The 5-HT2C receptor as a therapeutic target for alcohol and methamphetamine use disorders: A pilot study in treatment-seeking individuals.

Alcohol use disorder (AUD) and methamphetamine use disorder (MUD) are prevalent and have high adverse impacts on both the individual and society. Current treatment strategies for these disorders are ineffective at a population level. Lorcaserin, a 5-HT2C receptor agonist, has shown potential at reducing the symptoms of substance use disorder. This pilot study (initiated prior to market withdrawal) examined feasibility and safety of lorcaserin treatment in people undergoing residential detoxification and treatment for AUD and MUD. This was an open label pilot study of lorcaserin where participants (n = 10 AUD; n = 8 MUD) received 10-mg lorcaserin daily for 4 days then twice daily for 1 month. Primary outcome measures included recruitment and retention rate, incidence of treatment-emergent events, incidence of methamphetamine or alcohol withdrawal-related events, heart rate, and blood pressure. Secondary measures included pharmacokinetic data and self-reported alcohol or methamphetamine use, craving, and psychological distress. AUD participants were recruited faster and had a greater retention rate compared with MUD participants. Lorcaserin did not alter vital signs, was well tolerated, and had a similar pharmacokinetic profile to individuals with obesity. Lorcaserin reduced self-reported alcohol and amphetamine-type substance use and craving in AUD and MUD participants, respectively. Self-reported psychological health also improved over the treatment period for all participants. Despite the pilot nature of this study, our data support the notion of 5-HT2C receptors as a therapeutic target for drug and alcohol abuse.

Hepatic Failure Due to Hepatitis E Virus Infection in a Patient with Necrotic Hepatocellular Carcinoma

In patients with hepatocellular carcinoma (HCC) or liver cirrhosis (LC) accompanied by hepatitis E virus (HEV) infection, hepatic failure often leads to debility. Here, we report about a 63-year-old man with alcoholic LC who was referred to our hospital with jaundice and abdominal distension 10 days earlier. Abdominal computed tomography showed necrotic HCC accompanied by left lobe shrinkage without tumor progression. Laboratory and imaging findings revealed no acute infection focus. The patient reported no herbal medicine or alcohol consumption, and there was no evidence of acute viral hepatitis. One month later, HEV immunoglobulin M positivity was confirmed, and deterioration of liver function due to HEV infection was suspected. The patient often ate raw oysters and sashimi, as well as boar meat, which is a well-known risk food for HEV infection. His umbilical hernia deteriorated due to tense ascites and infection by skin abrasion. The patient progressed to hepatorenal syndrome and eventually died. Liver function preservation is important when treating HCC patients. Therefore, clinicians should pay more attention to the prevention of HEV and others causes of direct liver injury.

An Integrative Literature Review of Resilience in Adult Children of Alcoholics: Focusing on Operational Definitions and Moderators / 정신간호학회지

PURPOSE: The objective of this study was to explore operational definitions and moderators of the resilience of adult children of alcoholics (ACOA) and its associated variables. METHODS: This integrative review was conducted based on a literature review method suggested by Whittemore and Knafl. Databases including PubMed, CINAHL, PsycINFO, and RISS were searched using the combinations of search terms such as; ‘adult children of alcoholics,’ ‘parental alcoholism,’ ‘resilience,’ and ‘children of alcoholics.’ RESULTS: Seventeen studies were selected for this review. Findings of integrative reviews reported operational definitions for the resilience of ACOA and moderators. The operational definition of ACOA's resilience is: (1) having no behavioral and emotional problem, (2) meeting social and developmental expectancies, (3) having the ability to cope with adversity, (4) having high self-concept, and (5) having a meaningful relationship. In addition, the varying environmental moderators include family communication, qualities of caring environment, parental communication, parentification, and social support. Several moderators were identified as positive effect, self-esteem, alcohol-specific coping style, locus of control, spirituality, the image of God, and dyadic cohesion in marital communication. CONCLUSION: Our study findings emphasize comprehensive understanding of diverse definition of resilience and moderators in developing nursing interventions to promote resilience in ACOA.

