Limbic system dysrhythmia: a diagnostic electroencephalogram procedure utilizing procaine activation.

A diagnostic method is presented that makes it possible to distinguish patients who are most likely to show a positive response to treatment with anticonvulsant medication, thereby cutting across many DSM-III-R diagnoses. Patients are evaluated to determine whether they exhibit at least 4 of 12 groups of symptoms, and the local anesthetic procaine is used, along with an electroencephalogram (EEG) to evaluate for omega band activity (30-50 Hz) of at least 50 microvolts or approximately three times baseline values in the anterior temporal leads. This method was studied in 145 patients with varying diagnoses. Eighty-three percent of patients who were symptom- and procaine-positive responded to anticonvulsants. Specific application to patients with attention-deficit hyperactivity disorder, bipolar disorder, and panic disorder is made. This method may provide a basis for identifying subpopulations of anticonvulsant-responsive patients who often are considered treatment-resistant.

Laboratory test changes in young abstinent male alcoholics.

Data collected over time from an abstaining young alcoholic population were analyzed together with data from a nonalcoholic population, which served as a reference group. The laboratory tests of the abstaining alcoholics were measured at baseline (zero weeks), three weeks, and six weeks, while those of the nonalcoholic group were measured once, at baseline. The analysis attempts to reveal how abstinence from beverage alcohol consumption in an alcoholic population affects 25 commonly ordered laboratory tests over time and whether cigarette smoking mediates any observed effects. The primary findings of this detailed examination of clinical chemistries in abstaining alcoholics indicate that drinking and smoking have independent effects and that the effects of drinking persist even after six weeks of abstinence.

The effectiveness of biologic markers to diagnose alcoholism.

This study explored the effectiveness of biologic markers in alcoholism where correct diagnosis does not result from relatively simple inspection. After review of the use of individual biologic markers and their limitations, data is presented from a multivariate analysis of 351 young healthy male alcoholics and 339 nonalcoholic male patients in which an overall accuracy rate of 84.3% was obtained. A discussion of what biologic markers may be measuring, issues in sample selection, statistical issues and problems with laboratory variability in the use of biologic markers is presented.

Effects of abstinence on the ability of clinical laboratory tests to identify male alcoholics.

Quadratic discriminant analysis of 25 commonly ordered clinical laboratory tests resulted in correct classification of 100% of nonalcoholic inpatients (n = 41), 100% of medical ward alcoholics as alcoholic (n = 63), and 95% of alcoholism treatment program participants as alcoholic (n = 274). Admission laboratory values for a random sample of 138 additional alcoholism treatment program participants were used to correctly classify 96% of them as alcoholics. Repeat analysis of these same laboratory tests after some 27 days of hospitalization resulted in 94% of the 138 patients still being classified as alcoholic, even though significant improvements in individual hepatic and hematologic laboratory values were noted. Classification was not changed with reanalysis after long-term abstinence (7 or 24 months), suggesting widespread and persistent alcohol-related alterations in organ system functioning with chronic alcohol abuse. Quadratic discriminant analysis of laboratory tests is an effective means of identifying people with present or past alcohol abuse but is not yet of value in detecting compliance with a treatment goal of abstinence.

The search for a biochemical marker in alcoholism.

A diagnostic aid using routinely available blood chemistry batteries is being developed which shows promise for use in identification of individuals with drinking problems as well as in individuals having alcoholic and nonalcoholic liver disease. A statistically complex form of pattern recognition known as quadratic discriminant analysis is performed on common clinical laboratory tests such as total protein, total bilirubin, phosphorus, chloride, carbon dioxide, glucose, WBCs, RBCs, and MCV values. The relationship of each of the tests to each other is analyzed, providing a type of biochemical "fingerprint," such that any one test may not be unique. Rather, the interrelationships to one another provide a unique statistical profile of an alcoholic, or an individual with alcoholic or nonalcoholic liver disease.

Pretreatment consumption as a predictor of posttreatment consumption in male alcoholics.

Pretreatment levels of alcohol consumption for 72 male alcoholics were found to be related statistically to posttreatment levels of consumption determined approximately 8 months after completion of an inpatient alcoholism treatment program. Multiple logistic regression analysis was used successfully to determine the risk of relapse. Increased risk was associated with excessive drinkers who were relatively early in their alcoholic careers as assessed by years of abusive drinking and lifetime gallons consumed. Logistic regression appears to be a clinically useful procedure that would allow individual treatment programs to set their own criteria of success and increase their treatment effectiveness.

Biochemical and hematologic correlates of alcoholism and liver disease.

