Andreas Heinz

Impairment of cognitive abilities and decision making after chronic use of alcohol: the impact of multiple detoxifications.

AIMS In the present study, the effect of previous detoxifications on prefrontal function and decision making was examined in alcohol-dependent patients. Further, we examined whether the length of abstinence affects cognitive function. METHODS Forty-eight alcohol-dependent patients were recruited from an inpatient detoxification treatment facility and cognitive function was compared to a control group of 36 healthy controls. The patient population was then divided into a group of patients with less than two previous detoxifications (LO-detox group, n = 27) and a group of patients with two or more previous detoxifications (HI-detox group, n = 21) and cognitive function was compared. In addition, cognitive function of recently (i.e. less than 16 days; median split) and longer abstinent patients was compared. We assessed prefrontal function, memory function and intelligence. RESULTS Alcoholics, when compared to healthy controls, performed worse with regard to the performance index Attention/Executive function. Cognitive impairment in these tasks was pronounced in recently abstinent patients. We found no significant differences between HI-detox and LO-detox patients with regard to the Attention/Executive function. However, in the IOWA gambling Task, the HI-detox group seemed to be less able to learn to choose cards from the more advantageous decks over time. CONCLUSIONS Our results provide additional evidence for cognitive impairment of alcohol-dependent patients with regard to tasks sensitive to frontal lobe function and underline the importance of abstinence for these impairments to recover. We found only little evidence for the impairing effects of repeated withdrawal on prefrontal function and we suggest that executive function is affected earlier in dependence.

Reduced availability of serotonin transporters in obsessive-compulsive disorder correlates with symptom severity – a [11C]DASB PET study

SummaryReduced availability of brainstem serotonin transporters (5-HTT) has been observed in vivo in obsessive-compulsive disorder (OCD). However, results vary and may be influenced by competition with endogenous serotonin. Using positron emission tomography (PET) and [11C]DASB, a specific 5-HTT ligand that showed no competition with serotonin for 5-HTT binding in vitro, we tested the hypothesis that 5-HTT availability is reduced in OCD patients and correlated with OCD severity. Methods. 5-HTT availability in the thalamus and the midbrain was measured in nine drug-free OCD patients and compared with 19 healthy controls, matched for the individual combination of 5-HTT genotype, gender and smoking status. OCD severity was assessed with the Yale-Brown obsessive compulsive scale (Y-BOCS). Results. 5-HTT availability was significantly reduced in the thalamus and midbrain of OCD patients. Age and 5-HTT in the thalamus explained 83% of OCD severity in patients that were drug-free for at least 1 year. Conclusion. This PET study confirms a central role of the serotonergic system, particularly the thalamus in the pathogenesis of obsessive compulsive disorder.

The startle reflex in alcohol-dependent patients: Changes after cognitive-behavioral therapy and predictive validity for drinking behavior : A pilot study

Background: Previous studies demonstrated an attenuation of the affect-modulated startle reflex when alcohol-dependent patients were viewing alcohol-associated pictures. This indicates an appetitive valence of these stimuli. We used the affect-modulated startle reflex to assess the effects of behavioral treatment on the emotional processing of alcohol-associated stimuli. Further, we examined whether the affect-modulated startle reflex is a predictor of treatment success. Methods: Forty-three alcohol-dependent patients (21 females, mean age 45.67 years, SD 9.45) were recruited consecutively from an inpatient alcohol detoxification facility where patients attended a 3-week detoxification program including cognitive-behavioral treatment to successfully handle high-risk situations. The eye blink component of the affect-modulated startle response, self-reported cue-induced craving and skin conductance responses to alcohol-associated and control slides were assessed before and after treatment. Changes were analyzed using repeated measures analysis of variance. Drinking behavior was assessed in the 6 months following treatment, and a regression analysis was performed to evaluate the predictive validity of the affect-modulated startle response for drinking behavior. Results: Drinking behavior as well as craving and skin conductance responses decreased significantly over time. The pattern of the affective modulation of the startle reflex was not altered over time. However, startle modulation and relapse were related, and within the group of relapsers, startle modulation was a significant predictor of drinking behavior. Conclusions: Our results suggest that the modulation of the startle reflex may reflect more enduring and permanent processes of emotional responding to alcohol-related cues than autonomic arousal and self-reported craving, and that startle modulation by alcohol-associated cues may be a better predictor of drinking behavior for relapsers than other measures. Further studies including a control condition are necessary to validate these findings.

Reduced serotonin transporter availability in patients with unipolar major depression reflect the level of anxiety

Reduced serotonin transporter availability in patients with unipolar major depression reflect the level of anxiety

Risiko für psychische Erkrankungen in Städten

Ergebnisse: Studien zeigen, dass das Risiko für bedeutsame psychiatrische Erkrankungen in Städten generell höher ist als in ländlichen Gebieten. Epidemiologische Studien bestätigen, dass Menschen, die in Städten aufwuchsen, ein höheres Schizophrenierisiko haben. Allerdings sind Korrelationen keine Kausalerklärungen, denn das Leben in Armut kann zu einer geringeren psychischen Gesundheit führen, wie auch umgekehrt Beeinträchtigungen der psychischen Gesundheit zur Verarmung beitragen können. Soziale Isolation und Diskriminierung sowie Armut in der Nachbarschaft tragen zu psychischen Belastungen bei, allerdings ist bisher wenig über die spezifischen Wechselwirkungen zwischen diesen Faktoren und der baulichen Struktur der Städte bekannt.

Akuttherapie der Alkoholabhängigkeit

Ziel einer Akutbehandlung bei Alkoholabhängigkeit ist die „unmittelbare Remission“, das heißt Nachlassen körperlicher und psychischer Krankheitssymptome, ohne dass jedoch zwingend eine Genesung erreicht wird. Neben der Beendigung oder Verminderung des exzessiven Alkoholkonsums wird eine weitgehende Beseitigung der damit verbundenen Entzugserscheinungen angestrebt. Spezielle Screeningverfahren können erste Hinweise liefern, ob eine Alkoholerkrankung vorliegt. Die Therapie der Alkoholabhängigkeit umfasst neben dem Entzug ein komplexes Therapiekonzept, das medikamentöse wie psychotherapeutische Elemente integriert und stationär oder ambulant erfolgen kann.