Identification of potential hub genes involved in alcohol use disorder via bioinformatics analysis / 四川精神卫生

BackgroundAlcohol use disorder （AUD） is a type of chronic relapsing brain disorder. Genetic factors play an important role in the pathogenesis of AUD. And screening for molecular markers of AUD is of great significance for further elucidating the pathogenesis of the disease， discovering novel therapeutic targets and preventing relapse. ObjectiveTo explore relevant hub genes and potential signal pathways associated with the development of AUD through bioinformatics analysis， and to provide a new direction for the prevention and treatment of AUD. MethodsThe GSE161986 dataset was acquired from the Gene Expression Omnibus （GEO） database. The limma package in R was utilized to identify differentially expressed genes （DEGs）. Gene set enrichment analysis （GSEA） was carried out using the Database for Annotation， Visualization and Integrated Discovery （DAVID）. A protein–protein interaction （PPI） network of DEGs was assessed using the STRING database and visualized by Cytoscape software. Finally， hub genes were validated in GSE44456 dataset. ResultsA total of 114 DEGs were identified. GSEA revealed that these genes were mainly involved in the regulation of signal transduction， protein binding， membrane trafficking and MAPK signaling pathway. PPI network and validation study indicated that GAD1， TIMP1 and CD44 were potential hub genes involved in AUD. ConclusionAberrant expression of GAD1 and TIMP1 as well as MAPK signaling pathway may play a key role in the pathogenesis of AUD， and may serve as potential molecular targets for the diagnosis and treatment of AUD. ［Funded by "Flying Project" of Shanghai Mental Health Center （number， 2022-FX-01）］

Fatores associados à exposição ao HIV em usuários de álcool / Factors associated with HIV exposure in alcohol users

Introdução: A prevalência de HIV é maior em Porto Alegre comparada ao restante do país. O abuso de álcool afeta o juízo crítico, sendo associado a comportamentos de risco que podem levar à contaminação pelo HIV. Objetiva-se analisar fatores associados à exposição ao HIV em alcoolistas com práticas sexuais de risco comparando com aqueles que se previnem.Métodos: Estudo transversal com 126 homens alcoolistas (HIV negativo), divididos em 2 grupos: Exposto Sexual (n = 42) e Pouco Exposto Sexual (n = 84), considerando uso de preservativo e número de parceiros sexuais.Resultados: A maioria dos sujeitos do grupo Exposto Sexual era solteiro, sem ocupação laboral, com histórico de moradia de rua e de relação com profissional do sexo, apresentavam maior preocupação com infecção por HIV (p < 0,05).Conclusão: Sugere-se o desenvolvimento e monitoramento de intervenções preventivas específicas, considerando as características do abuso de álcool e seu papel na transmissão do HIV.

Introduction: The HIV prevalence is higher in Porto Alegre compared to other capitals in Brazil. Alcohol abuse affects critical judgment, being associated with risky behaviors that can lead to HIV infection. Aim:To analyze factors associated with exposure to HIV in alcohol users, comparing those with risky sexual practices and those who use prevention methods.Methods: Cross-sectional study with 126 male alcohol users (HIV negative), divided into 2 groups: Sexually Exposed (n = 42) and Less Sexually Exposed (n = 84), considering condom use and number of sexual partners.Results: Most subjects in the Sexually Exposed group were single, without a job, with a history of homelessness and a relationship with a sexual worker, and were more concerned about HIV infection (p < 0.05).Conclusion: The development and monitoring of specific preventive interventions is suggested, considering the characteristics of alcohol abuse and its role in HIV transmission.

Recaída en el consumo de alcohol después del trasplante de hígado por hepatopatía alcohólica / Alcohol relapse after liver transplantation for alcoholic liver disease

Introducción. La enfermedad hepática inducida por uso de alcohol se ha considerado una enferme-dad autoinfligida que limitaba el acceso al trasplante. Actualmente es una de las principales indicacio-nes de trasplante hepático en Colombia y el mundo, con excelente sobrevida. Metodología. Estudio descriptivo observacional donde se realizó una caracterización de los pacientes con trasplante hepá-tico por hepatopatía alcohólica en una institución de cuarto nivel, que incluyó un estudio cualitativo de la recaída en el consumo de alcohol postrasplante. Resultados. De 87 pacientes de una cohorte inicial de 96 pacientes trasplantados entre 2003 y 2021, se describieron características sociodemo-gráficas, comorbilidades previas y adquiridas posterior al trasplante, supervivencia del paciente y del injerto, y factores de riesgo asociados al consumo de alcohol. Adicionalmente, a 65 pacientes se les pudo realizar una entrevista estructurada para evaluar la recaída en el consumo de alcohol, 41,53 % volvieron a consumir alcohol; 23,07 % en patrón de riesgo de recaída y 18,46 % en patrón de slip (desliz). El antecedente de hepatitis alcohólica tuvo un RR de 3,273 (1,464­7,314) y p=0,007 para recaída en el consumo de alcohol, y la comorbilidad psiquiátrica un RR de 2,395 (1,002­5,722) y p=0,047. Finalmente, haber presentado al menos una recaída postrasplante tuvo un RR de 5,556 (1,499­20,588) con p=0,005 para rechazo del injerto. Conclusiones. La recaída en el consumo de alcohol fue frecuente, la hepatitis alcohólica previa y la comorbilidad psiquiátrica son factores de riesgo asociados. La recaída se asoció a rechazo del injerto sin afectar la sobrevida del paciente.

