Treatment of the Alcohol Use Disorder at Outpatient Psychiatric Clinic / 신경정신의학

Alcohol use disorder is a kind of chronic illness that is difficult to treat. The disorder often recurs easily and patients visit the outpatient clinic while intoxicated. Therefore, is often too difficult to treat all people of concern, i.e., the caregiver, patient, and doctor, due to the frequent helpless and hopeless relapse. If the patient has severe withdrawal symptoms or poor physical condition, it is very difficult to maintain treatment at an outpatient clinic. On the other hand, many patients abstain or reduce drinking and go on to live a sober life by outpatient-based management. In addition, psychosocial treatment techniques and efficient medications are available at the level of a psychiatric outpatient clinic. Under the scope and limitations of outpatient-based approaches, patients with alcohol use disorder can develop a new life called ‘recovery’ with the help of psychiatrists, by the way of motivating changes, correcting cognitive errors, establishing effective coping skills, utilizing external resources actively, and facilitating healthy roles with their families.

Comparison of Mental Health Act about Involuntary Admission among 4 East Asian Countries / 신경정신의학

OBJECTIVES@#The aim of this study was to explore trends associated with the amendment of The Mental Health Welfare Act by comparing involuntary admission processes in Asian countries.@*METHODS@#We obtained copies of the Mental Health Acts for four East Asian countries ??Korea, Japan, Singapore, and Taiwan (China). We then analyzed the contents of the acts including their definitions of mentally ill patients, the types of hospitalization, and the procedures for involuntary admission.@*RESULTS@#The Japanese provision for involuntary admission was the prototype used for the Korean system prior to the total revision of the Korean system in 2016. Regardless, Korea and Japan still regard family members as pivotal in deciding on involuntary admission. Taiwan and Singapore acts are characterized by the involvement of government or government-designated medical practitioners, not caregivers, in the hospitalization process. In Taiwan, involuntary admission is decided by a judgment of a review committee and is a task of the government. In Singapore, the opinions of experts are considered when making the initial decision on involuntary hospitalization, whereas a judicial decision is essential for extension of that hospitalization.@*CONCLUSION@#Despite cultural and historical similarities, the systems of involuntary admission were considerably different across the countries. We observed a reduction in the role of family guardians and an increase in the use of more objective screening processes. All four countries were in the process of applying those recommendations from international organizations that were in accordance with their society/culture. There may be a need to partially amend The Mental Health Welfare Act in Korea in order to protect the human rights of psychiatric patients while maintaining a stable therapeutic environment.

Operation Status and Improvement Plan of Continuing Hospitalization Judgement System in Mental Health Review Board / 보건행정학회지

BACKGROUND: The recent revision of South Korea's Mental Health Law emphasizes the role of the Mental Health Review Board. For this study, we examined the current status of continuing hospitalization judgement in Mental Health Review Board at the national level and aimed to determine the directions of improvement. METHODS: Using a qualitative case study as the research method, we interviewed 30 Mental Health Review Board members and analyzed the results. RESULTS: Each municipality had very different continuing hospitalization judgement methods. In our systematic review, which consisted of document inspection, we identified reliability problems due to limitations in Mental Health Review Board's operating systems, discharge orders, etc. Additionally, continuing hospitalization judgement needs to improve the objectivity, fairness, and effectiveness of their screening examinations. CONCLUSION: Based on the results of this study, we suggest policy proposals to improve these systems, such as standardizing examination processes, strengthening on-site inspections, increasing the independence and neutrality of judgment in Mental Health Review Board, building community mental health infrastructures, and establishing integrated management systems.

Erratum: The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges / 신경정신의학

This correction is being published to correct the errors and to added missing contents.

The Significance and Limitations of Korean Diagnosis-Related Groups in Psychiatric Inpatients' Hospital Charges / 신경정신의학

