Multidimensional alcoholism typologies: could they guide clinical practice? Results from a 3-month prospective study.

OBJECTIVE: The current nosological classifications may describe a syndrome of "alcoholism" that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. METHOD: This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. RESULTS: The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. CONCLUSIONS: Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.

Effectiveness of Neuropsychological Rehabilitation in the Recovery of Executive Deficits in Patients with Alcohol Use Disorder: A Systematic Review Protocol.

INTRODUCTION: Changes in executive functions associated with alcohol consumption are frequently found in alcohol use disorder. Neuropsychological rehabilitation can play an essential role as an effective treatment in the recovery from these deficits, leading to the maintenance of abstinence. However, there are still some uncertainties regarding its impact on the recovery of deficits in executive functions. Our purpose is to present a protocol for a systematic review aiming to assess which neuropsychological rehabilitation programs are effective in the recovery of executive deficits in patients with alcohol use disorder. METHODS: We will search the following databases: PubMed, Cochrane Library (CENTRAL), Web of Science, and Scopus, as well as the list of references of the identified studies. Screening, data extraction, and synthesis, as well as evaluation of the risk of bias, will be carried out by two reviewers independently, using ROBINS-I and RoB 2. Disagreements will be resolved using a third additional reviewer. Primary outcomes will correspond to changes in executive functions, following a neuropsychological rehabilitation program in patients with alcohol use disorder. The evidence will be synthesized using a narrative description of neuropsychological rehabilitation programs and the indicators of their effectiveness will be identified. The neuropsychological rehabilitation programs for executive functions will be assessed considering their different components and their impact on the recovery of these functions. The review described in this protocol will allow the development of guidelines for the design of more effective rehabilitation programs for clinical populations with alcohol use disorder.

Clinical Challenges in Pedophilia-Themed Obsessive-Compulsive Disorder.

In obsessive-compulsive disorder, pedophilia-themed obsessions-distressing intrusive thoughts about being sexually attracted to, or sexually abusing, children-are the most distressing for patients and the most misdiagnosed among healthcare professionals. Our aim is to present a case report highlighting the role stigma plays in delaying treatment, the clinical challenges in the diagnosis, and in the treatment of pedophilia-themed obsessive-compulsive disorder, in order to address the lack of literature on the subject. The case concerns a 33-year-old man with suicidal thoughts associated with the unbearable suffering caused by pedophilia-themed obsessions he had been having over the previous decade, without ever asking for help. This situation was highly disabling, leaving him mostly isolated in his bedroom. After the differential diagnosis was made, a treatment plan combining pharmacological and cognitive-behavioural therapy was implemented. After 18 months he showed a degree of remission that made it possible for him to apply for a job.

Na perturbação obsessivo-compulsiva as obsessões pedofílicas - pensamentos intrusivos sobre ser sexualmente excitado, ou abusar sexualmente, de crianças - estão entre os mais angustiantes para os doentes e os mais incorretamente diagnosticados pelos profissionais de saúde. O nosso objetivo é apresentar um caso clínico destacando o papel que o estigma tem no atraso do início do tratamento e os desafios clínicos que se verificam em relação ao diagnóstico e ao tratamento desta perturbação, de modo a colmatar a falta de literatura sobre o assunto. O caso é relativo a um homem de 33 anos, com ideação suicida associada ao sofrimento insuportável causado pelas obsessões sexuais pedofílicas que tinha desde há uma década, sem nunca ter recorrido a um profissional de saúde. Esta situação teve muito impacto no seu funcionamento deixando-o maioritariamente isolado no seu quarto. Após o diagnóstico diferencial, implementou-se o projeto terapêutico combinando tratamento farmacológico e psicoterapia cognitivo-comportamental. Após 18 meses o doente apresentou uma melhoria significativa permitindo-o concorrer a um emprego.

The alcoholic phenotypes among different multidimensional typologies: similarities and their classification procedures.

