Ioannis Liappas

Treatment of alcohol dependence with low-dose topiramate: an open-label controlled study

BackgroundGABAergic anticonvulsants have been recommended for the treatment of alcohol dependence and the prevention of relapse. Several studies have demonstrated topiramates efficacy in improving drinking behaviour and maintaining abstinence. The objective of the present open-label controlled study was to assess efficacy and tolerability of low-dose topiramate as adjunctive treatment in alcohol dependence during the immediate post-detoxification period and during a 16-week follow-up period after alcohol withdrawal.MethodsFollowing a 7-10 day inpatient alcohol detoxification protocol, 90 patients were assigned to receive either topiramate (up to 75 mg per day) in addition to psychotherapeutic treatment (n = 30) or psychotherapy alone (n = 60). Symptoms of depression and anxiety, as well as craving, were monitored for 4-6 weeks immediately following detoxification on an inpatient basis. Thereafter, both groups were followed as outpatients at a weekly basis for another 4 months in order to monitor their course and abstinence from alcohol.ResultsA marked improvement in depressive (p < 0.01), anxiety (p < 0.01), and obsessive-compulsive drinking symptoms (p < 0.01) was observed over the consecutive assessments in both study groups. However, individuals on topiramate fared better than controls (p < 0.01) during inpatient treatment. Moreover, during the 4-month follow up period, relapse rate was lower among patients who received topiramate (66.7%) compared to those who received no adjunctive treatment (85.5%), (p = 0.043). Time to relapse in the topiramate augmentation group was significantly longer compared to the control group (log rank test, p = 0.008). Thus, median duration of abstinence was 4 weeks for the non-medicated group whereas it reached 10 weeks for the topiramate group. No serious side effects of topiramate were recorded throughout the study.ConclusionsLow-dose topiramate as an adjunct to psychotherapeutic treatment is well tolerated and effective in reducing alcohol craving, as well as symptoms of depression and anxiety, present during the early phase of alcohol withdrawal. Furthermore, topiramate considerably helps to abstain from drinking during the first 16-week post-detoxification period.

An open pilot study of tiagabine in alcohol dependence: tolerability and clinical effects

There is evidence that GABAergic anticonvulsants can be efficacious in the treatment of alcohol dependence and in the prevention of alcohol relapse because these agents act on the substrate that is involved in alcoholism. Tiagabine, a selective GABA transporter1 reuptake inhibitor, may be a promising candidate for the treatment of alcohol-dependent individuals. In this randomized, open pilot study, we aimed to investigate the efficacy and tolerability of tiagabine as adjunctive treatment of alcohol-dependent individuals (N = 60) during the immediate post-detoxification period and during a 6-month follow-up period following alcohol withdrawal. A control non-medicated group of alcohol-dependent individuals (N = 60) was used for comparisons in terms of anxiety and depressive symptoms, craving and drinking outcome. Although a steady improvement in terms of psychopathology, craving and global functioning was observed in both groups throughout the study, subjects on tiagabine improved significantly more compared to the control subjects (P < 0.001). Furthermore, the relapse rate in the tiagabine group was lower than in the control group (7 vs 14.3%). Tiagabine was well tolerated and only a minority of the participants reported some adverse effects in the beginning of tiagabine treatment. Results from this study suggest that tiagabine is a safe and effective medication for the management of alcohol dependence when given adjunctively to a standard psychotherapy treatment. Further studies are warranted before definite conclusions can be reached.

Agomelatine and sertraline for the treatment of depression in type 2 diabetes mellitus

The present study compared the efficacy of agomelatine and sertraline in the treatment of symptoms of depression/anxiety, diabetes self‐care and metabolic control in a sample of depressed patients with non‐optimally controlled type 2 diabetes mellitus (DM).

Preliminary Report of a Validation Study of Instrumental Activities of Daily Living in a Greek Sample

To validate the Instrumental Activities of Daily Living in Greek, 44 men (M age = 70.5 yr., SD = 7.2) and 58 women (M age = 68.4, SD = 9.2), outpatients of memory clinics, were studied. Sex differences in the item responses were evaluated. Reliability assessed as Cronbach alpha was .84, while validity was assessed by correlation of .77 with the Mini-Mental State Examination. 21 men and 20 women had moderate to severe dementia, with Mini-Mental State Examination scores < 20. The results show that this Greek language version can be effectively used in Greece.

