[Polycystic lipomembranous osteodysplasia with sclerosing leukoencephalopathy]. / Polyzystische lipomembranöse Osteodysplasie mit sklerosierender Leukenzephalopathie.

A 32-year-old patient presented with presenile dementia syndrome and complex-partial seizures. The dementia was preceded by recurrent bone pain which led to surgical intervention for ossear cysts. Computed tomography revealed intracerebral calcification and marked brain atrophy. Clinical, radiological, genetic, and histopathological features of PLOSL disease are discussed in the differential diagnosis of presenile dementia and basal ganglia calcification.

Reliability and validity of the form 90 interview.

OBJECTIVE: Alcohol consumption is a central variable in substance abuse research and treatment. The study reports the psychometric characteristics of the German version of the Form 90 interview for the assessment of recent alcohol consumption. METHOD: Reliability was evaluated in a test-retest study (7 days) with 30 consecutively admitted psychiatric inpatients with alcohol dependence. Validity of Form 90 was assessed with a second sample of 60 alcohol-dependent inpatients. RESULTS: Form 90 demonstrated good to excellent retest reliability for the central variables of alcohol consumption. Retest reliability Pearson correlation coefficients (r) ranged from 0.76 to 0.99 and Intraclass Correlation Coefficients (ICC) ranged from 0.74 to 0.98. Reliability coefficients proved to be stable throughout the whole assessment window (90 days). Confidence intervals demonstrated sufficient precision of measures of alcohol consumption. Validity was supported by significant correlations of the amount of alcohol consumed with outcome parameters of the Lifetime Drinking History Interview (r=0.47 and 0.58), gamma-glutamyltransferase on admission to detoxification treatment (r=0.37), physical withdrawal symptoms (r=0.56) and the withdrawal symptom index (r=0.48). CONCLUSIONS: Form 90 presented evidence of good to excellent psychometric properties, and its applicability to clinical populations of alcohol-dependent patients in German-speaking countries could be confirmed.

[Combination treatment with SSRI and cognitive behavior therapy for relapse prevention of alcohol-dependent men. Results of a randomized, controlled multicenter therapeutic study]. / Rückfallverhinderung bei alkoholabhängigen Männern durch die Kombination von SSRI und kognitiver Verhaltenstherapie. Ergebnisse einer randomisierten kontrollierten, multizentrischen Therapiestudie.

BACKGROUND: This study evaluates the serotonergic antidepressant nefazodone (SSRI) vs placebo (PL) and specific cognitive-behavioral therapy (CBT) vs nondirective group counseling (GC) for relapse prevention in alcohol dependence in a large, prospective, randomized and placebo-controlled, double-blind study at three German university centers. METHODS: Male patients fulfilling at least five criteria for alcohol dependence according to DSM-IV and ICD-10 were eligible, after detoxification, for one of the following treatment combinations: SSRI+CBT, SSRI+GC, PL+CBT, and PL+GC. The SSRI or PL were administered throughout the evaluation period of 15 months. CBT or GC was applied during the first 12 weeks as group therapy according to operationalized manuals. The main outcome measures (assessed at 3 and 12 months of treatment) were the cumulative number of abstinent days, the amount of ethanol consumed during specified evaluation periods of 3 and 12 months, the number of relapses, and the duration of time until first relapse. RESULTS: After 12 weeks of treatment, no statistically significant differences in any outcome measure were observed between the four treatment combinations. After 52 weeks, the only significant difference was observed in the amount of ethanol consumed, with the SSRI+GC group showing higher intake. CONCLUSIONS: The results of this carefully designed clinical trial suggest that the four treatment combinations do not differ substantially in their efficacy in relapse prevention of nondepressed, severely alcohol-dependent patients. Nefazodone may even promote ethanol drinking in a subset of patients. Cognitive-behavioral therapy as performed in this study was associated with little additional benefit compared with structured GC.

Neuropsychological status of alcohol-dependent patients: increased performance through goal-setting instructions.

