Prospective cohort study of daily alcoholic beverage intake as a potential trigger of headaches among adults with episodic migraine.

PURPOSE: To determine whether alcohol intake is associated with occurrence of headaches on the following day. METHODS: In this prospective cohort study, adults with episodic migraine completed electronic diaries every morning and evening for at least six weeks in March 2016-October 2017. Every day, participants reported alcohol intake, lifestyle factors, and details about each headache. We constructed within-person fixed-effect models adjusted for time-varying factors to calculate odds ratios for the association between 1,2,3,4, or 5+ servings of alcohol and headache the following day. We also calculated the adjusted risk of headache the following day for each level of intake. RESULTS: Among 98 participants who reported 825 headaches over 4,467 days, there was a statistically significant linear association (p-trend = 0.03) between alcohol and headache the following day. Compared to no alcohol, 1-2 servings were not associated with headaches, but 5+ servings were associated with a 2.08-fold (95% confidence interval [CI] 1.16-3.73) odds of headache. The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol compared with 33% (95%CI 22%-44%) on days following 5+ servings. CONCLUSION: 1-2 servings of alcoholic beverages were not associated with higher risk of headaches the following day, but 5+ servings were associated with higher risk. KEY MESSAGES 1-2 servings of alcoholic beverages were not associated with a higher risk of headaches on the following day, but higher levels of intake may be associated with higher risk. Five or more servings were associated with 2.08 times (95% confidence interval 1.16-3.73 the odds of headache on the following day. The adjusted absolute risk of headaches was 20% (95%CI 19%-22%) on days following no alcohol consumption compared with 33% (95% CI 22%-44%) on days following 5+ servings.

Analysis of QT Dispersion, Corrected QT Dispersion, and P-Wave Dispersion Values in Alcohol Use Disorder Patients With Excessive Alcohol Use.

OBJECTIVE: To identify the changes in QT dispersion (QTd), corrected QTd (QTcd), and P-wave dispersion (Pd) values with long-term alcohol abuse that could lead to severe ventricular arrhythmia, atrial fibrillation, and sudden death in alcohol use disorder (AUD) patients with excessive alcohol use. METHODS: This cross-sectional study included 48 individuals diagnosed with AUD based on DSM-5 criteria. Patients with a history of psychiatric diseases were not included. The control group comprised 48 individuals with no psychiatric diagnosis who did not abuse alcohol or other substances. Participants with body mass index > 24.9 kg/m² were excluded. Twelve-derivation electrocardiograms (ECG) were obtained from all participants. RESULTS: The mean ± SD age was 44.35 ± 10.24 years in the AUD group and 40.90 ± 13.45 years in the control group. There was no significant difference between the groups based on age (P = .108). There was a significant difference between the groups based on smoking status (P = .000). The mean ± SD period of alcohol use was 20.71 ± 12.04 years, and the alcohol intake was 5.88 ± 1.65 units/d. The AUD group demonstrated elevations in all ECG measures (QTd: 46.56 vs 26.67 ms, QTcd: 54.25 vs 30.88 ms, Pd: 44.69 vs 28.54 ms, all P = .000). CONCLUSIONS: AUD patients with excessive alcohol use had a higher risk of arrhythmia and sudden death compared to the control group. Consideration of ECG and referral to cardiologic examinations would contribute to the follow-up and health of patients with AUD.

Guía de práctica clínica consumo perjudicial y dependencia de alcohol y otras drogas en personas menores de 20 años / Clinical practice guide harmful consumption and dependence on alcohol and other drugs in people under 20 years of age

Generar recomendaciones basadas en la mejor evidencia disponible acerca del manejo clínico del consumo perjudicial y dependencia de alcohol y otras drogas en personas menores de 20 años.

Development and initial validation of the alcohol-induced blackout measure.