AIM: This detailed cross-sectional analysis, obtained from a sample of alcohol-dependent patients, attempts to compare multiple methods that have been created to classify or subtype alcoholics. METHODS: The sample comprised 318 alcohol-dependent patients recruited from the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital in Lisbon (Portugal). All subjects were evaluated during the outpatient therapeutical programme for operationalized criteria, reported by each alcoholism typology. RESULTS: Regarding concordance agreement (kappa values) for the three type I/II classifications, von Knorring versus Sullivan yielded the higher rate of agreement, followed by von Knorring versus Gilligan and Gilligan versus Sullivan criteria. Chi-square comparisons showed a significant overlap between Babor type A and Cloninger type I of von Knorring and Sullivan. Over-two-type classifications showed the following significant positive relations: Lesch type I versus NETER heredopathic subtype; Lesch type II versus NETER anxiopathic subtype and Babor type A; Lesch type III versus NETER tymopathic subtype; Lesch type IV versus Cloninger type II of von Knorring and Sullivan criteria; and NETER adictopathic subtype versus Cloninger type II of von Knorring, Sullivan and Gilligan criteria. CONCLUSIONS: There is a significant overlap across many of the multivariate alcoholic subtypes purposed, in which much of the concordance is a function of common characteristics in subtype operationalization. Commonalities among these different subtyping classification systems offers the possibility of identifying important dimensions that better differentiate individuals among problem drinker's populations.

Are Patients With Alcohol-Related Seizures a Specific Subgroup?

OBJECTIVE: Alcohol-related seizures are acute symptomatic seizures most frequently associated with alcohol withdrawal. However, little is known about the phenotypic characteristics of patients with alcohol-related seizures. This study evaluated the clinical features and personality traits of alcohol use disorder patients with alcohol-related seizures. METHODS: This comparative correlational study assessed the clinical and psychological covariates of alcohol-related seizures. A total of 144 alcohol-dependent patients were recruited from an alcoholism unit from January 2017 to January 2019 and divided into 2 subgroups: alcohol-dependent patients reporting alcohol-related seizures and alcohol-dependent patients with no history of alcohol-related seizures. RESULTS: The alcohol-related seizures subgroup significantly started to abuse (F = 4.1, P = .019) and depend (F = 0.12, P = .008) on alcohol at an earlier age and had more alcohol detoxification episodes (F = 4.4, P = .048), a higher degree of alcohol dependence severity (F = 0.30, P = .009), and a more frequent family history of alcoholism (χ² = 4.9, P = .026). These patients also had lower levels of openness to experience (F = 4.0, P = .029) after adjustment for current age, age at onset of alcohol misuse and dependence, severity of alcohol dependence level, number of previous alcohol detoxifications, and family history. CONCLUSIONS: The findings will help clinicians better understand this subgroup of patients and highlight the importance of considering personality traits and other clinical features when tailoring treatment for these individuals.

Neuropsychological function and platelet monoamine oxidase activity levels in type I alcoholic patients.

AIMS: To explore neuropsychological function in two differentiated patterns of platelet monoamine oxidase B (MAO B) activity in alcoholic patients. METHODS: Neuropsychological examination and platelet MAO B activity extracted from blood were collected from 42 alcohol-dependent patients recruited in the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital. RESULTS: Alcoholics presented significantly low levels of platelet MAO B activity, when compared with control subjects; platelet MAO B activity in alcoholics classified as "under average subgroup" showed significant lower scores in the Raven Progressive Matrix and higher scores in hostility dimension, when compared with platelet MAO B activity in "above average subgroup." CONCLUSIONS: Results suggested platelet MAO B as a trait marker also to type I alcohol-dependent patients and the two observed associations between platelet MAO B activity with neurocognitive measures of executive functions (nonverbal reasoning) and psychopathological dimension such as hostility may support the notion about the effect of platelet MAO B activity in the further development of an impulsive cognitive style.

The role of affective temperament as a predictor of relapse in alcohol dependence.

BACKGROUND: Personality traits have been proposed as relapse risk factors in alcohol use disorders. So far, no study has assessed the association between affective temperamental traits and the prospective relapse risk. METHODS: This was a 3-month prospective naturalistic study, designed to assess the impact of affective temperaments in relapse. A sample of 61 alcohol-dependent patients was collected from an ambulatory clinical setting. Socio-demographic information, drinking and substance use habits, drinking status, craving and affective temperament traits were assessed. RESULTS: Age, age of onset of alcohol abuse and dependence and drug consumption correlate with drinking status. Male alcohol-dependent patients who relapsed presented higher scores on cyclothymic temperament than patients with an alcohol dependence diagnosis who remain sober. Hierarchical logistic regression indicates that cyclothymic temperament predicted relapse in a 3-month follow-up. However, the coefficient was marginally significant after controlling for all potential confounding predictors. CONCLUSIONS: Our results provide new insights about the role of affective temperaments in alcohol use disorders, specifically in predicting short-term relapse in detoxified male alcohol-dependent patients. Copyright © 2017 John Wiley & Sons, Ltd.

