Effects of childhood trauma and clinical features on determining quality of life in patients with bipolar I disorder.

BACKGROUND: We explored how childhood trauma (CHT) affects the clinical expression of disorder and quality of life in patients with bipolar I (BP-I) disorder. METHODS: Euthymic patients (n=116) who subsequently received a diagnosis of BP-I disorder were consecutively included and were interviewed using the following sociodemographic and clinical data forms; Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Childhood Abuse and Neglect Questionnaire (CANQ) and the 36-item Medical Outcome Study Short Form Health Survey (SF-36). The quality of life of BP-I patients with and without a history of CHT were examined. RESULTS: The percentage of trauma was 61.2%. Patients who had CHT had higher frequencies of depressive episodes (t=-2.38, p=0.019), total episodes (t=-2.25, p=0.026), attempted suicide more often (χ(2)=18.12, p=0.003) and had lower scores on the pain subscale of the SF-36 (z=-2.817, p=0.005). In patients with mixed or rapid-cycling episodes, SF-36 subscale scores except general health and pain were found to be lower. LIMITATIONS: Our sample may fail to reflect the general BD population; the patients were included consecutively and consisted of a majority of female patients. CONCLUSIONS: CHT plays an important role in the clinical expression of BP-I disorder and having mixed/rapid-cycling episodes negatively affects both physical and mental components, as measured by the SF-36. While both males and females reported experiencing sexual abuse, female BP-I patients complained about pain more often. It is suggested that treatment of BP-I patients with a history of CHT should differ from that provided for patients with no CHT history.

Childhood trauma and psychopathology among alcohol-dependent men: no interaction with temperament and character.

OBJECTIVE: The aim of this study was to evaluate possible interactions between childhood trauma, temperament, character, and psychopathology among alcohol-dependent men. METHODS: Participants were 156 alcohol-dependent men consecutively admitted to a dependency treatment unit. The Childhood Abuse and Neglect Questionnaire, the Temperament and Character Inventory, and the Symptom Checklist-Revised were administered to all participants. RESULTS: Childhood abuse and neglect did not have any effect on temperament and character scores in multivariate analysis. Whereas childhood abuse had a significant main effect on all types of clinical psychopathology except depression and psychoticism scores, childhood neglect only had a significant main effect on depression scores. There was no interaction between childhood abuse and neglect on these analyses. CONCLUSIONS: Among alcohol-dependent men, childhood abuse and neglect contribute to general psychopathology through distinct clinical consequences, independently of temperamental and characterological features.

Personality dimensions in male patients with early-onset alcohol dependence who seek treatment.

AIMS: The aim of this study is to examine the capacity of different personality dimensions to predict early-onset alcoholism (EOA). METHODS: Participants were 176 consecutively admitted male inpatient alcohol dependents. Patients were grouped as EOA (onset before age 25) and late onset alcoholism (LOA). RESULTS: Overall severity of psychopathology and alcohol dependence were higher in EOAs (51.1%) than LOAs, whereas self-directedness (SD) dimension of personality was lower in EOAs. Among the other personality dimensions only lower SD scores, together with lower current age predicted EOA. CONCLUSION: Present study suggests that it is important to take EOA into consideration while planning the treatment of alcohol dependency, because of their higher probability of having low SD scores, as well as higher severity of psychopathology and alcohol-related problems.

Social anxiety and dissociation among male patients with alcohol dependency.

The aim of this study was to investigate the relationship between social anxiety and dissociation among male patients with alcohol dependency. Participants were 176 male patients consecutively admitted to an alcohol dependency treatment unit. The Liebowitz Social Anxiety Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State and Trait Anxiety Inventory, the Michigan Alcoholism Screening Test, and the Symptom Checklist-90-Revised were administered to all participants. The dissociative (N=58, 33.0%) group had significantly higher social anxiety scores than the non-dissociative participants. Patients with a history of suicide attempt or childhood abuse had elevated social anxiety scores compared to those without. In multivariate analysis, dissociative taxon membership predicted both of the two social anxiety subscale scores consisting of fear/anxiety and avoidance in a highly significant level while trait anxiety was a significant covariant for these subscales. Among dissociative symptoms, only depersonalization and amnesia/fugue were predictors of social anxiety. Dissociation and social anxiety are interrelated among alcohol-dependent men. This relationship may have implications for prevention and treatment of alcohol dependency among men with a childhood trauma history in particular.