BACKGROUND: Blackouts are common among young adults and predict alcohol-related harm. However, existing measures do not capture the range of alcohol-induced memory impairment involved in blackout experiences and do not differentiate between fragmentary and en bloc blackouts. This study aimed to develop and validate a brief, reliable measure of alcohol-induced blackouts among young adults. METHODS: College students reporting alcohol-induced memory impairment in the past year were recruited via Qualtrics to participate in an online survey (N = 350, 56% female). A subsample (n = 109, 67% female) completed a one-month follow-up. Principal component analysis was used to determine the structure of the Alcohol-Induced Blackout Measure (ABOM), which was designed to reflect two components (fragmentary and en bloc blackouts). The reliability and validity of the total ABOM score was assessed. RESULTS: The final five items fit in a two-component scale structure; however, a single principal component accounted for 73% of variance in blackout items, all of which demonstrated high component loadings and communalities. The total blackout score demonstrated strong internal consistency, test-retest reliability, and convergent and incremental validity. ABOM scores predicted alcohol-related consequences at baseline and one-month follow-up. CONCLUSIONS: The ABOM is a brief and reliable, self-report measure that quantifies the frequency of a range of blackout experiences in the past 30 days. Accounting for this range of experiences improved predictive validity over single-item blackout measures. Blackout frequency is a strong, unique predictor of alcohol-related problems.

[Alcohol induced neurocognitive disorder: screening strategies and tools]. / Repérage des troubles cognitifs liés à l'alcool.

Alcohol induced neurocognitive disorder: screening strategies and tools. Chronic and excessive alcohol consumption results in cognitive disorders partially reversible with abstinence. These heterogeneous cognitive impairments affect executive functions, episodic memory and social cognition. They may interfere with the motivational process to abandon excessive drinking behavior, impair patients' ability to benefit from treatment and increase the risk of relapse. Alcohol-related neuropsychological deficits should thus be evaluated and considered for personalized alcohol treatment. Several screening tools available in clinical settings enable clinicians to detect patients with cognitive impairments and to offer them appropriate and adjusted treatment.

Repérage des troubles cognitifs liés à l'alcool. La consommation chronique et excessive d'alcool est fréquemment associée à des troubles cognitifs, en partie réversibles à l'arrêt de l'alcool. Variables d'un individu à l'autre, ils touchent principalement les fonctions exécutives et motrices, la mémoire épisodique, ainsi que la cognition sociale. Ces troubles peuvent freiner le processus motivationnel, amoindrir les capacités des patients à bénéficier des prises en charge et augmenter le risque de rechute. Plusieurs outils de dépistage rapide sont disponibles en pratique clinique. Ils permettent d'orienter les patients ayant une altération cognitive vers des prises en charge spécialisées pour la réalisation de bilans complémentaires. Le profil neuropsychologique des patients peut aussi éclairer les difficultés de prise en charge et permettre de personnaliser les soins addictologiques.

A quantification of the alcohol use-consequences association in college student and clinical populations: A large, multi-sample study.

BACKGROUND: The present study sought to quantify the relationship between alcohol use and alcohol-related consequences in both college student and clinical samples. METHODS: We gathered 33 college student datasets comprising of 15,618 participants and nine clinical sample datasets comprising of 4,527 participants to determine the effect size of the relationship between alcohol use and alcohol-related consequences. We used random-effects meta-analytic techniques, separately in college and clinical samples, to account for a distribution of true effects and to assess for heterogeneity in effect sizes. RESULTS: Results demonstrated that the clear majority of the variability in alcohol-related consequences is not explained by alcohol use (ie, >77% in college samples; >86% in clinical samples), and that there was significant heterogeneity in all effect sizes. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Experiencing alcohol-related consequences results from factors that extend beyond frequency and quantity of alcohol consumed suggesting a need to examine other predictors of alcohol-related consequences beyond alcohol use. (Am J Addict 2018;27:116-123).

Cribaje de trastornos por uso de alcohol en pacientes psiquiátricos ambulatorios: influencia de género, edad, y diagnóstico psiquiátrico / Screening of alcohol use disorders in psychiatric outpatients: influence of gender, age, and psychiatric diagnosis