Greek academic psychiatry and neurology before the firing squad

The coat should be cut to fi t the man, not the man to fi t the coat. The procrustean levelling tactics adopted by the Greek state under the direction of the International Monetary Fund and the European Central Bank in response to the economic crisis are having a dangerous eff ect on the country’s academic psychiatry and neurology. The Aeginition University Hospital in Athens, home of the Psychiatric and Neurological Departments of the Athens University Medical School (the only large departments in these disciplines serving the capital), is on the verge of collapse; at best, it faces painful and destructive cutbacks. A drastic 30% reduction in government funding, an extraordinary delay in the provision of essential resources, and bureaucratic obstructions have already led the hospital to suspend inpatient care and limit out-of-hours emergency services once this year. The Aeginition Hospital was founded in 1904 and has been the traditional nursery of psychiatry and neurology in Greece as well as a centre of excellence. The quality of the services off ered, the development of specialised programmes for tertiary care (highly innovative in the Greek context), the high level of research activity, and the hospital’s role in the community have made the Aeginition the most soughtafter teaching hospital in psychiatry and neurology in Greece at both the undergraduate and graduate level. The educational provision covers the whole spectrum of both disciplines and fully meets the high standards demanded inter nationally. The symbolic importance and reputation of the Aeginition Hospital are also refl ected in the fact that the head of its Psychiatric Clinic for 25 years also served as president of the World Psychiatric Association from 1983 to 1990; directors of the clinic have periodically held or hold high offi ces in various international organisations. The situation in Greece is except ionally diffi cult: the country seems to have entered a long period of crisis with clearly evident consequences for the mental health of its citizens. Recent preliminary data show a doubling of the annual suicide rate and an increase in the abuse of alcohol and addictive substances. A short-sighted rationale that expects mental health services to form part of a profi table enterprise can only make matters worse. Greek academic psychiatry and neurology, along with their essential institutional base, the Aeginition Hospital, seem now to be endangered species. May all who are able contribute to their preservation.

Left parieto-occipital lesion with epilepsy mimicking panic disorder.

Panic attacks, the cardinal manifestation of panic disorder, can occur in the context of cerebral disorders, especially epilepsy with simple and complexpartial seizures (Sazgar et al., 2003; Trimble and Schmitz, 2002; Vazquez and Devinsky, 2003). Similarities between psychogenic and epileptic panic attacks can be misleading, especially when the presence of comorbid psychiatric conditions and the absence of other epileptic manifestations fail to raise the index of suspicion that will lead to a complete workup. We present the case of a woman misdiagnosed with panic disorder before being diagnosed and successfully treated for epilepsy. This is also the first published case of a left parieto-occipital lesion generating panic attacks as manifestations of seizures.

Should impaired liver function be held responsible for cognitive impairment and poor health‐related quality of life in alcoholic cirrhosis?

colonic lactulose fermentation recorded by a new extensometer. Neurogastroenterol Motil 2003;15:427-433. 8. Conn H, Bircher J. Adverse reactions and side effects of lactulose and related agents. In: Conn H, Bircher J, eds. Hepatic Encephalopathy: Syndromes and Therapies. Bloomington, IL: Medi-Ed Press, 1994:299-310. 9. Orlandi F, Freddara U, Candelaresi MT, Morettini A, Corazza GR, Di Simone A, et al. Comparison between neomycin and lactulose in 173 patients with hepatic encephalopathy: a randomized clinical study. Dig Dis Sci 1981;26:498-506. 10. Als-Nielsen B, Gluud LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic review of randomised trials. BMJ 2004;328:1046-1051.