OBJECTIVES: This study was conducted to investigate whether the charges associated with Korean Diagnosis-Related Groups for mental health inpatients adequately reflect the degree of medical resource consumption for inpatient treatment in the psychiatric ward. METHODS: This study was conducted with psychiatric inpatients data for 2014 from the National Health Insurance claim database. The main diagnoses required for admission, classification of the hospitals, and main treatment services were analyzed by examining descriptive statistics. Homogeneities of the major diagnostic criteria were assessed by calculating coefficient variances. Explanation power was determined by R2 values. RESULTS: The most frequent disorders for psychiatric inpatient treatment were alcohol-use disorder, depressive episodes, bipolar affective disorder, and dementia in Alzheimer's disease. Hospitalization and psychotherapy fees were the main medical expenses. Regardless of the homogeneity of the disease group, duration of hospital stay was the factor that most influenced medical expenses. In the psychiatric area, explanation power of Korean Diagnosis-Related Groups was 16.52% (p<0.05), which was significantly lower than that for other major diagnostic area. CONCLUSION: Most psychiatric illnesses are chronic, and the density of services can vary depending on illness severity or associated complications. The current Korean Diagnosis-Related Groups criteria did not adequately represent the amount of in-hospital medical expenditures. A novel Korean classification system that reflects the expenditures of medical resources in psychiatric hospitals should be developed in order to provide appropriate reimbursements.

Korean Addiction Treatment Guidelines (III) : Psychosocial Treatment of Alcohol Use Disorder / 신경정신의학

OBJECTIVES: The aim of this study is to develop guidelines for psychosocial treatment of alcohol use disorder. METHODS: According to the ADAPTE manual, the Korean alcohol use disorder treatment guidelines were developed by the guideline development committee. Recommendations from foreign guidelines were evaluated regarding the applicability and acceptability to domestic circumstances. In addition, a survey from experts was conducted, along with a review of Korean literature. By these means, recommendations of psychosocial treatment for alcohol use disorder were established. RESULTS: The main findings of the survey were as follows : 1) Although Group therapy was not recommended by foreign clinical guidelines, it was considered as a first-line treatment by Korean experts. 2) Among many psychosocial treatment programs, cognitive behavior therapy (CBT), coping skills training, 12-step facilitation, and Group therapy were commonly used programs in Korea. Finally, the following treatment methods were selected for recommendations : Group therapy, motivational enhancement treatment, CBT, behavioral self-management, alcoholic anonymous, 12-step facilitation, psychodynamic psychotherapy, psychoeducational intervention, continuous case management, and community residential rehabilitation program. CONCLUSION: Just as in treatment of chronic diseases such as hypertension, continuity is important for management of alcohol use disorder. Therefore, not only pharmacological treatment but also psychosocial treatment should be provided comprehensively after treatment of acute withdrawal symptoms.

Korean Addiction Treatment Guidelines Series (I) : Development of Korean Guidelines for the Treatment of Alcohol Use Disorder / 신경정신의학

OBJECTIVES: The aim of this study is to develop Treatment Guidelines for Alcohol Use Disorder-the Korean Addiction Treatment Guidelines-using the Adaptation method. METHODS AND PROCEDURES: As the Adaptation method of Guidelines, the ADAPTE Manual, which is developed by ADAPTE collaboration is applied. In Part 1 : preparatory work prior to the beginning of Adaptation is performed. In Part 2 : the core phase of the Adaptation in which we searched the guidelines and performed a systematic review of the literature. The two guidelines (of the AU and the UK) are selected by gone through the methodological quality and currency evaluation for guidelines. And, in order to choose the proper recommendations, the contents were evaluated with regard to the applicability and acceptability of guidelines to the domestic. Finally, in Part 3 : the adapted guideline is reviewed externally, with review and plan update. Therefore, in this way, the Korean Guidelines for Treatment of Alcohol Use Disorder, comprised of 55 recommendations, was developed. CONCLUSION: In this study, Korean Guidelines for Treatment of Alcohol Use Disorder were developed by application of the Adaptation method of ADAPTE. These are the first evidence-based Korean Guidelines for Treatment of Alcohol Use Disorder, which were modified and accepted in accordance with Korean circumstances within the range not damaging the validity of the treatment worth, and it is expected to contribute to improvement in quality and efficiency enhancement of Korean treatment of Alcohol Use Disorder.

Korean Addiction Treatment Guidelines Series (II): Pharmacological Treatment of Alcohol Withdrawal / 신경정신의학

