Domiciliary alcohol detoxification outcomes: a study from Goa, India.

Alcohol use disorder (AUD) is a significant public health problem across all regions of the world. Overall evidence regarding outcomes is available from western regions. Detoxification is one of the first steps in treating AUDs. The following case note review looks at community detoxification outcomes in a naturalistic setting. We looked at 100 clients with domiciliary detoxification. We found only 35% had a favorable outcome (follow up as advised) while 65% had unfavorable outcomes (lost to follow up or required admission). Trends of higher alcohol use (units/day) were seen in the unfavorable group. We also found that having a medical co-morbidity was associated with unfavorable outcome. In resource poor setting like our country there is a need to look at ways to enhance home detoxification programs; use of technology and supervised monitoring could probably improve the outcomes.

Pseudo-Wellens syndrome, acute pancreatitis, and an anomalous coronary artery: a case report.

BACKGROUND: Chest pain associated with transient electrocardiogram changes mimicking an acute myocardial infarction have been described in acute pancreatitis. These ischemic electrocardiogram changes can present a diagnostic dilemma, especially when patients present with concurrent angina pectoris and epigastric pain warranting noninvasive or invasive imaging studies. CASE PRESENTATION: A 45-year-old African-American man with a history of alcohol use disorder presented to the emergency department of our institution with 36 hours of concurrent epigastric pain and left-sided chest pain radiating to his left arm and associated with nausea and dyspnea. On physical examination, he was afebrile; his blood pressure was elevated; and he had epigastric tenderness. His laboratory test results were significant for hypokalemia, normal troponin, and elevated serum lipase and amylase levels. Serial electrocardiograms for persistent chest pain showed ST-segment elevations with dynamic T-wave changes in the right precordial electrocardiogram leads, consistent with Wellens syndrome. He was immediately taken to the cardiac catheterization laboratory, where selective coronary angiography showed normal coronary arteries with an anomalous origin of the right coronary artery from the opposite sinus. Given his elevated lipase and amylase levels, the patient was treated for acute alcohol-induced pancreatitis with intravenous fluids and pain control. His chest pain and ischemic electrocardiogram changes resolved within 24 hours of admission, and coronary computed tomography angiography showed an interarterial course of the right coronary artery without high-risk features. CONCLUSIONS: Clinicians may consider deferring immediate cardiac catheterization and attribute electrocardiogram changes to acute pancreatitis in patients presenting with angina pectoris and acute pancreatitis if confirmed by normal cardiac enzymes and elevated levels of lipase and amylase. However, when clinical signs and electrocardiogram findings are highly suggestive of myocardial ischemia/injury, immediate noninvasive coronary computed tomography angiography may be the best approach to make an early diagnosis.

Psychological interventions for alcohol use disorders in people living with HIV/AIDS: a systematic review.