Quadratic multiple discriminant analysis of 25 commonly ordered laboratory tests resulted in correct classification of 100% of nonalcoholics without overt liver disease, 98% of alcoholism treatment program patients with presumed mild liver involvement, 96% of alcoholics with liver disease, and 89% of nonalcoholics with liver disease. Direct comparison of the biopsy-verified alcoholic and nonalcoholic liver disease groups resulted in 100% discrimination, and removal of traditionally evaluated liver tests from the battery of 25 tests did not substantially alter the original classification accuracy. Alcoholic and nonalcoholic liver disease was still 100% differentiable when equated for number of patients with cirrhosis, hepatitis, and hepatitis combined with cirrhosis or fibrosis. Additional utility of the quadratic discriminant approach was demonstrated when 83% alcoholic and 83% nonalcoholic liver disease cases were diagnosed correctly in a prospective manner. In contrast, use of aspartate aminotransferase to alanine aminotransferase ratios (ie, SGOT to SGPT) identified correctly 75% and 33% of patients, respectively.

Biochemical diagnosis of alcoholism. A test of the discriminating capabilities of gamma-glutamyl transpeptidase and mean corpuscular volume.

Quadratic discriminant analysis was conducted between 121 medically documented male alcoholics who presented for treatment and 130 male nonalcoholic outpatients who were concerned about the possibility of venereal disease. Analysis of gamma-glutamyl transpeptidase (GGT) and mean corpuscular volume (MCV) resulted in correct classification of 94% of nonalcoholics but only 36% of alcoholics. In contrast, analysis of 24 commonly ordered clinical laboratory tests produced correct classification of 100% of nonalcoholics and 98% of alcoholics. Transforming the laboratory-determined values to a normal-abnormal dichotomy on the basis of reference values improved the classification accuracy of GGT and MCV to 77%. However, consideration of ten of the other tests resulted in an accuracy of 98% for alcoholics and 95% for nonalcoholics.

Effect of chronic ethanol administration on plasma levels of LH and the estrous cycle in the female rat.

Intragastric intubation of 4 or 8 g/kg of body weight of ethanol per day for 12 consecutive days disrupted the normal estrous cycle in female rats as monitored by vaginal epithelial cell changes. Plasma luteinizing hormone levels were unchanged suggesting that blood ethanol in the 50--100 mg/100 ml range acted as a direct gonadal toxin and not at the hypothalamic-pituitary gland level.

Neuropsychological deficits in alcoholic men in their mid thirties.

The authors examined performances on 24 commonly used clinical neuropsychological tests for drug-free alcoholic men in their mid to late 30s either within 2--6 days of their last drink (N = 59) or between 14 and 31 days after their last drink (N = 20). Although mean scores were indicative of impairment on approximately half of the tests, no statistically significant overall difference in performance between individuals tested at these two time periods was observed. Recent and chronic alcohol consumption variables were found to interact with each other and with age and education in a nonlinear fashion in predicting neuropsychological performance. Increased consumption predicted decreased performance even on tests whose mean scores were in the normal range.

Clinical relationships between serum phosphorus and other blood chemistry values in alcoholics.

Hypophosphatemia was found in 11 of 434 (2.5%) male patients admitted to an alcohol treatment program and 21 of 69 (30.4%) male alcoholic patients admitted to the medical wards. In contrast, hyperphosphatemia was found in 43 of 434 (9.9%) treatment program alcoholics, and only one of 69 (1.4%) medical-ward alcoholics. Analysis of a sample of 57 nonalcoholic inpatients from the same hospital revealed one (1.8%) patient with hypophosphatemia and one (1.8%) patient with hyperphosphatemia. No relationship was found between phosphorus levels and magnesium, creatinine phosphokinase, RBCs, or hematocrit. A transient by significant (P less than .05) hypophosphatemia was found between the second and fifth days after admission in a subsample of 26 medical-ward alcoholics who had had a normal serum phosphate level on admission. It is suggested that phosphate levels of less than 1.1 mg/dL may predict impending hemolysis or rhabdomyolysis in the alcoholic.

Biochemical and hematological correlates of alcoholism.

Alcoholic patients admitted to medical wards (n=63) and to an alcoholism treatment program (n=412), respectively, were differentiated biochemically and hematologically from each other, as well as from a group of nonalcoholic hospitalized controls (n=40). A quadratic multiple discriminant analysis of blood chemistry tests classified 100% of medical ward alcoholics as alcoholic, 94% of treatment program alcoholics, and 100% of medical controls as nonalcoholic. An expanded control group (n=52) containing 12 patients with biopsy-verified nonalcoholic liver disease was compared with a combined group of age-matched medical ward and treatment program alcoholics (n=126). All controls and 86% of the alcoholics were correctly identified. Sixteen of a group of purported nonalcoholics (n=23), whose drinking practices exceeded our criteria for the nonalcoholic sample, were identified as alcoholic. It is concluded that routine chemistries can be used reliably as a clinical adjunct by the physician to identify individuals whose biochemical and hematological profiles are similar to those of documented alcoholics.

Data attrition in follow-up studies of alcoholics.

Alcoholics who responded to posttreatment follow-up evaluation showed more improvement than those wh did not respond. Thus nonresponders may bias follow-up research tht does not account for missing data. Several procedures are outlined to increase follow-up return.