Cristina D'Angelo

Effectiveness and safety of baclofen for maintenance of alcohol abstinence in alcohol-dependent patients with liver cirrhosis: randomised, double-blind controlled study.

BACKGROUND Intervention to achieve alcohol abstinence represents the most effective treatment for alcohol-dependent patients with liver cirrhosis; however, anticraving drugs might worsen liver disease. We aimed to investigate the effectiveness and safety of baclofen in achieving and maintaining alcohol abstinence in patients with liver cirrhosis. METHODS Between October, 2003, and November, 2006, 148 alcohol-dependent patients with liver cirrhosis were referred to the Institute of Internal Medicine, Rome, Italy. 84 were randomly allocated either oral baclofen or placebo for 12 weeks. Primary outcome was proportion of patients achieving and maintaining alcohol abstinence. Measures of this outcome were total alcohol abstinence and cumulative abstinence duration, which were assessed at outpatient visits. Relapse was defined as alcohol intake of more than four drinks per day or overall consumption of 14 or more drinks per week over a period of at least 4 weeks. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00525252. FINDINGS Of 42 patients allocated baclofen, 30 (71%) achieved and maintained abstinence compared with 12 (29%) of 42 assigned placebo (odds ratio 6.3 [95% CI 2.4-16.1]; p=0.0001). The number of dropouts (termination of treatment) did not differ between the baclofen (6/42 [14%]) and placebo (13/42 [31%]) groups (p=0.12). Cumulative abstinence duration was about twofold higher in patients allocated baclofen than in those assigned placebo (mean 62.8 [SE 5.4] vs 30.8 [5.5] days; p=0.001). No hepatic side-effects were recorded. INTERPRETATION Baclofen is effective at promoting alcohol abstinence in alcohol-dependent patients with liver cirrhosis. The drug is well tolerated and could have an important role in treatment of these individuals.

State and trait anxiety and depression in patients affected by gastrointestinal diseases: psychometric evaluation of 1641 patients referred to an internal medicine outpatient setting

Objectives:  To evaluate state and trait form of anxiety and current depression in patients affected by gastrointestinal diseases.

State and trait anxiety and depression in patients with primary brain tumors before and after surgery: 1-Year longitudinal study

OBJECT The aim in this study was to assess the state and trait types of anxiety as well as current depression before and after surgery in patients affected by brain tumors. The relationships between these affective disorders and the patients sex, tumor histology, and laterality of the tumor were also evaluated. METHODS A total of 72 patients affected by a primary brain tumor were enrolled in the study. Histological grades were assigned according to the World Health Organization classification. State and trait anxiety were assessed using the State and Trait Anxiety Inventory; current depression was assessed using the Zung Self-Rating Depression Scale. Cognitive impairment was assessed using the 10-item Short Portable Mental Status Questionnaire. Psychometric evaluation was assessed before surgery and at 1, 3, 6, and 12 months after surgery. RESULTS Before brain surgery, 62.5% of patients showed state anxiety, 50% of patients showed trait anxiety, and 9.7% of patients showed current depression. During the follow-up period there was no significant variation in the percentage of patients with state anxiety (p=0.416) and trait anxiety (p=0.7), whereas a significant increase in the percentage of those with current depression was found (p<0.0001), in particular at 1 month (p=0.002) and 3 months (p=0.039) after surgical treatment. The tumors laterality and histology showed no correlation with psychometric variables, whereas a relationship between the presence of trait anxiety at the enrollment and current depression after surgery (p<0.0001) was found. CONCLUSIONS Patients affected by brain tumors frequently experience affective disorders. After brain surgery, a depressive state can develop. The psychometric assessment could be useful in these patients for quick recognition of psychological disorders.