BACKGROUND: Alcohol use disorders (AUDs) in people living with HIV/AIDS (PLWH) are a significant impediment to achieving virological control. HIV non-suppression in PLWH with AUDs is mainly attributable to sub-optimal antiretroviral therapy adherence. Sub-optimal adherence makes control of the epidemic elusive, considering that effective antiretroviral treatment and viral suppression are the two key pillars in reducing new infections. Psychological interventions have been proposed as effective treatments for the management of AUDs in PLWH. Evidence for their effectiveness has been inconsistent, with two reviews (2010 and 2013) concluding a lack of effectiveness. However, a 2017 review that examined multiple HIV prevention and treatment outcomes suggested that behavioural interventions were effective in reducing alcohol use. Since then, several studies have been published necessitating a re-examination of this evidence. This review provides an updated synthesis of the effectiveness of psychological interventions for AUDs in PLWH. METHODS: A search was conducted in the following databases: PubMed, Cochrane Central Register of Trials (CENTRAL), MEDLINE (Ovid), EMBASE, PsychInfo (Ovid) and Clinical trials.gov (clinicaltrials.gov) for eligible studies until August 2018 for psychotherapy and psychosocial interventions for PLWH with AUDs. Two reviewers independently screened titles, abstracts and full texts to select studies that met the inclusion criteria. Two reviewers independently performed data extraction with any differences resolved through discussion. Risk of bias was assessed by two independent reviewers using the Cochrane risk of bias tool, and the concordance between the first and second reviewers was 0.63 and between the first and third reviewers 0.71. Inclusion criteria were randomised controlled trials using psychological interventions in people aged 16 and above, with comparisons being usual care, enhanced usual care, other active treatments or waitlist controls. RESULTS: A total of 21 studies (6954 participants) were included in this review. Studies had diverse populations including men alone, men and women and men who had sex with men (MSM). Use of motivational interviewing alone or blended with cognitive behavioural therapy (CBT) and technology/computer-assisted platforms were common as individual-level interventions, while a few studies investigated group motivational interviewing or CBT. Alcohol use outcomes were all self-report and included assessment of the quantity and the frequency of alcohol use. Measured secondary outcomes included viral load, CD4 count or other self-reported outcomes. There was a lack of evidence for significant intervention effects in the included studies. Isolated effects of motivational interviewing, cognitive behavioural therapy and group therapy were noted. However for some of the studies that found significant effects, the effect sizes were small and not sustained over time. Owing to the variation in outcome measures employed across studies, no meta-analysis could be carried out. CONCLUSION: This systematic review did not reveal large or sustained intervention effects of psychological interventions for either primary alcohol use or secondary HIV-related outcomes. Due to the methodological heterogeneity, we were unable to undertake a meta-analysis. Effectiveness trials of psychological interventions for AUDs in PLWH that include disaggregation of data by level of alcohol consumption, gender and age are needed. There is a need to standardise alcohol use outcome measures across studies and include objective biomarkers that provide a more accurate measure of alcohol consumption and are relatively free from social desirability bias. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD  42017063856 .

The Effects of Cognitive-Behavioral Model-Based Intervention on Depression, Anxiety, and Self-Efficacy in Alcohol Use Disorder.

Exercise is constantly gaining attention as adjuvant treatment for alcohol use disorder (AUD), supplementing classical pharmacological and psychotherapeutic approaches. The aim of this study was to determine the effects of cognitive-behavioral model-based (CBM-based) intervention on the depression, anxiety, and self-efficacy levels in AUD. This quasi-experimental study was conducted using pre- and posttests and repeated measurements with a control group; it was completed between February 2015 and August 2015 in Turkey. Participants were 41 individuals with AUD, 20 in the experimental group and 21 in the control group. The individuals in the experimental group performed aerobic exercise 3 days a week as well as attended the psychoeducation provided 1 day a week. The difference between mean scores of the individuals in the experimental and control groups taken in posttest and 4-month follow-up test in the Beck Depression Inventory (BDI) as well as the difference between mean posttest scores in the Beck Anxiety Inventory (BAI) and Self-Efficacy Scale (SES) were found to be statistically significant ( p < .05). In the intragroup comparisons, a significant difference was found between the "BDI," "BAI," and "SES" measurement times ( p < .05). It was concluded that CBM-based intervention was effective in reducing depression and anxiety, increasing self-efficacy in individuals with AUD. Appropriate nurse-managed CBM-based intervention for individuals with AUD can promote their health.

Padrões mínimos para assistência de enfermagem segura a usuários de bebidas alcoólicas / Normas mínimas para cuidado de enfermería segura a los usuarios de las bebidas alcohólicas / Minimum standards for safe nursing care for users of alcoholic beverages

To develop minimum standards for nursing care for people intoxicated by alcohol and treated in the emergency units. Method: documental research, built upon the experience of the authors as members of the nursing care team of a center of toxicological assistance, based on literature review. Results: we presented the results in two units. Firstly, through a brief literature review on patient safety and alcohol users attended in emergency department, and secondly through a description of minimum standards for initial nursing care necessary for the safety of users of alcohol in three aspects: clinical/biological, psycho-emotional and social. Conclusion: The presented standardization, besides regulating nursing practice, improves the execution of assistance programs in the toxicology centers...

