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  • 1
    ISSN: 1360-0443
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine , Psychology
    Notes: Aim  To test the clinical performance of carbohydrate-deficient transferrin (%CDT), γ-glutamyltransferase (γ-GT) and mean corpuscular erythrocyte volume (MCV) as biomarkers for alcoholism with a special focus on patients suffering from liver diseases.Design  Well-characterized collectives of alcohol-dependent patients with current consumption (ALC patients, n = 101), and relevant control groups (115 social drinkers, 46 patients with unspecifically increased γ-GT, 51 hepatitis patients and 20/31 patients with non-alcohol/alcohol-dependent liver cirrhosis) were included into the study. The Positive Alcohol Use Disorders Test (AUDIT) score, International Classification of Diseases version 10 (ICD-10)/Diagnostic and Statistical Manual version IV (DSM-IV) criteria and blood drawn within 4 days of last drinking were inclusion criteria for subjects with regular heavy drinking. %CDT was determined using an automated assay which recently had been completely modified.Findings  Median AUDIT scores of patients without/with regular heavy drinking were 1–3/27. The following medians/95th percentiles were obtained for %CDT: social drinkers 2.2/3.0, patients with unspecifically increased γ-GT 2.1/3.0, hepatitis 2.0/4.4, non-alcohol-dependent liver cirrhosis 2.4/4.8, alcohol-dependent liver cirrhosis 3.0/5.9, ALC patients 3.9/14.9. Differences between patients without and with alcohol abuse were highly significant (P 〈 0.001). No differences in CDT values were found between males and females. There was no correlation between %CDT values, γ-GT, MCV and the amount of alcohol consumed in ALC patients; 3.0%CDT (95th percentile social drinkers) is proposed as cut-off for the test used (Tina-quant®%CDT 2nd-generation). At this cut-off, the sensitivity for ALC patients was 73.3%, whereas γ-GT/MCV had a sensitivity of 71.3%/64.4%. Multivariate analysis performed at 95% specificity resulted in an improvement of the sensitivity by combining %CDT with γ-GT (83.2%). A further enhancement of the sensitivity to 88.1% was obtained by combination of %CDT, γ-GT and MCV. The diagnostic specificity of %CDT calculated at the cut-off of 3% was 93.5% in patients with unspecifically increased γ-GT, 88.2% in hepatitis patients and 70.0% in patients with non-alcohol-dependent liver cirrhosis. %CDT was more specific in these patient collectives than MCV, and especially more than γ-GT (specificity in hepatitis 52.9%, and 35.0% in non-alcohol-dependent liver cirrhosis).Conclusion  %CDT is of high diagnostic value to support diagnosis of alcohol-use disorders. The specificity of this marker in patient groups with liver disorders is superior to the biomarkers γ-GT and MCV.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1369-1600
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Because corticotrophin-releasing hormone (CRH) plays a central role in stress regulation, the possible role of CRH1 polymorphism for anxiety-related personality variables such as harm avoidance possibly associated with alcoholism was studied. The research instruments used to phenotype patients were adopted partly from the US collaborative study of the genetics of alcoholism and include a number of personality inventories such as the temperament and character inventory (TCI). Based on the examination of 170 alcoholic subjects no association was found between CRH1 receptor haplotypes of four single nuclotid polymorphisms (SNPs) and low and high temperament traits of harm avoidance, novelty seeking and reward dependence. The possible implications of these findings are discussed.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1369-1600
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: The serotonergic neurotransmission was suggested to play an important role in the aetiology of alcoholism. This study explores the association between tryptophan hydroxylase (TPH)-alleles and Loudness Dependence of Auditory Evoked N1/P2 Potentials (LDAEP). The TPH is the rate-limiting biosynthetic enzyme in serotonergic pathway. The LDAEP is one of the best validated non-invasive indicators for serotonergic neurotransmission. A sample of 54 alcoholics was recruited. N1/P2 potentials were evoked by five different sound intensities. A dipole source analysis using BESA (brain electric signal topography) was performed and intensity dependence was computed. The TPH intron 7 polymorphism was determined by using PCR in DNA samples. There was a weak but significant association between low LDAEP and the L-TPH allele. No influence from an individual's history of alcohol dependence or a positive family history of alcohol dependence on LDAEP was found. The weak but significant relationship found between L-TPH-allele and high serotonergic neurotransmission may contribute to a more detailed neurobiological characterization of alcohol dependents using functional and genetic parameters.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1369-1600
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: A serotonergic dysfunction was suggested to be involved into the biological susceptibility of suicidal behaviour. Tryptophan hydroxylase (TPH), the rate-limiting enzyme in serotonin biosynthesis, is a significant regulating factor in the serotonergic system. Recently the A-6526G, and G-5806T and A-779C polymorphisms of the TPH 1 gene were identified and suggested to be associated with suicidal behaviour, but study results are conflicting. We examined a possible association of the A-6526G, and G-5806T and A-779C polymorphisms with suicide attempts in a sample of 80 alcohol-dependent individuals with a history of at least one suicide attempt. This group was analysed in comparison with 241 alcohol-dependent subjects without such a history. No significant relationship between haplotype and genotype distribution and allele frequencies of these polymorphisms with suicide attempts were detected. Furthermore, no association with number of suicide attempts and TPH haplotypes were found. Our data do not support the hypothesis of A-6526G, G-5806T or A-779C polymorphisms to be associated with suicide attempts in alcohol-dependent individuals.