Depression and anxiety in alcohol dependent inpatients who smoke.

BACKGROUND: Research supports the observation that "smokers drink and drinkers smoke." In this study, we aim to evaluate the relationship between nicotine dependence and the severity of anxiety and depression among alcohol dependent inpatients. METHOD: The study comprised 125 inpatients diagnosed as having alcohol dependence. They were given the SCID-I, AUDIT, Fagerstrom Test for Nicotine Dependence,Hamilton Rating Scale for Depression, and Hamilton Anxiety Rating Scale. RESULTS: Our findings showed that the mean scores of the severity of anxiety and depression were high in alcohol dependent inpatients with nicotine dependence, but there was no significant difference between the nicotine dependent and nondependent groups in the severity of anxiety and depression. CONCLUSION: Comparative studies between alcohol dependent patients who smoke and different smoking or nonsmoking groups with anxiety or depression may provide valuable information. Further studies are needed to examine the correlations between these groups.

Dissociation and alexithymia among men with alcoholism.

AIM: The aim of the present study was to evaluate the relationship between alexithymia and dissociation among men with alcoholism. METHODS: Participants were 176 patients consecutively admitted to the inpatient unit of a addiction treatment center. The Toronto Alexithymia Scale, the Symptom Checklist-Revised, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State-Trait Anxiety Inventory, and the Michigan Alcoholism Screening Test were administered to all participants. RESULTS: Fifty-three patients were considered as having alexithymia. The alexithymic group had a significantly higher rate of dissociative taxon members (patients with pathological dissociation; 62.3%) according to Bayesian probability. Trait anxiety, overall psychiatric symptom severity, and pathological dissociation predicted alexithymia on covariance analysis. A multivariate analysis of covariance demonstrated that these predictors were related only to difficulty of identifying feelings, whereas trait anxiety was a significant covariant for difficulty of expressing feelings as well. CONCLUSION: Alexithymic phenomena are interrelated with dissociation and chronic anxiety among men with alcoholism. The relevance of this triad for prevention and treatment of alcoholism deserves interest in further research.

Quality of life, depression and anxiety in alcohol dependence.

INTRODUCTION AND AIMS: Quality of life is recognised increasingly as an important component in the evaluation of disease processes. Comorbid psychiatric diagnoses accompanying alcohol addiction, especially severe cases of anxiety or depression, may have a negative impact on quality of life. This study focused on the impact of severity of anxiety and depression on quality of life of 150 alcohol-dependent patients treated in hospital. DESIGN AND METHODS: Consecutive patients were evaluated using relevant quality of life scales at the study's onset and 3 and 6 weeks after the complete disappearance of withdrawal symptoms. Patients were classified into three groups: patients with alcohol dependence only, patients with depression and patients with anxiety. RESULTS: The level of anxiety and depression decreased from the initial evaluation to week 3 in patients with a high level of anxiety and depression, whereas the level of anxiety increased in the alcohol only-dependent patients. Initial evaluation conducted using the quality of life scales indicated significant differences between the three patient groups: physical health (F = 7.92, p = 0.001); psychological (F = 32.21, p = 0.001); social relationship (F = 3.45, p = 0.03); and environment (F = 7.79, p = 0.001). At weeks 3 and 6, quality of life for physical health, psychological and environment areas differed significantly between patient groups, but social relationships did not. At weeks 3 and 6, quality of life was lowest in patients with depression and highest in alcohol only-dependent patients with a low severity of depression or anxiety. DISCUSSION AND CONCLUSIONS: Symptoms of anxiety and depression accompanying alcohol addiction lead to an increase in severity of the problems associated with the addiction and have a negative effect on quality of life. Measurement of quality of life within the scope of treatment programmes would help to identify treatment requirements in addicted patients.

Clinical correlates of self-mutilation in Turkish male substance-dependent inpatients.

OBJECTIVE: The aim of this study was to evaluate the prevalence of self-mutilation (SM) in male substance-dependent inpatients, and to investigate the relationship of SM with childhood abuse and neglect, axis I disorders and personality disorders. METHODS: Participants were 112 consecutively admitted male substance dependents (56 alcohol and 56 drug). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I, Turkish version). Patients were evaluated by the Childhood Abuse and Neglect Questionnaire, SCID-I, SCID-II, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS: Among substance-dependent patients, SM was found to be present in 33% (SM group). Mean age and educational status were lower in the SM group. Moreover rates of being single, history of childhood physical and emotional abuse and neglect, suicide attempt history and personality disorder were higher. Mean depression and anxiety scores were also higher in the SM group. Personality disorder, physical abuse, suicide attempt history and drug dependency were predictors for SM. CONCLUSIONS: SM is more common in drug dependents than alcohol dependents. Also results of this study suggest that among Turkish substance dependents SM might be related to the presence of personality disorder and childhood physical abuse and suicide attempts.