Los trastornos por uso de alcohol (TUA) son 2 veces más frecuentes en pacientes psiquiátricos que en la población general. El infradiagnóstico de patología dual puede tener diversas consecuencias negativas; una valoración precoz con herramientas de cribaje como la escala CAGE podría mejorar el pronóstico de estos pacientes. El objetivo de este estudio es valorar el riesgo de TUA en pacientes psiquiátricos ambulatorios con una CAGE modificada, considerando la influencia de edad, género, y diagnóstico psiquiátrico. Se realizó un estudio descriptivo observacional, multicéntrico. La escala CAGE de 4 ítems, camuflada en un cuestionario de vida saludable, se aplicó utilizando el punto de corte de 1. Se valoraron 559 pacientes. El 54% eran mujeres, y la edad media fue de 50,07 años. 182 pacientes presentaron una puntuación ≥1 (45,1% de los hombres y 21,9% de las mujeres). El género fue el predictor principal de un resultado positivo en la escala CAGE, siendo 3,03 veces más probable que los hombres obtengan una puntuación ≥1 (p < ,001, 95% IC: 0,22-0,49). El trastorno bipolar y los trastornos de personalidad presentaron las tasas más altas de puntuaciones ≥1 (45,2 y 44,9%, respectivamente) con una asociación significativa entre diagnóstico y un resultado positivo (p = ,002). Los pacientes de más de 60 años mostraron 2,5 veces menos probabilidades de obtener una puntuación positiva (p = ,017, 95% IC: 0,19-0,85). Cuestionarios específicos, como CAGE, pueden ser herramientas sencillas y útiles para valorar el riesgo de TUA en pacientes psiquiátricos ambulatorios. Los pacientes hombres con trastorno bipolar o de personalidad presentan un riesgo más elevado de TUA

Alcohol use disorders (AUD) are 2 times higher among psychiatric patients than in the general population. The under-recognition of this dual diagnosis can entail several negative outcomes. Early assessment with a screening tool like the CAGE questionnaire could be an opportunity to improve patients’ prognoses. The objective of this study is to assess AUD risk in an outpatient psychiatric sample with a modified CAGE, considering the influence of age, gender and clinical psychiatric diagnosis. An observational, multicentric, descriptive study was carried out. The 4-item CAGE scale, camouflaged in a healthy lifestyle questionnaire, was implemented, using a cut-off point of one. 559 outpatients were assessed. 54% were female and the average age was 50.07 years. 182 patients presented a CAGE score ≥1 (45.1% of men and 21.9% of women). Gender was the strongest predictor of a positive result in CAGE, as men were 3.03 times more likely to score ≥1 on the CAGE questionnaire (p < .001, 95% CI: 0.22-0.49). Patients with bipolar and personality disorders had the highest rates of CAGE scores ≥1 (45.2 and 44.9%, respectively), with a significant association between diagnosis and a positive score (p = .002). Patients above 60 years were 2.5 times less likely to score ≥1 on the CAGE (p = .017, 95% CI: 0.19-0.85). Specific screening questionnaires, like the CAGE scale, can be an easy and useful tool in the assessment of AUD risk in psychiatric outpatients. Male patients with a bipolar or personality disorder present a higher risk of AUD

[Alcohol-associated mortality in Russia (based on the materials for the period from 2011 till 2016)]. / Alkogol'-assotsiirovannaia smertnost' v Rossii (po materialam 2011-2016 gg.).

The objective of the present study was to evaluate the frequency of alcoholic drunkenness documented during forensic medical expertises (investigations) of the corpses carried out in this country throughout the period from 2011 till 2016. The investigations were conducted with the use of medical statistics methods by calculating the fractional difference, dynamics, and rates of detection of the cases of alcoholic intoxication depending on the cause of death. The study has demonstrated the high frequency of the cases of alcoholic drunkenness revealed during forensic medical expertises (investigations) of the corpses that amounted to 30.5% [15, 16]. The total number of the corpses examined in 2016 was 8.6% higher than in 2011. The frequency of the documented cases of alcoholic drunkenness during the same period decreased by 19.7%. The frequency of the documented cases of alcoholic drunkenness in the cases of violent death was 2.8 times that in the cases of death from various diseases (52.8 and 19.0% respectively). The enhanced frequency of alcoholic drunkenness in relation to the number of the conducted forensic medical expertises was documented in the cases of death by drowning and from hypothermia whereas the lowest frequency of alcoholic intoxication was recorded for the corpses of the people who had died from malignant tumours and diseases of the nervous system. Various regions of Russia differed in terms of the frequency of alcoholic drunkenness recorded among the recently deceased people.

