Occurrence and severity of cocaine-induced hallucinations: Two distinct phenotypes with shared clinical factors but specific genetic risk factors.

Cocaine-induced transient hallucinations (CIH) are a frequent complication following cocaine intake that is associated with addiction severity. METHODS: Two hundred and forty-two non-psychotic and Caucasian lifetime cocaine users were included in a French multicentric study. Clinical variables and dopamine pathway genotype data were extracted and tested with CIH scores using a zero-inflated binomial model, which allows for the exploration of factors associated with occurrence and severity separately. RESULTS: Cocaine dependence (poccurrence= 6.18 × 10-5, pseverity= 9.25 × 10-8), number of cocaine dependence DSM IV-Tr criteria (poccurrence= 1.22 × 10-7, pseverity= 5.09 × 10-6), and frequency of intake during the worst period of misuse (poccurrence= 8.51 × 10-04, pseverity= 0.04) were associated with greater occurrence and higher severity of CIH. The genetic associations did not yield significant results after correction for multiple tests. However, some nominal associations of SNPs mapped to the VMAT2, DBH, DRD1, and DRD2 genes were significant. In the multivariate model, the significant variables were the number of cocaine dependence criteria, lifetime alcohol dependence, and the nominally associated SNPs. CONCLUSION: Our study shows that CIH occurrence and severity are two distinct phenotypes, with shared clinical risk factors; however, they likely do not share the same genetic background.

Childhood trauma are not associated with the intensity of transient cocaine induced psychotic symptoms.

A personal history of childhood trauma has been associated with the severity of psychotic symptoms in several disorders. We evaluated retrospectively cocaine-induced psychotic symptoms with the SAPS-CIP and childhood trauma with the CTQ in a clinical sample of 144 cocaine users. The SAPS-CIP score was not statistically associated with the presence or number or intensity of trauma, but was associated with rapid routes of administration (intravenous and smoked) and with frequent cocaine use.

Chronic excessive alcohol consumption and male fertility: a case report on reversible azoospermia and a literature review.

AIMS: The aim of this work was to report on a heavy drinker whose azoospermia was reversed after alcohol withdrawal. We also review the literature on links between alcohol consumption and azoospermia. METHOD: This study is a clinical case report and a literature review. RESULTS: Two years after alcohol withdrawal, a child was born following assisted reproduction technique. Excessive alcohol consumption (i.e. more than 60 g a day) is strongly associated with azoospermia and this condition may be reversible after alcohol withdrawal. CONCLUSIONS: Testicular biopsies should be countra-indicated for heavy drinkers, and in order to increase the chances of obtaining a pregnancy, alcohol abstinence should be encouraged in male with low-to-moderate alcohol intakes.

[Consumption of alcohol and tobacco remain high in hospital population]. / Les consommations d'alcool et de tabac restent élevées en population hospitalière.

BACKGROUND: Consumption of alcohol and tobacco are influenced by many factors that require regular epidemiological assessments. As such, the study of a hospital population seems all the more relevant it can help to better identify patients at risk and tailor addiction interventions. OBJECTIVES: Determine the prevalence of risky alcohol use and tobacco use among hospitalized patients in order to propose to the scale of a General Hospital (CHG), algorithms of interventions with these patients. The secondary objective was the analysis socio-demographic determinants of these patients. METHODS: A descriptive study on any given day was done. Regarding tobacco use, patients were classified as "smoking", "no smoking" and "ex smoker". Regarding alcohol consumption, test DETA and AUDIT Court were able to classify patients into "consumer risk", "user without risk" and "non user". RESULTS: Hence, 20.5% of patients reported smoking and 23% of patients were classified as having a risky alcohol use. CONCLUSION: Given the importance of prevalence, it appears necessary to improve activity-tracking consumption of tobacco and alcohol at the hospital. To this end, we propose decision algorithms to better differentiate what is a matter of allowing the patient service (tracking and consultants), which may fall to a strategy of specialized care.