    Type of Medium: Electronic Resource
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  • 5
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 69 (1998), S. 440-445 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Dissoziative Identitätsstörung ; Multiple Persönlichkeitsstörung ; Paranoide Schizophrenie ; Persönlichkeitsstörung vom Borderlinetypus ; Dissoziative Störung ; Key words Dissociative identity disorder ; Multiple personality disorder ; Paranoid schizophrenia ; Borderline personality disorder ; Dissociation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Recently the concept of dissociative identity disorder (formerly known as multiple personality disorder) has attracted increasing public and scientific interest. However, it is rarely diagnosed in the clinical setting. The reported case of a 47-year-old woman with a history of child abuse demonstrates the problems of differential diagnosis. A number of psychopathologic symptoms pointed to a multiple personality disorder, but in the follow-up psychotic symptoms such as delusions, possible hallucinations and bizarre behavior clearly emerged. The differential diagnosis of dissociative identity disorder includes paranoid schizophrenia, as in the case described, borderline personality disorder, hysteria, simulation and the false memory syndrome. Finally, social and cultural factors have to be considered.
    Notes: Zusammenfassung In der letzten Zeit ist die dissoziative Identitätsstörung (multiple Persönlichkeitsstörung) zunehmend Gegenstand von öffentlichem und wissenschaftlichem Interesse geworden. Klinisch wird die Diagnose allerdings sehr selten gestellt. Anhand der vorliegenden Kasuistik sollen Schwierigkeiten der differentialdiagnostischen Abgrenzung aufgezeigt werden. Bei einer 47jährigen Patientin, die eigenanamnestisch im Kindesalter schweren psychosozialen Belastungsfaktoren mit Mißbrauch ausgesetzt war, ließen verschiedene psychopathologische Befunde zunächst an eine sog. multiple Persönlichkeit denken. Im Verlauf traten aber zunehmend psychotische Symptome, wie inhaltliche Denkstörungen, bizarres Verhalten und fragliche Halluzinationen in den Vordergrund. In die differentialdiagnostischen Überlegungen sind bei einer dissoziativen Identitätsstörung die paranoide Schizophrenie, wie im beschriebenen Fall, die Persönlichkeitsstörung vom Borderlinetyp, die Hysterie, die Simulation und das „false memory syndrome” einzubeziehen. Schließlich müssen auch Probleme, die sich aus der soziokulturellen Einbettung des Syndroms ergeben, diskutiert werden.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 70 (1999), S. 76-80 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Psychiatrie ; Psychotherapie ; Internet ; Telemedizin ; Cybertherapie ; Key words Psychiatry ; Psychotherapy ; Internet ; Telemedicine ; Cybertherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The Internet is a fast growing medium, which is about to alter our all day life. Most impact is given to advantages of telemedicine to psychiatrists and psychotherapists as well as patients. After introduction of the essential features of the Internet practical aspects of medicine in Cyberspace for psychotherapists, psychiatrists and their patients are shown. Then, the general prohibition of advertisement for physicians is discussed on the bases of actual laws related to Internet activities. Relevant resources of medical information are shown with regard to the detailed facilities of using searchengines. Highlighting opportunities and possible resources of medicine in cyberspace, it is made clear, that the rising interest in telemedicine on Internet is more than justified. Finally, some risks of virtual communication are visible. Important and mentioned Web-sites are listed at the end.
