A randomized, double-blind, placebo-controlled trial of quetiapine in patients with bipolar disorder, mixed or depressed phase, and alcohol dependence.

BACKGROUND: Alcohol dependence is common in bipolar disorder (BPD) and associated with treatment nonadherence, violence, and hospitalization. Quetiapine is a standard treatment for BPD. We previously reported improvement in depressive symptoms, but not alcohol use, with quetiapine in BPD and alcohol dependence. However, mean alcohol use was low and a larger effect size on alcohol-related measures was observed in those with higher levels of alcohol consumption. In this study, efficacy of quetiapine in patients with BPD and alcohol dependence was examined in patients with higher mean baseline alcohol use than in the prior study. METHODS: Ninety outpatients with bipolar I or II disorders, depressed or mixed mood state, and current alcohol dependence were randomized to 12 weeks of sustained release quetiapine (to 600 mg/d) add-on therapy or placebo. Drinking was quantified using the Timeline Follow Back method. Additional assessment tools included the Hamilton Rating Scale for Depression, Inventory of Depressive Symptomatology-Self-Report, Young Mania Rating Scale, Penn Alcohol Craving Scale, liver enzymes, and side effects. Alcohol use and mood were analyzed using a declining-effects random-regression model. RESULTS: Baseline and demographic characteristics in the 2 groups were similar. No significant between-group differences were observed on the primary outcome measure of drinks per day or other alcohol-related or mood measures (p > 0.05). Overall side effect burden, glucose, and cholesterol were similar in the 2 groups. However, a significant weight increase was observed with quetiapine at week 6 (+2.9 lbs [SE 1.4] quetiapine vs. -2.0 lbs [SE 1.4], p = 0.03), but not at week 12. Scores on the Barnes Akathisia Scale increased significantly more (p = 0.04) with quetiapine (+0.40 [SE 0.3]) than placebo (-0.52 [SE 0.3]) at week 6 but not week 12. Retention (survival) in the study was similar in the groups. CONCLUSIONS: Findings suggest that quetiapine does not reduce alcohol consumption in patients with BPD and alcohol dependence.

Language in Alzheimer's disease.

OBJECTIVE: To ascertain the clinical utility of language examination by psychiatrists in evaluating Alzheimer's disease (AD) patients. METHOD: Data collected between 1986 and 2003 from a standardized psychiatric examination and neuropsychological testing of probable AD patients (diagnosed according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association) were gathered from the database of the University of Texas Southwestern Alzheimer's Disease Center, Dallas. The variables studied were articulation, word-finding ability, hypofluency, hyperfluency, repetition, confrontational naming, and semantic (category) fluency. Articulation, word-finding ability, hypofluency, hyperfluency, repetition, and confrontational naming were rated as normal or abnormal. Semantic fluency was scored numerically as the number of animals named in a minute. Cognitive impairment was assessed with the Mini-Mental State Examination (MMSE) and global impairment by the Clinical Dementia Rating (CDR) scale. RESULTS: There was a significant association (p < .0001) between MMSE and CDR scores for all language measures except hyperfluency. The MMSE scores were higher in the group with responses rated as normal compared to those with abnormal responses. Patients with greater cognitive and global impairment named fewer animals in a minute. CONCLUSIONS: Abnormal articulation and repetition of words were unusual and therefore would not be useful for early detection, but when present, were associated with more advanced disease. Impairment in fluency, animal naming, and confrontational naming were common and increased in frequency with greater cognitive and global impairment. Because animal naming is a numerical measure, changes in the number of animals named in a minute can be used to monitor disease progression.