OBJECTIVES: In development of Korean addiction treatment guidelines, the aim of this study was to investigate the experts' consensus regarding current pharmacological practice in treatment of alcohol withdrawal. METHODS: Using recommendations from foreign clinical guidelines, which were either lacking in evidence or could not be directly applied to Korea, the executive committee developed a questionnaire consisting of 17 questions. Using a nine-point scale, members of the Korean Addiction Psychiatry, who were experts (n=150) with sufficient experience in treatment of alcohol use disorder, were asked to evaluate the appropriateness of each item on the questionnaire. We classified the experts' opinion according to three categories, based on the lowest scores of 6.5 or greater as a first-line/preferred treatment, 3.5-6.5 as a second-line/reasonable treatment, and lower than 3.5 as a third-line/inappropriate treatment. The consensus was determined by chi-square test (p<0.05). Response rate was 70.4% (81/115). RESULTS: The results of the survey from the experts were as follows: 1) Symptom triggered therapy (STT) was the most appropriate strategy in treatment of alcohol withdrawal (95% CI 7.41-8.04). 2) Prophylactic benzodiazepine was recommended for management of expecting alcohol withdrawal in out-patient-department patients. 3) Among benzodiazepines, lorazepam was the most preferred. 4) For patients with severe withdrawal, lorazepam 7.4 mg/day (95% CI 6.48-8.25, maximum dose=20 mg) was recommended. 5) Risperidone, quetiapine, and haloperidol were the first-line drugs for patients with alcohol withdrawal and combined psychotic symptoms. 6) 127.5 mg (95% CI 111-145) for 2.8 months of prophylactic thiamine and 213.5 mg (95% CI 190-240) for 6.2 months of thiamine for Wernicke-Korsakoff's syndrome were recommended. CONCLUSION: We hope that these Korean addiction treatment guidelines, added by the Korean experts' consensus, will be helpful in promoting the efficacy of treatment for alcohol withdrawal.

Standardization Study of the Korean Version of the Stages of Change Readiness and Treatment Eagerness Scale for Smoking Cessation (K-SOCRATES-S) and Its Predictive Validity

OBJECTIVE: The purpose of the study was to develop the Korean version of the Stage of Change Readiness and Treatment Eagerness Scale for Smoking Cessation (K-SOCRATES-S) based on the Korean version of the Stages of Readiness for Change and Eagerness for Treatment scale (K-SOCRATES). This paper also demonstrates its reliability and validity among patients with nicotine dependence in South Korea. METHODS: At seven healthcare promotion centers in Gyeonggi-do, 333 male smokers aged 20 to 70 who visited smoking cessation clinic were recruited for this study and the K-SOCRATES-S was administered. After three months, the number of respondents who successfully stopped smoking was assessed by testing their urine cotinine level. Subsequently, exploratory factor analysis was performed to verify the reliability and validity of the K-SOCRATES-S. Also, a logistic regression analysis was performed to examine the variables that can predict the successful cessation of smoking on subscales of the K-SOCRATES-S. RESULTS: Exploratory factor analysis of the K-SOCRATES-S showed that the scale consisted of three factors: Taking Steps, Recognition, and Ambivalence. The scales measuring Taking Steps and Recognition in this scale had a significantly positive correlation with the scores observed on Kim's smoking cessation motivation scale. The scales measuring Taking Steps and Recognition had a significantly negative correlation with Ambivalence. Overall, the results indicate that the K-SOCRATES-K scale showed high validity. CONCLUSION: The K-SOCRATES-S developed in the present study is highly reliable and valid for predicting a patient's likelihood of success in quitting smoking among patients who want to cease smoking.

Alcohol-Related Dementia

Chronic alcohol use may have direct or indirect neurotoxic effects on the brain that can lead to cognitive impairment. However, the precise relationship between alcohol and dementia remains unclear. There are several epidemiological studies suggest that the protective effect of light-moderate alcohol drinking in dementia. But obviously the heavy alcohol drinking can lead to brain damage and increase the risk of various types of dementia. The clinicopathological issues and criteria regarding so-called 'alcoholic dementia' remain under debate. Alcohol-induced persisting amnestic disorder, alcohol-induced persisting dementia, and Wernicke-Korsakoff syndrome (thiamine deficiency) may constitute distinct disease entities, but they may also share some common features. Based on this theory, Oslin and colleagues proposed the broader diagnostic scheme and criteria for Alcohol Related Dementia (ARD), which may include cases of Wernicke-Korsakoff syndrome and also other cases of dementia that appear to be alcohol-related. In pathogenesis of the alcoholic dementia, the chronic exposure to ethanol results in the adaptive up-regulation of NMDA receptor sensitivity, which can result in an increased vulnerability to glutamate induced excitotoxicity. Despite the clinical importance of ARD, few medical treatments for ARD have been proposed and studied. Most of all, the gold standard of the treatment in alcoholic dementia is the maintaining abstinence. Some therapeutic trials with cholinesterase inhibitors (donepezil and rivastigmine) and memantine (NMDA receptor antagonist) have been conducted for the patients with Wernicke-Korsakoff syndrome and alcohol-related dementia, and these studies reported favorable outcomes. Especially memantine can be a more effective agent in the treatment of alcoholic dementia because of anti-craving effect reported in several studies.

