Trace Element Levels and Oxidant/Antioxidant Status in Patients with Alcohol Abuse.

Alcohol abuse is a well-known cause of imbalance in trace element levels and oxidant/antioxidant status of individuals with long time consumption. However, the levels of these parameters in the patients on the early stages of alcohol dependence without liver damage differ on various studies. The aim of our study was to measure the levels of trace elements in the serum and oxidative/antioxidative system members in the red blood cells (RBC) of early-stage alcoholic individuals and compare with control subjects. Our study included 21 male patients recently hospitalized for alcohol abuse and 25 healthy non-abusing male controls. Levels of Fe, Zn, and Cu in the serum and MDA, SOD, CAT, and GSH in the red blood cells (RBC) of the subjects were measured. Fe, Zn, and Cu levels were lower in the study group when compared to the controls. Levels of lipid peroxidation marker MDA was high, whereas the activities of antioxidant enzymes SOD and CAT were decreased in our study group. However, levels of GSH, an antioxidant compound were higher in the alcohol abuse group. RBC SOD levels were positively correlated with Fe, Cu, Zn, and CAT. There was a positive correlation between Fe-Cu, Zn-Fe, Zn-Cu, CAT-Zn, and CAT-SOD. MDA was negatively correlated with Fe, Zn, SOD, and CAT. The results obtained from present study indicate that high levels of alcohol intake are related with increased oxidative damage and decreased levels of antioxidant enzymes and trace elements. Additionally, antioxidant compensation mechanisms are still on process in the early stages of chronic alcohol exposure.

A Highly Specific, Fully Validated Urinary Ethyl Glucuronide Analysis Using Solid Phase Extraction-Liquid Chromatography/Electrospray Ionization-Tandem Mass Spectrometry.

A highly specific and selective analytical method using LC/MS/MS for the quantitative determination of ethyl glucuronide (EtG) in urine was developed and fully validated. Since the determination of EtG in urine may be possible days after the elimination of alcohol, it is an indication of alcohol use in alcohol treatment programs and antemortem and postmortem toxicological investigations. Propyl glucuronide (PrG), which increased the selectivity of the method, was used as an internal standard. The method was validated in terms of selectivity, linearity, LOD, LOQ, intraday and interday precision, and recovery. The analyte and PrG in the SPE cleaned up extract were separated on a 150 mm C18 column in 3.3 min with high resolution. The rest of the peaks from the matrix were eluted in 9.0 min. The LOD was 90.8 ng/mL and the LOQ was calculated using the EURACHEM method as 185.0 ng/mL. The intraday and the intermediate precision of the method was calculated using analysis of variance and confirmed with calculation of HorRat values, which were found within acceptable limits. The method provided a reliable solution for monitoring patients under alcohol addiction treatment and was successfully applied to real samples.

Neurosyphilis presenting as psychiatric symptoms: an unusual case report.

OBJECTIVE: Neurosyphilis remains a differential diagnosis for a wide variety of psychiatric syndromes, including dementia, mood disorders and psychosis. However, the incidence of neurosyphilis presenting initially with psychiatric symptomalogy is unclear. In this article, a clinical case is reported so as to illustrate some of the issues involved. CASE PRESENTATION: A 33-year-old married man was admitted because of a depressive episode associated with somatic preoccupations and a gradual loss of ability to function a year prior to his admission. The symptoms described above raised the question of an organic brain syndrome associated with the psychotic depression. Some laboratory and additional examinations were performed. Serological tests for syphilis were positive for both the hemagglutination test, Treponema pallidum hemaglutination (TPHA), and the immunofluorescent antibody test, fluorescent treponemal antibody-absorption (FTA-ABS). Based on these findings, the diagnosis of neurosyphilis was made. The patient was treated with benzathine penicillin (2 400 000 units i.m. once a week) for 3 weeks and venlafaxine (150 mg daily) and olanzapine (5 mg daily). His depression disappeared gradually, and he was discharged in partial remission. CONCLUSION: High-risk groups such as patients with neuropsychiatric diseases should be screened with serological tests so as to prevent morbidity and help eliminate syphilis.

Heroin-dependent patients attempting and not attempting suicide: a comparison.

