Seasonality and Delirium Tremens in Hospitalized Patients with Alcohol Dependence Syndrome.

INTRODUCTION: Due to the high rate of mortality, recognizing the contributing factors of alcohol-related delirium tremens (DT), which is the most severe form of alcohol withdrawal state (AWS) is pivotal in clinical settings. Previous studies suggested relationship between seasonality and other types of delirium; however, to our knowledge, this is the first empirical study which examined the role of seasonality in DT in alcohol dependence syndrome (ADS). METHODS: A retrospective study was undertaken between 2008 and 2015; medical records of 1,591 patients were included, which yielded 2,900 hospital appearances. Three groups were formed based on the ICD-10 diagnoses: ADS, AWS, and DT. The characteristics of the groups were analysed with one-way ANOVA and χ2 tests. Multinomial logistic regression was used to explore the potential predictors of DT, including seasonality. RESULTS: The highest incidence of DT was in spring (36.8%; χ2 (3) = 27.666; p < 0.001), especially in March (13.9%; χ2 (11) = 33.168; p < 0.001). Spring, higher mean age, higher presence of comorbid somatic disorders, and lower occurrence of comorbid psychiatric disorders were significant predictive variables for DT with the control of socio-demographic and clinical variables. CONCLUSIONS: The present study revealed that spring, especially March is a critical period in temperate climate zone regarding DT. This can be interpreted as a late winter effect since the temperature is lower in this month compared to other spring months. Furthermore, higher age and the occurrence of comorbid somatic disorders can be considered as risk factors in case of DT. These results support the need of further clinical studies to better understand the impact of seasonality on DT.

Externalizing personality characteristics define clinically relevant subgroups of alcohol use disorder.

AIMS: Higher levels of externalizing characteristics, i.e. impulsivity, novelty seeking and aggression, could contribute to the development, progression and severity of alcohol use disorder (AUD). The present study aims to explore whether these externalizing characteristics together have a potential group-forming role in AUD using latent profile analysis (LPA). METHODS: Externalizing characteristics of 102 AUD patients were analyzed using LPA to explore the group-forming role of externalizing symptoms; groups were compared in terms of demographic and alcohol-related variables, indices of psychopathological, depressive and anxiety symptom severity. RESULTS: LPA revealed and supported a two-group model based on externalizing symptoms. The group with higher levels of externalizing symptoms showed significantly elevated levels of alcohol-related and anxio-depressive symptoms. CONCLUSIONS: Externalizing characteristics converge and have a group-forming role in chronic AUD, and are associated with a more severe form of AUD. By making the diagnostic category less heterogeneous, these different subtypes within AUD may provide aid in tailoring treatments to patients' specific needs.

The personality profile of chronic alcohol dependent patients with comorbid gambling disorder symptoms.

BACKGROUND AND AIMS: The importance of personality characteristics in the diagnosis and treatment of gambling disorder (GD) and alcohol use disorder (AUD) is often highlighted in scientific literature. This study aimed to test predictions about the associations of temperament and character in chronic AUD patients with comorbid GD symptoms and without them. METHODS: Chronic AUD patients enrolled from an inpatient clinic were divided in two groups based on cluster analysis, AUD patients with (AUD + GD group: n = 30) and without (AUD group: n = 68) GD symptoms. Severity of GD symptoms and personality dimensions (Cloninger's Temperament and Character Inventory Revised, TCI-R) were assessed. Associations of tested variables were analysed with analysis of covariance, one-sample and independent sample t-tests. RESULTS: GD symptoms proved to be a clustering factor in terms of personality, where AUD + GD group expressed a more maladaptive personality profile. Compared to Hungarian normative TCI-R scores, both patient groups showed elevated levels of Harm Avoidance and Novelty Seeking with lower scores of Self-directedness, while the AUD + GD group scored lower on Persistence and Cooperation as well. The AUD + GD group reported significantly higher levels of Harm Avoidance, with lower scores of Reward Dependence compared to the AUD group. DISCUSSION: Comorbid GD symptom severity is an important factor in chronic AUD, where AUD patients with comorbid GD symptoms exhibited a more maladaptive personality constellation than singular AUD patients. These emphasize the need of special attention for comorbid GD symptoms in AUD, since treatment recommendations and prognosis for them may also differ.

Different aspects of impulsivity in chronic alcohol use disorder with and without comorbid problem gambling.

BACKGROUND AND AIMS: Alcohol use disorder (AUD) and problem gambling are highly comorbid disorders. This study aims to explore the role of four aspects of impulsivity (trait concept of impulsivity, choice impulsivity, impulsive aggression and response inhibition/decision-making) in long-term chronic AUD patients with and without problem or pathological gambling symptoms. METHODS: Cognitively intact chronic AUD patients were enrolled with (n = 32) and without (n = 71) problem gambling symptoms in an inpatient clinic for chronic alcohol users. Multiple facets of impulsivity, cognitive ability, psychopathological symptoms, alcohol and gambling severity were measured. RESULTS: Chronic AUD patients with gambling disorder symptoms showed longer lifetime alcohol consumption, more severe alcohol use and higher psychopathological symptom severity than AUD patients without gambling symptoms. Gambling severity correlated with overall trait impulsivity, but not with choice impulsivity, impulsive aggression or cognitive impulsivity with controlling for lifetime alcohol consumption, lifetime alcohol use and psychopathological symptom severity. High trait impulsivity and non-planning was associated with comorbid gambling symptoms in AUD patients, which was independent of the level of intelligence, age and psychopathological symptoms. CONCLUSION: Comorbid gambling disorder symptoms in chronic AUD was connected to more severe alcohol-related variables. Higher trait impulsivity was also linked with gambling disorder symptoms in patients with chronic AUD. This accents the need of special focus on comorbid GD symptoms in AUD, since prognosis and treatment for them may vary.

