Bachaar Arnaout

Treatment With Acamprosate in Patients With Schizophrenia Spectrum Disorders and Comorbid Alcohol Dependence

Objective: Alcohol use disorders and schizophrenia frequently co-occur with rates higher than in the general population. There is no consensus on the best treatment for patients with these comorbid conditions. Several clinical trials have shown that acamprosate is superior to placebo in reducing drinking and is particularly effective in sustaining abstinence. No study to date has examined the efficacy of acamprosate in patients with alcohol dependence and comorbid schizophrenia. The aims of this study are to assess the efficacy of acamprosate when compared to placebo in reducing drinking and to examine its effects on schizophrenic symptoms. Methods: This was a double-blind, randomized, 12-week treatment trial of acamprosate versus placebo. Twenty-three recently abstinent patients with diagnosed alcohol dependence and comorbid schizophrenia, schizoaffective disorder, or psychosis not otherwise specified were included in this study. Results: All participants significantly decreased their drinking during medication treatment, although acamprosate was not superior to placebo in increasing consecutive days of abstinence. There was a significant difference favoring the acamprosate group on obsessive thoughts of drinking but no significant group X time interaction. Overall, medication treatment significantly reduced positive symptoms of schizophrenia, but there were no group differences. Conclusions: Acamprosate was not more effective than placebo in reducing drinking or symptoms of schizophrenia. It can be safely used in patients with alcohol dependence and comorbid schizophrenia spectrum disorders.

Alcohol withdrawal hallucinations in the general population, an epidemiological study

Hallucinations are sometimes encountered in the course of alcohol withdrawal; however, both the factors predisposing to alcohol withdrawal hallucinations (AWH) and the implications of AWH with respect to the mechanisms of hallucinations remain unclear. To clarify these issues, we used data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) to investigate the demographic correlates, alcohol-use clinical patterns, and psychiatric comorbidities in two groups: drinkers with and without a history of AWH. We estimated the odds ratios for studied factors and used logistic regression analyses to compare the two groups. We found that over 2% of drinkers reported AWH (758 of a sample of 34,533 subjects). Alcohol tolerance and withdrawal seizures were highly associated with AWH, and exposure to alcohol during brain development was associated with a 10-fold increase in AWH compared to exposure during adulthood. African Americans, Native Americans, and unmarried subjects, as well as subjects with lower levels of education and lower levels of income were more likely to experience AWH. Furthermore, those with a history of AWH had higher odds ratios for most psychiatric illnesses than those without such history-yet of anxiety disorders, only panic was associated with AWH. These associations suggest that higher levels of education and of standard of living could protect against AWH; while social isolation, hypervigilance, exposure to alcohol during brain development, and long and severe exposure to alcohol could predispose to AWH.

Description of a Comprehensive Addiction Rotation at a Psychiatry Residency Program

Despite the increased recognition of the need to provide quality education in addiction psychiatry, there continues to be a gap and little standardization in delivering relevant clinical education during residency training [1–3]. This has particular urgency, given the current opioid epidemic and generally acknowledged inadequate level of expertise among psychiatrists to treat addiction. The Accreditation Council for Graduate Medical Education (ACGME) requires one-month full-time equivalent experience in addiction psychiatry for general psychiatry residents, which is expected to encompass the evaluation and management of patients with substance use and co-occurring psychiatric disorders, including detoxification and overdose management and medication-assisted and psychosocial treatment and recovery strategies [4]. This presents a challenge for many programs due to limited availability of trained staff and adequate clinical settings, and lack of integration between addiction treatment and general psychiatric and medical care [5–7]. In addition, advances in the psychopharmacology and treatment interventions for addiction do not consistently make their way into mainstream general psychiatry, where antiquated perceptions of addiction treatment and recovery continue to linger [8]. We provide a description of the addiction psychiatry rotation at a psychiatry residency program, along with an elaboration of its objectives and challenges.We offer this as a model for other programs, as it affords a comprehensive experience across several domains, both fulfilling ACGME requirements and preparing residents for treating addiction regardless of the setting of their future practice.

Mecamylamine for Treatment of People With Dual Diagnoses of Depression and Alcohol Dependence

Objective: Currently there is no consensus on the best treatment for individuals with dual diagnoses of alcohol dependence and depression. The aim of this study was to assess the efficacy of mecamylamine augmentation of an antidepressant in reducing drinking, smoking, and depressive symptoms. Methods: This was a double-blind, randomized 12-week treatment trial comparing mecamylamine to placebo. Twenty-one participants with diagnosed alcohol dependence and comorbid depression were included in this study. Eleven participants were assigned to mecamylamine and ten were assigned to placebo. The main outcome variables included drinking measures and depressive symptoms. Analyses included all participants. Results: Mecamylamine augmentation was effective in reducing drinking outcomes particularly in nonsmokers. Symptoms of depression decreased for all participants and there was a trend indicating that this was more pronounced again for nonsmokers receiving mecamylamine. The rates of smoking decreased for all smokers. There were no significant differences in the rates of side effect reporting between those receiving mecamylamine and those receiving placebo or smokers versus nonsmokers. Conclusions: Mecamylamine was more effective than placebo in reducing drinking in nonsmokers. The data regarding depressive symptoms and smoking need further study. This study is registered on www.clinicaltrials.gov under number NCT00563797.

Sedative-Hypnotics and Anxiolytics

The sedative-hypnotics and anxiolytics are central nervous system depressants that have a wide array of uses in psychiatry, neurology, anesthesiology, and general medicine. These medications include the benzodiazepines, the new-generation non-benzodiazepine hypnotics, the barbiturates, and other agents. Despite their therapeutic value, they have been associated with misuse, abuse, and dependence, and may cause an array of medical and psychiatric adverse events. In this chapter, we introduce this group of medications and discuss the epidemiology of their non-medical use, as well as recommendations pertaining to the prevention and management of their deleterious effects, including: intoxication and overdose, tolerance and withdrawal, abuse and dependence, mood and anxiety disorders, cognitive disorders, psychotic manifestations, sleep disorders, and sexual dysfunction.

Does a History of Alcohol Use Disorder Affect Response to Antidepressant Medication in Patients With Dysthymic Disorder

ABSTRACT Background: Research on the relationship between depression and alcohol use disorder in remission has been scarce. The authors examined whether a lifetime history of alcohol use disorder affected response to antidepressant treatment of dysthymic disorder (DD) in adult outpatients. Methods: This is a secondary analysis of data from previous prospective medication trials. Data from 123 subjects with DD were included. Subjects were categorized into 2 groups: (1) no lifetime alcohol use disorder (NLAUD) (n = 99) and (2) lifetime alcohol use disorder (LAUD) (n = 24). None of the subjects met criteria for alcohol use disorder for 6 months prior to intake. Rating scales from baseline and after 8 weeks of pharmacotherapy were collected. Results: After 8 weeks of treatment, the NLAUD and LAUD groups did not differ in rates of response or remission, despite significantly higher baseline Hamilton Depression Rating Scale (HDRS)-24 scores in the LAUD group. We also found a greater decrease in symptoms in the LAUD group, as measured by the HDRS-24. Conclusions: Our preliminary findings suggest that DD in remitted alcoholics is at least as responsive to pharmacotherapy as DD in nonalcoholics and support adequate evaluation and treatment of DD in remitted alcoholic patients.