Motivational factors and negative affectivity as predictors of alcohol craving.

Craving is thought to play an important role in alcohol use disorders. The recent inclusion of "craving" as a formal diagnostic symptom calls for further investigation of this subjective phenomenon with multiple dimensions. Considering that alcohol-dependent patients compensate negative physical/emotional states with alcohol, the aim of this study is to investigate alcohol craving and its correlation with drinking measures and affective personality dimensions. A sample of 135 alcohol-dependent patients (104 males and 31 females) was collected from a clinical setting. Subjects self-rated their cravings (Penn Alcohol Craving Scale) and the stage of change. Several personality scales were also administered. Craving was related to drinking status, abstinence time, age, and taking steps. After controlling for these conditions, psychological characteristics related to low self-concept, neuroticism, cyclothymic affective temperament, depression, and hostility were found to be predictors of craving in sober alcohol-dependent patients. Our results support craving as a component of the phenomenology of alcohol dependence and highlight the presence of unpleasant feelings as predictors of craving in sober alcohol-dependent patients without co-occurring psychiatric conditions. The predisposition to experience negative emotions may induce a stronger craving response and increase the likelihood of a first drink and a subsequent loss of control.

Métodos cognitivos e comportamentais para quando o paciente não está disponível para parar de beber / Cognitive and behavioral methods when the patient is not available to stop drinking

As orientações para a prática clínica dos Transtornos Relacionados ao Álcool (TRA) preconizam que a avaliação dos pacientes deve ser efetuada desde logo sob os princípios da abordagem motivacional e que devem ser disponibilizadas intervenções psicológicas baseadas na terapia cognitivo-comportamental para prevenção da recaída ou treinamento do beber "moderado" (quando apropriado), que possam ser combinadas com fármacos. Considerando que existem poucas evidências sobre o que fazer quando os pacientes não estão preparados para parar totalmente de beber ou no período que antecede o início de um programa de desintoxicação medicamente assistida, esta revisão incidiu sobre os vários métodos comportamentais e cognitivos que podem ser aplicadas nos casos em que a cessação total do consumo do álcool não se coloca como objetivo terapêutico imediato. As seguintes abordagens foram apresentadas: método BRENDA, Intervenção Comportamental para Preparação da Abstinência, Método Comportamental de Extinção de Sinclair, Experiência de um Mês de Abstinência e as Técnicas de Moderação/Controle. Foram discutidos e caracterizados vários métodos comportamentais que permitem repensar radicalmente os tratamentos tradicionais para os TRA.(AU)

Guidelines for the clinical practice of alcohol use disorders (AUD) suggest that patient assessment should be carried out immediately under the principles of the motivational approach and that psychological interventions based on cognitive behavioral therapy should be available to prevent relapse or "moderate" (when appropriate) drinking, which can be combined with medication. Given that there is little evidence on what to do when patients are not fully prepared to stop drinking or in the period preceding the start of a medically assisted detoxification program, this review focused on the various behavioral and cognitive methods that may be applied in cases where the total cessation of alcohol consumption is not an immediate therapeutic goal. The following approaches were presented: the BRENDA method, Behavioral Intervention for Abstinence Preparation, Sinclair's Behavioral Extinction Method, One Month Abstinence Experienceand the Moderation/Control Techniques. Several behavioral methods have been discussed and characterized allowing a radical rethinking of traditional treatments for AUD.(AU)

Las orientaciones para la práctica clínica de las perturbaciones del uso del alcohol (PUA) preconizan que la evaluación de los pacientes debe ser efectuada desde el principio bajo los principios del abordaje motivacional y que deben ser disponibles intervenciones psicológicas basadas en la terapia cognitivo-conductual para prevenir la recaída o entrenar el beber "moderado" (cuando sea apropiado), las cuales pueden ser combinadas con fármacos. Teniendo en cuenta que hay pocas evidencias sobre qué hacer cuando los pacientes no están preparados para parar totalmente de beber o en el período anterior al inicio de un programa de desintoxicación médicamente asistida, esta revisión se centró en los diversos métodos conductuales y cognitivos que pueden ser se aplican en los casos en que el cese total del consumo de alcohol no se plantea como objetivo terapéutico inmediato. Se presentaron los siguientes enfoques: método BRENDA, intervención conductual para la preparación de la abstinencia, método de extinción conductual Sinclair, Experiencia de un mes de abstinenciay técnicas de moderación/control. Se discutieron y caracterizaron varios métodos comportamentales que permiten repensar radicalmente los tratamientos tradicionales para las PUA.(AU)

Are the binary typology models of alcoholism valid in polydrug abusers?

