Interoceptive accuracy and interoceptive sensibility in individuals with alcohol use disorder-Different phenomena with different clinical correlations?

BACKGROUND: Interoception may contribute to substance use disorder as it relates to the body's experience of substance use or withdrawal. However, only a few studies have directly investigated associations between interoception and alcohol use. The objective of this study was to compare individuals with alcohol use disorder (AUD) and healthy controls on interoceptive sensibility and accuracy. METHODS: The sample was comprised of two groups: individuals meeting criteria for AUD (N = 114) and healthy controls (N = 110) not meeting criteria for AUD. Interoceptive sensibility was assessed with a self-report measure (the Private Body Consciousness subscale) and interoceptive accuracy - with a behavioral measure (the Schandry test). In addition, associations between interoception and other well-recognized correlates of AUD (sleep problems, depressive and anxiety symptoms, impulsivity) were tested. Barratt's Impulsiveness Scale, Brief Symptom Inventory, and Athens Insomnia Scale were utilized to assess psychopathological symptoms as covariates. RESULTS: When controlling for level of anxiety, sleep problems, age, sex and education, individuals with AUD scored significantly higher on self-reported interoceptive sensibility and lower on interoceptive accuracy in comparison to healthy controls. Higher interoceptive sensibility was associated with more severe sleep problems and anxiety symptoms. CONCLUSIONS: These results have to be treated as preliminary and need to be replicated; however, findings indicate that interoception may present a novel therapeutic target for treatment of AUD.

Effect of Disturbances of Zinc and Copper on the Physical and Mental Health Status of Patients with Alcohol Dependence.

The concentrations of copper and zinc in the tissues of alcohol-addicted people can significantly correlate with the variables describing their mental state. Studies on the homeostasis of zinc in alcohol-dependent patients have often been characterized by low hypozincemia detection. This may be caused by a low content of zinc in blood serum (1%) compared to the average zinc level in the body. Unfortunately, most authors have identified extracellular zinc in their studies. In the available literature, data on the level of copper in patients suffering from alcohol dependence are inconsistent. Our study included 100 alcohol-addicted patients (the study group) and 50 healthy subjects (the control group). Mental state was measured using appropriate psychometric scales. We used inductively coupled plasma mass spectrometry (ICP-MS) to determine copper and zinc content. Our results confirm the purposefulness of the use of zinc concentration in erythrocytes as a diagnostic parameter for low zinc status in alcohol-dependent patients. Alcohol-dependent patients with reduced concentrations of zinc in erythrocytes/copper in blood plasma differed significantly from alcohol-dependent patients with normal concentrations in terms of clinical parameters. With regard to zinc in blood plasma and copper in erythrocytes, this situation has not been found. The clinical symptoms of hypozincemia and copper deficiency in patients addicted to alcohol usually relate to disorders in central nervous system functioning, and they result in a decreased quality of physical and mental life.

Improving screening and brief intervention activities in primary health care: Secondary analysis of professional accuracy based on the AUDIT-C.

INTRODUCTION AND OBJECTIVE: The ODHIN trial found that training and support and financial reimbursement increased the proportion of patients that were screened and given advice for their heavy drinking in primary health care. However, the impact of these strategies on professional accuracy in delivering screening and brief advice is underresearched and is the focus of this paper. METHOD: From 120 primary health care units (24 in each jurisdiction: Catalonia, England, the Netherlands, Poland, and Sweden), 746 providers participated in the baseline and the 12-week implementation periods. Accuracy was measured in 2 ways: correctness in completing and scoring the screening instrument, AUDIT-C; the proportion of screen-negative patients given advice, and the proportion of screen-positive patients not given advice. Odds ratios of accuracy were calculated for type of profession and for intervention group: training and support, financial reimbursement, and internet-based counselling. RESULTS: Thirty-two of 36 711 questionnaires were incorrectly completed, and 65 of 29 641 screen-negative patients were falsely classified. At baseline, 27% of screen-negative patients were given advice, and 22.5% screen-positive patients were not given advice. These proportions halved during the 12-week implementation period, unaffected by training. Financial reimbursement reduced the proportion of screen-positive patients not given advice (OR = 0.56; 95% CI, 0.31-0.99; P < .05). CONCLUSION: Although the use of AUDIT-C as a screening tool was accurate, a considerable proportion of risky drinkers did not receive advice, which was reduced with financial incentives.