Associations of Spiritual Well-being, Attitude toward Death and Quality of Life among Alcoholics Anonymous / 정신간호학회지

PURPOSE: The aim of the study was to investigate associations of spiritual well-being, attitude toward death, and quality of life among Alcoholics Anonymous (AA). METHODS: This study was cross-sectional and descriptive in design. The data was collected from August to September 2018 with 133 AA members drawn from two provinces of South Korea. The data were analyzed using descriptive statistics, independent t-tests, one-way ANOVA with Turkey tests, Pearson's correlation coefficients, and hierarchical multiple linear regression analyses using SPSS/WIN 20.0 program. RESULTS: The existential spiritual well-being (β=.52, p<.001), attitude toward death (β=.24, p<.001), dual diagnosis (β=−.17, p=.003), occupation (β=.12, p=.035) of the participants were significant factors, which explained 63.7% of the variance of quality of life. CONCLUSION: The study findings highlight the need to develop psychological nursing strategies to enhance the spiritual well-being and improve a positive attitude toward death based on the job and dual diagnosis among AA members to improve their better quality of life.

Therapeutic Potential of the Rhizomes of Anemarrhena asphodeloides and Timosaponin A-III in an Animal Model of Lipopolysaccharide-Induced Lung Inflammation

Investigations into the development of new therapeutic agents for lung inflammatory disorders have led to the discovery of plant-based alternatives. The rhizomes of Anemarrhena asphodeloides have a long history of use against lung inflammatory disorders in traditional herbal medicine. However, the therapeutic potential of this plant material in animal models of lung inflammation has yet to be evaluated. In the present study, we prepared the alcoholic extract and derived the saponin-enriched fraction from the rhizomes of A. asphodeloides and isolated timosaponin A-III, a major constituent. Lung inflammation was induced by intranasal administration of lipopolysaccharide (LPS) to mice, representing an animal model of acute lung injury (ALI). The alcoholic extract (50–200 mg/kg) inhibited the development of ALI. Especially, the oral administration of the saponin-enriched fraction (10–50 mg/kg) potently inhibited the lung inflammatory index. It reduced the total number of inflammatory cells in the bronchoalveolar lavage fluid (BALF). Histological changes in alveolar wall thickness and the number of infiltrated cells of the lung tissue also indicated that the saponin-enriched fraction strongly inhibited lung inflammation. Most importantly, the oral administration of timosaponin A-III at 25–50 mg/kg significantly inhibited the inflammatory markers observed in LPS-induced ALI mice. All these findings, for the first time, provide evidence supporting the effectiveness of A. asphodeloides and its major constituent, timosaponin A-III, in alleviating lung inflammation.

Bilateral optic neuropathy related to severe anemia in a patient with alcoholic cirrhosis: A case report and review of the literature

Anemia appears frequently in patients with alcoholic liver disease (ALD) but has never been linked to bilateral nonarteritic anterior ischemic optic neuropathy (NAION). A 65-year-old woman with a medical history of alcoholic cirrhosis was admitted for bilateral NAION. On admission, she was found to have a low arterial pressure and severe normocytic anemia (48 g/L). The anemia was related to chronic bleeding due to antral gastritis along with other factors associated with ALD. The applied treatment consisted of urgent transfusion followed by high doses of proton-pump inhibitors, iron and vitamin supplementation, and support in lifestyle measures. Her hemoglobin levels remained stable after 2 years but the patient still suffered from visual loss. This case highlights the link between anemia and bilateral NAION in ALD patients. The optic nerve head is prone to infarction in this context due to the vascularization characteristics of ALD. Hemoglobin levels should be monitored in ALD patients to avoid the severe complication of NAION.

