Alcohol Use Disorder in Primary Cares: How to Integrate Brief Interventions and Continuous Care?

BACKGROUND: In Belgium, 82% of the population consumes alcohol occasionally while 10% consume in a way that can be seen as problematic. On a European level, only 8% of the people who can be characterized as having Alcohol Use Disorder (AUD) would have consulted professional assistance in the past year. In this context, the KCE (Belgian Health Care Knowledge Centre) has addressed multiple recommendations to health professionals to reduce the "treatment gap" concerning the patients' care: (1) encourage screening and preventative interventions, (2) promote the acquirement of communicational and relational competences (3) develop collaborations between professionals. The objective of this article is to better understand their functioning. METHOD: We format a non-systematic literature review concerning these recommendations. RESULTS: The implementation of these Brief Interventions programs in primary care is relevant due to the moderately positive impact on the frequency and quantity of alcohol consumption but both the quality of the therapeutic relationship and collaboration with the care network would optimize Brief Interventions. The quality of the therapeutic relationship alone appears to have an impact on therapeutic outcome. CONCLUSION: Training concerning patient-professional relationship is necessary to maximize the effectiveness of BIs.

Liaison psychiatry and bariatric surgery: double standards. What are the possibilities for the systematization of the pre-operative psychiatric assessment in Belgium?

BACKGROUND: In the context of health care in Belgium, the psychological or psychiatric opinion of a multidisciplinary team is required in the assessment of bariatric surgery candidates. In clinical practice, a wide variety of liaison psychiatry assessment methods exist. SUBJECTS AND METHODS: On the basis of a post-operative psychiatric comorbidity case report and a literature review on "liaison psychiatry and bariatric surgery" we aim to identify opportunities for the systematization of bariatric pre-surgery psychiatric evaluation. RESULTS: The bariatric pre-surgery evaluation must be rigorous and founded on evidence-based medicine. On this basis, specific psychiatric criteria may be defined and researched in assessments. The issue remains for psychiatric comorbidities that develop after surgery and for which a preventive framework should be sustained in the liaison psychiatry approach. CONCLUSIONS: The aim of the research is to support an improved systematization of the psychological assessments of pre-operative bariatric surgery candidates. We believe that systematic evaluation tools should be defined for the identification of possible absolute or relative contra-indications and that a preventive approach to post-operative psychiatric disorders should be included in this assessment.

Proposing concurrent alcohol and tobacco withdrawal. Analysis of the perceptions of Belgian nurses in the alcoholism unit.

INTRODUCTION: Dual tobacco-alcohol addiction is common, but the literature often considers only the issue of withdrawal from one substance at a time and emphasises that the assessment of tobacco use seems to be neglected in psychiatry. SUBJECT AND METHODS: In this study, we analysed the perceptions of nurses working in alcoholism units before and after motivational interviewing trainingon proposing concurrent alcohol-tobacco withdrawal to patients. RESULTS: Nurses, unlike psychiatry postgraduates, were able to achieve acomprehensive and systematic history of substance abuse, but bothtended not to recommend concurrent tobacco-alcohol withdrawal. Training in motivational interviewing was inclined to reverse this tendency. DISCUSSION: Reducing feelings of helplessness that carers experience when patientsrelapse is one of the factors to change. CONCLUSION: Recommendations for the development of concurrent alcohol tobacco withdrawal programmes.

Intensity of symptoms from alcohol withdrawal in alcohol-dependent patients: comparison between smokers and non-smokers.