Reductions in physical pain predict lower risk of relapse following alcohol treatment.

OBJECTIVE: Physical pain is considered a potential predictor of relapse in alcohol-dependent individuals after treatment. The aim of this study was to evaluate whether reductions in pain level during the follow-up period after treatment were associated with lower relapse risk. METHOD: A sample of 366 participants was recruited from alcohol treatment centers in Warsaw, Poland. At baseline, information was obtained about pain level, demographics, childhood abuse, impulsivity, depressive symptoms, severity of alcohol and sleep problems. After finishing the alcohol treatment program, patients were followed for 12 months and alcohol drinking (relapse) as well as pain severity were evaluated. RESULTS: In the followed-up group, 29.5% of patients confirmed that they drank any alcohol during past 4 weeks. Comparing follow-up to baseline pain, 48.6% of subjects reported an increased severity of pain, 28.8% reported the same level of pain, 22.6% reported decreased level of pain. There was a significant association between the decrease in level of pain and the lower risk of relapse. Other factors associated with relapse during 4 weeks prior to the follow-up were baseline severity of depressive symptoms, low baseline social support and number of drinking days during 4 weeks prior to entering treatment. In multivariate analysis, a decrease in pain level was associated with a lower likelihood of relapse (OR=0.159; 95%CI:0.04-0.62; p=0.008) even when controlled for other factors associated with relapse. CONCLUSIONS: Decreases in pain level following treatment for alcohol dependence are associated with, and may contribute to, a lower risk of alcohol relapse.

Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care.

BACKGROUND: Alcohol use disorders (AUDs) are highly prevalent in Europe, but only a minority of those affected receive treatment. It is therefore important to identify factors that predict treatment in order to reframe strategies aimed at improving treatment rates. METHODS: Representative cross-sectional study with patients aged 18-64 from primary health care (PC, six European countries, n=8476, data collection 01/13-01/14) and from specialized health care (SC, eight European countries, n=1762, data collection 01/13-03/14). For descriptive purposes, six groups were distinguished, based on type of DSM-IV AUD and treatment setting. Treatment status (yes/no) for any treatment (model 1), and for SC treatment (model 2) were main outcome measures in logistic regression models. RESULTS: AUDs were prevalent in PC (12-month prevalence: 11.8%, 95% confidence interval (CI): 11.2-12.5%), with 17.6% receiving current treatment (95%CI: 15.3-19.9%). There were clear differences between the six groups regarding key variables from all five predictor domains. Prediction of any treatment (model 1) or SC treatment (model 2) was successful with high overall accuracy (both models: 95%), sufficient sensitivity (model 1: 79%/model 2: 76%) and high specificity (both models: 98%). The most predictive single variables were daily drinking level, anxiety, severity of mental distress, and number of inpatient nights during the last 6 months. CONCLUSIONS: Variables from four domains were highly predictive in identifying treatment for AUD, with SC treatment groups showing very high levels of social disintegration, drinking, comorbidity and functional losses. Earlier intervention and formal treatment for AUD in PC should be implemented to reduce these high levels of adverse outcomes.

Assessing and treating alcohol relapse risk in liver transplantation candidates.

