Mario Vitali

Affective temperaments in alcoholic patients

Ninety-four consecutive responders to treatment alcoholics, 39 with and 55 without psychiatric comorbidity, were compared, regarding affective temperaments, according to the formulation of Akiskal and Mallya, with 50 healthy volunteers displaying the same social characteristics and belonging to the same environment. No differences were observed between alcoholics and controls on the hyperthymic scale. Significant discrepancies were measured on the depressive, cyclothymic, and irritable scales, where alcoholics scored higher, regardless of the presence or absence of dual diagnosis. In a multivariate discriminant analysis, mainly cyclothymic, but also depressive traits to a lesser degree, make it possible to distinguish between alcoholics and controls, but not between alcoholics with and without a dual diagnosis. The present study shows the main ways in which alcoholics can be distinguished from controls in terms of cyclothymic traits, with a depressive component, and why these characteristics are unrelated to the presence of dual diagnosis.

Leucocyte Subset Redistribution in a Human Model of Physical Stress

This study has investigated, under controlled conditions, peripheral mononuclear cells (PMNC) subset redistribution in a human experimental stress model consisting of cycloergometer activity in healthy male volunteers exposed to a stressful stimulus. After stressful stimuli, leucocyte subpopulations undergo a stereotyped redistribution peculiar for each PMNC cytotype. PMNC subpopulations involved to a greater extent were natural killer (NK) cells and lymphocytes T “memory” cells. The post-stress period was characterized by a decrease of the NK subpopulation. Our findings confirm the view of a sensible functional reduction of immunocompetence in stress conditions. This brings to the opening, even if for a short time, an “immunological window.”. This window remains open throughout the time of the stimulus, probably representing the basis of the progressive reduction of the competency of immune system. Catecholamines support the acute effects of stress influencing the anatomical redistribution of lymphocyte subpopulation and intermediating acute effects on PMNC. Cortisol, acting for longer time, contributes to create and maintain both the neutrocytosis and lymphopenia in the post-stress period following lymphocytosis.

Varenicline and neuronal nicotinic acetylcholine receptors: A new approach to the treatment of co-occurring alcohol and nicotine addiction?

BACKGROUND AND OBJECTIVES Alcohol and nicotine dependence are serious public health problems worldwide. They are associated with substantial morbidity and mortality, as well as adverse social effects and increased healthcare costs. Although efficacious treatments are available for these disorders, additional therapeutic options are required to ensure greater treatment utilization. In this paper, we describe the empirical basis on which varenicline, a nicotinic partial agonist approved for smoking cessation, may also have utility in the treatment of alcohol addiction. METHODS We sought to identify papers examining nicotine dependence, alcohol dependence, smoking, alcohol, and varenicline for possible inclusion in the present review. We identified over 600 papers through Pubmed/Medline, PsychINFO, and Google Scholar. We found 12 papers taking into consideration the following criteria: original language English, varenicline effect on alcohol consumption. RESULTS Animal studies have shown that varenicline reduces alcohol consumption. Two recent studies showed that varenicline also reduces alcohol consumption in humans. Both nicotine and alcohol interact with α4β2 and α3β4 nicotinic acetylcholine (ACh) receptors located in the ventral tegmental area of the brain, inducing dopamine (DA) release at the nucleus accumbens. Varenicline binds to nicotinic ACh receptors, where it has partial agonist effects, producing a moderate and constant level of DA release both in the mesolimbic pathway and in the prefrontal cortex. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Through these effects, varenicline may reduce alcohol craving, seeking, and consumption, in addition to promoting smoking cessation. Additional studies are needed to confirm the efficacy of varenicline in the treatment of alcohol dependence.

Treatment of major depressive disorder and dysthymic disorder with antidepressants in patients with comorbid opiate use disorders enrolled in methadone maintenance therapy: a meta-analysis

Depression and opiate-use disorders (abuse, dependence) often co-occur, each condition complicating the course and outcome of the other. It has been recommended that clinicians prescribe antidepressant therapy for mood symptoms in patients with active substance-use disorders, but whether antidepressants are effective in this specific population is not entirely clear. Therefore, the aim of this study was to examine the efficacy of antidepressants in patients with unipolar major depressive disorder (MDD) and/or dysthymic disorder (DD) with comorbid opiate-use disorders currently in methadone maintenance treatment (MMT). Medline/PubMed publication databases were searched for randomized, double-blind, placebo-controlled trials of antidepressants used as monotherapy for the treatment of MDD/DD in patients with comorbid opiate-use disorders currently in MMT. The search was limited to articles published between January 1, 1980, and June 30, 2010 (inclusive). Four manuscripts were found eligible for inclusion in our analysis (n = 317 patients). We found no statistically significant difference in response rates between antidepressant and placebo therapy in trials of MDD/DD patients with comorbid opiate-use disorders currently in MMT (risk ratio for response, 1.182; 95% CI: 0.822-1.700; P = 0.366). These results show no difference in the depressive outcome of patients with comorbid opiate-use disorders on MMT whether they are on medication or placebo. Future studies examining the effectiveness of antidepressants while controlling for several variables such as psychosocial treatment and assessing the specific classes of antidepressants are needed.

