Trastornos psiquiátricos asociados a alcoholismo: seguimiento a 2 años de tratamiento / Psychiatric disorders associated with alcoholism: 2 year follow-up of treatment

Introducción. Los alcohólicos registran altas tasas de comorbilidad con otros trastornos psiquiátricos. Se ha constatado que el sexo femenino tiene más posibilidades de presentar una comorbilidad psiquiátrica que el masculino. La existencia de comorbilidad en el alcoholismo implica un peor pronóstico en la evolución de la enfermedad. La terapia se hace más compleja debido a que estos pacientes padecen más problemas físicos, psíquicos, familiares y sociales que los alcohólicos sin comorbilidad. Con este trabajo se pretende estudiar la evolución a dos años de tratamiento de una población de pacientes afectados de patología psiquiátrica asociada a alcoholismo. Metodología. Se seleccionaron 100 pacientes, incluidos en el Programa de Alcoholismo, con trastorno psiquiátrico asociado a "Consumo Perjudicial" o "Síndrome de Dependencia" de Alcohol (CIE-10). Esta población se comparó con una muestra control constituida por 284 pacientes alcohólicos sin patología psiquiátrica asociada. Resultados y conclusiones. El porcentaje de mujeres afectadas de trastorno psiquiátrico asociado a alcoholismo es del 47% (casi un 1/1 en relación al varón), mucho mayor que el 10,56% de la muestra control. Los trastornos psiquiátricos más frecuentes asociados al alcoholismo son los trastornos de personalidad (30%), trastornos adaptativos (24%), trastornos depresivos (22%) y de ansiedad (18%). En la esquizofrenia la tasa de alcoholismo asociado es de un 11% y en los trastornos bipolares de un 9%. Después de dos años de seguimiento se obtiene que el 28% de los pacientes con patología psiquiátrica asociada a alcoholismo se encuentra en abstinencia frente al 41,90% de la muestra control. Por tanto, se evidencia una peor evolución de los enfermos afectados de patología dual (AU)

Introduction. Alcoholics show high rates of comorbidity with other psychiatric disorders. It is known that women are more likely to have psychiatric comorbidity than men. Existence of comorbidity in alcoholism implies a worse prognosis in the disease evolution. Treatment becomes more complex because these patients have more physical, psychological, familial and social problems than alcoholics without comorbidity. This two-year treatment follow-up study has aimed to assess the evolution of a group of patients who have a psychiatric disorder associated with alcoholism. Methods. We selected 100 patients enrolled in the alcohol program, with psychiatric disorder associated with "Harmful Use of Alcohol" or "Alcohol Dependence Syndrome" (ICD-10). This population was compared with a control sample consisting of 284 alcoholic patients without associated psychiatric disorders. Results and conclusions. The percentage of women with psychiatric disorder associated with alcoholism is 47% (almost 1/1 in relation to men), significantly higher than the10.56% of the control sample. Psychiatric disorders most frequently associated with alcoholism are personality disorders (30%), adjustment disorders (24%), depressive disorders (22%), and anxiety disorders (18%). In schizophrenic patients, the rate of alcoholism is 11% and in bipolar disorders 9%. After two years of follow up, it was found that 28% of the patients with psychiatric disorders associated with alcoholism were in abstinence compared to 41.90% of the control sample. Therefore, there is evidence of a worse outcome of patients suffering from a dual diagnosis (AU)

Factors associated with risky consumption and heavy episodic drinking among Spanish university students.

OBJECTIVE: The purpose of this study was to determine the prevalence of risky consumption (RC) and heavy episodic drinking (HED) in Spanish university students and their associated factors. METHOD: We conducted a cross-sectional analysis (target N = 2,700) within the framework of a cohort study designed to evaluate the neuropsychological and psychophysiological consequences of alcohol consumption. Alcohol consumption was measured with the Alcohol Use Disorders Identification Test (AUDIT). The following independent variables were also collected by questionnaire: gender, place of residence, parents' education, alcohol consumption in the family, age at onset of use, and alcohol expectancies. We constructed logistic regression models using two dichotomous variables: (1) RC, dichotomizing the AUDIT score and (2) HED, dichotomizing the AUDIT question about consumption of six or more drinks on a single occasion. RESULTS: The response rate on enrolled students was 50.7% (99% on students present in class the day of the survey). The prevalence of RC was 37.1%, the prevalence of HED was 12.2%, and the prevalence of abstainers was 12.6%. In relation to RC, the multivariate model showed that high expectancies (odds ratio [OR] = 4.77), early age at onset of use (OR = 4.75), and high maternal educational level (OR = 1.56) constituted risk factors. In contrast, living with parents constituted a protective factor (OR = 0.39). For HED, early age at onset of use (OR = 7.16), high expectancies (OR = 2.89), and being male (OR = 3.41) were risk factors. CONCLUSIONS: Results suggest that, to decrease consumption among adolescents in Spain, strategies should focus on modifying expectancies, limiting access to alcohol at young ages, and targeting students of higher socioeconomic status and those living away from home.

Increased anxiety and other similarities in temperament of alcoholics with and without antisocial personality disorder across three diverse populations.

According to Cloninger's model, type I alcoholics are thought to be innately vulnerable to anxiety and depression. In contrast, type II alcoholics are thought to have increased likelihood of antisocial personality disorder (ASPD) and reduced anxiety. However, allostatic activations of stress, anxiety, and dysphoria may be a common thread in alcohol use disorders (AUDs). Our aim was to find commonalities and differences in temperament of alcoholics with and without ASPD in three diverse populations. By sib-sib comparisons, we also evaluated the extent to which the temperament traits were moderated by familial factors including inheritance. We compared harm avoidance (HA), novelty seeking (NS), and reward dependence (RD) in alcoholics with ASPD, alcoholics without ASPD, and controls. Correlations for each temperament dimension were evaluated in pairs of siblings concordant and discordant for AUD. Participants were derived from three independent populations: Finnish Caucasians (N=453, men=100%, including a sample of alcoholic criminals), a Plains American Indian community sample (N=378; men=42%), and a subset of the familial and predominantly Caucasian Collaborative Study on the Genetics of Alcoholism (COGA) sample (N=967, men=47%). In all the three populations, both alcoholics with and without ASPD were higher in HA than controls. The increase of HA among alcoholics as compared to controls ranged from 54% to 12%. In two populations (COGA and Finns), NS was highest in alcoholics with ASPD, intermediate in alcoholics without ASPD, and lowest in controls. HA levels were correlated in sib-pairs concordant (either affected or unaffected) for AUD but not in discordant pairs. In conclusions, despite cultural diversity and different modes of ascertainment we found a consistent pattern of elevated HA in all groups of alcoholics, including alcoholics with ASPD. Even in alcoholics with long-term exposure to the anxiogenic effects of repeated cycles of alcohol withdrawal, genetic and other familial influences seem to play a role in moderating anxiety.