In Europe between 30 and 50% of all liver transplantations (LTX) are done within the context of chronic end-stage alcoholic liver disease (ALD). However, post-operatively 20-25% of these patients lapse or relapse into heavy alcohol use. Thus, assessment of alcohol relapse risk before enlisting and therapeutic follow-up during and after LTX is of utmost importance. However, as yet there are enormous differences between European countries and between transplant centers, with regard to the assessment methods and criteria and the implementation of therapeutic follow-up. Only the so-called '6-month abstinence' rule is widely used. However, there are not much scientific data validating its use in predicting relapse. Thus, there is a clear need of a more homogeneous approach, which was the focus of a symposium of the European Federation of Addiction Societies during the 14th conference of the European Society for Biomedical Research on Alcoholism, 2013 (ESBRA), entitled 'Liver transplantation: A European perspective'. In a follow-up on this symposium, the authors aim to sum up the evidence of psychiatric assessment criteria and psychiatric treatment interventions relevant in the context of patient selection and patient follow-up within ALD transplantation procedures. Based upon these findings, we propose elements of a procedure that can serve as a first step toward a model of good practice regarding addiction-specialist input within the pre- and post-transplantation period.

History of sexual abuse and suicide attempts in alcohol-dependent patients.

History of child abuse is considered one of the important risk factors of suicide attempt in general population. At the same time it has been shown that suicide attempts appear significantly more frequently in alcoholics than in healthy individuals. The objective of this study was to investigate associations between history of childhood sexual abuse and suicide attempts in a sample of Polish alcohol dependent patients. A sample of 364 alcohol-dependent subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, family history of psychiatric problems, history of suicide attempts, sexual and physical abuse during childhood and adulthood and severity of alcohol problems. When analyzed by gender, 7.4% of male and 39.2% of female patients had a lifetime history of sexual abuse; 31.9% of the study group reported at least one suicide attempt during their lifetime. Patients who reported suicide attempts were significantly younger (p=0.0008), had greater severity of alcohol dependence (p=0.0002), lower social support (p=0.003), and worse economic status (p=0.002). Moreover, there was a significant association between history of suicide attempts and family history of psychiatric problems (p=0.00025), suicide attempts in the family (p=0.0073), childhood history of sexual abuse (p=0.009) as well as childhood history of physical abuse (p=0.002). When entered into linear regression analysis with other dependent variables history of childhood sexual abuse remained a significant predictor of suicide attempt (OR=2.52; p=0.035). Lifetime experience of sexual abuse is a significant and independent risk factor of suicide attempts in alcohol-dependent individuals.

Morphological examination of the intraorbital muscles (musculi bulbi) in dogs in the perinatal period.

Twelve American Staffordshire terriers, gestational day 60, and 10 dogs de Bordeaux, gestational day 57 were examined in respect of the morphology and morphometry of their intraorbital muscles. The location of the retractor bulbi, recti and oblique muscles was described and the length of the muscles, the length and breadth of their tendons as well as the distance of the distal insertions of the muscle tendons from the corneal limbus were measured. Similarly, the shape of the line of distal insertions was investigated. The measurements were taken with an electronic caliper to the nearest 0.1 mm. The distance insertion-corneal limbus was measured by means of the Hifny and Misk method (1982). The following differences between the breeds in the morphometry of the intraorbital muscles and their tendons were found out. The distal insertions of the tendons of the dorsal, ventral and lateral recti muscles are further from the corneal limbus in American Staffordshire terriers than in dogs de Bordeaux. The muscular funiculi of the retractor bulbi muscle are further from the corneal limbus in dogs de Bordeaux, except the dorsolateral funiculus (1.96/1.94 mm). In addition, there are differences in the morphometry of the intraorbital muscles and their tendons. No differences, however, were found in the morphology of the intraorbital muscle tendons (their insertion line) and their location. The study can be applied to clinical sciences (surgery) and veterinary ophthalmology, in particular.

Orbital pseudotumor caused by a foreign body--a case report.

The case of a patient with a foreign body in the orbit is presented. The presence of this foreign body induced an aggressively expanding pseudotumor, infiltrating the eyelids, orbital muscles and the sclera. The process of diagnosis, management and the results of treatment are described. This case is noteworthy because of the atypical course of the disease in a patient with a foreign body following ocular injury.

Assessment and prevalence of depression in women 45-55 years of age visiting gynecological clinics in Poland: screening for depression among midlife gynecologic patients.

The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45-55, who were screened by 120 gynecologists throughout Poland. Patients completed the Beck's Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.