Agreement between Self-Report on Smoking Cessation and Urinary Cotinine Test / 대한정신약물학회지

OBJECTIVE: Self-report is being used in most of studies investigating the therapeutic effect of smoking cessation clinics of public health centers in Korea instead of cotinine or other chemical markers of nicotine exposure. This study was conducted to evaluate the agreement between self-report and urinary cotinine test after smoking cessation program. METHODS: The study subjects were 333 adult male who visited public health center and participated in 12-week scheduled smoking cessation program. Questionnaires including demographic data and information about cigarette use, blood test, and urinary cotinine test were performed to all subjects during initial evaluation. At the end of the program, smoking status of subjects was assessed by an oral self-report and additional blood and urinary cotinine tests were done to the subjects who agreed. RESULTS: 52 participants who gave both self-report on smoking status and urine sample were included in the final analysis. The overall percentage agreement was 67.3%, and the overall Kappa index was 0.367. The sensitivity, specificity, positive predictive value, and negative predictive value of self-report in detecting smoking state were 46.43%, 91.67%, 86.67%, and 59.46%, respectively. CONCLUSION: The agreement between self-report and urinary cotinine test in detecting smoking status after smoking cessation program was relatively low on account of participants who failed to quit smoking but reported their smoking status incorrectly. Therefore, the use of objective measures such as urine cotinine should be considered in evaluation of successful smoking cessation.

The Effects of Antidepressants on the Leptin, Adiponectin, and Adiponectin Receptor mRNA Expression in Model Diabetogenic Rats / 신경정신의학

OBJECTIVES: Weight gain and glucose intolerance are the most common symptoms of metabolic syndrome. Certain patients complain of weight-change and hyperglycemia after receiving antidepressants. Our study evaluated the effects of antidepressants on serum glucose and energy metabolism. METHODS: Subjects were 32 Otsuka Long-Evans Tokushima Fatty (OLETF) and 35 wild-type Long-Evans Tokushima Otsuka (LETO) rats. From age 11 weeks, the rats were divided into 4 subgroups within each strain. We administered the designated antidepressant-amitriptyline, fluoxetine, or mirtazapine-to these subgroups, allocating the fourth as the control. After exactly 4 weeks' medication, we sacrificed the animals and checked their weight, glucose, insulin, leptin, adiponectin, and expression of adiponectin receptor mRNA. RESULTS: Fluoxetine subgroups in both strains gained the least weight. The glucose, triglyceride, and cholesterol levels of all OLETF antidepressant subgroups did not differ from the controls. Adiponectins in amitriptyline- and mirtazapine-subgroups were higher than control. All antidepressant subgroups showed elevated expressions of adiponectin receptor mRNA in fat, muscle, and the pancreas. CONCLUSION: Amitriptyline and mirtazapine seem to regulate adiponectin and expression of adiponectin receptor mRNA. Even though the underlying mechanisms were different, we conclude none of the antidepressants would have negative influences on energy metabolism in diabetogenic animals.

The Effects of Antidepressants on the Energy Metabolism in LETO Rat / 대한정신약물학회지

Objectives : A diverse range of adverse effects has been linked to the application of antidepressants for the treatment of depressive disorder. Recently, evidence has been emerging of the adverse metabolic effects of antidepressants. This study investigated the effects of antidepressants on plasma glucose and other factors in the fat and muscle tissue relating to metabolism. METHODS : Long-Evans-Tokushima-Ostuka (LETO) rats were used to evaluate the effects of different antidepressants. Amitriptyline, fluoxetine, and mirtazapine were administered to each of three subgroups for 4 weeks, between 11 and 15 weeks old, while a fourth subgroup was administered no antidepressant during the same period. Changes of weight and daily intake were monitored. Tissues and blood were collected at 15 weeks. RESULTS : The fluoxetine subgroup showed lower weight gain and lower food efficacy ratio than did the other subgroups. Blood glucose and other circulating factors showed no significant differences among groups, except for the leptin levels of the fluoxetine subgroup. However, the amitriptyline and mirtazapine subgroups showed similar patterns in the response of mRNA expression of peroxisome proliferator-activated receptors gamma cofactor-1 and uncoupling protein-1, 2, 3. CONCLUSION : These results could indicate possible differences in metabolic response based on the kind of antidepressant used.

