ABSTRACT
Disulfiram has been used for the treatment of alcohol dependence for nearly 65 years and is approved by the Food and Drug Administration. It causes negative reinforcement by accumulating toxic acetaldehyde due to irreversible inhibition of aldehyde dehydrogenase. Disulfiram has very few side effects when taken without alcohol. Epileptic seizure induction is a rare side effect in therapeutic doses, and its mechanism is unknown. We present a patient with a single epileptic seizure which was thought to be due to disulfiram used in the treatment of alcohol dependence. We did not find it ethical to administer disulfiram again because the patient discontinued alcohol use and was afraid of epileptic seizures.
Subject(s)
Humans , Acetaldehyde , Alcoholism , Aldehyde Dehydrogenase , Disulfiram , Epilepsy , Reinforcement, Psychology , United States Food and Drug AdministrationABSTRACT
ABSTRACT Objective The objective of this study was to replicate Babor's Typology and to explore clinical features related to personality traits that may underlie this classification, in order to improve its therapeutic possibilities. Methods Observational prospective study on a group of 273 male alcoholics. After a replication of Babor's variables, Cluster Analysis, Chi-Square – applied on clinical variables related to a Lappda Tipology – and Kappa tests were performed. Results The study identified two distinct clusters that held similar features to those described for the Type A/Type B classification. Besides presenting a lower socio-economic situation, Cluster 2 patients were associated with higher vulnerability and severe clinical features and also differed from Cluster 1 in their response to treatment. These replicated clusters retained connections and also differences in relation to the variables derived from the Lappda Typology. Conclusion Considering that each of the two replicated clusters seem to be associated to different personality traits – according to their correlations to the affective, cognitive and behavioral dimensions brought forward by the Lappda Typology – it is acceptable that this study may contribute to the development of more comprehensive and effective therapeutic strategies specifically tailored to target more specific personality traits of these subgroups of alcoholic patients.
RESUMO Objetivo O objetivo deste estudo foi replicar a tipologia do Babor e explorar características clínicas relacionadas a traços de personalidade que podem estar subjacentes a essa classificação, a fim de melhorar suas possibilidades terapêuticas. Métodos Estudo observacional prospectivo em um grupo de 273 alcoolistas masculinos. Depois de uma replicação das variáveis de Babor, foram realizados Análise de Cluster, testes de Qui-quadrado — aplicados em variáveis clínicas relacionadas com uma tipologia desenvolvida pelo Lappda — e testes Kappa. Resultados O estudo identificou dois clusters distintos que mantiveram características semelhantes àquelas descritas na classificação Tipo A/Tipo B. Além de apresentar uma pior situação socioeconômica, os pacientes do Cluster 1 foram associados a maior vulnerabilidade e a características clínicas de maior gravidade; e também diferiram do Cluster 2 em sua resposta ao tratamento. Esses clusters replicados mantiveram conexões e também diferenças em relação às variáveis derivadas da tipologia do Lappda. Conclusão Considerando que cada um dos dois clusters replicados parece estar associado a diferentes traços de personalidade - de acordo com suas correlações a dimensões afetivas, cognitivas e comportamentais identificadas pela tipologia Lappda - é aceitável que este estudo possa contribuir para o desenvolvimento de estratégias terapêuticas mais abrangentes e eficientes, especificamente dirigidas a traços da personalidade mais específicos desses subgrupos de pacientes alcoolistas.
ABSTRACT
OBJECTIVES: The patient with alcohol dependence needs continuing care in an outpatient treatment setting. This naturalistic retrospective study is the first report investigating the long-term follow-up rate and predictors of outcome in outpatient-based alcoholism treatment in Korea. METHODS: We conducted a chart review of patients, who visited a university-affiliated hospital alcohol clinic from 2005 to 2007. All patients diagnosed with alcohol dependence were enrolled. Patients were evaluated using a customized alcoholism evaluation package. Demographic factors, clinical data and self rating scales were included in the evaluation form. RESULTS: Of 109 patients, 27 (24.8%) adhered to our outpatient-based treatment for 30 months. The mean follow-up duration of participants was 11.1 months. A Kaplan-Meier survival analysis showed that comorbidity, initial treatment on admission, previous treatment history and family history made a significant difference to follow-up duration. Age, sex, alcohol history, motivation, AUDIT-K, BDI, BAI and RTCQ-TV were not significantly associated with follow-up duration. CONCLUSION: Comparing to outcomes of previous inpatient alcohol treatment in Korea, long term follow-up rate in outpatient treatment was superior, and abstinence/controlled drinking rate is not inferior. This finding suggests that outpatient based alcoholism treatment has sufficient efficacy.