AIMS: The effects of goal-setting instructions on neuropsychological performance of alcohol-dependent patients and control subjects were assessed. METHODS: 57 alcohol-dependent patients and 59 carefully age- and education-matched healthy control subjects underwent standard neuropsychological investigation. In addition, the goal-setting paradigm was used to systematically manipulate motivation. Participants were requested to calculate simple mathematical problems repeatedly within phases of a 2-min duration receiving normal or goal setting-instructions (to increase performance in the next phase by 20%). RESULTS: The patients demonstrated deficits in standard neuropsychological tests. Patients under goal-setting instructions demonstrated significantly higher improvement (correct responses: P = 0.016) relative to patients with standard instructions. Control subjects with goal-setting instructions demonstrated tendencies for higher improvement relative to control subjects with normal instructions. However, the differences were not significant. Interaction of group (patients vs. control subjects) and instructions (goal setting vs. normal) remained insignificant (P = 0.489) indicating that the increase through goal setting for the patients was not significantly higher than that for the control subjects. CONCLUSIONS: Despite of neuropsychological deficits in reasoning and psychomotor functioning, alcohol-dependent patients early in recovery are responsive to goal setting and able to increase neuropsychological performance. Therefore, goal-setting strategies might possibly be used in cognitive rehabilitation and therapy of alcohol-dependent patients. As there was no significant interaction in increase between patients and control subjects, our results do not support the hypothesis that the neuropsychological deficits are affected by or even caused by motivational limitations of the alcohol-dependent patients.

Kindling-induced overexpression of Homer 1A and its functional implications for epileptogenesis.

Despite an extensive research on the molecular basis of epilepsy, the essential players in the epileptogenic process leading to epilepsy are not known. Gene expression analysis is one strategy to enhance our understanding of the genes contributing to the functional neuronal changes underlying epileptogenesis. In the present study, we used the novel MPSS (massively parallel signature sequencing) method for analysis of gene expression in the rat kindling model of temporal lobe epilepsy. Kindling by repeated electrical stimulation of the amygdala resulted in the differential expression of 264 genes in the hippocampus compared to sham controls. The most strongly induced gene was Homer 1A, an immediate early gene involved in the modulation of glutamate receptor function. The overexpression of Homer 1A in the hippocampus of kindled rats was confirmed by RT-PCR. In order to evaluate the functional implications of Homer 1A overexpression for kindling, we used transgenic mice that permanently overexpress Homer 1A. Immunohistochemical characterization of these mice showed a marked Homer 1A overexpression in glutamatergic neurons of the hippocampus. Kindling of Homer 1A overexpressing mice resulted in a retardation of seizure generalization compared to wild-type controls. The data demonstrate that kindling-induced epileptogenesis leads to a striking overexpression of Homer 1A in the hippocampus, which may represent an intrinsic antiepileptogenic and anticonvulsant mechanism in the course of epileptogenesis that counteracts progression of the disease.

Cue exposure in alcohol dependent patients: preliminary evidence for different types of cue reactivity.

Craving is considered to be an important phenomenon in addictive behaviours. However, there is still an unresolved debate on what craving for alcohol means, how it is best measured and which clinical and therapeutical consequences its presence or absence may imply. Cue reactivity paradigms have been developed to elicit craving under standardized experimental conditions. Here we present preliminary results characterizing alcohol-dependent patients with regard to subjective and psychophysiological aspects of exposure to alcohol-associated cues in a cue reactivity paradigm. Thirty-six patients fulfilling at least 5 criteria of alcohol dependence according to DSM-IV criteria were studied after detoxification. Cue reactivity was assessed as subjective (by visual analogue scales) and neurophysiological response (by ECG, EMG, electrodermal activity, respiratory frequency, salivation) to the presentation of the favourite alcoholic beverage or water. While 22% of the patients were both subjective and physiological responders, 42% of the subjects showed only a physiological reaction without subjective response, and 31% of the patients were neither a subjective nor a physiological reaction. Subjective responders to alcohol cues had significantly higher state anxiety levels than subjective non-responders. These results suggest that alcohol dependent patients may be divided into typological subgroups with respect to cue reactivity. Different types of cue reactivity might be important for treatment strategies involving repeated cue exposure or so-called anti-craving drugs.

Reliability and validity of the German version of the European Addiction Severity Index (EuropASI).

OBJECTIVE: This study provides data on the psychometric characteristics of the German version of the European Addiction Severity Index (EuropASI). The ASI is a frequently used clinical and research instrument that measures problem severity among people with substance dependence. METHOD: The German ASI was used in a sample of 112 consecutively admitted male psychiatric inpatients seeking treatment for severe alcohol problems. The conceptual structure of the German ASI subscales was investigated by analyzing the intercorrelations of the severity ratings and composite scores. Internal consistency, interrater reliability and concurrent validity in terms of correlations with other assessment instruments were evaluated. RESULTS: The German ASI subscales proved to be independent or moderately correlated (-0.17 < r < 0.34). Each correlation coefficient between corresponding severity ratings and composite scores was significant (p < .0005), ranging from r = 0.47 to r = 0.93. Reliability measures indicated moderate to good internal consistency (Cronbach's alpha: 0.69-0.92) and moderate to excellent interrater reliability (intraclass correlation coefficient: 0.62-0.99). Validity was supported by significantly higher ratings in the alcohol section in alcohol dependent patients compared to patients without dependence (t = 2.99, 108 df, p = .004). Significant correlations (p < .001) were found between the alcohol use section and the Michigan Alcoholism Screening Test (r = 0.34 composite score and r = 0.44 severity rating) and between psychiatric status and the Symptom Checklist-90-revised (r = 0.55/0.51), supporting concurrent validity. CONCLUSIONS: The German version presented evidence of acceptable psychometric properties and its applicability in German-speaking countries could be confirmed.

