Life Goals Increase Self-regulation among Male Patients with Alcohol Use Disorder.

BACKGROUND: Alcohol use disorder (AUD) has been conceptualized as a chronic self-regulation failure. OBJECTIVES: The aim of this study was to examine the most probable pathways related to self-regulation among patients with AUD. In this study, a hypothetical model was proposed that focused on the relationship between risk factors (extrinsic life goals, emotion dysregulation) and protective factors (intrinsic life goals, self-control, and abstinence self-efficacy). METHODS: Male patients with AUD (N = 188) were recruited from alcohol centers of four psychiatric hospitals between March 2015 and September 2015. All participants completed psychological assessments, including the Future Oriented Goals Scale (FOGS), the Alcohol Abstinence Self-Efficacy Scale (AASE), the Brief Self-Control Scale (BSCS), and the Difficulties in Emotion Regulation Scale (DERS) as well as sociodemographic characteristics. RESULTS: The final model was found to be a good fit to data. In testing indirect effects, it was shown that intrinsic life goals via emotion dysregulation, self-control, and alcohol abstinence self-efficacy decreased alcohol self-regulation failure. On the other hand, extrinsic life goals via these factors increased alcohol self-regulation failure. Conclusions/Importance: These results suggest that intrinsic goals might indirectly be the important and protective factors for AUD. Moreover, the findings implicate that self-regulation through goal setting may be necessary to alleviate symptoms and improve function among patients with AUD.

The relationship between brain-derived neurotrophic factor and cognitive functions in alcohol-dependent patients: a preliminary study.

BACKGROUND: As a neurotoxic substance, alcohol can induce neurodegenesis in the brain. Alcohol-dependent patients' cognitive functioning can be affected by chronic alcohol use. In addition, brain-derived neurotrophic factor (BDNF) is known to reflect the status of neuroadaptive changes. The purpose of this study was to investigate the relationship between cognitive functions and BDNF in alcohol-dependent patients. METHODS: The subjects were 39 alcohol-dependent patients. BDNF was measured using an enzyme-linked immunosorbent assay kit. We examined clinical features and administered the Korean version of Alcohol Dependence Scale. We also used the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) to measure cognitive functioning. Then, we determined the relationships between BDNF and various parts of the CERAD. RESULTS: The performance of alcohol-dependent patients proved stable in most parts of the CERAD. Within the different parts of the CERAD, only Trail Making Test B correlated with BDNF. Trail Making Test specifically assesses executive functions. CONCLUSIONS: BDNF might play an important role in the detection of neurocognitive function among individuals with alcohol dependence.

The Ratio of Second and Fourth Digit Length: A Biomarker for Methamphetamine Dependence?

Objective: The ratio of 2nd and 4th digit length (2D:4D) is considered to be a sexually dimorphic trait. Low 2D:4D is implicated in alcohol dependence and heroin dependence and correlated with psychological traits such as aggression, physical aggression, and sensation. The purpose of this study is to compare the 2D:4D between methamphetamine (METH) dependence and controls and the 2D:4D ratio that is a potential biomarker for METH dependence. Methods: In this study, 40 patients diagnosed with METH dependence in Eulji University Gangnam Eulji Hospital and 50 healthy volunteers were all employees in the same hospital. Images of participants' hands were created using a scanning device. The images contained both the right and left hands; computer software was used to measure the 2D:4D ratio for both hands. We compared the ratios, analyzed by t test, between the METH dependence group and the control group. Results: The mean 2D:4D values were 0.941 (right hand) and 0.943 (left hand) for the patients with METH dependence; in contrast, they were 0.961 (right hand) and 0.961 (left hand) for the control group. These values were significantly smaller than the control in patients' right hands (p = 0.003) and left hands (p = 0.012). Conclusion: Patients with METH dependence had smaller 2D:4D ratios than those in the control group, which is similar to the results from the previous substance use disorder studies. Thus, elevated prenatal testosterone levels during the gonadal period could be related to future METH problems. Furthermore, the 2D:4D ratio is a potential marker for the prediction of METH dependence.

