Showing papers by "Michael Soyka published in 2001"

Impulsive traits and 5-HT2A receptor promoter polymorphism in alcohol dependents: possible association but no influence of personality disorders.

Abstract: Objective: Impulsive behavior in alcoholics puts them at serious risk of severer course of disease and has been related to the serotonergic neurotransmission dysfunction. The aim of this study is to investigate the association between impulsive aggression in alcohol dependents with regard to the G-1438A polymorphism in the promoter region of the 5-HT2A receptor gene. Furthermore, we investigated the statistical interaction between 5-HT2A alleles, antisocial personality disorder (APD) and impulsive aggression in alcohol dependents. Alcohol dependents were investigated because these personality disorders and impulsive behavior are very frequent in alcohol dependence anf of clinical relevance. Methods: One hundred and thirty-five patients of German descent meeting DSM-IV criteria of alcohol dependence were recruited. Blood samples were taken from alcohol dependents to determine 5-HT2A promoter polymorphisms using PCR (polymerase chain reaction) of lymphocyte DNA. Impulsive aggression was assessed using a German version of the Barratt Impulsiveness Scale which was translated and backtranslated. Alcohol dependents were subdivided into low- or high-impulsivity groups using a median split of the Barratt score. APD and borderline personality disorder (BPD) were assessed using the SCID-II interview. Results: The low-impulsivity group was slightly older and showed a later age at alcoholism onset than the highly impulsive group. Alcohol dependents with high impulsive traits showed a significant association with 5-HT2A 1438 A alleles. After excluding alcohol dependents with APD or BPD from the analysis, this association remained significant. Furthermore, no association between APD, BPD and 5-HT2A alleles was noted. Conclusions: Inpatient alcohol dependents showed a significant association between 5-HT2A A alleles and impulsive traits, independent of the presence of APD or BPD. No association was noted between personality disorders and the polymorphism. This is the first report about an association of 5-HT2A promoter polymorphism and impulsive behavior in alcohol dependents. This finding may refer only to impulsive traits and may be independent of personality disorders in this sample. These results have to be confirmed in larger samples and in healthy control subjects to determine whether this association is of general validity.

Elevated serum levels of S-100B reflect the extent of brain injury in alcohol intoxicated patients after mild head trauma.

Abstract: Elevated systemic levels of S-100B are proposed as a potential indicator of brain damage in identifying high-risk patients after mild head trauma (MHT). Although incidence of alcohol intoxication is high in these patients, the influence of alcohol intoxication on S-100B levels is unclear. Therefore, the aim of our study was to investigate serum concentrations of S-100B in intoxicated (group 1) and sober (group 2) patients after MHT in comparison with those of mild (group 3) or severely intoxicated (group 4) individuals without trauma. S-100B was significantly increased in MHT patients exhibiting posttraumatic lesions in initial cranial computed tomography scan. Alcohol intoxication did not elevate S-100B levels in group 3 or 4 subjects. Our data indicate for the first time that alcohol intoxication does not influence the diagnostic value of S-100B measurements in patients after MHT.

Psychopathology in dual diagnosis and non-addicted schizophrenics--are there differences?

Abstract: In a previous publication we reported lifetime and 3-month prevalence estimates for substance use in two large samples of schizophrenic inpatients (Soyka et al. 1993). A subsequent analysis of psychopathological findings assessed by means of the AMDP Manual (Guy and Ban 1982) in schizophrenic inpatients of the Haar Mental State Hospital (N=447), in whom a lifetime prevalence for substance use of 42.9 % (3-month prevalence 29 %) had been reported, was performed. While the overall differences between substance using (dual diagnosis) and nonusing schizophrenics were small, dual diagnosis patients in general reported more positive symptoms, especially more intense hallucinations. These differences could basically be demonstrated in patients with current (3-month) substance use on admission but not on discharge possibly as a result of substance use. Most marked and highly significant results were found with respect to previous suicide attempts and delinquency which were more prevalent in dual diagnosis schizophrenics. Results of this study indicate that dual diagnosis patients compared to other schizophrenics represent a more disturbed patient group. Implications for the self-medication hypothesis for substance use in schizophrenia and future research in this area are discussed.

Role of aggressivity on reactivity and craving before and after cue exposure in recently detoxified alcoholics: results from an experimental study.

Abstract: The role of aggressivity and cue exposure in induction of craving were investigated in a clinical setting. Thirty abstinent alcoholic patients were divided into a low and a high aggressive group based on scores on the physical aggression subscale of the Buss-Durkee Hostility Inventory and exposed to alcohol cues. Craving was measured by means of the Alcohol Craving Questionnaire (ACQ) and Visual Analogue Scales (VAS). Important findings are: (1) main effects of aggressivity on 'emotionality', 'purposefulness' and 'expectancy' of ACQ were very significant; (2) on 'drinking intention' and 'craving for alcohol' of VAS, aggressivity and cue exposure showed a significant interaction; (3) the main effect of cue exposure on heart rate also reached a significance level of 0.007. The results were discussed in the context of the Classical, Operant Conditioning Theory, the Cognitive Craving Theory of Tiffany, Gilbert's STAR Model, and the Self-Medication Hypothesis.