Age-related differences in the course of alcohol withdrawal in hospitalized patients.

The aim of this study was to compare the course of alcohol withdrawal (AW) syndromes in different age groups of hospitalized patients. Medical records of 892 patients treated for AW in Nowowiejski Hospital in Warsaw, Poland from 1973 to 1987 were reviewed using a structured questionnaire; a further 321 patients were observed on a prospective basis in the years 1990-1999. We compared severity of the symptoms and the course of AW episodes in five age groups: <30, 30-39, 40-49, 50-59 and > or =60 years old. Although the age groups did not differ in respect of gender, there were significant differences in other demographic variables, such as marital status, education, employment and number of households. We found a greater prevalence of somatic diseases and hypokalaemia in the older age groups. Older patients were hospitalized longer than the younger patients. The amount of alcohol consumed was significantly smaller in the older patients. No significant differences were found between age groups in the duration and severity of AW symptoms. All age groups required comparable doses of medication. The relationship between the duration of AW and the amount of alcohol consumed during the last drinking bout was significant in patients aged >50 years. There was also a significant positive correlation between the occurrence of withdrawal seizures or the severity of AW symptoms and the number of previous AW episodes in patients aged > or =40 years. Although the results did not confirm some previously reported differences in the course of AW between older and younger patients, they point to some new important differences in the conditions and course of AW in the elderly.

[A map of delusional world according to Zdzislaw Bizon]. / Mapa swiata urojeniowego wedlug Zdzislawa Bizonia.

The paper describes an instrument for presentation of content of delusions, which thanks to its synthetic graphic form, leads to improved systematization and understanding of delusional beliefs.

Vibrio vulnificus septicemia in a patient with the hemochromatosis HFE C282Y mutation.

Vibrio vulnificus is an extremely invasive gram-negative bacillus found in marine waters that causes overwhelming bacteremia and shock that is associated with high mortality. Impaired iron metabolism has been implicated in the susceptibility to V vulnificus bacterial infections. We report a case of fatal V vulnificus sepsis in a 56-year-old man who died within 1 to 3 days after consuming raw seafood. At autopsy, he was found to have micronodular cirrhosis and iron overload. Postmortem genetic analysis revealed the presence of the hemochromatosis gene (HFE) C282Y mutation. To our knowledge, this is this first documented fatal case of V vulnificus infection in a patient proven to carry the HFE C282Y mutation. Because this patient was heterozygous for the major hereditary hemochromatosis mutation and was not previously diagnosed with clinical iron overload, the spectrum of clinical susceptibilities to V vulnificus infection may include carriers of the C282Y mutation.

[Bizon's method of social network and social support assessment: description of the method and its application]. / Ocena otoczenia i oparcia spolecznego wedlug Zdzislawa Bizonia. Opis metody i jej zastosowania.

The development of the social network and social support assessment method designed by Bizon is concisely outlined. The final version of the measurement method is described and all its components are presented in the appendix. It consists of the Interview Questionnaire, including Social Support Inventory, the Map of Social Network, the List of Social Network, Table of the data coding and Questionnaire of Demographic Data. The main studies with this instrument are reviewed. They indicate that Bizon's method is a helpful diagnostic tool and has some advantages in comparison with similar methods applied in the studies of social support.

Alterations in tissue glucose uptake during the hyperglycemic and hypoglycemic phases of sepsis.