    Notes: Zusammenfassung Das Internet ist im Begriff, zahlreiche Bereiche des zwischenmenschlichen Lebens zu verändern. Im Vordergrund der Betrachtung stehen Aspekte des Internet, die im Rahmen der Psychiatrie und Psychotherapie von aktueller Bedeutung sind. Nach der Einführung in das Wesen der Therapie im Internet werden praktische Aspekte der Medizin im virtuellen Raum für Psychotherapeuten und Psychiater sowie Patienten konkret aufgezeigt. Das Werbeverbot für Ärzte und die gesetzlichen Regelungen zur Selbstdarstellung im World Wide Web werden erörtert. Medizinische Informationsquellen werden aufgezeigt und die Möglichkeit zur detaillierten Suche im Internet erläutert. Schließlich werden einige der Risiken dieser Art der zwischenmenschlichen Kommunikation im Bereich der psychotherapeutischen und psychiatrischen Anwendungen anschaulich. Der Anhang gliedert tabellarisch erwähnte und wichtige Internet-Adressen.
    Type of Medium: Electronic Resource
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  • 7
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 67 (1996), S. 891-895 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Alkohol ; Alkoholhalluzinose ; Pathophysiologie ; Therapie ; Key words Alcohol ; Alcohol hallucinosis ; Pathophysiology ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary In recent years, little research has been focused on alcohol hallucinosis. The psychopathology of alcohol hallucinosis (vivid acoustic hallucinations, paranoid symptoms and fear) resembles paranoid schizophrenia, but other organic mental disorders have to be excluded too. Prognosis is usually good, but in 10–20 % of cases alcohol hallucinosis tends to become chronic. Possible pathophysiological mechanisms involved in the development of the syndrome are changes in dopaminergic transmission or other neurotransmitter systems and neuronal membranes, elevated levels of betacarbolines and an impaired auditory system. For treatment, highly potent neuroleptics (haloperidol) are the drugs of first choice. In the case of alcohol abstinence the prognosis is good, but otherwise the risk of a recurrence is high.
    Notes: Zusammenfassung Unter den Alkoholpsychosen zählt die Alkoholhalluzinose zu den vergleichsweise schlecht untersuchten Krankheitsbildern. Psychopathologisch ähnelt sie der paranoiden Schizophrenie mit den Leitsymptomen akustische Halluzinationen (Stimmenhören), Verfolgungswahn und Angst. Differentialdiagnostisch sind auch ein Alkoholdelir und andere organische Psychosen auszuschließen. Die Prognose ist in den meisten Fällen gut, in ca. 10–20 % der Fälle kommt es aber zu chronischen Halluzinosen, die sich phänomenologisch dann nur schwer von schizophreniformen Psychosen differenzieren lassen. Pathophysiologisch werden neben Veränderungen im dopaminergen System und anderen Neurotransmittern auch die Bedeutung von Betacarbolinen, Veränderung neuronaler Membranen und sensorische Störungen diskutiert. Zur Akutbehandlung sind eher hochpotente Neuroleptika vom Typ des Haloperidol indiziert. Bei Alkoholabstinenz ist die Prognose gut; in anderen Fällen ist mit häufigen Rezidiven zu rechnen.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 67 (1996), S. 896-904 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Alkohol ; Abhängigkeit ; Psychopathologie ; Depression ; Affektive Störungen ; Key words Alcohol ; Dependence ; Psychopathology ; Depression ; Affective disorders
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The frequent comorbidity of psychiatric disorders and alcohol dependence has raised increasing interest in the scientific literature over the last few years. Special attention has been given to the coincidence of depressive syndromes and alcohol dependence. Depressive syndromes can both precede and follow the onset of alcohol dependence. Their diagnostic classification can cause considerable problems. In clinical studies, very different prevalence rates of depressive syndromes in alcohol-dependent persons were found. The frequency of primary depressive syndromes appeared to be substantially smaller than the frequency of secondary depressive syndromes. Epidemiological studies did not point at the exceedingly high comorbidity of affective disorders and alcohol dependence. In this review article, scientific results about possible causes of depressive syndromes in alcohol-dependent persons are demonstrated; genetic and neurobiological links between depression, alcohol dependence and the possible importance of changes in serotoninergic transmission are discussed; methodological problems are described, and implications of the comorbidity problem for treatment planning are presented.