OBJECTIVE: To evaluate the dichotomy of type I/II and type A/B alcoholism typologies in opiate-dependent patients with a comorbid alcohol dependence problem (ODP-AP). METHODS: The validity assessment process comprised the information regarding the history of alcohol use (internal validity), cognitive-behavioral variables regarding substance use (external validity), and indicators of treatment during 6-month follow-up (predictive validity). RESULTS: ODP-AP subjects classified as type II/B presented an early and much more severe drinking problem and a worse clinical prognosis when considering opiate treatment variables as compared with ODP-AP subjects defined as type I/A. Furthermore, type II/B patients endorse more general positive beliefs and expectancies related to the effect of alcohol and tend to drink heavily across several intra- and interpersonal situations as compared with type I/A patients. CONCLUSIONS: These findings confirm two different forms of alcohol dependence, recognized as a low-severity/vulnerability subgroup and a high-severity/vulnerability subgroup, in an opiate-dependent population with a lifetime diagnosis of alcohol dependence.

The role of 5-HTTLPR polymorphism in alcohol craving experience.

The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.

The burden of cyclothymia on alcohol dependence.

BACKGROUND: The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. METHODS: A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. RESULTS: Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. LIMITATIONS: Correlational study CONCLUSIONS: CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.

[After the booze comes the hangover: a perspective of alcohol consumption in young]. / Depois da embriaguez vem a ressaca: uma perspectiva sobre o consumo de álcool nos jovens.

Until today, little relevance has been given to the main cause of alcohol consumption related morbidity in young population, the so called "the next day morning alcohol hangover". The hangover is defined by the presence of symptoms connected to excessive alcohol consumption and its total metabolism, with severity enough to disturb responsibilities and daily life activities. Numerous observations show us that generally the young populations tend to be involved in a series of behaviors to cope with the unpleasant effects of a night of immoderate alcohol consumption. Through an empirical evaluation, it will be argued in this study the circumstances implicated in alcohol hangover and which behaviors the young population normally tends to be involved in order to attenuate it. The sample comprised 134 university students (1º year). It can be concluded that the frequency of the behaviors to cope with alcohol hangover translates the need to remove or alleviate in an accurate and symptomatic way the most reiterated effects of aversive alcohol hangover cluster. This work provides reliable information that could be employed from an educational point of view, while we profound which cognitive, behavior and physiological mechanisms occurs during an episode of alcohol hangover. Taken into account that the consumption of alcoholic beverage is a normative behavior in adolescence, we propose a realistic perspective of the phenomenon (more than ideological and utopic), that encompass the maximum delay of the beginning of alcohol consumption in young, educating them in what concerns the potential harm of its consumption, incorporated in a broad perspective of promotion of an healthy life style and of proximity with the adolescent.

Are the binary typology models of alcoholism valid in polydrug abusers ?

Objective: To evaluate the dichotomy of type I/II and type A/B alcoholism typologies in opiate-dependent patients with a comorbid alcohol dependence problem (ODP-AP). Methods: The validity assessment process comprised the information regarding the history of alcohol use (internal validity), cognitive-behavioral variables regarding substance use (external validity), and indicators of treatment during 6-month follow-up (predictive validity). Results: ODP-AP subjects classified as type II/B presented an early and much more severe drinking problem and a worse clinical prognosis when considering opiate treatment variables as compared with ODP-AP subjects defined as type I/A. Furthermore, type II/B patients endorse more general positive beliefs and expectancies related to the effect of alcohol and tend to drink heavily across several intra- and interpersonal situations as compared with type I/A patients. Conclusions: These findings confirm two different forms of alcohol dependence, recognized as a low-severity/vulnerability subgroup and a high-severity/vulnerability subgroup, in an opiate-dependent population with a lifetime diagnosis of alcohol dependence. .