The purpose of the present study was to characterize the alterations in tissue glucose uptake during the hyperglycemic, euglycemic, and hypoglycemic phases of peritonitis. Rats had vascular catheters implanted, and sepsis was induced by cecal ligation and puncture. Rates of whole-body glucose appearance (Ra), disappearance (Rd), and metabolic clearance (MCR) were determined by the constant infusion of 3H-glucose, and in vivo glucose uptake (Rg) by individual tissues was assessed by using 14C-deoxyglucose. During the hyperglycemic phase of sepsis (2 h), glucose Ra and Rd were increased, but glucose MCR was unaltered. In contrast, during the euglycemic phase (6 h), the sepsis-induced increase in glucose Ra and Rd was associated with an elevation in the MCR. Finally, during the hypoglycemic phase (24 h), sepsis decreased glucose Ra and Rd and the glucose MCR. The sepsis-induced changes in Rg for skeletal muscle and adipose tissue mimic those seen for the whole body at each time point. Rg for skin and intestine was elevated at 2 h and 6 h but was not different from control values at 24 h. In contrast, the Rg for liver, lung, and spleen was increased at all 3 time points. In a second study, there was no difference in Rg for any tissue between 2-h septic rats and control animals in which blood glucose and insulin levels were artificially elevated to the same degree. In a third study, the prevailing glucose and insulin levels in control animals were decreased, by injection of the gluconeogenic inhibitor 3-mercaptopicolinic acid, to levels seen in 24-h septic rats. There was no difference in the Rg for muscle and adipose tissue between 24-h septic rats and hypoglycemic insulinopenic control animals. However, the Rg for liver, lung, and spleen remained elevated in 24-h septic rats, compared with hypoglycemic insulinopenic control values. These data indicate that the increased tissue glucose uptake observed during the early phase of sepsis is a consequence of concomitant changes in plasma glucose and insulin. In contrast, during the euglycemic and hypoglycemic stages of sepsis, glucose uptake in macrophage-rich tissues remains elevated and is independent of changes in glucose and insulin.

Basilar artery dissection in a young woman: a case report.

The case of a young woman with basilar artery dissection, possibly precipitated by trauma, is presented, and the literature is reviewed.

Assessment of the role of kindling in the pathogenesis of alcohol withdrawal seizures and delirium tremens.

The aim of this study was to evaluate the hypothetical role of kindling phenomenon in the development and course of alcohol withdrawal (AW) seizures and delirium tremens (DT). The 2186 medical records of 1179 patients hospitalized in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Investigating the role of kindling, a course of consecutive AW episodes of patients hospitalized several times was analyzed. The relationships of withdrawal seizures with the duration of alcohol abuse, the number of prior detoxification episodes, and other variables were also studied. Increasing severity of AW symptoms was observed during the course of consecutive episodes in 22.5% of patients. The first episode of DT was preceded by withdrawal seizures in 11% of cases. First-ever withdrawal seizures occurred more frequently in patients with head injury in the past and with coexisting symptoms of alcohol liver disease. Occurrence of withdrawal seizures and DTs did not correlate with the number of previous withdrawal episodes or with the length of period of intensive drinking. We concluded that the kindling model could be applied only to some cases in the development of AW seizures and DTs. Kindling should be considered as one of the multiple mechanisms involved in the pathogenesis of AW delirium.

The role of somatic disorders and physical injury in the development and course of alcohol withdrawal delirium.

In a retrospective study, we evaluated the role of somatic disease and physical injury in the development and course of alcohol withdrawal delirium. Medical records of 1179 patients treated for alcohol withdrawal in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Development, symptoms' severity, and the course of alcohol withdrawal delirium were assessed in possible relation to the somatic state of patients and other variables of alcohol dependence. Development of the first episode of delirium tremens (DT) was associated with the incidence of somatic disease or injury in 19% of cases. Somatic disorders directly preceded the second episode of DT in 73% and the third in 57% of cases. A positive correlation was found between the greater severity and/or longer duration of DT symptoms, and occurrence of pneumonia, coronary heart disease, alcohol liver disease, and anemia, as well as daily amount of alcohol consumed during the last drinking bout. There was no relationship of severity of DT with the duration of alcohol abuse. Early development and severe course of alcohol withdrawal delirium correlated with the late beginning of excessive drinking (over the age of 40) and concomitant abuse of benzodiazepines or barbiturates. We concluded that somatic disorders or physical injury might trigger delirium during alcohol withdrawal, and have essential influence on the symptoms' severity and duration of DT. A more severe course of DT is also correlated with the quantity of alcohol consumed and concomitant abuse of sedatives.