    Notes: Zusammenfassung Die häufige Komorbidität von psychischen Erkrankungen und Alkoholabhängigkeit hat in der wissenschaftlichen Literatur in den letzten Jahren zunehmende Beachtung gefunden. Fokussiert wurde dabei v. a. die Koinzidenz von depressiven Syndromen und Alkoholabhängigkeit. Depressive Syndrome können einer Alkoholabhängigkeit zeitlich vorangehen oder auch folgen. Ihre diagnostische Zuordnung kann erhebliche Probleme bereiten. In klinischen Untersuchungen wurden bei Alkoholikern sehr unterschiedliche Prävalenzraten für depressive Syndrome berichtet. Die Häufigkeit von primär depressiven Syndromen war dabei wesentlich geringer als die sekundär depressiver Syndrome. Epidemiologische Untersuchungen zeigten eine vergleichsweise niedrige Komorbiditätsrate von affektiven Störungen und Alkoholabhängigkeit. In dieser Übersichtsarbeit werden Forschungsergebnisse über mögliche Ursachen depressiver Syndrome bei Alkoholikern dargestellt, genetische und neurobiologische Querverbindungen zwischen Depression und Alkoholabhängigkeit aufgezeigt, die Bedeutung von Veränderungen im serotonergen System diskutiert, methodische Probleme erörtert und Implikationen des Komorbiditätsproblems für die Behandlungsplanung dargelegt.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    Der Nervenarzt 70 (1999), S. 457-462 
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Methadonsubstitution ; Fahrtauglichkeit ; HIV-Infektion ; Key words Methadone substitution ; Driving ability ; HIV-infection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The aim of our experimental study was to gain informations and data on the driving ability of patients undergoing a methadone substitution programme as well as to explore the influence of an HIV infection. 28 patients, five of them HIV-positive, were compared to a control group equal in age, sex and education. For the traffic relevant tests the methadone patients showed significantly reduced performance. Six of the methadone patients passed the tests in a way regarded to have sufficient driving skills. We were unable to prove an influence of HIV infection on driving skills when lacking relevant somatic and neuropsychiatric symptoms. There was no significant correlation between the test results and patients age or dose of medication. We conclude that in general methadone substitution does not implicate driving inability although the majority of our patients showed some reduction of their psychomotoric skills.
    Notes: Zusammenfassung Ziel dieser experimentellen Studie war es, die Fahrtauglichkeit von Patienten unter Methadonsubstitution zu untersuchen, wobei auch der mögliche Einfluß einer HIV-Infektion geklärt werden sollte. Es wurden 28 Methadonpatienten, von denen 5 HIV-infiziert waren, mit einer in bezug auf Alter, Geschlecht und Schulbildung gemachten Kontrollgruppe verglichen. Dabei zeigten sich in den fahrrelevanten psychophysischen Leistungstests bei der Methadongruppe signifikante Einbußen. Einzeln betrachtet hatten 6 Methadonpatienten einen unauffälligen Testbefund und wären somit als fahrtauglich einzustufen. Einen Einfluß der HIV-Infektion auf die Leistungstests, beim Fehlen relevanter somatischer und neuropsychiatrischer Symptome, ließ sich nicht nachweisen. Auch ein Zusammenhang zwischen Testleistung und Alter bzw. Methadondosis konnte nicht festgestellt werden. Das Ergebnis dieser Studie zeigt, daß Methadoneinnahme nicht grundsätzlich mit Fahruntauglichkeit gleichzusetzen ist, sich aber doch bei einer großen Zahl methadonsubstituierter opiatabhängiger Patienten Anhaltspunkte für eine Beeinträchtigung der psychomotorischen Leistungsfähigkeit ergeben.
    Type of Medium: Electronic Resource
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  • 10
    Electronic Resource
    Electronic Resource
    Springer
    Der Internist 40 (1999), S. 590-596 
    ISSN: 1432-1289
    Keywords: Schlüsselwörter Sucht ; Alkoholismus ; Alkoholismus ; Drogenabhängigkeit ; Alkoholismus
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Zum Thema Bezüglich des schädlichen Gebrauchs von Alkohol konkurrieren 2 Klassifikationssysteme, das Diagnostic and Statistic Manual IV der American Psychiatric Society (DSM-IV) und die International Classification of Diseases 10 (ICD-10), die sich im Hinblick auf die diagnostischen Kriterien erheblich, hinsichtlich der Abhängigkeitskriterien aber nur gering unterscheiden. Psychische Faktoren, die eine Voraussetzung zur Abhängigkeit darstellen, werden ausdrücklich genannt. Anstelle früher gebräuchlicher Termini spricht man heute von Mißbrauch und Abhängigkeit. In dieser Übersicht wird über die Begriffsbestimmungen, Alkoholtypologien und wichtigsten diagnostischen Instrumente zur Klassifikation der Alkoholabhängigkeit berichtet.
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