NETER 1 alcoholic 5 subtypes: Validity with Lesch four evolutionary subtypes.

Objective. To validate NAT (NETER's alcoholic typology), taking into account the differentiated distribution of the measures used as external criteria in alcohol-dependent sub-groups and its relationship with Lesch's alcoholic typology (LAT). Method. A sample of 133 alcohol-dependent patients integrated in the alcoholism unit of the Psychiatric Service of Santa Maria University Hospital were included in the study. Results and Conclusions. Convergent validity was assured by the agreement between the subtypes of the two typologies (NAT and Lesch), considering the same underlying model of alcoholism development: anxiopathic subtype of NAT and Type II (model of anxiety, alcohol as conflict solution) of Lesch and the tymopathic subtype of NAT and type III (model of depression, alcohol as antidepressant) of Lesch. Discriminant analysis (external criteria) showed significant differences between the subtypes in the following variables: gender; tobacco; beer and whisky consumption; daily average of drinks; clinical conditions such as delirium tremens, alcoholic blackouts and seizures; severity of alcohol-related problems; psychological dimensions such as psychological maturity and extroversion; and suicidal ideation during the alcohol consumption period. A more exhaustive description of alcoholic sub-groups may improve genetic studies of alcoholism and provide the alcoholic patient with an adequate specific therapeutic protocol.

[Association of the functional serotonin transporter promoter polymorphism (5-HTTLPR) with externalizing and internalizing aggressivity and alcohol abuse]. / Associação entre o polimorfismo funcional do promotor ligado ao transportador da serotonina (5-HTTLPR): agressividade externalizada e internalizada e abuso do álcool.

Genetic factors of alcoholism influence the phenotypic heterogeneity of alcohol dependence, allowing the higher or lower expression of related aggressive behaviours. The pathogenesis of alcoholism and anti-social behaviour has been connected to serotonergic system dysfunction, given support to examine the association with 44-basepair insertion/deletion polymorphism of serotonin gene transporter (5-HTT). The study aims to assess the relationship between 5-HHTLPR polymorphism, aggressive behaviour and alcohol consumption pattern. There were recruited 97 alcohol dependent patients from the alcoholism unit (Etilo-Risco) of the Psychiatric Service of Santa Maria Hospital. Blood for DNA extraction and clinical and behavioural information was collected during the therapeutic program. Regarding 5-HTTLPR polymorphism prevalence in alcoholic population, 30.7% were homozygotic to l allele, 19.8% were homozygotic to s allele and 49.5% were heterozygotic l/s. Alcoholic patients carrying the l allele from 5-HTTLPR genotype showed significant lower scores of aggressivity during acute alcohol consumption, and alcoholic patients carrying the s allele showed significant higher scores of aggressivity (during acute alcohol consumption and abstinence), however, the results were not significant. The association between the functional nature of the s allele of 5-HTTLPR polymorphism with aggressive behaviour is in agreement with the general models of aggressivity that report low levels of central serotonergic activity related to impulsive and anti-social behaviours. The results demonstrate an association between 5-HTTLPR polymorphism and the auto and heteroaggressive behaviour in alcohol dependent population, particularly when aggressivity appears under acute alcohol consumption. During acute alcohol consumption stage, the presence of the l allele may act as a protective factor of aggressive behaviour risk, whereas the results tendency showed the s allele as susceptibility factor. Data suggests that the presence of s allele may confer a genetic vulnerability factor to the development of aggressive behaviour in alcohol dependent subjects, specially, in interaction with acute alcohol consumption stage.

NETER alcoholic typology (NAT).

AIMS: To establish an alcohol-dependent drinker's clinical typology, based on patients attending the Alcoholism Unit of Santa Maria's General Hospital in Lisbon, Portugal. METHODS: A multivariate statistical analysis was used to extract the typology solution. RESULTS: We obtained five factors: Anxiopathic, typifies anxious functioning; Heredopathic, congregates familiar and genetic influences on alcoholism; Thimopathic, typified by affective symptomatology; Sociopathic, characterized by disruptive behaviours under alcohol influence; and Adictopathic, isolates younger individuals who consume alcohol and other types of psychoactive substances. CONCLUSIONS: There are increasingly alcoholic polymorphic subtypes derived from the interactive complexity between genetic/family and psychosocial factors.