BACKGROUND: In patients with a dual dependence on alcohol and tobacco, the spontaneous discourse among doctors is not to encourage them to consider preparing to give up both substances. The argument put forward is that withdrawal would be more difficult. We wanted to compare the intensity of withdrawal symptoms in patients hospitalised for alcohol detoxification between smokers and non-smokers. SUBJECT AND METHODS: We compared patients hospitalised for alcohol detoxification who smoke versus non-smokers who received replacement therapy through benzodiazepines and not nicotine replacement. The blood pressure and the cardiac frequency measure on the first day of hospitalisation, the doses of Diazepam dispensed on the first day, and the Clinical Institute Withdrawal Assessment of Alcohol Scale Revised (CIWA-Ar) score on the second day were compared. RESULTS: A trend emerged whereby smoking patients undergoing alcohol detoxification showed higher blood pressure, higher cardiac frequency and required higher doses of benzodiazepines on the first day of hospitalisation. Patients who smoke also had higher CIWA-Ar scores on the second day of hospitalisation. DISCUSSION: From a physiological point of view, the intensity of the symptoms of alcoholic withdrawal seems to be greater in hospitalised patients who smoke vs. non-smokers in the first two days. Does giving up both substances at the same time result in fewer withdrawal symptoms? And in this case, should a double replacement be recommended: benzodiazepines and nicotine replacement therapy? CONCLUSION: To be able to refine the recommendations on alcohol-tobacco dual withdrawal programmes, other studies are needed to compare giving up both substances with or without nicotine replacement.

Methadone and lung transplants.

OBJECTIVES: The aim of this article is to better understand the role of the liaison psychiatrist regarding the pulmonary pre-transplantation assessment for a patient treated by methadone. METHOD: At the beginning, we collected data concerning the different habits of patients requiring pulmonary transplantation. Through a literature review, we studied the possible guidelines related to this subject, the effects of methadone, the side-effects explaining the psychiatrist's concerns. Finally, this problem is involved in the bio-psycho-social model to underline the influence of methadone on post-operative prognosis. RESULTS: In our database, only 4.3% of patients were treated by methadone. However, this addiction is one of the most important stressors for psychiatrists and involves a great deal of multidisciplinary staff time. There are absolutely no guidelines on this topic. Due to the action of methadone, the pulmonary, cardiac, urologic, drug and immune side effects are more understandable. Thanks to clinical labels, we are able to handle this dual problem. Different parameters are considered such as patient's history, drug addiction, deterioration of physical condition, possible surgery and its consequences, choice of treatment to better estimate the post-operative prognosis. CONCLUSION: Until now, there is nor indication or contra-indication regarding the duration of treatment by methadone for patients requiring pulmonary transplantation. The main advantage is the patient's stabilization by minimizing possible relapses. This advantage is to compare the following major inconvenience: increased confusional risk, delicate management of the post-operative pain, negative impact on the immunity. The support, a double psychoeducation and the patient's decision making are to be encouraged.

Quit smoking? quit drinking? why not quit both? analysis of perceptions among belgian postgraduates in psychiatry.

INTRODUCTION: cooncurrent alcohol and tobacco dependency appears to be a common phenomenon yet medical literature often focuses on only one substance at a time when examining the question of withdrawal and illustrates that the evaluation of tobacco consumption appears to be overlooked in psychiatry. SUBJECT AND METHODS: in this study, we analyse perceptions among first-year postgraduates in Psychiatry, before and after training in Motivational Interviewing, with regard to the idea of suggesting that patients might consider simultaneous dual alcohol-tobacco withdrawal. RESULTS: the trend is to disregard the systematic history of substance consumption and to not recommend concurrent alcohol-tobacco withdrawal. Motivational interview training tends to reverse this trend. DISCUSSION: the lessening of the therapist's feeling of powerlessness in the face of relapse is one of the explanatory factors behind this change of approach. A study design is proposed focusing on the patient's perceptions. CONCLUSION: guidelines concerning dual alcohol-tobacco withdrawal programs are to be developed.

Natural killer cell cytotoxity and course of illness in depressed mood.

There is now some evidence that depressed mood is associated with activation of the immune system. First, we evaluated, within a cross-sectional design, NKCA (in vitro) in 49 subjects meeting inclusion criteria either for a major depressive episode, for dysthymia, or for "double depression". We found that recent and long depressive episodes (dysthymia) are associated with a lower immunodepression. Second, we compared two subset of subjects: 14 patients meeting criteria of major depression to 14 healthy controls. The data show a significant improvement in major depression when compared to controls througout a treatment combining supportive psychotherapy and 8 mg Reboxetine™.