Liver Transplantation in Alcoholic Patients: Impact of an Alcohol Addiction Unit Within a Liver Transplant Center

BACKGROUND Many concerns about liver transplantation in alcoholic patients are related to the risk of alcohol recidivism. Starting from 2002, an Alcohol Addiction Unit (AAU) was formed within the liver transplant center for the management of alcoholic patients affected by end-stage liver disease and included in the waiting list for transplantation. We evaluated retrospectively the impact of the AAU on alcohol recidivism after transplantation. The relationship between alcohol recidivism and the duration of alcohol abstinence before transplant was evaluated as well. METHODS Between 1995 and 2010, 92 cirrhotic alcoholic patients underwent liver transplantation. Clinical evaluation and management of alcohol use in these patients was provided by psychiatrists with expertise in addiction medicine not affiliated to the liver transplant center before 2002 (n = 37; group A), or by the clinical staff of the AAU within the liver transplant center starting from 2002 (n = 55; group B). RESULTS Group B, as compared with group A, showed a significantly lower prevalence of alcohol recidivism (16.4 vs. 35.1%; p = 0.038) and a significantly lower mortality (14.5 vs. 37.8%; p = 0.01). Furthermore, an analysis of group B patients with either ≥6 or <6 months of alcohol abstinence before transplantation showed no difference in the rate of alcohol recidivism (21.1 vs. 15.4%; p = ns). CONCLUSIONS The presence of an AAU within a liver transplant center reduces the risk of alcohol recidivism after transplantation. A pretransplant abstinence period <6 months might be considered, at least in selected patients managed by an AAU.

Relationship Between the Hypothalamic–Pituitary–Thyroid Axis and Alcohol Craving in Alcohol‐Dependent Patients: A Longitudinal Study

BACKGROUND A relationship between some hypothalamic-pituitary-related hormones and craving for alcohol has been suggested, leading to hypothesize a role of some hormones in the neurobiology of alcohol dependence. Investigating this association in alcohol-dependent (AD) patients was the aim of this preliminary and exploratory study. METHODS Cortisol, adrenocorticotropic hormone, prolactin, thyroid-stimulating hormone (TSH), free T3, free T4, growth hormone, follicle-stimulating hormone, luteinizing hormone as well as administering the Obsessive-Compulsive Drinking Scale (OCDS) and Penn Alcohol Craving Scale (PACS) were assessed at baseline and after 12 weeks in 25 current AD patients. Patients were treated with baclofen (10 mg t.i.d.) for these 12 weeks. Sixteen patients remained totally abstinent for 12 weeks. RESULTS At baseline, a significant inverse correlation was found between TSH and PACS (r = -0.46; p = 0.022) and OCDS scores (r = -0.53; p = 0.007). A significant direct correlation was found between free T3 and OCDS score (r = 0.44; p = 0.026). In the 16 abstinent patients, craving scores were significantly decreased at 12 weeks (p < 0.01). At 12 weeks, no significant correlation was found between TSH and craving, but free T3 remained directly correlated with OCDS score (r = 0.60; p = 0.013). CONCLUSIONS A relationship between alcohol craving and free T3 and TSH was demonstrated in AD patients, suggesting the potential involvement of the hypothalamic-pituitary-thyroid axis in the neurobiology of alcohol craving.

Affective and Psychiatric Disorders in Celiac Disease

Several extraintestinal clinical manifestations have been reported in celiac disease (CD). Among them, growing evidence suggests the association between CD and affective and psychiatric disorders. In this review the most frequent affective and psychiatric disorders associated with CD and the possible mechanisms involved in these associations were analyzed. The available data suggest that screening for CD in patients with affective and/or psychiatric symptoms may be useful since these disorders could be the expression of an organic disease rather than primary psychiatric illnesses.