Endotoxin-induced changes in IGF-I differ in rats provided enteral vs. parenteral nutrition.

The purpose of the present study was to determine whether acute changes in the insulin-like growth factor (IGF) system induced by mild surgical trauma/fasting or endotoxin [lipopolysaccharide (LPS)] are differentially modulated by total enteral nutrition (TEN) or total parenteral nutrition (TPN). Rats had vascular catheters and a gastrostomy tube surgically placed and were fasted overnight. The next morning animals randomly received an isocaloric, isonitrogenous (250 kcal. kg-1. day-1, 1.6 g N. kg-1. day-1) infusion of either TEN or TPN for 48 h. Then rats were injected intravenously with Escherichia coli LPS (1 mg/kg) while nutritional support was continued. Time-matched control animals were injected with saline. After mild surgical trauma and an 18-h fast, TEN was more effective at increasing plasma IGF-I levels than TPN. Subsequent injection of LPS decreased IGF-I in blood, liver, and muscle in both TEN- and TPN-fed rats compared with saline-injected control animals. However, this decrease was approximately 30% greater in rats fed TPN compared with those fed TEN. LPS-induced downregulation of IGF-I mRNA expression in liver and muscle was also more prominent in TPN-fed rats. The LPS-induced increase in plasma corticosterone and tumor necrosis factor-alpha was greater (2- and 1.6-fold, respectively) in TPN-fed rats, and these changes were consistent with the greater reduction in IGF-I seen in these animals. In similarly treated rats allowed to survive for 24 h after LPS injection, the LPS-induced increase in the urinary 3-methylhistidine-to-creatinine ratio was smaller in TEN-fed rats. In summary, LPS reduced systemic levels of IGF-I as well as IGF-I protein and mRNA in critical target organs. Enteral feeding greatly attenuated this response. Maintenance of higher IGF-I levels in TEN-fed rats was associated with a reduction in inflammatory cytokine levels and lower rates of myofibrillar degradation.

Role of central IL-1 in regulating peripheral IGF-I during endotoxemia and sepsis.

Inflammatory cytokines may mediate the host response to infection via central nervous system, endocrine, and/or paracrine/autocrine signaling mechanisms. Previous studies have shown that intravenous administration of interleukin (IL)-1 beta alters the concentration of the anabolic hormone insulin-like growth factor (IGF)-I in plasma and various tissues. The purpose of the present study was to determine 1) whether the intracerebroventricular injection of IL-1 beta can influence peripheral IGF-I levels in control animals and 2) whether the central administration of a IL-1 receptor antagonist (IL-1ra) can prevent the changes in peripheral IGF-I induced by endotoxin [lipopolysaccharide (LPS)] or sepsis produced by cecal ligation and puncture. In the first experiment, injection of IL-1 beta (100 ng/rat) decreased IGF-I levels in plasma, liver, and gastrocnemius muscle 28-36% by 1.5 h in conscious fasted rats. IGF-I levels remained reduced at 3 h, but returned to baseline by 6 h. IGF-I content was not altered in soleus, kidney, spleen, intestine, or whole brain after IL-1 beta. In the second series of experiments, LPS injected intravenously decreased IGF-I levels in plasma, liver, and gastrocnemius at 1.5 h, and levels were even further reduced at 3 and 6 h in these tissues (59, 57, and 48%, respectively). Moreover, the IGF-I content was also decreased in soleus (30-35%) and increased in kidney (2- to 3-fold) after LPS. In the third experiment, changes in IGF-I levels in plasma and tissues, similar to those seen in LPS-treated rats, were detected 24 h after induction of peritonitis. Intracerebroventricular infusion of IL-1ra did not alter any of the changes in IGF-I produced by either LPS or sepsis, although it did attenuate the concomitant changes in growth hormone levels. These data suggest that, although central IL-1 beta is capable of modulating peripheral IGF-I levels, central administration of IL-1ra was unable to modulate the changes in peripheral IGF-I in blood and tissues produced by either endotoxemia or peritonitis.