[New patterns of alcohol consumption: what management?]. / Nouveaux modes d'alcoolisation: quelle prise en charge?

Our discipline must include in its therapeutic models the multiple dimensions of the problem (the paradigm medico-psycho-social support for alcohol dependence), and an "update" software to respond better to new patterns of alcohol misuses. Our strategies inspired by philosophy of motivational interviewing and by harm reduction, can be tested on these specific populations of hazardous and harmful alcohol users.

Influence of liver biopsy on abstinence in alcohol-dependent patients.

BACKGROUND: Liver biopsy indication for the evaluation of alcoholic liver disease is controversial. Our aim was to investigate the influence of the biopsy on the patients' motivation for abstinence. METHODS: We retrospectively analysed, in a population of 324 patients hospitalized for alcohol withdrawal, the impact of liver biopsy on the following clinical outcomes: rapid loss to follow-up (immediately after hospital discharge), early relapse (< 3 months) and long-lasting abstinence (> 12 months). The biopsy was performed in 136 patients who had liver enzymes perturbations. Hepatic lesions were graded as mild (isolated steatosis and/or non-bridging fibrosis), moderate (bridging fibrosis and/or moderate alcoholic hepatitis) or severe (cirrhosis and/or marked alcoholic hepatitis) in 66 (48%), 41 (30%) and 29 (21%) cases, respectively. RESULTS: In univariate analysis, patients who had a liver biopsy were less likely to be rapidly lost to follow-up (12% versus 27%, P = 0.003) but had a lower rate of long-term abstinence (20% versus 34%, P = 0.025). In multivariate analysis, age was the only factor significantly associated with clinical outcome: older patients had higher rate of long-term abstinence (OR = 1.041; P = 0.010). Among patients who had a biopsy, those with severe hepatic lesions had a lower rate of rapid relapse than those with moderate or mild lesions (32% versus 68% and 56%, P = 0.018) but the rate of long-term abstinence was similar in the three groups. CONCLUSION: This observational study does not support the notion that liver biopsy has a significant influence on the maintenance of alcohol abstinence in patients with alcoholic liver disease.

Analytical evaluation of a new capillary electrophoresis method for carbohydrate-deficient transferrin measurement.

BACKGROUND: Carbohydrate-deficient transferrin (CDT), the sum of a- and disialotransferrin, is considered the most efficient routine biological marker of alcohol abuse. In recent years, methods based on capillary zone electrophoresis (CZE) have been developed using specialized monocapillary systems. These are characterized by a high analytical detection level, counterbalanced by a poor productivity. We evaluated a new CZE method for CDT measurement on the Sebia Capillarys, an eight-capillary system developed for routine serum capillary electrophoresis. METHODS: Precision and possible biases due to abnormal (low or high) transferrin levels or lipemic samples were assessed. Exactitude and precision were tested by comparison with a HPLC procedure acknowledged to be the most reliable to date. The validity of the manufacturer's cut-off was checked by measuring CDT in a population comprising abstaining patients, moderate alcohol consumers and alcohol abusers. Lastly, the method was compared to the routine %CDT TIA and N Latex CDT methods. RESULTS: The imprecision was 18.5% at the minimum detection level and decreased to 6.1% for high CDT values. No significant shift in the CDT results was observed in relation to abnormally low or high serum transferrin, or in lipemic samples. A high level of concordance was observed with the HPLC method used as reference. The results were strongly correlated with both other routine methods (r>0.90). The diagnostic values were comparable to the literature data, even if differences in the studied populations make difficult a direct comparison of the results. Our data suggested that the cut-off could be raised from 1.3% to 1.4% to reduce the number of false positive values without loss of diagnostic efficiency. CONCLUSIONS: This Capillarys method from Sebia showed good precision as compared to those published using other CZE methods. Capillarys method correlated well with HPLC and two routine methods. However, we noticed significant bias at low CDT concentrations. Therefore, with the advantage of high throughput and full automation, these results indicate that the new method is a consistent alternative to the other methods proposed for routine CDT measurement.