Modellprojekt “Qualifizierte ambulante Entgiftung”

Abstract: Berichtet wird uber ein 1998 begonnenes Modellprojekt zur ambulanten Entgiftung Alkoholkranker, das in einer, auf die Therapie von Suchterkrankungen spezialisierten Fachambulanz etabliert und von der Psychiatrischen Klinik der Universitat Munchen initiiert und wissenschaftlich supervidiert wurde. Ein- und Ausschlusskriterien des Modellprojektes sowie die praktische Durchfuhrung der ambulanten Alkoholentzugsbehandlung werden dargestellt. In die ambulante Entgiftung sind psychotherapeutische “motivierende” Elemente integriert, sodass man von einer “qualifizierten” Entgiftung sprechen kann. Im Zeitraum vom August 1998 bis Juni 2000 konnten insgesamt 205 Patienten, die sich zur Frage einer Entzugsbehandlung vorstellten, untersucht werden. 141 Patienten konnten in die ambulante Entgiftung aufgenommen werden, von denen 127 (90%) die Behandlung erfolgreich beendeten. Bei taglicher Protokollierung der Entzugssymptomatik konnten rund die Halfte der Patienten ohne psychotrope Medikation entzogen werden. 121 der 127 entzogenen Patienten (96%) begannen nach Abschluss der Entgiftung eine ambulante Alkoholtherapie. Eine erste Nachuntersuchung, im Mittel 10 Monate nach Beendigung der Entgiftung, zeigte, dass 61 (50%) der 127 Patienten noch abstinent waren und sich in einer ambulanten Alkoholtherapie befanden. Diese Befunde sprechen fur die Effizienz der psychotherapeutisch gefuhrten Motivationsbehandlung wahrend der ambulanten Behandlung.

Memantine treatment in alcohol dementia: rapid PET changes and clinical course.

Abstract: Alcohol dementia (ALD) usually follows long-term alcohol dependence. The major psychiatric features of ALD are general loss of short-and long-term memory combined with disturbances in concentration and a decrease in intellectual capacity, all of which persist during abstinence. Despite its clinical importance, few studies have been published up to now on medical treatment of ALD and other alcohol-induced mental disorders [1]. The central nervous gluta-matergic system, with its N-methyl-D-aspartate (NMDA) receptors, is suggested to be involved in toxic neuronal loss [2] due to an increased glutamatergic neurotransmission during repeated alcohol withdrawal and may subsequently contribute to the development of ALD. The low-affinity NMDA receptor antagonist memantine (ada-mantine, 1-amino-3,5-dimethyladamantine hydrochloride, CAS 41100-52-1) modulates the glutamatergic system most likely through Ca 2+ influx blockage of NMDA receptors [3] and shows positive effects on memory in the treatment of other psychogeriatric disorders with memory loss such as Alzheimer's dementia (AD) or Parkinson's disease [4]. We would like to report the case of a 71-year-old female patient with chronic alcoholism for at least 30 years. She was found neglected in her home and was admitted to our ward from an emergency unit with symptoms of disorientation, apraxia, ataxia, severe short-and long-term memory disturbances, deficits in intellectual capacity and concentration. There were no signs of electrolyte imbalance on admission. A further thorough neurological investigation and NMR showed a general atrophy without severe basal brain damage of Wer-nicke encephalopathy. No other signs of Wernicke encephalopathy, i.e. ophthalmoplegia or evidence of hepatic encephalopathy such as flapping tremor, were found. Ultrasound of brain arteries showed some plaques without hemodynamic compromise. After excluding Alzheimer's disease or vascular dementia, the diagnosis of ALD according to ICD10 criteria was made.

Psychomotor Performance Under Neuroleptic Treatment in Schizophrenia

Abstract: Cognitive dysfunction has been recognized as an important clinical feature of schizophrenia. The possible pharmacological effect of neuroleptics on cognitive and psychomotor function incl...

Biological and genetic markers of alcoholism — a psychiatric perspective

Abstract: With respect to alcoholism the term “marker” often is used misleading. Generally, state markers of alcoholism must be differentiated from trait markers or markers of alcohol intoxication. Trait markers are hereditary, time independent factors. Trait markers persist during the whole time. For alcoholism a number of possible neurochemical and neurophysiological trait markers including the monoaminoxidase-B-activity in platelets, activity of adenylatcyclase, endocrine markers (Cortisol, ACTH, prolactin), dopamin-beta-hydroxylase, evoked potentials (P 300) and ADH/ALDH genotypes have been proposed, but none of these markers has been firmly established. State markers are occuring during the phases of alcohol consumption. State markers such as blood alcohol concentration, CDT, GGT, ASAT, ALAT, MCV, HDL- and VDRL-cholesterol, and others are widely used for diagnosis and screening of alcoholics but both sensitivity and specifity are limited (Gjerde et al., 1988). Also except for MCV, pathologic findings are bound to a relatively fast biological turnover and return to normal values in abstinent patients. Some authors shown association markers for example HLA antigen, blood groups or transketolase.

Alcohol-related Disorders

Abstract: Alcohol consumption has been shown to be causally related to numerous medical conditions and is a significant cause for psychiatric and somatic morbidity and premature death worldwide. While the repeatedly reported moderate mortality reduction in individuals with low alcohol consumption with a lower risk coronary heart disease and ischemic stroke compared to abstainers is controversial, increased alcohol consumption is related to increased risk for liver disorder and many other medical conditions, as well as injuries or accidents, mostly in a rather dose–response relation. The central nervous system is especially vulnerable to alcohol's effects. Brain damage, epileptic seizures, wernicke-korsakoff syndrome, and alcohol psychoses are frequent in individuals with heavy alcohol intake. Numerous other severe disorders are associated with increased alcohol intake. A brief overview about pharmacological and neurobiological actions of alcohol and its effect in brain and body are given.