Elaborar padrões mínimos para assistência de enfermagem às pessoas intoxicadas por álcool e atendidas em unidades de atenção às urgências. Método: investigação documental, construída a partir da experiência dos autores como integrantes da equipe assistencial de enfermagem de um centro de assistência toxicológica, alicerçada em revisão de literatura. Resultados: foram apresentados em duas unidades. Breve revisão bibliográfica sobre segurança do paciente e de usuários de bebidas alcoólicas atendidos em serviços de urgência, e descrição de padrões mínimos de assistência inicial de enfermagem, necessários à segurança de usuários de bebida alcoólica, em três aspectos; clínico/biológico, psicoemocional e social. Conclusão: A padronização apresentada, além de normatizar a prática de enfermagem, melhora a execução de programas assistenciais em centros de assistência toxicológica...

Desarrollar normas mínimas para la atención de enfermería para las personas intoxicadas por alcohol y tratadas en las unidades de atención de emergencia. Método: la investigación documental, construida a partir de la experiencia de los autores como miembros del equipo de atención de enfermería en un centro de asistencia toxicológica, basado en revisión de la literatura. Resultados: fueron presentados en dos unidades. Primeramente, una breve revisión de la literatura sobre la seguridad de los usuarios y de los pacientes vistos en un departamento de emergencias, y la descripción de las normas mínimas para la atención inicial de enfermería necesaria para la seguridad de los usuarios de alcohol en tres aspectos: clínico/biológico, psico-emocional y social. Conclusión: La normalización presenta, además de regular la práctica de la enfermería, la mejora de la ejecución de los programas de asistencia en los centros de toxicología...

El Alcohol en Atención Primaria. Características diferenciales entre los pacientes dependientes del alcohol que han solicitado o no tratamiento / Alcohol in Primary Care. Differential characteristics between alcohol dependent patients receiving or not treatment

A pesar de la elevada morbi-mortalidad de la dependencia del alcohol (DA), pocos pacientes afectos reciben tratamiento. Sin embargo, muchos de ellos son visitados en atención primaria por otras razones. El objetivo del presente estudio es describir las características diferenciales de los pacientes dependientes del alcohol atendidos en Atención Primaria, distinguiendo también entre aquellos que realizan tratamiento o no, y los motivos por los que no lo solicitan. Se trata de un estudio transversal en el que los pacientes fueron entrevistados tanto por sus médicos de atención primaria (MAP) como por un investigador del estudio. Se recabaron datos sociodemográficos, diagnósticos y clínicos. De 1372 entrevistados, 118 (8,6%) fueron diagnosticados de DA. Éstos presentaron un nivel socioeconómico más bajo (48.3% vs 33.3%, odds ratio 2.02), más desempleo (32.2% vs 19.2 %, odds ratio 2.11), y mayores niveles de malestar psicológico y de incapacidad. Los que recibían tratamiento (16,9%), tenían más edad (44 vs 36 años), mayores tasas de desempleo (66% vs 25.5%, odds ratio 6.18) y mayor consumo diario de alcohol (61.5 vs 23.7 gramos), sugiriendo una mayor evolución de la enfermedad. La mayoría de variables clínicas analizadas mostraron una mayor comorbilidad en los pacientes afectos de dependencia del alcohol, y dentro de éstos, una mayor gravedad en los que recibían tratamiento respecto a los que no lo hacían. Las principales razones esgrimidas para no acudir a tratamiento fueron la vergüenza, el miedo a dejar de beber y las barreras para acceder al tratamiento. Estos datos sugieren pues la necesidad de implementar estrategias de detección y tratamiento precoces de la DA

Despite its high associated morbidity and mortality, few alcoholdependent (AD) patients receive treatment. However, many use primary health care services for other reasons. The aim of the present study is to describe the differential characteristics of AD patients in primary care, distinguishing between those who receive treatment and those who do not, and their reasons for not seeking it. In a cross-sectional study patients were evaluated by their general practitioner (GP) and interviewed by a member of the research team. Sociodemographic, diagnostic and clinical data were collected. From 1,372 patients interviewed in Catalonia, 118 (8.6%) were diagnosed as AD. These patients showed a lower socioeconomic status (48.3% vs 33.3%, odds ratio 2.02), higher unemployment rates (32.2% vs 19.2 %, odds ratio 2.11), and greater psychological distress and disability. Patients with AD receiving treatment (16.9%), were older (44 vs 36 years of age), reported higher unemployment rates (66% vs 25.5%, odds ratio 6.32) and higher daily alcohol consumption (61.5 vs 23.7 grams), suggesting a more advanced disease. Patients with AD in general showed a higher degree of comorbidity compared to other patients, with patients in treatment showing the most elevated level. The main reasons given for not seeking treatment were shame, fear of giving up drinking and barriers to treatment. Taken together, the data suggest the need to implement earlier strategies for the detection and treatment of AD