Combined Extracts of Artemisia and Green Tea, Mitigated Alcoholic Gastritis Via Enhanced Heat-shock Protein 27 / 대한소화기학회지

BACKGROUND/AIMS: Several lines of evidence from epidemiologic and laboratory studies have shown that the consumption of Artemisia or green tea extracts (MPGT) is inversely associated with the risk of alcohol-induced damage and other chronic diseases. Supported by previous studies showing that the combined extract of Artemisia and green tea, MPGT, exerted significantly either antioxidative or anti-inflammatory actions against Helicobacter pylori-associated gastric diseases, it was hypothesized that MPGT can offer protection against alcoholic gastritis. METHODS: Ethanol was administered to induce gastric damage in Wistar rats, which had been pretreated with various doses of MPGT, to measure the rescuing action of a MPGT pretreatment against ethanol-induced gastric damage. In addition, the molecular mechanisms for the preventive effects were examined. RESULTS: The MPGT pretreatment (100, 300, and 500 mg/kg) alleviated the ethanol-induced gastric damage, which was evidenced by the significant decrease in calcium-dependent phospholipase A2, MAPKs, and NF-κB levels compared to ethanol alone. Furthermore, the MPGT pretreatment preserved 15-prostaglandin dehydrogenase, whereas cyclooxygenase-2 was decreased significantly. All of these biochemical changes led to the significant alleviation of alcohol-associated gastric mucosal damage. Ethanol significantly increased the TUNEL positivity in the stomach, but MPGT decreased the apoptotic index significantly, which was associated with significantly lower pathological scores of ethanol-induced mucosal ulcerations. The significant protective changes observed alcoholic gastritis with MPGT were related to the increased expression of cytoprotective genes, such as heat-shock protein (HSP)27, HSP60, and PDGF. CONCLUSIONS: The efficient anti-inflammatory, anti-apoptotic, and regenerative actions of MPGT make it a potential nutrient phytoceutical to rescue the stomach from alcoholic gastritis.

Development and Evaluation of Group Counseling Program using Neurolinguistic Programming for Alcoholics / 정신간호학회지

PURPOSE: The aim of this study was to develop and evaluate the effectiveness of a group counseling program using neurolinguistic programming (NLP) for individuals abusing alcohol. METHODS: In a quasi-experimental study, 48 participants were recruited from five alcohol medical centers. The NLP group counseling program was provided to the experimental group for 90 minute sessions twice a week for 5 weeks. Pre-post data were collected from November, 2014 to April, 2015. Data were analyzed using descriptive statistics, chi-squared tests, and independent t-tests. RESULTS: Compared with the control group, participants in the experimental group showed significantly decreasing scores for depression (t=−2.19, p=.033) and alcohol craving (t=−3.59, p=.001). Participants in the experimental group also showed improved self-efficacy related to drinking refusal (t=3.05, p=.004). CONCLUSION: Study findings support using the NLP group counseling program with patients abusing alcohol as it is effective in improving depression, drinking refusal self-efficacy, and craving. Therefore, the NLP group counseling program is a useful nursing intervention to prevent relapse in alcoholics.

Down on the upside: redemption, contamination, and agency in the lives of adult children of alcoholics.

We investigated differences in the nature and implications of Adult Children of Alcoholics (ACOAs; n = 53) and non-ACOAs' (n = 80) narrative identities. Participants described six autobiographical narratives and completed measures of emotional functioning. Narratives were coded for redemptive (bad things turning good), contaminated (good things turning bad), and agentic (perceived control) imagery. ACOAs exhibited similar levels of redemptive and contaminated imagery, and lower levels of agency in their narratives, relative to non-ACOAs. In addition, themes of redemption, contamination, and agency corresponded divergently with emotional functioning. Among ACOAs, narrative redemption and agency were related to poorer emotional functioning whereas, among non-ACOAs, narrative contamination predicted poorer emotional functioning. These findings provide indication of the manner in which ACOAs story their lives. They also align with the emerging area of research noting that, among certain vulnerable populations, redemptive and agentic imagery serve as predictors of maladaptive functioning.