Desarrollo de un test de detección de deterioro cognitivo en población alcohólica: TEDCA / Development of a screening test for cognitive impairment in alcoholic population: TEDCA

Introducción. Numerosos estudios han encontrado alteraciones cognitivas en pacientes con historia de trastorno por consumo de alcohol, afectando su funcionamiento psicosocial y consecución de objetivos terapéuticos. Para identificar estas afectaciones se han utilizado pruebas de cribado cognitivo a pesar de que no han sido diseñadas para esta población, aumentando el riesgo de error. Objetivo. Valorar los principales déficits cognitivos en pacientes con historia de trastorno por consumo de alcohol, para desarrollar una prueba de cribado de alteraciones cognitivas específica para estos pacientes. Metodología. El TEDCA (Test de detección de deterioro cognitivo en alcoholismo) se diseñó en base a tres dimensiones: Cognición Viso-espacial, Memoria/Aprendizaje y Función Ejecutiva. El estudio se dividió en dos fases: En la fase 1 se seleccionaron las pruebas con mayor capacidad de discriminación entre pacientes con diferentes niveles de afectación cognitiva, y en la fase 2 se realizaron los análisis de validez y fiabilidad. La muestra estuvo formada por 248 participantes, 88 controles (fase 2) y 160 pacientes (fase 1: n=70 y fase 2: n=90). Resultados. El TEDCA obtuvo una fiabilidad elevada (alfa de Cronbach 0.754), el análisis factorial confirmó la presencia de las 3 dimensiones definidas previamente, discriminó entre pacientes y controles, y presenta una buena validez diagnóstica de afectación cognitiva. Conclusiones. El TEDCA es una nueva prueba de cribado, que permite identificar la posible presencia de afectación cognitiva en pacientes con historia de trastorno por (AU)

Introduction. Several studies have found cognitive impairment in patients with a history of alcohol use disorder, affecting their psychosocial functioning and the achievement of therapeutic goals. In order to identify these effects, several cognitive screening tests have been used, though they were not specific for alcoholic population, possibly leading to an increase in the risk of error. Objective.The aim of this study is to assess the main cognitive deficits in patients with history of alcohol use disorders, through the development of a specific screening test for alcohol-related cognitive impairment. Methodology. The TEDCA (Test of detection of cognitive impairment in alcoholism) was designed based on three dimensions: Visuospatial Cognition, Memory / Learning and Executive Function. The study was divided in two phases: During phase 1, test items with greater capacity for discrimination between patients with different levels of cognitive impairment were selected, and during phase 2, the analysis for validity and reliability indexes took place. The sample consisted of 248 participants, 88 controls (phase 2) and 160 patients (phase 1: n=70 and phase 2: n=90). Results.TEDCA test obtained a high reliability (Cronbach's alpha 0.754) value and the factor analysis confirmed the presence of the three dimensions previously defined. The present screening tool also discriminated between patients and control group, together with a good diagnostic validity of cognitive impairment. Conclusions. TEDCA is a new screening test, which identifies the possible presence of cognitive impairment in patients with a history of alcohol use disorders, which can be used in the fields of psychiatry, primary care and research (AU)

Anxiety, Anxiety Sensitivity, and Perceived Stress as Predictors of Recent Drinking, Alcohol Craving, and Social Stress Response in Heavy Drinkers.

BACKGROUND: Stress and anxiety are widely considered to be causally related to alcohol craving and consumption, as well as development and maintenance of alcohol use disorder (AUD). However, numerous preclinical and human studies examining effects of stress or anxiety on alcohol use and alcohol-related problems have been equivocal. This study examined relationships between scores on self-report anxiety, anxiety sensitivity, and stress measures and frequency and intensity of recent drinking, alcohol craving during early withdrawal, as well as laboratory measures of alcohol craving and stress reactivity among heavy drinkers with AUD. METHODS: Media-recruited, heavy drinkers with AUD (N = 87) were assessed for recent alcohol consumption. Anxiety and stress levels were characterized using paper-and-pencil measures, including the Beck Anxiety Inventory (BAI), the Anxiety Sensitivity Index-3 (ASI-3), and the Perceived Stress Scale (PSS). Eligible subjects (N = 30) underwent alcohol abstinence on the Clinical Research Unit; twice daily measures of alcohol craving were collected. On day 4, subjects participated in the Trier Social Stress Test; measures of cortisol and alcohol craving were collected. RESULTS: In multivariate analyses, higher BAI scores were associated with lower drinking frequency and reduced drinks/drinking day; in contrast, higher ASI-3 scores were associated with higher drinking frequency. BAI anxiety symptom and ASI-3 scores also were positively related to Alcohol Use Disorders Identification Test total scores and AUD symptom and problem subscale measures. Higher BAI and ASI-3 scores but not PSS scores were related to greater self-reported alcohol craving during early alcohol abstinence. Finally, BAI scores were positively related to laboratory stress-induced cortisol and alcohol craving. In contrast, the PSS showed no relationship with most measures of alcohol craving or stress reactivity. CONCLUSIONS: Overall, clinically oriented measures of anxiety compared with perceived stress were more strongly associated with a variety of alcohol-related measures in current heavy drinkers with AUD.