Mild Effect of Nalmefene on Alcoholic Cue-Induced Response Invigoration in Alcohol Use Disorder Without Accompanying Changes in Electrophysiological Signatures of Early Visual Processing and Executive Control.

Nalmefene is approved for as-needed pharmacological treatment in alcohol use disorder (AUD) by the European Medicines Agency. While the cellular effects of nalmefene have been thoroughly investigated, data are very limited on how this agent influences neural signals associated with inhibitory control and the visual analysis of environmental cues. This double-blind crossover study assessed the behavioral and neural effects of acute nalmefene administration in patients diagnosed with AUD. In experiment 1, we validated our experimental paradigm (electroencephalography combined with a modified Go/NoGo task using images of alcoholic and nonalcoholic drinks as prime stimuli) in 20 healthy adults to ensure that our protocol is suitable for assessing the behavioral and neural aspects of executive control. In experiment 2, we recruited 19 patients with AUD, and in a double-blind crossover design, we investigated the effects of nalmefene versus placebo on task performance (response accuracy, the sensitivity index, and reaction times), visual responses to appetitive cues (occipital P1, N1, and P2 components), and electrophysiological markers of conflict detection and response inhibition (frontal N2 and P3 waveforms). Under placebo, patients produced faster reaction times to alcohol-primed Go stimuli, an effect that was weak despite being statistically significant. However, the effect of alcoholic cues on the speed of response initiation disappeared after receiving nalmefene. We found no placebo versus nalmefene difference regarding our patients' ability to accurately inhibit responses to NoGo stimuli or for occipital and frontal event-related potentials. Our results suggest that nalmefene might be potent in reducing the vigor to act upon alcoholic cues in AUD patients, but this effect is most probably mediated via subcortical (rather than cortical) neural circuits.

[The first step towards a unified approach: validation of the Hungarian version of the Clinical Institute Withdrawal Assessment of Alcohol, Revised in Hungarian general hospital settings]. / Elso lépés egy egységes szemlélet felé: az Alkohol Megvonási Skála bevezetése a hazai betegellátási gyakorlatba.

Introduction and aim: The available literature and protocols have unequivocally suggested that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a psychometric scale for identifying and following the signs of alcohol withdrawal. However, there has not been any validated tool for the identification of withdrawal symptoms in Hungarian general hospital settings. The aim of the present study was to evaluate the validity and the reliability of the Hungarian version of this scale among patients hospitalized with alcohol withdrawal syndrome. Method: The translation of the scale into Hungarian was done by 'back translation' method, followed by testing the face validity. The empirical phase was performed in the Department of Psychiatry, University of Szeged. Patients admitted with alcohol withdrawal syndrome (n = 30) were recruited from the inpatient units of the clinic. Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression - Severity Scale were recorded every two days. Statistical comparisons of data were performed with repeated-measures ANOVA. Cronbach's alpha, item-total correlation, convergent and discriminant validity were determined. Results: Significant decrease of the total scores of Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression - Severity Scale was observed between the six measurements (F = 202.46, p<0.001; F = 503.04, p<0.001). Cronbach alpha values were above 0.7 during the first 3 measurement days. The withdrawal and severity scores recorded the same day showed positively significant correlations (>0.45). Conclusion: Our findings demonstrate that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a reliable and valid psychometric tool for the detailed analysis of withdrawal symptoms in Hungarian general hospital settings. Orv Hetil. 2019; 160(30): 1184-1192.

Direct and indirect symptom severity indicators of alcohol dependence and the personality concept of the biosocial model.

Temperament and character factors are strongly related to the developmental, clinical, and treatment aspects of alcohol dependence. This study had the aim of revealing the underlying personality structure and individual differences in the symptoms of alcohol dependence measured by multiple severity indicators. Patients with alcohol dependence exhibited higher levels of novelty seeking and harm avoidance, and lower levels of persistence, self-directedness, and cooperativeness. Especially novelty seeking was connected with more severe alcohol dependence. These characteristics could be useful targets of interventions and Temperament and Character Inventory is therefore a useful measurement to identify patients with more severe alcohol-related problems.

A novel kynurenic acid analog (SZR104) inhibits pentylenetetrazole-induced epileptiform seizures. An electrophysiological study : special issue related to kynurenine.

The concentration of kynurenic acid (KYNA) in the cerebrospinal fluid, which is in the nanomolar range, is known to decrease in epilepsy. The experimental data suggest that treatment with L: -KYN dose dependently increases the concentration of the neuroprotective KYNA in the brain, which itself hardly crosses the blood-brain barrier. However, it is suggested that new synthetic KYNA analogs may readily cross the blood-brain barrier. In this study, we tested the hypothesis that a new KYNA analog administered systemically in a sufficient dose results in a decreased population spike activity recorded from the pyramidal layer of area CA1 of the hippocampus, and also provides protection against pentylenetetrazole-induced epileptiform seizures.