Bodo Lieb

The impact of alcohol dependence on social brain function.

The impact of alcoholism (ALC) or alcohol dependence on the neural mechanisms underlying cognitive and affective empathy (i.e. the different routes to understanding other peoples minds) in schizophrenic patients and non‐schizophrenic subjects is still poorly understood. We therefore aimed at determining the extent to which the ability to infer other peoples mental states and underlying neural mechanisms were affected by ALC. We examined 48 men, who suffered either from ALC, schizophrenia, both disorders or none of these disorders, using functional magnetic resonance imaging while performing on a mind reading task that involves both cognitive and affective aspects of empathy. Using voxel‐based morphometry, we additionally examined whether between‐group differences in functional activity were associated with deficits in brain structural integrity. During mental state attribution, all clinical groups as compared with healthy controls exhibited poor performance as well as reduced right‐hemispheric insular function with the highest error rate and insular dysfunction seen in the schizophrenic patients without ALC. Accordingly, both behavioral performance and insular functioning revealed schizophrenia × ALC interaction effects. In addition, schizophrenic patients relative to non‐schizophrenic subjects (regardless of ALC) exhibited deficits in structural integrity and task‐related recruitment of the left ventrolateral prefrontal cortex (vlPFC). Our data suggest that ALC‐related impairment in the ability to infer other peoples mental states is limited to insular dysfunction and thus deficits in affective empathy. By contrast, mentalizing in schizophrenia (regardless of ALC) may be associated with insular dysfunction as well as a combination of structural and functional deficits in the left vlPFC.

Alkoholbezogene Störungen im Alter - Aktueller Stand zu Diagnostik und Therapie

Due to demographic trends and an aging cohort, which has higher rates of substance abuse than any previous generation, an increase in numbers of elderly alcohol abusers is predicted. The number of older alcohol dependent adults in Germany has been estimated to 400 000, the prevalence of risky use up to 2 million. Despite this reported high prevalence, patients over age 60 are seldom seen attending in- or outpatient treatment programs for alcohol dependence. In addition, little is known about this growing population of older adults with alcohol-related disease, e. g. regarding course of alcohol addiction, consumption patterns, somatic and mental comorbid disorders. This article shows the state of research in this area and reviews clinically-relevant concepts related to identifying, assessing and treating older adults with alcohol-related disability. Emphasis will be placed on the psychotherapy-methods of brief interventions and cognitive-behavioral therapy and on the pharmacological approaches for treating alcohol dependence with disulfiram, acamprosate and naltrexone.

Use of Disulfiram for Alcohol Relapse Prevention in Patients in Opioid Maintenance Treatment

ObjectivesThe aim of this study was to assess the effectiveness, tolerability, and safety of alcohol relapse prevention with disulfiram in alcohol-dependent patients in opioid maintenance treatment under routine treatment conditions. MethodsTwenty-nine opioid maintenance treatment patients were observed from the beginning of outpatient disulfiram treatment for up to 6 months. Patients received disulfiram (mostly 300 mg/d) together with their daily opioid dose. Patients were assessed through urine screens for alcohol (ethyl gluconoride) and other drugs at least twice monthly; blood chemistry analyses after 1, 3, and 6 months; and clinical interviews after 3 and 6 months. ResultsMost patients presented with somatic and/or psychiatric comorbidity and/or polydrug use at baseline. Half of the patients completed 6 months of disulfiram treatment. Alcohol use was low during disulfiram treatment. Levels of other drug use did not change. For most patients, 1 or more adverse events were reported, often mild and/or short lived. Three patients experienced severe adverse events attributable to disulfiram. ConclusionsDisulfiram is a viable treatment option for the high-risk population studied here. A close monitoring of side effects and adverse events is necessary, in particular, in patients with polysubstance use.

Influence of the 393T>C polymorphism of the GNAS1 gene on the intensity of opiate withdrawal.

There are high interindividual differences regarding the intensity of withdrawal symptoms. in opiate addicts. This study was carried out in order to test whether the intensity of withdrawal is influenced by the 393T>C polymorphism of the GNASI gene. Only patients addicted exclusively to opiates were included. Thirty-three out of 39 patients undergoing inpatient detoxification treatment achieved a drug-free state. During the most intense period of withdrawal (stop of methadone and following days) TT homozygotes (n=4) had a significantly higher pulse rate (primary outcome criterion) than C-allele carriers (n=29). This study and a previous study about GNB3 825C> T underline the possible role of G-protein polymorphisms in the interindividual variability of opiate withdrawal.

Intensity of opiate withdrawal in relation to the 825C>T polymorphism of the G-protein beta 3 subunit gene.

OBJECTIVES The intensity of withdrawal in opiate dependence shows a high inter-individual variability. The 825C>T polymorphism (rs5443) of the G-protein beta 3 (GNB3) subunit gene has a strong influence on clinical signs of sympathetic activity in cardiac research. This study was carried out in order to test the hypothesis that carriers of the T allele have an increased sympathetic activity in opiate withdrawal. METHODS Thirty-nine monovalent opiate addicted patients consecutively admitted to a detoxification ward were investigated. The main parameter for sympathetic activity was the pulse rate in the first 3 days after the regular end of gradual methadone reduction. RESULTS Thirty-three out of 39 patients achieved a drug-free state: 22 carried a T allele (TT, CT), 11 belonged to the CC genotype group. The pulse rate was significantly (p<0.05) raised in the T allele group compared to the CC genotype group on the first 2 days after stopping methadone administration. In addition, about a third of the T allele carriers needed clonidine treatment on the respective days, but only one patient among the 11 CC homozygotes. There was no significant difference between groups in systolic and diastolic blood pressures as well as in subjective withdrawal ratings. CONCLUSION A group difference regarding pulse rate could be observed in a small sample and despite a higher degree of concomitant clonidine medication in T allele carriers. The failure to detect group differences in blood pressure and self-rated withdrawal symptoms may be attributed to the more complex regulation of blood pressure and the known weak correlation between objective and subjective withdrawal symptoms.