Posicionamiento de SEMERGEN para el abordaje de los trastornos por consumo de alcohol en atención primaria / SEMERGEN positioning for the treatment of alcohol disorders in primary care

Este artículo se basa en las recomendaciones de un grupo de profesionales sanitarios, incluidos expertos en la atención primaria, psiquiatría y adicciones. Los participantes son reconocidos especialistas en el tratamiento del trastorno por consumo de alcohol. El grupo se reunió en Barcelona el 22 de abril de 2015 para evaluar la situación actual en el manejo del trastorno por consumo de alcohol en atención primaria y desarrollar una estrategia para abordar este problema, basándose en la evidencia y las recomendaciones de sociedades científicas y organismos nacionales e internacionales (AU)

The present manuscript is based on the recommendations of a panel of health care professionals, including several experts in primary health care, psychiatry and addictions. The participants are recognized specialists in the treatment of alcohol use disorder. The panel met in Barcelona on 2015 April 22 with the aims of evaluating the current management of alcohol use disorder in primary health care and developing a strategy to address this problem, basing on the evidence and the recommendations of the scientific societies and national and international organizations (AU)

[Efficacy of alcohol withdrawal syndrome therapy in patients from Independent Public Hospital for Mental Diseases in Miedzyrzecz]. / Skutecznosc leczenia alkoholowego zespofu abstynencyjnego u pacjentów Samodzielnego Publicznego Szpitala dla Nerwowo i Psychicznie Chorych w Miedzyrzeczu.

Consumption of alcohol is a serious social problem. Research on alcohol addicts prove that its consumption affects the physical and mental health of drinking person, his/her family and the social dimension (eg. crime, unemployment, poverty). The aim of this study was to evaluate the effectiveness of the treatment of alcohol withdrawal syndrome (AW) in patients of 2417 Unit of Treatment of Alcohol Withdrawal Syndromes of Independent Public Hospital for Mental Diseases (SPSNPCH) in Miedzyrzecz. The study was conducted in 122 of 24/7 Unit of Treatment of Alcohol Withdrawal Syndromes (SPSNPCH) treated from January to March 2015. Patients during hospitalization were subjected to intensive pharmacotherapy of AW (Stage I) and cognitive-behavioral therapy (Stage II). Of the group of 122 people starting treatment Stage I was completed by 112 patients (90%); 10 patients (8%) have been discharged at their own request. The participation in Stage II was consented only by 54 patients, of which 6 (4%) withdrew from this form of therapy. Full two-stage treatment consisting of pharmacotherapy of AWS and then psychotherapy was completed only by 48 (39%) patients.

[Alcohol-induced psychotic disorder--a diagnostic entity of its own?]. / Psychotische Störungen durch Alkohol--eine eigene diagnostische Entität?

Alcohol-induced psychotic disorders are relatively rare schizophrenia-like disorders characterized by key symptoms, such as auditory hallucinations, anxiety and delusions while disorders of consciousness and orientation are lacking. The diagnostic entity of this disorder has been questioned. Recent findings indicate a high risk for rehospitalization and relapse but compared to other drug-induced disorders a low risk of schizophrenia-like course of the illness (5 % compared to 40-50 % with other drugs). Pathophysiological, diagnostic and therapeutic aspects of alcohol-induced psychotic disorders are discussed.

Effects of the minimum legal drinking age on alcohol-related health service use in hospital settings in Ontario: a regression-discontinuity approach.