Central and Extrapontine Myelinolysis after Alcohol Withdrawal and Correction of Hypernatremia in a Chronic Alcoholic: a Case Report

Osmotic demyelination syndrome (ODS) is a demyelinating disorder related to the rapid correction of hyponatremia. It usually affects the pontine area; hence, the name central pontine myelinolysis (CPM). However, it rarely occurs with the correction of hypernatremia and hyperosmolarity and involves extrapontine areas. A 56-year-old chronic alcoholic had been admitted with a history of confusion. He had been in alcohol withdrawal for 4 days. Laboratory examinations showed severe hypernatremia and hyperosmolarity. After serum sodium level was normalized; however, his clinical course did not improve and deteriorated to semicoma progressively. Magnetic resonance imaging (MRI) revealed abnormal signal intensity in the pontine and extrapontine areas, including the basal ganglia, thalamus, and cerebral cortices. This is the first case report of combined central pontine and extrapontine demyelination after alcohol withdrawal and correction of hypernatremia in a chronic alcoholic.

Guduchi Sawras (Tinospora cordifolia): An Ayurvedic drug treatment modulates the impaired lipid metabolism in alcoholics through dopaminergic neurotransmission and anti-oxidant defense system.

Tinospora cordifolia (Guduchi Sawras) though has been clearly demonstrated in literature for its hypolipidemic and anti-alcoholism properties but its anti-hyperlipidemia mechanistic approach is still missing. Moreover, its direct implication with alcohol induced hyperlipidemia has also not been reported till date. In order to explore the answers of these questions, phytochemicals of Tinospora cordifolia water extract "Guduchi Sawras" (GS) was analyzed using HPLC-Q-TOF-MS. On the basis of relative peak volumes 110 compounds were selected and identified in GS. Besides that, protein targets of most abundant compounds present in GS were fetched from ChEMBL and protein interaction network (PIN) was constructed. GO enrichment analysis showed that GS targets various pathways including dopamine metabolism, cAMP-dependent signaling pathway, and glycolytic process. Biological processes obtained via PIN were correlated with hyperlipidemia markers and dopamine metabolism in moderate alcohol consumers (n=25) and healthy volunteers (n=27) of age 41±3.8years. Metabolic analysis demonstrated the increased serotonin (1.9-fold) and decreased dopamine (-2.3-fold) levels in alcoholics. Further data analysis revealed a significant increase in urinary BCAAs (>2.0-fold), pantothenic acid (1.8-fold), carnitines (>2-fold) levels, and decrease in PPARα activation markers levels i.e. nicotinamide-1-oxide (-1.7-fold), and N-methylnicotinamide (-1.6-fold) in alcoholics. Biochemical analysis showed the increased AST/ALT ratio (1.91), along with triglycerides (20%), and MDA (34%) and GSH (56%) levels in alcoholics. GS treatment significantly reverted the most of the discussed metabolites levels (p<0.05) and enzymes activities (p<0.05) in alcoholics. The data depict that moderate chronic alcohol consumption lead to hyperlipidemia and oxidative burden; whereas GS treatment ameliorates hyperlipidemia by decreasing oxidative stress, activating PPARα, CREB and SREBP-1 through stimulation of dopamine D1 receptors mediated signalling molecules i.e. cAMP and protein kinase A.

Detection and qualitative analysis of fatty acid amides in the urine of alcoholics using HPLC-QTOF-MS.

Fatty acid amides (FAAs) in alcoholism lead to liver diseases. These amides have been reported in plasma and in other organs of the body, while their detection or presence in the urine is still unknown. Therefore, the focus of the current study was to detect and analyze FAAs qualitatively in urine samples of alcoholics. Furthermore, the effects of Tinospora cordifolia (hepatoprotective medicinal plant) intervention on FAA levels in moderate alcoholics were also analyzed. In the study, asymptomatic chronic alcoholics (n = 22) without chronic liver disease and nonalcoholic healthy volunteers (n = 24) with a mean age of 39 ± 2.0 years were selected. The first-pass urine and fasting blood samples were collected in the morning on day 0 and day 14 after T. cordifolia water extract (TCE) treatment and analyzed using automated biochemistry analyzer and HPLC-QTOF-MS. Results indicated the increased levels of serum triglycerides, cholesterol, and liver function enzymes in alcoholic subjects, which were significantly down-regulated by TCE intervention. Multivariate discrimination analysis of QTOF-MS data showed increased urinary levels of oleoamide (2.55-fold), palmitamide (5.6-fold), and erucamide (1.6-fold) in alcoholics as compared to control subjects. Levels of oleamide (1.8-fold), palmitamide (1.7-fold), and linoleamide (1.5-fold) were found to be increased in plasma. Treatment with TCE in alcoholics (3.0 g lyophilized water extract/day) significantly decreased the plasma and urinary levels of all FAAs except linoleamide. The HPLC-QTOF-MS approach for FAAs analysis in both urinary and plasma samples of alcoholics worked very well. Moreover, findings (i.e., increased levels of FAAs in urine and in plasma) further support other findings that these amides play a very important role in alcoholism. Further, like our previous findings, TCE proved its hepatoprotective effect against alcoholism not only by lowering the levels of these detected FAAs, but also by decreasing the level of liver-specific enzymes and lipids.