Post-Traumatic Stress, Quality of Life and Alcohol Use Problems among Out-of-School Youth.

OBJECTIVE: Post-traumatic stress symptoms (PTSS) in out-of-school youths (OSYs) may be influenced by alcohol use, but there is a lack of evidence explaining how PTSS affect alcohol use problems in OSYs. The present study aimed to investigate the relationships among PTSS, quality of life, and alcohol use in OSYs. METHODS: In total, 125 OSYs (46.4% male) in South Korea completed the Korean Version of the Child Report of Post-Traumatic Symptoms (CROPS), the KIDSCREEN-27 Quality of Life Measure for Children and Adolescents, and the Alcohol Use Disorders Identification Test-Consumption. RESULTS: Mean CROPS score was 18.7 (SD=11.6); 37.6% were problem drinkers. Quality of life in the domain of parent relations and autonomy significantly mediated the relationship between PTSS and alcohol use problems. OSYs with high parental satisfaction and autonomy were less likely to have alcohol use problems even with PTSS. CONCLUSION: Family assessments and therapeutic approaches are needed for OSYs with both PTSS and alcohol use problems.

Clinical utility of heart rate variability during Head-up tilt test in subjects with chronic posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is characterized by psychophysiological abnormalities, such as an altered baseline heart rate and hyperarousal, implying dysfunctional arousal regulation. Heart rate variabilities (HRVs) is known to reflect autonomic nervous system activity. We examined the changes of HRVs in PTSD patients with head-up tilt position to closely investigate disease-specific changes in autonomic function in PTSD patients. Sixty-seven patients with PTSD and 72 patients without PTSD were assessed using the PTSD Checklist for DSM-5 (PCL-5) and psychiatric interview. Heart rate data including standard deviation of the NN intervals, the square root of the mean squared differences of successive NN intervals, log low-frequency and log high-frequency were collected for 10 min before and after tilting. Considering interactions between groups and head-up tilting, the head-up tilting induced reduction of the high-frequency component of HRVs was significantly greater in the PTSD group [F (1, 272) = 4.718, p = 0.031]. The change of HRVs in PTSD patients suggested the presence of autonomic dysfunction in despite of the posture.

Depression as a Mediator of Chronic Fatigue and Post-Traumatic Stress Symptoms in Middle East Respiratory Syndrome Survivors.

OBJECTIVE: The relationship among chronic fatigue, depressive symptoms, and post-traumatic stress symptoms (PTSSs) among Middle East respiratory syndrome (MERS) survivors is poorly understood. METHODS: Of 148 survivors who consented to be registered and underwent assessments at 12 months (T1) and 18 months (T2) after the MERS outbreak, 72 (48.65%) were evaluated for chronic fatigue, depressive symptoms, and PTSSs based on the Impact of Event ScaleRevised (IES-R), the Patient Health Questionnaire-9 (PHQ-9), and the Fatigue Severity Scale (FSS). Data from 52 subjects, who completed both assessments, were analyzed using a regression-based serial multiple mediation model (PROCESS Model 6). RESULTS: Bootstrap analyses indicated no direct effects of T1 FSS on T2 IES-R but significant positive indirect effects of T1 FSS on T2 IESR through T1 PHQ-9 and T2 PHQ-9 (B=2.1601, SE=1.3268, 95% confidence interval=0.4250-6.1307). In other words, both T1 PHQ-9 and T2 PHQ-9 fully mediated the relationship between T1 FSS and T2 IES. CONCLUSION: Chronic fatigue 12 months after MERS had indirect effects on prolonged PTSSs 18 months after MERS via persisting depression in MERS survivors. This finding supports the need to promote interventional programs for emerging infectious disease survivors with chronic fatigue to reduce depression and prevent prolonged PTSSs.

Efficacy of the Life Goal-Focused Brief Intervention among Patients with Alcohol Use Disorder: A Preliminary Study.