Axis I psychiatric comorbidity among adult inhalant dependents seeking treatment.

The present study aimed to investigate the prevalence of Axis I disorders in adult inhalant-dependent patients in comparison to other substance-dependent patients and subjects without substance use disorders. The inhalant-dependent group consisted of 83 male inpatient and outpatient adults diagnosed according to DSM-IV criteria. This group was compared with 74 other substance-dependent patients and with 70 subjects without alcohol and substance use disorder diagnoses. Ninety-three percent of the inhalant dependents had a lifetime history of at least one type of comorbid Axis I disorder, while 77% of the same subjects had at least one type of any affective disorder and 75.9% of them had at least one type of anxiety disorder. Prevalence of Axis I disorders among inhalant dependents was 72.3% for lifetime major depression, 41% for major depression during the past month, 24% for dysthymic disorder, 20.5% for inhalant-induced depressive disorder, 27.7% for panic disorder, 30% for PTSD, 36.1% for social phobia and 20.5% for generalized anxiety disorder. The rate of lifetime axis I disorders was higher in patients with inhalant dependency in comparison to the other two groups. This finding suggests that inhalant-dependent adults have high rates of comorbid psychiatric problems, and that it is important to determine Axis I disorder comorbidity in this population before making an inpatient or outpatient treatment plan.

Role of family in alcohol and substance abuse.

Abuse is a family disease, which requires joint treatment of family members. Family is an important part of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and substance is a response to fluctuations in the family system. In consideration of interactions within the system, it seems an important requirement that the clinician involves, and maintains the presence of, the family in its entirety in the treatment process. A family often needs as much treatment as the family member who is the abuser of alcohol or a substance. In this regard, participation of the family in the treatment process as group members and by assuming a supportive role are assets in terms of preventing relapse, and extending clean time, and also very important for solving conflicts that give rise to abuse of alcohol or substances. Accordingly, it is important to know the family structure and its role in the treatment process. This article covers a review of family systems separately in terms of alcoholism and substance abuse.

[A case of tianeptine abuse]. / Tiyaneptin Kötüye Kullanimi: Bir Olgu Sunumu.

Tianeptine is an antidepressant agent like the selective serotonin reuptake inhibitors (SSRIs). The anxiolytic efficacy of tianeptine is similar to that of tricyclic and tetracyclic antidepressants. Very few cases have been reported in connection with excessive consumption of tianeptine. Although it is not reconciled with results of many studies on excessive consumption of tianeptine, stimulant action has been specifically emphasized on some case reports of tianeptine abuse. These reports indicate that a tolerance is developed, there is a strong mode of feeling, and there are physical withdrawal symptoms if not taken again. Treatment with tianeptine can pose a risk for addicted patients in terms of high doses as well as tolerability. In this article, we report a 24-year-old patient who abused tianeptine for one year. The biological tolerance was excellent, and hepatic parameters were not affected. The patient experienced and seeks a psychostimulant effect. The patient had a previous history of addiction to cannabis, opiates and cocaine. We concluded that the effect of tianeptine and its addiction risk at the patient who had a history of addiction to multiple substances, and spontaneously increased dose of tianeptine during the last one year up to 3000 mg per day at present. In the literature, reports of addictions to antidepressants are scarce and most of them involve agents with amphetamine-like properties, including amineptine and tranylcypromine. Other reports involving other antidepressant agents, including amitriptyline, fluoxetine and tianeptine remain exceptional.

Lifetime posttraumatic stress disorder in Turkish alcohol-dependent inpatients: relationship with depression, anxiety and erectile dysfunction.