Alcohol and Cognitive Disorder / 대한정신약물학회지

Despite epidemiological studies reporting no negative effects of mild to moderate alcohol drinking on cognitive functioning, a recent well-controlled study showed that chronic mild drinking diminished the volume of the brain and was associated with cognitive decline that worsened as a function of the amount of alcohol consumed. Animal studies have demonstrated that neural cell damage follows chronic alcohol intake and withdrawal. In addition, acute excessive alcohol intake has been shown to result in temporary impairment of memory, and chronic alcohol drinking is often related to neuronal damage and cognitive disorders. Even though a diverse spectrum of cognitive disorders can develop after sustained alcohol drinking, no definite diagnostic criteria existed before those proposed by Oslin; the availability of these criteria will provide more structured clinical and academic approaches to alcohol-related cognitive decline, including dementia. In general, diminished cognitive functioning has been related to excessive alcohol consumption, with cognitive functioning gradually recovering over time. With the exception of the administration of thiamine in Wernicke-Korsakoff syndrome, only supportive pharmacotherapies have been provided for patients with alcohol-related cognitive disorders. However, experimental trials with rivastigmine or donepezil have been conducted for special populations with persistent cognitive impairments, and these studies reported favorable outcomes. We administered memantine for alcohol-related dementia and observed improvements in verbal memory and scores on the mini-mental status exam. We anticipate that novel and appropriate therapeutic agents for various conditions in this domain will be developed based on systematic diagnostic criteria and the accumulation of neurobiological evidence about alcohol-related cognitive decline.

Smoking as an Addictive Disorder / 신경정신의학

Nicotine is the major substance that accounts for the addictive nature of smoking. Nicotine induces neurobiological and behavioral responses through diverse neurochemical mechanisms over the central nervous system. The brain reward system, particularly the dopaminergic pathway from the ventral tegmental area to nucleus accumbens, is central to understanding the behavioral reinforcement underlying substance addictions such as the addiction to nicotine. Nicotine acts as an agonist provoking activation or desensitization of nicotinic acetylcholine receptors in different brain areas including the brain reward system. Nicotine also indirectly influences the glutaminergic, GABAergic, noradrenergic, and serotonergic neurotransmission that lead ultimately to activation of the dopaminergic pathway in the brain reward system. Chronic exposure to nicotine activates neuroadaptation and associative learning with the nicotine-related stimulus through dopaminergic or cholinergic systems, which can lead to nicotine dependence or withdrawal. In sum, the neurobiological processes described above are deeply involved in the basis of nicotine dependence and underlie the frequent failure of attempts to quit smoking. In this review we discuss the neurobiological mechanisms of nicotine addiction focusing on the roles of the nicotinic acetylcholine receptor.

Smoking as an Addictive Disorder / 신경정신의학

Nicotine is the major substance that accounts for the addictive nature of smoking. Nicotine induces neurobiological and behavioral responses through diverse neurochemical mechanisms over the central nervous system. The brain reward system, particularly the dopaminergic pathway from the ventral tegmental area to nucleus accumbens, is central to understanding the behavioral reinforcement underlying substance addictions such as the addiction to nicotine. Nicotine acts as an agonist provoking activation or desensitization of nicotinic acetylcholine receptors in different brain areas including the brain reward system. Nicotine also indirectly influences the glutaminergic, GABAergic, noradrenergic, and serotonergic neurotransmission that lead ultimately to activation of the dopaminergic pathway in the brain reward system. Chronic exposure to nicotine activates neuroadaptation and associative learning with the nicotine-related stimulus through dopaminergic or cholinergic systems, which can lead to nicotine dependence or withdrawal. In sum, the neurobiological processes described above are deeply involved in the basis of nicotine dependence and underlie the frequent failure of attempts to quit smoking. In this review we discuss the neurobiological mechanisms of nicotine addiction focusing on the roles of the nicotinic acetylcholine receptor.