OBJECTIVES: We assessed the impact of the minimum legal drinking age (MLDA) on hospital-based treatment for alcohol-related conditions or events in Ontario, Canada. METHODS: We conducted regression-discontinuity analyses to examine MLDA effects with respect to diagnosed alcohol-related conditions. Data were derived from administrative records detailing inpatient and emergency department events in Ontario from April 2002 to March 2007. RESULTS: Relative to youths slightly younger than the MLDA, youths just older than the MLDA exhibited increases in inpatient and emergency department events associated with alcohol-use disorders (10.8%; P = .048), assaults (7.9%; P < .001), and suicides related to alcohol (51.8%; P = .01). Among young men who had recently crossed the MLDA threshold, there was a 2.0% increase (P = .01) in hospitalizations for injuries. CONCLUSIONS: Young adults gaining legal access to alcohol incur increases in hospital-based care for a range of serious alcohol-related conditions. Our regression-discontinuity approach can be used in future studies to assess the effects of the MLDA across different settings, and our estimates can be used to inform cost-benefit analyses across MLDA scenarios.

Overexpression of serum response factor in astrocytes improves neuronal plasticity in a model of early alcohol exposure.

Neuronal plasticity deficits underlie many of the cognitive problems seen in fetal alcohol spectrum disorders (FASD). We have developed a ferret model showing that early alcohol exposure leads to a persistent disruption in ocular dominance (OD) plasticity. Recently, we showed that this deficit could be reversed by overexpression of serum response factor (SRF) in the primary visual cortex during the period of monocular deprivation (MD). Surprisingly, this restoration was observed throughout the extent of visual cortex and most of the cells transfected by the virus were positive for the astrocytic marker GFAP rather than the neuronal marker NeuN. Here we test whether overexpression of SRF exclusively in astrocytes is sufficient to restore OD plasticity in alcohol-exposed ferrets. To accomplish that, first we exposed cultured astrocytes to Sindbis viruses carrying either a constitutively active form of SRF (SRF+), a dominant negative (SRF-) or control Green Fluorescent Protein (GFP). After 24h, these astrocytes were implanted in the visual cortex of alcohol-exposed animals or saline controls one day before MD. Optical imaging of intrinsic signals showed that alcohol-exposed animals that were implanted with astrocytes expressing SRF, but not SRF- or GFP, showed robust restoration of OD plasticity in all visual cortex. These findings suggest that overexpression of SRF exclusively in astrocytes can improve neuronal plasticity in FASD.

Severe acute bilateral alcohol-induced toxic optic neuropathy--case report.

Toxic optic neuropathies are not frequently encountered in routine practice, however, they present a challenge both in terms of diagnosis and treatment. The aim of this paper is to present an unusual case of ethyl alcohol poisoning causing bilateral toxic optic neuropathy with loss of vision.

[Subjective well-being, morbidity and health care consumption by hazardous, harmful and problem alcohol drinkers]. / Subjektivní zdraví, nemocnost a spotreba zdravotní péce u rizikového, skodlivého a problémového pití alkoholu.

BACKGROUND: The aim of this work was to investigate subjective well-being, morbidity and healthcare needs of persons with hazardous, harmful and problematic alcohol consumption. METHODS: Data from a questionnaire-based survey performed on a representative sample of 2221 persons (of these, 51.4% were men) aged 18 to 39 (average age 29.9, s.d. 5.8) were used for the analysis. The level of risk related to alcohol consumption was assessed through the screening questionnaire (the Alcohol Use Disorders Identification Test [AUDIT], and categorization into 4 groups with critical scores of 8, 16 and 20 was applied to the analysis. The questionnaire focussed on the respondents' drinking habits and health and their demographic, social, and psychological background and circumstances. RESULTS: The respondents' subjective assessment of their physical and mental health varied significantly across the different score categories in AUDIT. Over one-quarter of the respondents falling in the category of harmful or problem drinkers rated their physical and/or mental health as poor or very poor. Compared to no-problem alcohol users, problem drinkers sought special help for emotional problems more frequently (3.1% vs. 21.3%; p < 0.01); visited their doctors more frequently during the past year (3.1 vs. 4.8; p < 0.05); had more episodes of illness (1.4 vs. 6.8; p < 0.01), more days of sick leave (10.4 vs. 27.6; p < 0.01); and were hospitalized more frequently (6.9% vs. 18.7%; p < 0.01). CONCLUSIONS: The results support/confirm the link between hazardous, harmful and problematic alcohol consumption on the one hand and the drinkers' perception of their health status and use of medical/healthcare services on the other hand. A modification of inappropriate consumption patterns through a short intervention by a general practitioner can lead to health improvement and reduction of the drinkers' healthcare costs.