Occurrence, Predictors, and Prognosis of Alcohol Withdrawal Syndrome and Delirium Tremens Following Traumatic Injury.

OBJECTIVES: We sought to determine occurrence, predictors, and prognosis of alcohol withdrawal syndrome and delirium tremens in patients with traumatic injury. DESIGN: Retrospective multicenter cohort study. SETTING: Three U.S. trauma centers. PATIENTS: Twenty-eight thousand one hundred one trauma patients admitted from 2010-2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Measures included occurrence of alcohol withdrawal syndrome and delirium tremens, injury characteristics, risk factors for alcohol withdrawal syndrome, clinical outcomes, pharmacologic treatment for alcohol withdrawal syndrome, and Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar) scores. Alcohol withdrawal syndrome severity was defined by CIWA-Ar score as minimal (< 10), moderate (10-20), and severe (> 20). Alcohol withdrawal syndrome developed in 0.88% (n = 246), including 12% minimal, 36% moderate, and 53% severe. Alcohol withdrawal syndrome progressed to delirium tremens in 11%. Before adjustment, alcohol withdrawal syndrome severity was associated with injury severity, hypokalemia, baseline CIWA-Ar score, and established alcohol withdrawal syndrome risk factors. Logistic regression identified the following predictors of delirium tremens: baseline CIWA-Ar score greater than or equal to 10 (odds ratio, 6.05; p = 0.02) and age greater than or equal to 55 (odds ratio, 3.24; p = 0.03). In patients with severe alcohol withdrawal syndrome, severe head injury also predicted progression to delirium tremens (odds ratio, 6.08; p = 0.01), and hypokalemia was borderline significant (odds ratio, 3.23; p = 0.07). Clinical outcomes of hospital length of stay, ICU length of stay, and alcohol withdrawal syndrome complications differed significantly by alcohol withdrawal syndrome severity and were worse with more severe manifestations of alcohol withdrawal syndrome. Mortality also significantly differed by alcohol withdrawal syndrome severity but was only greater in patients who progressed to delirium tremens (11.1%; p = 0.02); otherwise, there were no differences in mortality by severity (4%, 4%, and 0% by minimal, moderate, and severe alcohol withdrawal syndrome). CONCLUSIONS: Trauma patients with alcohol withdrawal syndrome experience a high occurrence of delirium tremens that is associated with significant mortality. These data demonstrate the predictive ability of baseline CIWA-Ar score, age, and severe head injury for developing delirium tremens.

Atrophy of the corpus callosum in heavy alcoholic patients

Atrophy of the corpus callosum among alcoholics was classically restricted to patients affected by Marchiafava-Bignami (MB) disease. It was further observed in patients with thiamine and/or niacin deficiency, or in alcoholics who had consumed alcoholic beverages for a long period. A 42-year-old alcoholic patient was admitted with a full-blown alcohol withdrawal syndrome. After recovery, unstable gait and marked pyramidal signs were observed. A brain magnetic resonance was performed, which revealed corpus callosum atrophy. At discharge the patient was placed under ambulatory care. Nevertheless, he never attended his appointments and he was readmitted several times with withdrawal syndrome. Repeated MRI studies showed no remarkable changes besides progressive atrophy of the corpus callosum. Indeed, the area of corpus callosum was markedly reduced when compared with that of 20 alcoholics and 5 further patients with Wernicke´s encephalopathy. Therefore, the clinical picture is consistent with classic MB disease, and the more severe atrophy than that observed in the remaining alcoholics suggests that additional mechanisms may play a role in MB disease

No disponible

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea.

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.

[THE ROLE OF BIOLOGICAL MEMBRANES IN DIFFERENTIAL DIAGNOSTICS OF SALMONELLA AND ACUTE ALCOHOL GASTROENTERITIS].

