Changes of Self-reported PTSD and Depression Symptoms During Alcohol Detoxification Treatment.

Objective: There is a lack of empirical knowledge on how different comorbid disorders and symptoms change in the course of initial abstinence and withdrawal. The aim of this study is to replicate previous findings on the symptom course using a larger sample and up-to-date psychometric instruments. Methods: During inpatient alcohol detoxification, we measured comorbid depression (Beck Depression Inventory second revision; BDI-II) and posttraumatic stress disorder (PTSD Checklist for DSM-5; PCL-5) symptoms twice among 87 participants within a 10-day interval. Results: Significant decreases occurred for symptoms of reexperiencing (p < .001, d = .27), avoidance (p < .001, d = .41), negative cognitions (p = .03, d = .22), alteration in arousal (p < .001, d = .37), and the PCL-5 total score (p < .001, d = .35). Depression scores also significantly declined with a greater effect size (p < .001, d = .53). Depression screening was not stable, while posttraumatic stress disorder screening was revealed to be stable through alcohol detoxification. Interaction effects were detected, indicating the higher symptom decrease for patients who initially had positive posttraumatic stress disorder and depression screenings, F(1, 84) = 23.01, p < .001 and F(1, 84) = 10.01, p < .01, respectively. Conclusions: Patients in the first stage of alcohol treatment show high levels of comorbid psychopathology. These symptoms change during detoxification, especially for patients having a higher initial symptomatic burden. More research is needed to guide practitioners to make reliable comorbid diagnoses in this early treatment phase as this can motivate patients to pursue subsequent treatments.

Integrated Treatment at the First Stage: Increasing Motivation for Alcohol Patients with Comorbid Disorders during Inpatient Detoxification.

AIMS: Co-occurring mental disorders can complicate the detoxification treatment process and outcome. The aim of this study is to examine whether a brief psychoeducational group counseling session during detoxification treatment can increase the motivation for and utilization of subsequent treatments. SHORT SUMMARY: Interventions increased utilization of post-detoxification treatment and reduced alcohol-related readmissions. Higher depression or trauma scores were associated with higher rates of utilization of treatment. METHODS: Patients received either a brief manualised group intervention on the interrelation of alcohol use disorder (AUD) and major depression (MD) or AUD and post-traumatic stress disorder (PTSD) or a cognitive training session (control group). Of the 784 patients treated in the study period, 171 participants were quasi-randomly allocated to groups. Self-reported motivation was measured before and after intervention, transition into AUD treatment and readmissions were collected after detoxification treatment. RESULTS: Participating in any of the intervention groups increased the utilization of AUD treatment after inpatient detoxification (χ2 = 6.15, P = 0.02) and decreased readmissions 6 months after discharge (χ2 = 7.46, P = 0.01). Depression and trauma scores moderated the effect: associations with the utilization of post-detoxification treatment were found in participants with higher depression (OR = 5.84, 95% CI = 1.17-29.04) or trauma scores (OR = 10.17, 95% CI = 1.54-67.1). CONCLUSIONS: An integrated intervention approach for dual diagnosis at the beginning of the treatment can increase motivation for continued AUD treatment. Especially affected dual diagnosis patients can benefit from this treatment.

The Trier Social Stress Test in first episode psychosis patients: Impact of perceived stress, protective factors and childhood trauma.

Psychosis has been associated with abnormalities in hypothalamic-pituitary-adrenal axis functioning, which may emerge through heightened stress sensitivity following early life adversity - ultimately resulting in illness onset and progression. The present study assessed cortisol levels during an established psychosocial stress task and their association with current stress perception, putative protective factors and adverse childhood experiences in patients with a first episode of psychosis (FEP). A total of 100 volunteers participated in the study, 57 of whom were patients with a FEP (mean age 23.9 ± 3.8) and 43 healthy community controls (mean age 23.2 ± 3.9). Salivary cortisol, heart rate and blood pressure were measured at eight time points before and after the Trier Social Stress Test. Subjective stress and protective factors were assessed with the Perceived Stress Scale, the Self-Esteem Rating Scale and the Brief COPE. Early life adversity was assessed with the Childhood Trauma Questionnaire. Patients compared to controls showed significantly lower cortisol levels (F = 7.38; p = .008) throughout the afternoon testing period, but no difference in the cortisol response to the TSST. Heart rate was elevated and protective factors were lower in patients compared to controls. Attenuated cortisol levels were associated with higher levels of perceived stress, poor protective factors and more physical neglect during childhood. Our results suggest that attenuated baseline cortisol levels and not a blunted response during an acute stress task might be an indicator of heightened stress vulnerability and poor resilience in psychosis. The possible influence of childhood adversity and antipsychotic medication is discussed.