OBJECTIVE: The aim of this study was to examine the efficacy of the life goal-focused brief intervention, or the so-called the goal-focused self-regulation program (GFSRP), for patients with alcohol use disorder (AUD). METHODS: The GFSRP was developed as an 8-week group-program, which is based on a wide range of self-regulation theories, such as goal setting and implementation intentions. Patients with AUD (n=50) took part in the GFSRP and were compared to the control group (n=48). This study examined the changes in outcome measures from baseline to follow-up (12-week) in a mixed design. RESULTS: The GFSRP group had higher scores for the abstinence self-efficacy in negative affect situations than the control group at the post-test. In addition, it showed greater scores of optimisms compared to the control group. Furthermore, in the GFSRP group, there was no difference in intrinsic life goals from baseline to the 12-week follow-up, whereas the control group showed a significant decrease. CONCLUSION: The GFSRP could increase the abstinence self-efficacy and optimism among patients with AUD. Moreover, it might prevent loss of life-goals as core factors in self-regulation among patients with AUD.

Serial Progression from Attention-Deficit/Hyperactivity Disorder to Alcohol Use Disorder: Serial Multiple Mediated Effects of Externalizing Disorders and Depression.

OBJECTIVE: Externalizing disorders such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder and antisocial personality disorder, as well as depression are common comorbidities in alcohol use disorder (AUD). The current study focused on the temporal relationship between the onsets of these disorders and AUD, and investigated the serial multiple mediator model of externalizing disorders (e.g., ADHD) and depression on AUD. METHODS: We analyzed the mediated effects of the Adult ADHD Self-Report Scale (ASRS), the Barratt Impulsiveness Scale motor (BIS_M) and the Beck Depression Inventory (BDI) on Korean version of the Alcohol Dependence Scale (ADS_K) using the multiple-step multiple mediation procedure regression analysis. In addition, we comparatively analyzed different clinical characteristics in relation to conduct problems. RESULTS: The multiple-step multiple mediation procedure found the serial multiple mediated effects of the BIS_M and the BDI on the relationship between the ASRS and the ADS_K. Also, the group with conduct problem was significantly high in ADHD symptoms, depression, anxiety, impulsivity, legal problems and alcohol-related problems, compared to the group without conduct problems. CONCLUSION: To sum up, the results of this study show that ADHD symptoms in childhood could exert significant effects on the severity of AUD in adulthood, and both disorders might be mediated by the externalizing disorders characterized by the core feature of motor impulsivity, and depression serially. Thus, the treatment of preceding disorders in accordance with developmental stages is an overarching clinical component for preventing the subsequent development of AUD and for its treatment.

Reliability and Validity of the Korean Version of the Impaired Control Scale.

OBJECTIVE: The aim of this study was to examine the reliability and validity of the Korean version of the Impaired Control Scale (K-ICS), a scale to screen patients with alcohol use disorder. METHODS: Participants were 173 inpatients with alcohol use disorder (AUD), and 174 normal controls (NC). Both AUD and NC groups completed the K-ICS as well as the Alcohol Dependence Scale (ADS), the Alcohol Abstinence Self-Efficacy Scale (AASES), the Brief Self-Control Scale (BSCS), and the Hospital Anxiety and Depression Scale (HAD). RESULTS: The internal consistencies of K-ICS were good in both AUD and NC. A good convergent validity was clearly shown by significant correlations with the ADS and the AASES, respectively. But the K-ICS had no or weak correlations with the BSCS and the HAD. The ROC curve analyses indicated that the optimal cut-off points of failed control (FC) and predicted control (PC) were estimated as >15 and >13, respectively. Hierarchical multiple regression analysis suggested that FC is a robust predictor of the severity of AUD. CONCLUSION: The K-ICS, especially FC subscale of it appears to be a valid and reliable measure of impaired control among both clinical and non-clinical sample.

Low plasma BDNF is associated with suicidal behavior in major depression.

