Duran Cakmak

Quality of life, depression and anxiety in alcohol dependence

INTRODUCTION AND AIMS Quality of life is recognised increasingly as an important component in the evaluation of disease processes. Comorbid psychiatric diagnoses accompanying alcohol addiction, especially severe cases of anxiety or depression, may have a negative impact on quality of life. This study focused on the impact of severity of anxiety and depression on quality of life of 150 alcohol-dependent patients treated in hospital. DESIGN AND METHODS Consecutive patients were evaluated using relevant quality of life scales at the studys onset and 3 and 6 weeks after the complete disappearance of withdrawal symptoms. Patients were classified into three groups: patients with alcohol dependence only, patients with depression and patients with anxiety. RESULTS The level of anxiety and depression decreased from the initial evaluation to week 3 in patients with a high level of anxiety and depression, whereas the level of anxiety increased in the alcohol only-dependent patients. Initial evaluation conducted using the quality of life scales indicated significant differences between the three patient groups: physical health (F = 7.92, p = 0.001); psychological (F = 32.21, p = 0.001); social relationship (F = 3.45, p = 0.03); and environment (F = 7.79, p = 0.001). At weeks 3 and 6, quality of life for physical health, psychological and environment areas differed significantly between patient groups, but social relationships did not. At weeks 3 and 6, quality of life was lowest in patients with depression and highest in alcohol only-dependent patients with a low severity of depression or anxiety. DISCUSSION AND CONCLUSIONS Symptoms of anxiety and depression accompanying alcohol addiction lead to an increase in severity of the problems associated with the addiction and have a negative effect on quality of life. Measurement of quality of life within the scope of treatment programmes would help to identify treatment requirements in addicted patients.

Dissociation and alexithymia among men with alcoholism

Aim:  The aim of the present study was to evaluate the relationship between alexithymia and dissociation among men with alcoholism.

Role of family in alcohol and substance abuse

Abstract  Abuse is a family disease, which requires joint treatment of family members. Family is an important part of the diagnosis and treatment chain of alcohol and substance abuse. Abuse of alcohol and substance is a response to fluctuations in the family system. In consideration of interactions within the system, it seems an important requirement that the clinician involves, and maintains the presence of, the family in its entirety in the treatment process. A family often needs as much treatment as the family member who is the abuser of alcohol or a substance. In this regard, participation of the family in the treatment process as group members and by assuming a supportive role are assets in terms of preventing relapse, and extending clean time, and also very important for solving conflicts that give rise to abuse of alcohol or substances. Accordingly, it is important to know the family structure and its role in the treatment process. This article covers a review of family systems separately in terms of alcoholism and substance abuse.

Clinical Correlates of Self-Mutilation in Turkish Male Substance-Dependent Inpatients

Objective: The aim of this study was to evaluate the prevalence of self-mutilation (SM) in male substance-dependent inpatients, and to investigate the relationship of SM with childhood abuse and neglect, axis I disorders and personality disorders. Methods: Participants were 112 consecutively admitted male substance dependents (56 alcohol and 56 drug). Substance dependence was diagnosed by means of the Structured Clinical Interview for DSM-IV (SCID-I, Turkish version). Patients were evaluated by the Childhood Abuse and Neglect Questionnaire, SCID-I, SCID-II, Beck Depression Inventory and Beck Anxiety Inventory. Results: Among substance-dependent patients, SM was found to be present in 33% (SM group). Mean age and educational status were lower in the SM group. Moreover rates of being single, history of childhood physical and emotional abuse and neglect, suicide attempt history and personality disorder were higher. Mean depression and anxiety scores were also higher in the SM group. Personality disorder, physical abuse, suicide attempt history and drug dependency were predictors for SM. Conclusions: SM is more common in drug dependents than alcohol dependents. Also results of this study suggest that among Turkish substance dependents SM might be related to the presence of personality disorder and childhood physical abuse and suicide attempts.

Effects of childhood trauma and clinical features on determining quality of life in patients with bipolar I disorder

BACKGROUND We explored how childhood trauma (CHT) affects the clinical expression of disorder and quality of life in patients with bipolar I (BP-I) disorder. METHODS Euthymic patients (n=116) who subsequently received a diagnosis of BP-I disorder were consecutively included and were interviewed using the following sociodemographic and clinical data forms; Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Childhood Abuse and Neglect Questionnaire (CANQ) and the 36-item Medical Outcome Study Short Form Health Survey (SF-36). The quality of life of BP-I patients with and without a history of CHT were examined. RESULTS The percentage of trauma was 61.2%. Patients who had CHT had higher frequencies of depressive episodes (t=-2.38, p=0.019), total episodes (t=-2.25, p=0.026), attempted suicide more often (χ(2)=18.12, p=0.003) and had lower scores on the pain subscale of the SF-36 (z=-2.817, p=0.005). In patients with mixed or rapid-cycling episodes, SF-36 subscale scores except general health and pain were found to be lower. LIMITATIONS Our sample may fail to reflect the general BD population; the patients were included consecutively and consisted of a majority of female patients. CONCLUSIONS CHT plays an important role in the clinical expression of BP-I disorder and having mixed/rapid-cycling episodes negatively affects both physical and mental components, as measured by the SF-36. While both males and females reported experiencing sexual abuse, female BP-I patients complained about pain more often. It is suggested that treatment of BP-I patients with a history of CHT should differ from that provided for patients with no CHT history.