OBJECTIVE: Heroin dependence is a serious illness associated with an increased risk of suicidal behaviour. There are many risk factors associated with heroin dependence. The current study examined the sociodemographic and clinical characteristics of a number of young adult heroin-dependent patients who had attempted suicide. METHODS: We studied a group of 108 young adult heroin-dependent patients in our in-patient clinics. All diagnoses were made according to DSM-IV diagnostic criteria using the Structured Clinical Interview for DSM-IV Axis I-II Disorders (SCID-I, II). The age range of patients was 18-24 years. Their substance abuse histories were assessed by semistructured interview. The Addiction Severity Index (ASI) was administered to all the patients. Serum total cholesterol and high-density lipoprotein cholesterol (HDL-C) levels were routinely measured. In the statistical analyses, Student's t test, and chi-squared tests were applied. RESULTS: Of the 108 heroin-dependent patients, 40 (37.0%) had histories of attempted suicide. There was a statistically significant difference in the age at which heroin use had commenced between female attempters [mean = 16.82, standard deviation (SD) = 3.06] and nonattempters (mean = 18.32, SD = 2.68, t= 2.25, P < 0.05). Both the male (mean = 33.35, SD = 4.05) and the female (mean = 28.00, SD = 5.36) attempters had significantly higher ASI scores than did the male (mean = 20.16, SD = 3.80) and the female (mean = 18.88, SD = 4.14) nonattempters (t= 14.34, P < 0.001; t= 5.25, P < 0.001, respectively). A significant difference in total cholesterol (mean = 131.8, SD = 19.3; mean = 172.2, SD = 21.3, t= 3.9, P < 0.05) and HDL-C (mean = 30.9, SD = 1.0 and mean = 54.8, SD = 13.7; t= 5.1, P < 0.05) levels between the group of violent and nonviolent suicide attempters was revealed. CONCLUSIONS: These results suggest that suicide attempts in young adult heroin-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels. In particular, low levels of total cholesterol and HDL-C might indeed be associated with violent suicide attempts in young heroin-dependent patients.

Delirium-associated disulfiram and ethanol interactions.

BACKGROUND: Disulfiram, an agent used for the treatment of alcohol dependence, can exacerbate psychiatric syndromes (including psychosis, catatonia, delirium, depression, and mania) after extended use. However, delirium has yet to be reported following the short-term use of disulfiram in the setting of alcohol use. OBJECTIVES: We report a case with a neuropsychiatric presentation and discuss the prevention and the progression of delirium associated with an interaction of disulfiram and ethanol. CASE REPORT: We report the case of a 51-year-old woman who developed disorganized speech, diminished communication, a decrease in appetite, and thoughts of suicide 10 days after she began taking disulfiram (250 mg/day), to which she added 1 glass of alcoholic beverage for 2 days. Delirium developed in association with an interaction between disulfiram and alcohol. The patient met DSM-IV criteria for major depressive disorder, alcohol dependence, and delirium. DISCUSSION: Neuropsychiatric manifestations may develop in association with co-administration of disulfiram and alcohol; timely recognition and treatment are recommended.

Increased LDL+VLDL oxidizability and plasma homocysteine levels in chronic alcoholic patients.

The purpose of this study was to investigate the effect of heavy alcohol consumption on peroxidation status in apolipoprotein B-containing lipoproteins (LDL+VLDL) and plasma as well as plasma homocysteine (HC) levels in patients with chronic alcoholism who drank raki, a national Turkish beverage. For this reason, endogenous diene conjugate (DC) and lipid hydroperoxide (LOOH) levels and lag phase, maximum DC formation and propagation rate following copper induction were measured in apolipoprotein B-containing lipoproteins (LDL+VLDL) isolated by precipitation with dextrane sulfate and MgCl2 from plasma. In addition, serum malondialdehyde (MDA), DC, HC, folate and vitamin B12 levels as well as paraoxonase activity were determined. Serum MDA and DC levels were higher in heavy raki drinkers compared to control subjects. Significant increases in endogenous DC and LOOH levels in LDL+VLDL together with shortened lag phase were also observed in patients. In addition, HDL-cholesterol, HC and vitamin B12 levels and HDL-associated paraoxonase activity were found to be higher, but folate levels to be lower in serum of heavy raki consumers. In conclusion, our results indicate that increases in LDL+VLDL oxidizability and plasma HC levels may enhance the susceptibility to vascular diseases in heavy raki drinkers.

Major depressive disorder with psychotic features induced by interferon-alpha treatment for hepatitis C in a polydrug abuser.

Infectious diseases, especially hepatitis C, are prevalent among drug abusers. Interferon-alpha (IFN-alpha) is the pharmacological treatment of choice for this condition. Patients being treated with IFN-alpha can be expected to experience such psychiatric side-effects as development of depression, mania, irritability, changes in personality, hallucinations or delirium. In addition, certain patients are considered to be at greater risk of developing neuropsychiatric side-effects. Individuals meeting the following criteria are particularly vulnerable: over 40 years of age; having central nervous system abnormalities; a previous neurological or psychiatric history; a past familial psychiatric history; use of narcotics or having alcohol or substance use disorders; being HIV-positive; coadministration of other cytokines; receiving high doses of IFN-alpha (> 6 million units). We report the case of a 29-year-old patient with chronic non-active hepatitis C, a previous psychiatric history of polydrug abuse (cannabis, heroin and illegal use of the psychotropic drug biperiden) and anxiety disorder. Two weeks after the initiation of IFN-alpha treatment, he developed fatigue, sleeplessness and persecutory delusions. The patient responded partially to the discontinuation of the IFN-alpha treatment. Due to the presence of three risk factors in this patient, he was considered to belong to the group of patients being 'at high risk' of developing neuropsychiatric side-effects. This is the first case report of major depressive disorder with psychotic features in such a 'high-risk patient'. This case report may prompt other research by showing the importance of the close monitoring, and the prevention of the progression of IFN-alpha-related psychiatric disorders in 'a high-risk patient'.