Compulsive Alcohol Use and Other High‐Risk Behaviors among College Students

The association between heavy alcohol consumption and risky behaviors has been amply investigated among college students. However, less is known with regard to types of drinking behaviors associated with high-risk activities. The present study extends this area of research by examining the relationship between compulsive drinking and hazardous behaviors in this population. Nine hundred and four college students completed measures on compulsive drinking and other risky behaviors in the context of mental health screenings at three campuses. Results showed that in males, compulsive drinking increased the risk for compulsive street drugs use, compulsive prescription drugs use, compulsive sexual activities, and gambling. Among females, compulsive drinking increased the risk for compulsive street drugs use, and compulsive sexual activities. These findings suggest that inquiring about compulsive drinking among college students may have great utility in identifying those at greater risk for other risky behaviors. The high co-occurrence of compulsive drinking, illicit substances, compulsive sexual activities, and gambling in college students suggests the need for comprehensive programs addressing high-risk behaviors together.

Blood thiamine, zinc, selenium, lead and oxidative stress in a population of male and female alcoholics: clinical evidence and gender differences

INTRODUCTION Long term alcohol abuse is associated with deficiencies in essential nutrients and minerals that can cause a variety of medical consequences including accumulation of toxic metals. AIM The aim of this research is to get evidence-based data to evaluate alcohol damage and to optimize treatment. Thiamine and thiamine diphosphate (T/TDP), zinc (Zn), selenium (Se), lead (Pb) and oxidative stress in terms of reactive oxygen metabolites (ROMs) were examined in blood samples from 58 alcohol dependent patients (17 females and 41 males). RESULTS T/TDP concentration in alcoholics resulted significantly lower than controls (p < 0.005) for both sexes. Serum Zn and Se did not significantly differ from reference values. Levels of blood Pb in alcoholics resulted significantly higher (p < 0.0001) than Italian reference values and were higher in females than in males. ROMs concentration was significantly higher than healthy population only in female abusers (p = 0.005). CONCLUSION Alcoholics show a significant increase in blood oxidative stress and Pb and decrease in thiamine. Impairment occurs mainly in female abusers confirming a gender specific vulnerability.

Immunological pattern alteration in shoe, hide, and leather industry workers exposed to hexavalent chromium

Objective. The aim of this work was to assess the effects of hexavalent chromium [Cr(VI)] on shoe, leather, and hide industry workers, based on the assumption that Cr(VI) can behave as an environmental immunological “stressor.” Methods. The immunological patterns of 84 male subjects were studied in relation to Cr(VI) hematic and urinary levels. Cr(VI) was measured through atomic absorption. Lymphocyte subsets, mitogen‐mediated lymphocyte‐proliferation, cytokine levels, and natural killer (NK) cytotoxic activity were also assayed. Results. The urinary levels of the total amount of Cr(VI) were significantly higher in a subgroup of exposed subjects (group B) than in the control or in the lower exposed (group A). In group B, Cr(VI) caused a decrease in the density of glucocorticoid receptors (GR) on peripheral blood mononuclear cells (PBMC) and a increase of IL‐6. Cr(VI) did not modify NK‐mediated cytotoxicity, the plasmatic levels of inflammatory cytokines and related soluble receptors, and prostaglandin levels, while it tended to increase lymphocyte sensitivity to mitogens and the production of immunomodulant cytokines (IFN‐γ, IL‐4, and IL‐2). The experimental addition of Cr(VI) to the in vitro lymphocyte culture determined a significant inhibition of phagocytosis percentage, index, and killing percentage. These effects were neutralized by exogenous IFN‐γ. Conclusion. Cr(VI) could represent an environmental immunological stressor whose effects can be evaluated through laboratory surveys. The lymphocyte mitogen‐induced proliferation, GR receptor on PBMC, and IL‐6 plasma levels may represent a discriminating element between Cr(VI)‐induced stress and other kinds of stress.