The aim of the present study was to evaluate the prevalence of lifetime posttraumatic stress disorder (PTSD) in Turkish male alcohol-dependent inpatients, and to investigate the relationship of lifetime PTSD diagnosis with anxiety, depression, hopelessness, erectile dysfunction and psychosocial problems related with alcohol dependency. Eighty-two male inpatients who met DSM-IV criteria for alcohol dependence and 48 subjects without substance use disorder as a control group were included in the study. Subjects were applied the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Michigan Alcoholism Screening Test (MAST), the Beck Hopelessness Scale (BHS) and the International Index of Erectile Function (IIEF). Rate of lifetime PTSD diagnosis was found to be 26.8% among alcohol-dependent inpatients. The mean age of patients with lifetime PTSD was lower than in patients without this diagnosis, while there were no significant differences between these two groups in terms of age of first alcohol use, lifetime major depression, current depression, presence and severity of erectile dysfunction. Mean scores of HAM-D, HAM-A, BHS and MAST in the group with lifetime PTSD were significantly higher than the group without this diagnosis. There was a positive relationship between lifetime PTSD diagnosis and depression, anxiety, hopelessness and severity of psychosocial problems related to alcohol dependency, while there was no relationship between lifetime PTSD comorbidity and erectile dysfunction in alcohol-dependent patients.

Clinical correlates of childhood abuse and neglect in substance dependents.

The aim of this study was to evaluate the prevalence of childhood abuse and neglect (CAN) in Turkish substance dependents and to investigate the relationship between CAN with axis I disorders, personality disorders and severity of depression and anxiety symptoms. Among 132 substance dependents, 56.1% met dichotomous criteria for some form of CAN. Current age was lower, whereas rate of suicide attempt, self-destructive behavior, divorce of parents, major depression, posttraumatic stress disorder (PTSD), lifetime specific phobia and personality disorders were higher in patients with history of CAN. Severity of depression and anxiety symptoms were also higher in group with CAN and number of abuse type was correlated with depression and anxiety scores. Lifetime major depression, lifetime PTSD, suicide attempt, self-destructive behavior and divorce of parents predicted CAN. The high rate of CAN found among Turkish substance dependents suggests that special attention must be given to identify CAN in this group. Findings of this study showed that there is a relationship between history of CAN and some axis I disorders, personality disorders and severity of depression and anxiety symptoms.

Prevalence of alcohol use in Istanbul.

The current research assessed the prevalence of alcohol use in Istanbul, Turkey along with characteristics and severity of related problems. The data were collected from structured interviews including the CAGE Questionnaire to eliminate the severity of alcohol-related problems of 1,550 residents (743 women, 807 men) of Istanbul, ages 12 to 65 years. Current alcohol use was 25.6% (397 persons, 118 women and 279 men), including 15.9% of the women and 34.5% of the men. 67% reported never having used alcohol. The rate of alcohol use was highest in the 40- to 49-yr. age group: the onset of use was reported as most common for the 16- to 19-yr.-olds. Prevalence of risky drinking was 6.8% (106 persons). Men were more likely to have an earlier initiation to alcohol use, to consume more [5.2 standard drinks (SD=3.4) vs 3.6 standard drinks (SD=2.5)] and be problem drinkers (31.5% vs 15.2%) than women. Prevalence of alcohol use seems to be relatively low in Istanbul. Data on characteristics of alcohol use are important in estimating groups at risk for problems and in planning prevention strategies.

[Is substance abuse among physicians a problem?]. / Doktorlar arasinda madde kötüye kullanimi bir sorun mu?

In today's medical community, there is growing concern about substance use among physicians, not only because of their own health, but also because of the potential adverse effects on their clinical practices. Physicians affect public health both by treatment and preventive studies and as role models. Prevalence data concerning substance abuse are generally lacking. There is no consensus on the rates of substance abuse being higher among physicians than among the general public. Physicians are less likely to smoke cigarettes and use illicit substances (like marijuana, cocaine and heroin) and more likely to use alcohol and two types of prescription medications--benzodiazepines and minor opioids--compared with their age groups. Doctors are at special risk of developing addiction problems owing to the strain of medical practice, erosion of the taboo against injecting and using opiates, and particularly access to supplies. The most common precipitating factors mentioned are physical pain and illness, usually chronic, with family tragedy such as death of a wife or child next. The third most common factor is an addicted wife. Stress, overwork and marital problems are also mentioned. No data were found about physicians' substance use in Turkey. This article generally aims to review the knowledge on the prevalence of substance use among physicians, the drug of choice, the development of dependence, the treatment and prognosis and to discuss the importance of this issue by evaluating three cases treated at the Alcohol and Drug Addiction Treatment and Research Center (AMATEM), Bakirköy State Hospital for Mental and Neurological Diseases.