We evaluated the influence of Salmonella infection and alcohol on biological membranes from the content of serum phospholipid fraction known to be a component ofenterocyte membranes. Any change of membrane phospholipid content leads to a change of their blood level. The study included 50 patients with acute alcohol gastroenteritis, 50 ones with salmonella gastroenteritis, and 50 healthy subjects. Both salmonellosis and alcohol caused differently directed changes in biological membranes. The mechanism of diarrhea in patients with salmonella and acute alcohol gastroenteritis is different. Diarrhea associated with alcohol gastroenteritis is due to enhanced viscosity of biomembranes that decreases in salmonella gastroenteritis. It suggests different approaches to the treatment of these conditions. The membrane destruction coefficient below 2 is an additional proof of alcoholic etiology of gastroenteritis whereas its value above 3 confirms the involvement of salmonellosis in pathogenesis of gastroenteritis.

Neurologic Manifestations of Chronic Liver Disease and Liver Cirrhosis.

The normal functioning of brain is intimately as well as intricately interrelated with normal functioning of the liver. Liver plays a critical role of not only providing vital nutrients to the brain but also of detoxifying the splanchnic blood. Compromised liver function leads to insufficient detoxification thus allowing neurotoxins (such as ammonia, manganese, and other chemicals) to enter the cerebral circulation. In addition, portosystemic shunts, which are common accompaniments of advanced liver disease, facilitate free passage of neurotoxins into the cerebral circulation. The problem is compounded further by additional variables such as gastrointestinal tract bleeding, malnutrition, and concurrent renal failure, which are often associated with liver cirrhosis. Neurologic damage in chronic liver disease and liver cirrhosis seems to be multifactorial primarily attributable to the following: brain accumulation of ammonia, manganese, and lactate; altered permeability of the blood-brain barrier; recruitment of monocytes after microglial activation; and neuroinflammation, that is, direct effects of circulating systemic proinflammatory cytokines such as tumor necrosis factor, IL-1ß, and IL-6. Radiologist should be aware of the conundrum of neurologic complications that can be encountered in liver disease, which include hepatic encephalopathy, hepatocerebral degeneration, hepatic myelopathy, cirrhosis-related parkinsonism, cerebral infections, hemorrhage, and osmotic demyelination. In addition, neurologic complications can be exclusive to certain disorders, for example, Wilson disease, alcoholism (Wernicke encephalopathy, alcoholic cerebellar degeneration, Marchiafava-Bignami disease, etc). Radiologist should be aware of their varied clinical presentation and radiological appearances as the diagnosis is not always straightforward.

Steep Decrease of Gender Difference in DSM-IV Alcohol Use Disorder: A Comparison of Two Nation-wide Surveys Conducted 10 Years Apart in Korea

While decreasing trend in gender differences in alcohol use disorders was reported in Western countries, the change in Asian countries is unknown. This study aims to explore the shifts in gender difference in alcohol abuse (AA) and dependence (AD) in Korea. We compared the data from two nation-wide community surveys to evaluate gender differences in lifetime AA and AD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Face-to-face interviews using the Composite International Diagnostic Interview (CIDI) were applied to all subjects in 2001 (n=6,220) and 2011 (n=6,022). Male-to-female ratio of odds was decreased from 6.41 (95% CI, 4.81-8.54) to 4.37 (95% CI, 3.35-5.71) for AA and from 3.75 (95% CI, 2.96-4.75) to 2.40 (95% CI, 1.80-3.19) for AD. Among those aged 18-29, gender gap even became statistically insignificant for AA (OR, 1.59; 95% CI, 0.97-2.63) and AD (OR, 1.18; 95% CI, 0.80-2.41) in 2011. Men generally showed decreased odds for AD (0.55; 95% CI, 0.45-0.67) and women aged 30-39 showed increased odds for AA (2.13; 95% CI 1.18-3.84) in 2011 compared to 2001. Decreased AD in men and increased AA in women seem to contribute to the decrease of gender gap. Increased risk for AA in young women suggests needs for interventions.

The "Prediction of Alcohol Withdrawal Severity Scale" (PAWSS): systematic literature review and pilot study of a new scale for the prediction of complicated alcohol withdrawal syndrome.