IGF-I and IGFBP-3 before and after inpatient alcohol detoxification in alcohol-dependent subjects

Summary Background It is unclear whether alcohol detoxification has an effect on factors that are involved in growth, metabolic functions and cell proliferation. Alcohol abuse is associated with low IGF-I levels that tend to rise after alcohol withdrawal. There is a paucity of studies on the course of IGFBP-3 (the main binding protein for IGF-I) after alcohol detoxification. Material/Methods We prospectively assessed IGF-I and IGFBP-3 changes at the time of admission and after 4 to 6 weeks of detoxification in an inpatient alcohol detoxification facility in 118 alcohol-dependent subjects given a regular hospital diet. No participants dropped out of the study. Results Changes in IGF-I after alcohol detoxification showed a marked dimorphism in altered hepatic biochemistry upon admission, with a rise in those with normal liver enzymes upon admission (p=0.016, Kruskall-Wallis) and a drop in those with elevated liver enzymes upon admission (p=0.05); the latter was noted in subjects that had consumed alcohol close to the time of admission. Overall, however, IGF-I and IGFBP-3 were within normal limits for most subjects both upon admission and after alcohol detoxification; no significant differences were detected among the examined parameters in men vs. women, and there were no significant correlations of IGF-I, IGFBP-3 or the IGF-I/IGFBP-3 molar ratio with BMI or age. Conclusions Regardless of hepatic enzymes’ elevation, alcohol detoxification had overall slight effects on IGF-I and IGFBP-3.

EPA-1332 – Family burden in cerebrovascular accident (CVA)

Objective The CVA is one of the most serious medical problems. It represents the third most common cause of death in North Amerika and in most countries of Europe. In Japan and in China is the most frequent cause of death. We present a 18-month follow-up data on the burden of families of stroke individuals. The purpose of this study is to investigate the degree of family burden in families of patients with chronic CVA. Methods-subjects The sample comprised 110 patients with CVA aged 40–90 years old and their caregivers. The form-questionnaire consisting essentially of the Family Burden Scale (MG Madianos and M. Oikonomou). Descriptive statistics are used for the presentation of the results Results The caregivers were in the majority the spouse (50%), and the children (39%). The results show that the increased burden was related more to leisure of the caregivers and less to their daily activities. The type of CVA Is not associated with caregivers burden. Family burden is strongly dependent on the initial inability of the patients as well their age and the time elapsed from the start of the disease. The age of the caregiver does not play any role in family burden, Furthermore the financial burden is related only with the disability. Conclusion The factors that have been implicated for the family burden were mainly the severity of disability, the duration of the illness and the age of the chronically ill, factors which can influence severe the caregivers.

EPA-1240 – Sexual dysfunction and antidepressant medications in male depressed patients

Introduction Sexual dysfunction, such as low libido, erectile dysfunction and anorgasmia, is very common in patients taking serotoninergic antidepressants (SSRIs). These adverse effects persist throughout the treatment period, are not self-limited, and drive many male patients to treatment discontinuation in order to recuperate normal sexual functioning. Objectives - Aims The purpose of the present study was to investigate the sexual function of male patients treated with antidepressants for major depression, before initiation of treatment, during treatment and two months following withdrawal of SSRIs. Methods This observational study comprised 25 male patients (age: 30–50 years) followed-up on an outpatient basis for major depression. Sexual functioning was assessed with the Arizona Sexual Experience Scale (ASEX) and depressive symptoms with the Hamilton Rating Scale for Depression (HDRS) at three time points: baseline (period free of medication), three months after starting treatment with SSRIs, and two months following antidepressant discontinuation. Paired samples t-tests were used for comparisons between numeric variables at the three time points and Spearmans correlation coefficients were calculated between factors associated with sexual dysfunction. Results Mean values ??(± SD) of ASEX and HDRS scores at the initial, second and final assessment are shown in Table 1. Initial assessment Second assessment Final assessment ASEX 17.8± 5.4 25.6±7.9* 12.9±5.8** HDRS 22.3±4.2 4.2±3.4* 7.3±5.2** Correlation coefficients between ASEX, HDRS and age at the three points of evaluation are presented in Table 2. ASEX 1 Spearmans rho Sig. (2-tailed) ASEX 2 Spearmans rho Sig. (2-tailed) ASEX 3 Spearmans rho Sig. (2-tailed) HDRS 1 0.775 HDRS 2 0.318 0.340 HDRS 3 0,719 Age 0.842 Age 0.554 0.062 Age 0.856 Conclusions Antidepressants (SSRIs) have a negative impact on sexual functioning of male depressed patients. Quality of sexual functioning is negatively associated with age and the severity of depressive symptoms before the administration of antidepressant treatment. Sexual functioning significantly improves after discontinuation of antidepressants; this improvement is even superior to the pre-treatment period of sexual functioning.