 2011

Biological Psychiatry

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Background We examined whether any differences in brain volumes at entry into alcohol dependence treatment differentiate subsequent Abstainers from Relapsers. Methods Individuals in alcohol dependence treatment (N=75) underwent magnetic resonance imaging approximately 6 ± 4 days after their last alcoholic drink, and 40 age-matched non-smoking light drinkers were studied as controls. At follow-up 7.8 ± 2.6 months later, 23 alcoholics (31%) had abstained from drinking and 52 (69%) had relapsed. Deformation morphometry compared Relapsers, Abstainers, and light drinkers. Results Compared to light drinkers, future Abstainers had smaller brain tissue volumes in the left amygdala, hippocampal head, and entorhinal cortex, and bilaterally in the thalamus and adjacent subcortical white matter (WM), and had larger volume in the left lateral orbitofrontal region. Compared to light drinkers, future Relapsers had smaller brain tissue volumes in the right middle temporal, occipital, and superior frontal WM. Compared to future Abstainers, future Relapsers had smaller tissue volumes primarily in bilateral orbitofrontal cortex and surrounding WM. Results were virtually unaffected after controlling for common comorbidities. Conclusion At entry into alcohol dependence treatment, the brain structure of future Relapsers differs from that of future Abstainers. Future Relapsers have smaller brain volumes in regions of the mesocorticolimbic reward system that are critically involved in impulse control, emotional regulation, craving, and evaluation and anticipation of stimulus salience and hedonics. Structural abnormalities of this circuitry may confer greater risk for resumption of hazardous drinking after treatment and may contribute to the definition of a neurobiological relapse risk profile in alcohol dependence.

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“…Historically, research investigating the factors associated with relapse in alcohol use disorders (AUD) has focused on neuropsychological, psychiatric, sociodemographic and behavioral variables [e.g., (Glenn and Parsons, 1991; McKay, 1999; Driessen et al, 2001; Bottlender and Soyka, 2005; Bradizza et al, 2006; Moos and Moos, 2006; Zywiak et al, 2006; Ritvo and Park, 2007; Kodl et al, 2008; Vengeliene et al, 2008)]. A greater understanding of the neurobiological factors associated with the persistence of AUD is necessary to assist in the identification of mechanisms that confer increased vulnerability for the relapse/remit cycle that adversely affects the quality of life of so many with AUD.…”

Section: Introductionmentioning

confidence: 99%

Cortical perfusion in alcohol-dependent individuals during short-term abstinence: relationships to resumption of hazardous drinking after treatment

Durazzo¹,

Gaździński²,

Mon³

et al. 2010

Alcohol

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Relapse to hazardous levels of alcohol consumption following treatment for an alcohol use disorders is common. Investigation of the neurobiological correlates of resumption of hazardous drinking is necessary to clarify the mechanisms contributing to relapse. Fifty-seven treatment-seeking alcohol dependent participants (ALC) completed arterial spin labeling perfusion MRI of the frontal and parietal gray matter (GM) at 7 ± 3 days of abstinence (baseline). ALC participants were restudied after 35 ± 11 days of abstinence (assessment point 2: AP2). Twenty-eight non-smoking, light drinking controls (nsLD) from the community were studied with perfusion MRI. ALC Participants were followed over 12-months after baseline study and were classified as Abstainers (no alcohol consumption; n = 19) and Resumers (any alcohol consumption; n = 38) at follow-up. Cross-sectional and longitudinal perfusion was compared in Abstainers, Resumers and nsLD. At baseline Resumers demonstrated significantly lower frontal and parietal GM perfusion than nsLD and Abstainers. Abstainers and nsLD were not different on frontal or parietal GM perfusion. No significant longitudinal perfusion changes were observed in Abstainers and Resumers. At AP2, Resumers showed significantly lower frontal GM perfusion than nsLD and Abstainers, while no group differences were observed for parietal GM. Abstainers and nsLD were not different on frontal GM perfusion. The significantly decreased frontal GM perfusion in Resumers compared to both Abstainers and nsLD across the assessment interval suggests premorbid and/or acquired neurobiological abnormalities of the frontal GM in Resumers.

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The psychiatric management of patients with alcohol dependence

Cited by 6 publications

References 14 publications

Desipramine blocks alcohol-induced anxiety- and depressive-like behaviors in two rat strains☆

Desipramine blocks alcohol-induced anxiety- and depressive-like behaviors in two rat strains☆

Brain Morphology at Entry into Treatment for Alcohol Dependence Is Related to Relapse Propensity

Cortical perfusion in alcohol-dependent individuals during short-term abstinence: relationships to resumption of hazardous drinking after treatment

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