Joseph Brown

The type A/type B distinction. Subtyping alcoholics according to indicators of vulnerability and severity.

Multidimensional typologies of alcoholics are reviewed, including Cloningers neurobiological learning model, Morey and Skinners hybrid model, and Zuckers developmental model. The more recent Type A/Type B typology proposed by Babor and colleagues is reviewed in more depth, as is a previous replication and extension by Litt and colleagues. Both the original study and the replication indicate this typology is a useful tool in classifying alcoholic inpatients into two groups and in matching alcoholics to the most suitable treatment. The present study replicates the typology using outpatient samples of male alcoholics. The resulting two clusters are very similar to those identified by the two earlier studies. As expected, the relative proportion of Type A alcoholics is higher in the outpatient samples than in the previously studied inpatient samples. Preliminary analysis of the typologys clinical efficiency suggests that the variables used to classify subjects might be appreciably reduced, thus effecting a considerable time savings in assessment. A discriminant function analysis indicates that using only 5 of the original 16 clustering variables results in a correct classification rate of almost 95%. Future research directions are addressed.

Adverse effects limit the usefulness of fluvoxamine for the treatment of alcoholism

Open-label and placebo-controlled trials of fluvoxamine, a selective, serotonergic antidepressant, were conducted as an adjunct to relapse prevention psychotherapy in alcoholics. In the open trial, 16 inpatient alcoholics began a 12-week treatment program, with 10 patients dropping out during the first 4 weeks of treatment. In the controlled trial, 8 of 10 patients on fluvoxamine dropped out during the first 4 weeks of treatment, compared with only 1 of 9 patients on placebo. Baseline patient characteristics did not appear to explain the differential attrition in the controlled trial, although the placebo-treated patients were more alcohol dependent. In both trials, patients on fluvoxamine complained of a variety of adverse effects, which they often identified as the basis for early termination of treatment. These adverse effects appear to limit the usefulness of the medication for the treatment of alcoholism.

The Power of Statistical Studies in Consultation-Liaison Psychiatry

Several authors recently have proclaimed the need for empirically based research articles in consultation-liaison psychiatry. The authors report that although the proportion of empirically based studies published in Psychosomatics increased 148% from 1979 to 1989, the power of statistical analyses and the deleterious effect of multiple tests were often neglected. A power analysis of empirical studies published in the 1989 volume year of Psychosomatics is reported, showing statistical power to be low for all but the most robust of effect sizes.