Social phobia in coeliac disease

Objective. A high prevalence of anxiety and depression has been reported in coeliac disease (CD). Although social phobia is included among the anxiety disorders, its presence in CD has never been investigated. The aim of the present study was to evaluate social phobia in CD patients. Material and methods. A total of 40 CD patients were consecutively enrolled in the study. Fifty healthy subjects were studied as controls. Social phobia was assessed by the Liebowitz Social Anxiety Scale (LSAS) and current depression by the modified version of the Zung Self-rating Depression Scale (M-SDS). Results. The percentage of subjects with social phobia was significantly higher in CD patients than in controls (70% versus 16%; p<0.0001), and also when the more severe generalized form was considered (15.0% versus 0%; p=0.006). The percentage of subjects with social phobia was not statistically different between newly diagnosed subjects and patients on a gluten free diet (73.3% versus 68%; p: NS), nor considering its generalized form (7.0% versus 20%; p: NS). Current depression was present in a significantly higher percentage of CD patients in comparison with controls (52.5% versus 8%; p<0.0001). A direct correlation between social phobia and current depression was found in CD patients (r=0.582; p<0.0001). Conclusions. Despite the limited number of cases evaluated, the present study showed a significantly higher prevalence of social phobia in CD patients compared with in healthy subjects. Future studies are needed to clarify the possible social phobia-induced risks such as school and/or work failure in CD patients.

Role of trait anxiety in persistent radicular pain after surgery for lumbar disc herniation: a 1-year longitudinal study.

OBJECTIVETo evaluate anxiety and depression as prognostic factors for radicular and back pain after surgery in patients with lumbar disc herniation in a 1-year follow-up study. METHODSA total of 108 patients with lumbar disc herniation were enrolled in the study. Anxiety was assessed by State and Trait Anxiety Inventory; current depression was assessed by Zung Self-Rating Depression Scale. Severity of pain was scored on the visual analog scale (VAS). The State and Trait Anxiety Inventory, Zung Self-Rating Depression Scale, and VAS were administered before surgery and 1, 3, 6, and 12 months after surgery. RESULTSBefore surgery, 72.2% of patients showed state anxiety, 54.6% of patients showed trait anxiety, and 11.1% of patients showed current depression. During the follow-up period, there was a significant decrease in the prevalence of state anxiety (P < .0001), no variation in the prevalence of trait anxiety (P = .115), and a significant increase in the prevalence of current depression (P = .002). Linear regression analysis showed that the presence of trait anxiety before surgery was the main determinant of the presence of pain after surgery (P < .0001). VAS scores were evaluated by dividing patients into 2 groups based on the presence or absence of trait anxiety before surgery. The subgroup affected by trait anxiety before surgery had significantly higher VAS scores at each follow-up assessment compared with patients without trait anxiety (P < .0001). CONCLUSIONThe presence of trait anxiety before surgery is a prognostic factor for the persistence of pain after surgery.

Coeliac disease and hearing loss: Preliminary data on a new possible association

Objective. Coeliac disease (CD), an autoimmune gluten-dependent enteropathy, can be associated with several extra-intestinal manifestations, including neurological disorders. At present, no data are available on the presence of hearing loss disorder in coeliac patients. The aim of the present study was to investigate the prevalence of hearing loss in coeliac patients compared with that in healthy controls. Material and methods. Twenty-four adult coeliac patients and 24 healthy subjects matched for gender, age, smoking and drinking habits were enrolled in the study. Among the coeliac patients, 6 were newly diagnosed and 18 patients were on a gluten-free diet for at least one year. Results. A hearing loss was found in 10 (47.1%) coeliac patients and 2 (9.1%) healthy controls. All CD patients with hearing loss presented a sensorineural hearing loss. The prevalence of hearing loss was significantly higher in coeliac patients than in healthy controls (p=0.01) but it was not significantly different between untreated (33.3%) and treated (44.4%) coeliac patients (p: NS). Conclusions. Despite the low number of subjects evaluated, the present study showed a higher prevalence of hearing loss in coeliac patients than in healthy controls, suggesting an association between CD and hearing loss. Immunological processes such as ear-specific and non-specific autoantibodies and vasculitis could be the basis of this association. Further longitudinal investigations on a larger sample size will be necessary to confirm the present data.

Baclofen in the treatment of persistent hiccup: a case series

Persistent hiccup is a worrying symptom both for patients, because of reduced quality of life, and for physicians, because of frustration for unsuccessful treatments.