Compulsive use of alcohol among college students

Among college students alcohol consumption is associated with other high-risk behaviors that can lead to short- and long-term negative health consequences. Identification of college students consuming alcohol who are at high risk for problems may have important public health implications. This study examines the ability of the CHQ compulsive use of alcohol item to detect high-risk behaviors relative to other screening measures and its association with different dimensions of compulsive drinking. Three hundred thirty-two college students completed measures on compulsive drinking and hazardous behaviors. Results showed that among male students the CHQ compulsive use of alcohol item was not sensitive to detect hazardous alcohol consumption but co-occurred with the use of illicit drugs. Among female students it was sensitive to detect heavy drinking but not alcohol or drug problems. Among college students compulsive use of alcohol corresponds to an urge to consume alcohol that may be associated with use of illicit drugs in male students, with heavy drinking in female students and with substance use problems. This study suggest that the CHQ compulsive use of alcohol item should not be used as a stand-alone screening for alcohol or drug problems but it could be considered a marker for at-risk behaviors.

Adjunctive pregabalin in partial responders with major depressive disorder and residual anxiety.

Background Anxiety symptoms in depression result often in treatment resistance, residual symptoms, and persistent functional impairment. Objective To assess the effectiveness and safety of adjunctive pregabalin to antidepressants for residual anxiety in patients with major depressive disorder (MDD). Methods A retrospective chart review was conducted to identify partial responders among patients with MDD with residual anxiety. Twenty such patients (age, 58.4 ± 11.2 years; 15 women; baseline Hamilton Depression Rating Scale [HDRS], 17.1 ± 3.5) who received adjunctive pregabalin for residual anxiety were included. Antidepressants augmented were the selective serotonin reuptake inhibitors (n = 12), mirtazapine (n = 2), and selective serotonin-norepinephrine reuptake inhibitors (n = 6). Results Twenty patients received at least 4 weeks of pregabalin treatment after 8 weeks of antidepressant therapy. At week 1 (9 weeks after initiating treatment), pregabalin was prescribed at a mean ± SD dose of 71.2 ± 31.7 mg, and the mean maximum pregabalin dose prescribed was 156.2 ± 76.5 mg (range, 75–300 mg). At week 8, there were 13 responders (13/20 [65%]), and 7 of these 13 patients achieved remission (HDRS17 < 8). There were significant decreases in HDRS scores (13.5 ± 3.1 vs 9.1 ± 2.9, P < 0.000), and HDRS anxiety/somatization subscale scores (6.3 ± 2 to 3.6 ± 1.7, P < 0.000). Adverse effects included somnolence (n = 7), weight gain (n = 3), dizziness (n = 4), dry mouth (n = 6), edema (n = 3), blurred vision (n = 3), difficulty with concentration/attention (n = 8), headache (n = 6), and diarrhea (n = 5). Conclusions The results suggest a possible augmentation role for pregabalin when used in conjunction with conventional antidepressants for residual anxiety in MDD.

Serum BDNF and NGF Modulation by Olive Polyphenols in Alcoholics duringWithdrawal

Many studies have suggested possible relationships between the neurotrophins brain-derived neurotrophic factor (BDNF) and nerve growth factor (NGF) and alcohol addiction. Previous reports demonstrated severe changes in these neurotrophins in the serum of alcohol dependent patients and during withdrawal. Alcohol dependence syndromes during consumption and/or withdrawal are also characterized by elevated oxidative stress. Polyphenols, including olive polyphenols, are natural compounds known to possess marked antioxidant properties. Thus, this study was carried out in order to verify the effects of a blend of olive polyphenols supplementation containing mostly hydroxytyrosol (50 mg/day for 15 consecutive days) in alcoholic men during withdrawal on serum BDNF and NGF. As controls a group of alcohol dependent patients received sucrose tablets as placebo. BDNF and NGF were measured by ELISA on day 1, 3, 7 and 15 of the detoxification period. Some parameters of oxidative stress were analyzed too as free oxygen radicals defense (FORD) and free oxygen radicals test (FORT). No differences in oxidative status due to polyphenols were found. However, withdrawal elicited a mild increase in BDNF over two weeks that was counteracted on day 3 by polyphenols. As for NGF no effects of polyphenols supplementation were discovered to antagonize the expected NGF serum elevation during withdrawal. In conclusion the present data may indicate that monitoring serum BDNF and/or NGF in alcoholics undergoing detoxification could contribute to characterize alcohol dependence profiles to improve recovery processes throughout also antioxidant compounds.