Brain-derived neurotrophic factor (BDNF), the most abundant neurotrophin in the brain, has a known association with the pathophysiology of anxiety and depression. However, the role of BDNF in suicide has not been well investigated to date. This study examined plasma BDNF levels in 32 major depressive disorder (MDD) patients who had recently attempted suicide, 32 non-suicidal MDD patients, and 30 normal controls. The lethality of the suicide attempt was measured using the Risk-Rescue Rating (RRR) and Lethality Suicide Attempt Rating Scale (LSARS). The severity of depression was measured with the Hamilton Depression Rating Scale (HDRS). Plasma BDNF levels were measured by enzyme linked immunosorbent assay. BDNF levels were significantly lower in suicidal MDD patients (430.5+/-397.0 pg/ml) than non-suicidal MDD patients (875.80+/-663.02 pg/ml) or normal controls (889.4+/-611.3 pg/ml) (F=6.682, p=0.002). The most suitable cut-off point of BDNF level between suicidal depression and non-suicidal depression groups was 444.58 pg/ml. At this cut-off point, the sensitivity=68.7%, specificity=78.1%, positive predictive value=75.9%, and negative predictive value=71.4%. However, there was no significant difference in BDNF levels between the depressive control and normal control groups (p=0.996). LSARS and RRR did not reveal any significant correlations with BDNF levels in suicidal patients. In addition, BDNF levels were not different between fatal and non-fatal suicide attempts. These results suggest that reduction of plasma BDNF level is related to suicidal behavior in major depression and that BDNF level may be a biological marker of suicidal depression.

Somatic Symptoms as Mediating Factors between the Perceived Social Support and the Health-Related Quality of Life in North Korean Defectors.

OBJECTIVE: This study was conducted to examine the mediating effect of somatic symptoms between perceived social support and health-related quality of life among North Korean defectors living in South Korea. METHODS: A total of 200 North Korean defectors were assessed using the Multidimensional Scale of Perceived Social Support, the Short-Form 8-Item Health Survey, the Patient Health Questionnaire 15, the PTSD Checklist Civilian Version and the Patient Health Questionnaire 9. RESULTS: Somatic symptoms accounted for physical health-related quality of life after controlling for PTSD and depressive symptoms, but did not for mental health-related quality of life. Moreover, somatic symptoms mediated the relationship between perceived social support and physical and mental health-related quality of life, indicating that perceived social support indirectly affects physical and mental health-related quality of life through somatic symptoms in North Korean defectors. CONCLUSION: The results of this study suggest that not only intervention for PTSD or depressive symptoms but also for somatic symptoms might be effective to improve physical and mental health-related quality of life for North Korean defectors, especially those who have a lack of perceived social support.

Social Support as a Mediator of Posttraumatic Embitterment and Perceptions of Meaning in Life among Danwon Survivors of the Sewol Ferry Disaster.

PURPOSE: Our research was designed to test and explore the relationships among embitterment, social support, and perceptions of meaning in life in the Danwon High School survivors of the Sewol ferry disaster. MATERIALS AND METHODS: Seventy-five Sewol ferry disaster survivors were eligible for participation, and were invited to participate in the study 28 months after the disaster. Forty-eight (64%) survivors (24 males, 24 females) completed questionnaires; the Posttraumatic Embitterment Disorder (PTED) scale, the Functional Social Support Questionnaire (FSSQ), and the Meaning in Life Questionnaire (MLQ). RESULTS: PTED scores were negatively correlated with scores on the FSSQ and the Presence of Meaning (MLQ-P) (r=-0.43 and -0.40, respectively). The hierarchical regression analysis showed that FSSQ scores may fully mediate the effects of PTED scores on MLQ-P scores, given that the indirect effect was significant whereas the direct effect was not (95% confidence interval=-0.5912 to -0.0365). CONCLUSION: These findings imply that therapies targeting embitterment may play a vital role in increasing positive cognitions, such as those related to perceived social support and the meaningfulness of life.

The Ratio of 2nd to 4th Digit Length in Korean Alcohol-dependent Patients.

