Bert Theodor te Wildt

Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD).

AIMS Attention-deficit/hyperactivity disorder (ADHD) is of great clinical importance not only because of its high prevalence but also due to the frequent comorbid illnesses that are connected with this disorder. Several studies were able to demonstrate that ADHD constitutes a significant risk factor for the exacerbation of habit-forming illnesses, i.e. addictions. METHODS We conducted a study on 152 adult patients with alcohol dependence (n = 91) or multiple substance addiction (n = 61) to determine whether or not these patients were affected by ADHD. For retrospective assessment of childhood ADHD, the WURS-k was used as well as the DSM-IV symptom checklist for ADHD. The CAARS was used to assess the persisting symptoms of ADHD in adults. RESULTS 20.9% (WURS-k) or 23.1% (DSM-IV diagnostic criteria) of the alcohol-dependent patients showed evidence of retrospective ADHD affliction in childhood. With the help of CAARS, ADHD was proved to be persistent in 33.3% of the adult patients. In the group of substance-addicted patients 50.8% (WURS-k) and 54.1% (DSM-IV) presented with diagnostic criteria for ADHD in childhood and 65.5% (CAARS) showed evidence of ADHD persisting in adulthood. CONCLUSIONS These results reveal that habit-forming illnesses can be associated with a high comorbidity with ADHD, expressed in the form of alcohol abuse and also in consumption of illegal drugs. The results underline the great importance of early and adequate diagnostics and therapy of ADHD for the prevention of habit-forming illnesses.

Pathological Internet use and psychiatric disorders: A cross-sectional study on psychiatric phenomenology and clinical relevance of Internet dependency

Background and Objectives: With the Cyberspaces exponential growth of influence questions arise about its mental impacts. The presented study examines the question whether the dependent use of the Internet can be understood as an impulse con- trol disorder, an addiction or as a symptom of other psychiatric conditions. Methods: Internet dependent patients seeking for psychiatric assistance and fulfilling the criteria for pathological Internet use (PIU) were examined with the Structured Clinical Inter- view according to DSM-IV (SCID), and a variety of questionnaires including the Barratt Im- pulsiveness Scale (BIS), the Beck Depression Inventory (BDI) and the Dissociative Experi- ence Scale (DES). The patient group was compared to a matched group of healthy controls. Results: The adult patient-group consisted of 25 subjects, 76% male, with a mean age of 29.36 years. Average time spent in Cyberspace was 6.47 h/d, mostly in online-role- playing games. According to SCID I and BDI, 19 patients (76%) suffered from a depres- sive syndrome, with 10 cases of major depressive disorder (40%) and 8 cases of adjust- ment disorder with depression (32%). Six patients (24%) suffered from a comorbid anxiety disorder. Compared to controls, the patient group presented significantly higher levels of depression (BDI), impulsivity (BIS) and dissociation (DES). Conclusions: PIU shares common psychopathological features and comorbidities with substance related disorders. Therefore, it might be seen as a diagnostic entity in itself in a spectrum of behavioural and substance dependencies. Especially Internet role play may contain an addictive potential for adolescents and adults with subclinical psychopathology.

Motives for khat use and abstinence in Yemen - a gender perspective

BackgroundKhat consumption is widespread in Yemeni society and causes problems both in economic development and public health. Preventive measures have been largely unsuccessful and the cultivation continues to proliferate. The gender-specific motives for khat use and abstinence were studied to create a toe-hold for more specific interventions.MethodsIn a quota sample with equal numbers of males, females, abstainers and consumers, 320 subjects were interviewed on their specific opinions about khat and its impact on subjective and public health, and on social and community functioning. Strata were compared in their acceptance and denial of opinions. Notions that could predict abstinence status or gender were identified with multivariate logistic regression analysis.ResultsMale khat users had a strong identification with khat use, while females were more ambivalent. The notion that khat consumption is a bad habit (odds ratio (OR) 3.4; p < 0.001) and consumers are malnuorished (OR 2.2; p = 0.046) were associated with female gender among khat users. Among the females worries about health impact (OR 3.2; p = 0.040) and loss of esteem in the family (OR 3.1; p = 0.048) when using khat predicted abstinence. Male abstainers opposed khat users in the belief that khat is the cause of social problems (OR 5.1, p < 0.001). Logistic regression reached an accuracy of 75 and 73% for the prediction of abstinence and 71% for gender among consumers. (All models p < 0.001.)ConclusionsDistinct beliefs allow a differentiation between males, females, khat users and abstainers when targeting preventive measures. In accordance to their specific values female khat users are most ambivalent towards their habit. Positive opinions scored lower than expected in the consumers. This finding creates a strong toe-hold for gender-specific public health interventions.

Psychotherapeutic Approaches to the Treatment of Internet Addicts: Scientific Evidence and Clinical Experience in Germany

Treatment of Internet addiction within the German healthcare system is performed by two main clinical disciplines, “Psychiatry and Psychotherapy” on the one hand and “Psychosomatic medicine and Psychotherapy” on the other. Acute states of addiction and withdrawal are usually treated in psychiatric hospitals, which can deal with any medical implications that arise and which offer expertise in psychopharmacology. Long-term rehabilitation treatment is traditionally offered by psychosomatic hospitals, which boast expertise in inpatient psychotherapy. However, the majority of Internet addicted patients are treated as outpatients. The chapter presents an overview of the two different psychotherapeutic approaches to the treatment of Internet addiction from a scientific and a clinical angle. As in the case of addiction medicine more generally, cognitive behavioural approaches have shown the greatest efficacy in the initial treatment of Internet addiction. A growing body of evidence supports this approach. However, far less is known about the effectiveness of psychodynamic psychotherapy. It most likely has a place in the long-term treatment and management of Internet Addiction and in the treatment of underlying co-morbid disorders, such as depression or anxiety. We will outline the current state of play in both psychotherapeutic schools, before concluding with a more holistic, integrative view of how an ideal integrated treatment scenario could work.

Skorbut — eine zu Unrecht vergessene Hypovitaminose

We treated a chronic alcoholic patient who showed all the symptoms of scurvy (petechiae, greyish skin colour, areas of thinning hair on the head, gingivitis, elevated liver enzyme levels, hyponatraemia, hypalbuminaemia and hypothyroidism) at admission. Even today, alcoholics and chronically ill people in particular can develop symptoms of diet-related vitamin C deficiency.ZusammenfassungDen alkoholabhängigen Patienten führte ein dringender Entzugswunsch in die Notaufnahme. Sein körperlicher Zustand war deutlich reduziert. Die Symptomkonstellation Petechien, Gingivitis und gelichtete Haarareale ließ jedoch noch ein anderes Problem vermuten: Skorbut. Nach erfolgreicher Primärtherapie stellten die rasch progredienten Unterschenkelödeme die Behandler erneut vor ein Rätsel …