Validation Study of Kim's Smoking Cessation Motivation Scale and Its Predictive Implications for Smoking Cessation

OBJECTIVE: The purpose of this study was to develop a scale to measure motivation for smoking cessation. Motivation is known to be important for success of smoking cessation. The reliability of the scale was assessed and its predictive validity for smoking cessation was evaluated. METHODS: We recruited 333 men aged 20 to 70 that visited smoking cessation clinics at seven public health centers. The demographic characteristics were recorded and the Korean version of Stages of Readiness for Change and Eagerness for Treatment Scale for Smoking (K-SO-CRATES-S) performed. A smoking cessation motivation scale was developed with 10 questions based on the theory of motivation enhancement therapy. RESULTS: The motivation scale was composed of four subscales based on the factor analysis; each subscale had an adequate degree of internal consistency. In addition, the newly developed scale had a high degree of validity based on its significant correlation with the smoking version of SOCRATES. Moreover, the precontemplation level of motivation was found to significantly predict the success of smoking cessation. And one of the subscales of the Korean Nicotine Dependence Syndrome Scale (K-NDSS), stereotypy which also significantly predicted the success of smoking cessation, significantly correlated with the preparation 1 and 2 level of motivation. CONCLUSION: The smoking cessation motivation scale with 10 questions that was developed in this study was a highly reliable and valid scale for the prediction of success for smoking cessation for those who wanted to stop smoking.

Validation Study of Kim's Smoking Cessation Motivation Scale and Its Predictive Implications for Smoking Cessation

OBJECTIVE: The purpose of this study was to develop a scale to measure motivation for smoking cessation. Motivation is known to be important for success of smoking cessation. The reliability of the scale was assessed and its predictive validity for smoking cessation was evaluated. METHODS: We recruited 333 men aged 20 to 70 that visited smoking cessation clinics at seven public health centers. The demographic characteristics were recorded and the Korean version of Stages of Readiness for Change and Eagerness for Treatment Scale for Smoking (K-SO-CRATES-S) performed. A smoking cessation motivation scale was developed with 10 questions based on the theory of motivation enhancement therapy. RESULTS: The motivation scale was composed of four subscales based on the factor analysis; each subscale had an adequate degree of internal consistency. In addition, the newly developed scale had a high degree of validity based on its significant correlation with the smoking version of SOCRATES. Moreover, the precontemplation level of motivation was found to significantly predict the success of smoking cessation. And one of the subscales of the Korean Nicotine Dependence Syndrome Scale (K-NDSS), stereotypy which also significantly predicted the success of smoking cessation, significantly correlated with the preparation 1 and 2 level of motivation. CONCLUSION: The smoking cessation motivation scale with 10 questions that was developed in this study was a highly reliable and valid scale for the prediction of success for smoking cessation for those who wanted to stop smoking.

The Comorbidity of Alcohol Dependence and Nicotine Dependence / 대한정신약물학회지

Alcohol and nicotine dependencies are known to be severe disorders on their own and particularly they get worse if they coexist. However, few optimal therapeutic approaches are available for comorbid nicotine and alcohol dependencies, although studies have suggested that more than 95% of alcoholics had comorbid nicotine dependence. Nonetheless patients, caregivers, and even health professionals gave a failure to notice of the health problems caused by nicotine dependence. In addition, some clinicians believe that concomitant intervention of nicotine dependence may have the risks increased during treatments of alcohol dependence, possibly by aggravating symptoms of alcohol dependence or provoking relapse. However, we need to give more attention onto the fact that harmful effects of alcohol and nicotine would be amplified when they coexist. In fact currently available data showed that medical morbidity may be dramatically increased when the two psychiatric conditions coexist. Furthermore, alcoholics have an increased tendency of smoking during a recovery phase from alcohol dependence and even may suffer more complications from smoking. Hence we will review the health risks posed by concurrent alcohol and nicotine dependencies as well as explore the effects of additional smoking cessation therapy on the quitting rate, the alteration of drinking behavior and relapse rate of alcohol dependence, in comorbid alcohol and nicotine patients. Finally proper smoking cessation therapy should be also provided for motivated patients to quit smoking at proper treatment phase and routine clinical advices should be appropriately provided for patients who are not motivated to quit smoking as well in clinical practice.

Pharmacological Treatment in Alcohol-induced Cognitive Disorder

Alcohol-induced cognitive disorder is a very severe problem in problem alcohol drinker and alcohol itself seems to be one of the main causalities in the development of senile dementia. However, the spectrum of alcohol induced cognitive disorder is quite broad, for example, it covered from alcohol-induced persistent amnestic disorder to Wernicke-Korsakoff syndrome and alcohol-induced persistent dementia. By that reason, broad spectrum of cognitive impairment by excessive alcohol drinking is regarded as alcohol related dementia. The pharmacological treatment is not well established yet in alcohol related dementia, except Wernicke-Korsakoff syndrome which is definitely related to thiamine deficiency. Therefore we introduced that some reports about the clinical efficacies by rivastigmine or donepezil trial and recent outcomes of memantine trial by authors in this review.