BACKGROUND: To date, no screening tools for alcohol withdrawal syndromes (AWS) have been validated in the medically ill. Although several tools quantify the severity of AWS (e.g., Clinical Institute Withdrawal Assessment for Alcohol [CIWA]), none identify subjects at risk of AWS, thus missing the opportunity for timely prophylaxis. Moreover, there are no validated tools for the prediction of complicated (i.e., moderate to severe) AWS in the medically ill. OBJECTIVES: Our goals were (1) to conduct a systematic review of the published literature on AWS to identify clinical factors associated with the development of AWS, (2) to use the identified factors to develop a tool for the prediction of alcohol withdrawal among patients at risk, and (3) to conduct a pilot study to assess the validity of the tool. METHODS: For the creation of the Prediction of Alcohol Withdrawal Severity Scale (PAWSS), we conducted a systematic literature search using PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines for clinical factors associated with the development of AWS, using PubMed, PsychInfo, MEDLINE, and Cochrane Databases. Eligibility criteria included: (i) manuscripts dealing with human subjects, age 18 years or older, (ii) manuscripts directly addressing descriptions of AWS or its predisposing factors, including case reports, naturalistic case descriptions, and all types of clinical trials (e.g., randomized, single-blind, or open label studies), (iii) manuscripts describing characteristics of alcohol use disorder (AUD), and (iv) manuscripts dealing with animal data (which were considered only if they directly dealt with variables described in humans). Obtained data were used to develop the Prediction of Alcohol Withdrawal Severity Scale, in order to assist in the identification of patients at risk for complicated AWS. A pilot study was conducted to assess the new tool's psychometric qualities on patients admitted to a general inpatient medicine unit over a 2-week period, who agreed to participate in the study. Blind to PAWSS results, a separate group of researchers retrospectively examined the medical records for evidence of AWS. RESULTS: The search produced 2802 articles describing factors potentially associated with increased risk for AWS, increased severity of withdrawal symptoms, and potential characteristics differentiating subjects with various forms of AWS. Of these, 446 articles met inclusion criteria and underwent further scrutiny, yielding a total of 233 unique articles describing factors predictive of AWS. A total of 10 items were identified as correlated with complicated AWS (i.e., withdrawal hallucinosis, withdrawal-related seizures, and delirium tremens) and used to construct the PAWSS. During the pilot study, a total of 68 subjects underwent evaluation with PAWSS. In this pilot sample the sensitivity, specificity, and positive and negative predictive values of PAWSS were 100%, using the threshold score of 4. DISCUSSION: The results of the literature search identified 10 items which may be correlated with risk for complicated AWS. These items were assembled into a tool to assist in the identification of patients at risk: PAWSS. The results of this pilot study suggest that PAWSS may be useful in identifying risk of complicated AWS in medically ill, hospitalized individuals. PAWSS is the first validated tool for the prediction of severe AWS in the medically ill and its use may aid in the early identification of patients at risk for complicated AWS, allowing for prophylaxis against AWS before severe alcohol withdrawal syndromes develop.

Altered anterior cingulate neurochemistry in emerging adult binge drinkers with a history of alcohol-induced blackouts.

BACKGROUND: Binge alcohol consumption is associated with multiple neurobiological consequences, including altered neurophysiology, brain structure, and functional activation. Magnetic resonance spectroscopy (MRS) studies have demonstrated neurochemical alterations in the frontal lobe of alcohol users, although most studies focused on older, alcohol-dependent subjects. METHODS: In this study, neurochemical data were acquired using MRS at 4.0 Tesla from emerging adults (18 to 24 years old) who were binge alcohol drinkers (BD, n = 23) or light drinkers (LD, n = 31). Since binge drinking is also associated with increased prevalence of experiencing an alcohol-induced blackout, BD were stratified into alcohol-induced blackout (BDBO) and non-blackout (BDN) groups. RESULTS: Overall, BD had significantly lower gamma amino-butyric acid (GABA) and N-acetyl-aspartate (NAA) in the anterior cingulate cortex (ACC) than LD. When stratified by blackout history, BDBO also had lower ACC glutamate (Glu) than LD. No group differences in MRS metabolites were observed in the parietal-occipital cortex. Lower ACC GABA and Glu remained significant after accounting for lower gray matter content in BD, however, NAA differences were no longer evident. In addition, low ACC GABA levels were associated with greater alcohol use consequences, and worse response inhibition and attention/mental flexibility in BD. CONCLUSIONS: These data indicate that binge drinking affects frontal lobe neurochemistry, more so in those who had experienced an alcohol-induced blackout. Characterization of the neurochemical profiles associated with binge alcohol consumption and blackout history may help identify unique risk factors for the later manifestation of alcohol abuse and dependence, in young individuals who are heavy, frequent drinkers, but who do not meet the criteria for alcohol abuse disorders.