Fluvoxamine or placebo in the treatment of panic disorder and relationship to blood concentrations of fluvoxamine.

A six-week double-blind placebo-controlled trial of fluvoxamine was undertaken in 46 patients suffering from panic disorder with or without agoraphobia diagnosed by DSM-III-R guidelines. Average daily dosage of fluvoxamine was 160 mg, with a highest permitted dose of 300 mg/day. Weekly evaluation included a diary in which the number, severity, and duration of full-blown and limited panic attacks and the duration and severity of anticipating fear, CAS, GAS, CGI, HAM-D, adverse effects and the number of capsules not taken were noted. Fluvoxamine was not significantly superior to placebo with regard to the main outcome criterion, i.e., the reduction in the number of panic attacks, but it was significantly more effective with regard to the diminution in the number of limited panic attacks and showed a tendency to significance in respect of GAS and CGI. Plasma levels of fluvoxamine were measured at the end of week one and at the end of the study. Most patients with complete remission at the end of the study were found in the verum group with plasma fluvoxamine levels ranging from 10 to 100ng/ml. It is suggested that therapeutic response might be maximized by monitoring fluvoxamine concentrations in blood.

The effects of school, family, self-concept, and deviant behaviour on adolescent suicide ideation.

In this study of a population of junior and senior high school students in a mid-sized, Western city, adolescent emotional and ideological disparity with parents and disparity between the importance the adolescent placed on academic achievement and satisfaction with academic achievement were linked to suicide ideation through the intervening variables of self-esteem, purpose in life, and two forms of deviant behaviour--alcohol use and eating disorder. Self-confidence and the deviant behaviours of delinquency and drug use did not prove to be meaningful intervening variables.

Church youth alcohol and drug education programs.

This study indicates that pastors believe that their churches should have a role in influencing the alcohol and drug use of their members; that about half of the churches in this study actually had youth alcohol and drug education programs; and that the content of these education programs and church attitudes toward substance use are affected by the degree of fundamentalism-liberalism of the church.

Religion and youth substance use.

This research study of 13,878 youths indicates that religion is not by itself a very important predictor of youth substance use. It is, however, more strongly related to alcohol use than drug use. Also, fundamentalist religious groups have the lowest percentages of substance use in general, while the more liberal types of religious groups have the lowest percentages of heavy substance use. Of the six dimensions of religion used in the study to predict youth substance use, importance of religion to the subject was the most important, with church membership second, and the fundamentalism-liberalism scale of religious groups third.

Social and psychological characteristics of alcoholics: a male--female comparison.

Male and female alcoholics from a public health clinic were compared on social and psychological characteristics. Although sex was not found to be associated with the number of close friends reported by subjects, it was found to be significantly associated with designations of the alcoholic's "significant others", incidence of marital difficulty and with scores on the Definition of Alcohol Scale and the Neuroticism Index. There was a statistically significant relationship between sex and the number of social complications resulting from alcohol abuse; however, male and female alcoholics conceptualized their drinking as a problem in strikingly similar ways.

First drinking experiences and present drinking patterns: a male-female comparison.

The authors predicted that sex roles in America would contribute to variation between male and female alcoholics in first drinking experiences and current drinking patterns. Moderate support for this hypothesis was observed. Though first drinking experiences were found to be very similar for males and females, females reported a significantly longer period of time between their first and second drinks of an alcoholic beverage. Females were significantly more likely to have consumed their first alcoholic beverage with family members, while males more commonly were with friends. Beer was the most frequently consumed beverage of the first drinking occasion for both sexes; the second most popular beverage among men was whiskey, while women chose mixed drinks. Regarding current drinking patterns, men drank significantly more often than women. The differences pertaining to general drinking pattern (drinking daily, several times a week, or on weekends, or engaging in binge drinking) approached significance.