Lifetime posttraumatic stress disorder in Turkish alcohol-dependent inpatients: Relationship with depression, anxiety and erectile dysfunction

Abstract  The aim of the present study was to evaluate the prevalence of lifetime posttraumatic stress disorder (PTSD) in Turkish male alcohol‐dependent inpatients, and to investigate the relationship of lifetime PTSD diagnosis with anxiety, depression, hopelessness, erectile dysfunction and psychosocial problems related with alcohol dependency. Eighty‐two male inpatients who met DSM‐IV criteria for alcohol dependence and 48 subjects without substance use disorder as a control group were included in the study. Subjects were applied the Hamilton Depression Rating Scale (HAM‐D), the Hamilton Anxiety Rating Scale (HAM‐A), the Michigan Alcoholism Screening Test (MAST), the Beck Hopelessness Scale (BHS) and the International Index of Erectile Function (IIEF). Rate of lifetime PTSD diagnosis was found to be 26.8% among alcohol‐dependent inpatients. The mean age of patients with lifetime PTSD was lower than in patients without this diagnosis, while there were no significant differences between these two groups in terms of age of first alcohol use, lifetime major depression, current depression, presence and severity of erectile dysfunction. Mean scores of HAM‐D, HAM‐A, BHS and MAST in the group with lifetime PTSD were significantly higher than the group without this diagnosis. There was a positive relationship between lifetime PTSD diagnosis and depression, anxiety, hopelessness and severity of psychosocial problems related to alcohol dependency, while there was no relationship between lifetime PTSD comorbidity and erectile dysfunction in alcohol‐dependent patients.

Social anxiety and dissociation among male patients with alcohol dependency

The aim of this study was to investigate the relationship between social anxiety and dissociation among male patients with alcohol dependency. Participants were 176 male patients consecutively admitted to an alcohol dependency treatment unit. The Liebowitz Social Anxiety Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, the Spielberger State and Trait Anxiety Inventory, the Michigan Alcoholism Screening Test, and the Symptom Checklist-90-Revised were administered to all participants. The dissociative (N=58, 33.0%) group had significantly higher social anxiety scores than the non-dissociative participants. Patients with a history of suicide attempt or childhood abuse had elevated social anxiety scores compared to those without. In multivariate analysis, dissociative taxon membership predicted both of the two social anxiety subscale scores consisting of fear/anxiety and avoidance in a highly significant level while trait anxiety was a significant covariant for these subscales. Among dissociative symptoms, only depersonalization and amnesia/fugue were predictors of social anxiety. Dissociation and social anxiety are interrelated among alcohol-dependent men. This relationship may have implications for prevention and treatment of alcohol dependency among men with a childhood trauma history in particular.

Axis I psychiatric comorbidity among adult inhalant dependents seeking treatment.

Abstract The present study aimed to investigate the prevalence of Axis I disorders in adult inhalant-dependent patients in comparison to other substance-dependent patients and subjects without substance use disorders. The inhalant-dependent group consisted of 83 male inpatient and outpatient adults diagnosed according to DSM-IV criteria. This group was compared with 74 other substance-dependent patients and with 70 subjects without alcohol and substance use disorder diagnoses. Ninety-three percent of the inhalant dependents had a lifetime history of at least one type of comorbid Axis I disorder, while 77% of the same subjects had at least one type of any affective disorder and 75.9% of them had at least one type of anxiety disorder. Prevalence of Axis I disorders among inhalant dependents was 72.3% for lifetime major depression, 41% for major depression during the past month. 24% for dysthymic disorder, 20.5% for inhalant-induced depressive disorder, 27.7% for panic disorder. 30% for PTSD, 36.1% for social phobia and 20.5% for generalized anxiety disorder. The rate of lifetime axis I disorders was higher in patients with inhalant dependency in comparison to the other two groups. This finding suggests that inhalant-dependent adults have high rates of comorbid psychiatric problems, and that it is imponant to determine Axis I disorder comorbidity in this population before making an inpatient or outpatient treatment plan.

Childhood Trauma and Psychopathology among Alcohol-Dependent Men: No Interaction with Temperament and Character

Objective: The aim of this study was to evaluate possible interactions between childhood trauma, temperament, character, and psychopathology among alcohol-dependent men. Methods: Participants were 156 alcohol-dependent men consecutively admitted to a dependency treatment unit. The Childhood Abuse and Neglect Questionnaire, the Temperament and Character Inventory, and the Symptom Checklist-Revised were administered to all participants. Results: Childhood abuse and neglect did not have any effect on temperament and character scores in multivariate analysis. Whereas childhood abuse had a significant main effect on all types of clinical psychopathology except depression and psychoticism scores, childhood neglect only had a significant main effect on depression scores. There was no interaction between childhood abuse and neglect on these analyses. Conclusions: Among alcohol-dependent men, childhood abuse and neglect contribute to general psychopathology through distinct clinical consequences, independently of temperamental and characterological features.