Wernicke's encephalopathy after total parenteral nutrition in patients with Crohn's disease

Micronutrient deficiencies in Crohn's disease (CD) patients are not uncommon and usually result in a combination of reduced dietary intake, disease-related malabsorption, and a catabolic state. Decreased serum thiamine levels are often reported in patients with CD. Wernicke's encephalopathy (WE) is a severe form of thiamine deficiency that can cause serious neurologic complications. Although WE is known to occur frequently in alcoholics, a number of non-alcoholic causes have also been reported. Here, we report two cases of non-alcoholic WE that developed in two severely malnourished CD patients who were supported by prolonged total parenteral nutrition without thiamine supplementation. These patients complained of sudden-onset ophthalmopathy, cerebellar dysfunction, and confusion. Magnetic resonance imaging allowed definitive diagnosis for WE despite poor sensitivity. The intravenous administration of thiamine alleviated the symptoms of WE dramatically. We emphasize the importance of thiamine supplementation for malnourished patients even if they are not alcoholics, especially in those with CD.

Biological Activities and Stability of a Standardized Pentacyclic Triterpene Enriched Centella asiatica Extract

Pentacyclic triterpenes, mainly, asiatic acid, madecassic acid, asiaticoside, and madecassoside are the active constituents of Centella asiatica. A pentacyclic triterpene enriched C. asiatica extract (PRE) was prepared and standardized to contain a total pentacyclic triterpenes not less than 65% w/w. This work was focused on determination of antiinflammatory, antioxidant, and tyrosinase inhibitory activities of PRE and its stability. The PRE exhibited a satisfactory nitric oxide inhibitory effect, with an IC50 value of 64.6 µg/mL. In addition, the PRE inhibited tyrosinase enzyme activity with an IC50 value of 104.8 µg/mL. In contrast, the PRE possessed only weak antioxidant activity. The PRE was stable over a period of four months when stored as a dried powder but only in a well-closed container protected from light at 4 °C. An aqueous alcoholic solution of the PRE was stable at pH values of 5.8 and 7.0, but was not stable at a pH of 8.2. Preparations of the PRE in an aqueous solution should be performed in acidic or neutral conditions.

The Influence of Self-esteem, Trait anger, Depression, Family Function, and Interpersonal Relations on Existential Spiritual Well-being in Patients with Alcohol Dependence / 정신간호학회지

PURPOSE: The aim of this study is to identify the factors influencing the existential spiritual well-being in the patients with alcohol dependence. METHODS: The research design was a descriptive survey research with self-report questionnaire about existential spiritual well-being, self-esteem, trait anger, depression, family function, and interpersonal relations scale. Participants in the study were 240 patients with dependence who were collected randomly from 10 mental hospitals and 5 alcoholic centers and 1 alcoholics anonymous in Busan, Deagu city and Gyeongsangbuk-do and Gyeongsangnam-do region. RESULTS: The forecasting regression model of existential spiritual well-bing appeared to be significant, the order of influencing factor was self-esteem (beta=.36, p<.001), depression (beta=-.38, p<.001), interpersonal relations (beta=.18, p=.001), and not being employed for last one year (beta=-.11, p=.007). CONCLUSION: The development of program which vitalizes the vocational rehabilitation and intervention is needed to increase the existential spiritual well-being of the patients with alcohol dependence by increasing the self-esteem and interpersonal relations and decreasing depression which are the major influencing factors.