Childhood trauma in alcoholics.

AIMS: Many studies have been conducted to evaluate the relationship between childhood trauma and alcoholism. In this study 80 alcoholics were chosen according to their hospitalization order. The control group consisted of 60 subjects, with no history of alcohol use, matched with the patient group in age and sex. METHODS: A sociodemographic and clinical data form, a questionnaire focusing on traumatic life experiences in childhood and The Childhood Trauma Questionnaire, Hamilton Depression Rating Scale, and Hamilton Anxiety Rating Scale were applied to both groups. RESULTS: Significant differences were found between the two groups on traumatic life experiences in childhood. Results suggested that childhood trauma positively correlates with anxiety and affective symptoms among alcoholics. CONCLUSIONS: Further studies are needed concerning this issue.

Alcohol-dependent patients attempting and not attempting suicide: a comparison.

BACKGROUND: Alcohol dependence is a psychiatric disorder associated with an increased risk of suicidal behaviour. This is also associated with an increased number of suicide risk factors. OBJECTIVE: The current study examined the sociodemographic and clinical characteristics of a number of alcohol-dependent patients who attempted suicide. METHODS: We studied a consecutive series of 377 alcohol-dependent patients in our in-patient clinics. Their alcohol-use histories were assessed through semistructured interviews. The Suicidal Behaviors Questionnaire, the Childhood Trauma Questionnaire, the Michigan Alcoholism Screening Test and the Hamilton Depression Rating Scale were administered to all patients. Serum total cholesterol levels, mean corpuscular volume, the liver enzymes gamma glutamyl transferase, aspartate aminotransferase and alanine aminotransferase were routinely measured. In the statistical analyses, Student's t-test and chi-squared tests were applied. RESULTS: Of the 377 alcohol-dependent patients, 89 (23.6%) had histories of attempted suicide. Thirty-four (42.5%) of the 80 female alcohol-dependent patients and 55 (18.5%) of the 297 male alcohol-dependent patients had attempted suicide; this gender difference was statistically significant (χ2 = 27.7, P < 0.001). A greater proportion of the suicide attempters than of the non-attempters met the Diagnostic Statistical Manual IV criteria for another psychiatric disorder (60.6%, n = 54, vs. 40.6%, n = 117; χ2 = 14.8; df = 6; P < 0.05). The difference of total cholesterol levels between female (mean = 144.0, SD = 58.3; mean = 158.0, SD = 83.9; t = 4.5; P < 0.05) and male (mean = 133.7, SD = 50.5; mean = 163.6, SD = 69.7; t = 11.7; P < 0.01) attempters and non-attempters was statistically significant. CONCLUSION: These results suggest that suicide attempts in alcohol-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels.

[Ecchymosis associated with the use of fluoxetine: case report]. / Fluoksetin kullanimi ile iliskili ekimoz: olgu sunumu.

UNLABELLED: Selective Serotonin Reuptake Inhibitors (SSRI) are well established in psychopharmacological therapy. SSRIs have been shown to be very effective in the treatment of depressive, anxiety and obsessive-compulsive disorders and have a favorable side effect profile. Although bleeding events are rare, there may be potentially severe hematologic complications following treatment with SSRIs. Fluoxetine has been reported to cause ecchymosis, bleeding and other hematologic problems. The aim of this article is to report a case of suspected fluoxetine-induced ecchymosis and to review the literature about this adverse effect. CASE SUMMARY: A 23-year-old woman was diagnosed with depressive disorder according to DSM-IV criteria and treated with fluoxetine 20 mg/day. After treatment for 10 weeks, the patient reported ecchymosis without any trauma. Her complete blood cell count, prothrombin time, partial thromboplastin time, bleeding time and other hematologic screening tests were within the normal limits. Her complete physical examination was also normal. After the medication was discontinued for 4 weeks, ecchymosis disappeared. A month later, the patient took fluoxetine for a week, and then the ecchymosis restarted. Fluoxetine was suspected to be the cause of these lesions. SSRIs cause these side effects by disrupting the normal platelet aggregation process through the blockade of serotonin uptake into platelets. For this reason, caution is recommended when using fluoxetine and other SSRIs in patients with thrombocytopenia or suspected platelet dysfunction.