OBJECTIVE: The ratio of 2nd to 4th digit length (2D:4D) is a sexually dimorphic trait. Men have a relatively shorter second digit than fourth digit. This ratio is thought to be influenced by higher prenatal testosterone level or greater sensitivity to androgen. The purpose of this study is to investigate the relationship between alcohol dependence and 2D:4D in a Korean sample and whether 2D:4D can be a biologic marker in alcohol dependence. METHODS: In this study, we recruited 87 male patients with alcohol dependence from the alcohol center of one psychiatric hospital and 52 healthy male volunteers who were all employees in the same hospital as controls. We captured images of the right and left hands of patients and controls using a scanner and extracted data with a graphics program. We measured the 2D:4D of each hand and compared the alcohol dependence group with the control group. We analyzed these ratios using an independent-samples t-test. RESULTS: The mean 2D:4D of patients was 0.934 (right hand) and 0.942 (left hand), while the mean 2D:4D of controls was 0.956 (right hand) and 0.958 (left hand). Values for both hands were significantly lower for patients than controls (p<0.001, right hand; p=0.004, left hand). CONCLUSION: Patients who are alcohol dependent have a significantly lower 2D:4D than controls, similar to the results of previous studies, which suggest that a higher prenatal testosterone level in the gonadal period is related to alcoholism. Furthermore, 2D:4D is a possible predictive marker of alcohol dependence.

Association between insulin and executive functioning in alcohol dependence: a pilot study.

Alcohol dependence is a disorder ascribable to multiple factors and leads to cognitive impairment. Given that insulin dysregulation can cause cognitive impairment, patients with alcohol dependence are likely to develop insulin dysregulation such as that in diabetes. The purposes of this study are to identify an association between cognitive functioning and insulin and to investigate insulin as the biomarker of cognitive functioning in alcohol-dependent patients. Serum insulin levels were measured and cognitive functions were assessed in 45 patients with chronic alcoholism. The Korean version of the Consortium to Establish a Registry for Alzheimer's Disease (CERAD-K), a battery of cognitive function tests, was used to assess cognitive functioning. Serum insulin levels were not significantly correlated with most CERAD-K scores, but there was a significant negative correlation with scores on the Trail Making Test B, which is designed to measure executive functioning. Lower serum insulin levels were associated with slower executive functioning responses on the Trail Making Test B, suggesting that executive functioning may be in proportion to serum insulin levels. Thus, in patients with alcohol dependence, insulin level is associated with cognitive functioning. In addition, the present findings suggest that insulin level is a potential biomarker for determining cognitive functioning.

Association between insulin-like growth factor-1 and cognitive functions in alcohol-dependent patients.

Studies in alcohol-dependent patients show that cognitive function can be influenced by chronic use of alcohol. Alcohol is a known neurotoxin that induces neurodegeneration in the brain. Although there are various causes of cognitive deficiency in alcohol-dependent patients, in this study we focus on the role of corticosteroids. The hypothalamus-pituitary-adrenal system (i.e., the HPA axis) plays a part in the control of corticosteroids. Recent studies show that insulin-like growth factor-1 (IGF-1) reflects the status of growth hormones under the action of the HPA axis. Therefore, IGF-1 is a potential indicator that reflects activity of the HPA axis, and a biomarker that may reflect the decline of cognitive function associated with alcohol-induced hypercortisolism. The purposes of this study are to identify an association between cognitive function and IGF-1, and to investigate IGF as the biological marker of cognitive decline in alcohol-dependent patients. Forty alcohol-dependent patients were selected as the subjects of this study. IGF-1 was measured through an enzyme-linked immunosorbent assay (ELISA). Clinical features were examined using the Korean version of the alcohol dependence scale (ADS-K). Cognitive functions were measured using the Consortium to Establish a Registry for Alzheimer's Disease (CERAD). Comparative analysis was utilized to identify an association between CERAD measurement items and IGF-1. Alcohol-dependent patients demonstrated stable performance of most of the CERAD measures. Among the measures of the CERAD, only trail making test A showed a correlation to IGF-1. Compared to trail making test B, trail making test A is assumed to reflect basic cognitive functions including psychomotor speed, visual search and sequencing in alcohol-dependent patients, regardless of demographic characteristics such as the level of education of patients. Therefore, IGF-1 seems to play an important role in detecting the decline of basic cognitive functions in alcohol-dependent patients.