Posterior Reversible Encephalopathy Syndrome (PRES) in a Chronic Alcoholic Patient after Having Steam Bath: A Case Report

Posterior reversible encephalopathy syndrome (PRES) is a rare disorder that is associated with hypertensive crises. In this article, we present a 59-year-old male patient with posterior reversible encephalopathy syndrome (PRES) caused by an acute hypertensive crisis after entering a steam bath in alcohol intoxicated status. In our case, oxidative stress resulting from alcohol metabolism may have lead to blood brain barrier (BBB) breakdown, serving as an aggravating factor in PRES. Thus we must always consider the possibility of PRES when treating chronic alcoholic patients with abnormal neurologic symptoms.

Plain water intake of Korean adults according to life style, anthropometric and dietary characteristic: the Korea National Health and Nutrition Examination Surveys 2008-2010

BACKGROUND/OBJECTIVES: The objective of the study was to provide useful insights into plain water intake of Korean adults according to life style, anthropometric, and dietary characteristics. SUBJECTS/METHODS: The data from the 2008-2010 Korea National Health and Nutrition Examination Survey were used. The subjects were 14,428 aged 20-64 years. Water intake was estimated by asking the question "How much water do you usually consume per day?". Dietary intake was estimated by 24-hour dietary recall. A qualitative food frequency questionnaire including 63 food items was also administered. RESULTS: The mean plain water intake for men and women were 6.3 cup/day and 4.6 cup/day, respectively. Plain water intake increased as lean body mass, waist circumference, and body mass index levels increased, except for percentage of body fat. As energy and alcohol intakes increased, plain water intake increased. As total weight of food intake and total volume of food intake increased, plain water intake increased. Plain water intake increased as consumption of vegetables increased. Plain water intake increased as frequencies of green tea, alcoholic drink, and all beverages were increased in men. Plain water intake increased with increased frequencies of green tea, milk, soy milk, and alcoholic drink and decreased frequencies of coffee and soda in women. CONCLUSIONS: Our results suggest that persons who had a higher waist circumference or lean body mass and women with higher BMI consumed more plain water. The persons eating high quality diet, or the persons who had more vegetables, green tea, milk, soy milk, or alcoholic drink consumed more plain water.

Perception of the role of spirituality and religiosity in the addiction treatment program among the Italian health professionals: a pilot study.

In this pilot study, 69 health professionals working in public and private programs treating drug users and alcohol misusers in Italy were interviewed during 2012 using the Vederhus and Laudet questionnaire as a framework to explore the importance of the concepts of spirituality and religiosity and their possible roles in the treatment through patient's referral to mutual-help groups. The study's limitations are noted.

Spirituality and the health professional.

The inclusion of spirituality in addictions recovery began with the 12-steps program of Alcoholics Anonymous. Cofounded by Bill Wilson, the 12-steps' spiritual orientation is based on Wilson's own recovery from alcoholism that was associated with a spiritual experience. His correspondence with Carl Jung, who verified the importance of Wilson's experience, empowered Wilson to make spirituality central to the 12 steps. Spirituality remains a source of misunderstanding between the scientific, empirically informed mental health community, and the 12-step recovery movement. This article offers an outline of spiritual development, based on neuroscience, which the professional can utilize in the spiritual aspect of a patient's recovery.

Spirituality, drugs, and alcohol: a philosophical analysis.

Spirituality has long been associated with recovery from the socially constructed "addictive disease." Alcoholics Anonymous (AA) and its analogs have enjoyed widespread acceptance as a spiritual approach for achieving recovery. AA or its derivatives are the predominant approaches in treatment programs even though a wide array of evidence-based approaches are now promoted by governmental sources in the United States. This philosophical analysis contrasts the state of science about addictive disorders with the reliance on a spiritual approach that is heavily grounded in Christian theology. We present four problems that need consideration before accepting the applicability of 12-step spiritual practices as the backbone of addiction treatment or recovery.