Introduction. Alcohol-induced liver disease has been considered a self-inflicted disease that limited access to transplantation. It is currently one of the main indications for liver transplantation in Colom-bia and the world, with excellent survival. Methodology. Observational descriptive study where a characterization of liver transplant patients due to alcoholic liver disease was carried out in a fourth level institution, which included a qualitative study of relapse in post-transplant alcohol consumption. Results. Of 87 patients from an initial cohort of 96 transplant patients between 2003 and 2021, sociodemographic characteristics, previous and acquired post-transplant comorbidities, patient and graft survival, and risk factors associated with alcohol consumption were described. Additionally, 65 patients were able to undergo a structured interview to assess relapse in alcohol consumption, 41.53% returned to alcohol consumption; 23.07% in risk relapse pattern, and 18.46% in slip pattern. The history of alcoholic hepatitis had a RR of 3.273 (1.464-7.314) and a p=0.007 for relapse in alcohol consumption, and psychiatric comorbidity a RR of 2.395 (1.002-5.722) and a p=0.047. Finally, having presented at least one post-transplant relapse had a RR of 5.556 (1.499-20.588) with ap=0.005 for graft rejection. Conclusions. Relapse in alcohol consumption was fre-quent, previous alcoholic hepatitis and psychiatric comorbidity were associated risk factors. Relapse was associated with graft rejection without affecting patient survival.

Internações por transtornos mentais e comportamentais devidos ao uso de álcool no Brasil e regiões: análise de tendência temporal, 2010-2020 / Hospitalizaciones por trastornos mentales y de conducta por consumo de alcohol en Brasil y regiones: análisis de tendencia temporal, 2010-2020 / Hospitalizations for mental and behavioral disorders due to alcohol use in Brazil and regions: a temporal trend analysis, 2010-2020

Objective: to analyze the trend in hospitalization rates for mental and behavioral disorders due to alcohol use (ICD-10: F10.0), Brazil and its five regions, 2010-2020. Methods: this was an ecological time-series study using data from the Hospital Information System of the Brazilian National Health System; to calculate the trend in hospitalizations, we used the Prais-Winsten generalized linear regression model and the Stata Statistical Software 14.0; a decreasing trend was considered when p-value < 0.05, and the regression coefficient was negative. Results: in the period analyzed, there were 423,290 hospitalizations for mental and behavioral disorders due to alcohol use in the country; the data analyzed showed a decreasing trend in adult hospitalization rates for this cause in the country (p-value < 0.001; 95%CI -0.094;-0.079) and in all its regions, for both sexes (p-value < 0.001). Conclusion: hospitalizations for mental and behavioral disorders due to alcohol use have reduced in Brazil and in its macro-regions.

Objetivo: analizar la tendencia de las tasas de hospitalizaciones por trastornos mentales y comportamentales debidos al consumo de alcohol (CID-10 F10.0) en Brasil y sus regiones, entre 2010 y 2020. Métodos: estudio de series temporales ecológicas, con datos extraídos del Sistema de Información Hospitalaria del Sistema Único de Salud. Se utilizó la regresión lineal generalizada de Prais-Winsten para calcular la tendencia de las hospitalizaciones; los análisis se realizaron con el software Stata 14.0. La tendencia se consideró descendente cuando p-valor < 0,05 y coeficiente de regresión negativo. Resultados: 423.290 hospitalizaciones ocurrieron en Brasil en el período. Los datos analizados permitieron observar una tendencia decreciente en las tasas en adultos por esta causa en Brasil (p-valor < 0,001; IC95% -0,094;-0,079) y en todas las regiones para ambos sexos (p-valor< 0,001). Conclusión: hubo una reducción en las hospitalizaciones por trastornos mentales y comportamentales debido al consumo de alcohol en Brasil y regiones.

Objetivo: analisar a tendência das taxas de internações por transtornos mentais e comportamentais devidos ao uso de álcool (CID-10: F10.0), Brasil e suas cinco regiões, 2010-2020. Métodos: estudo ecológico de série temporal, com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde; para o cálculo da tendência de internações, utilizou-se a regressão generalizada linear de Prais-Winsten e o software estatístico Stata 14.0; considerou-se tendência declinante quando p-valor < 0,05, com coeficiente da regressão negativo. Resultados: no período analisado, ocorreram 423.290 internações por transtornos mentais e comportamentais decorrentes do uso do álcool, no país; os dados analisados permitiram observar uma tendência declinante das taxas de internação de adultos por essa causa no país p-valor < 0,001; IC95% -0,094;-0,079) e em todas as suas regiões, para ambos os sexos (p-valor < 0,001). Conclusão: as internações por transtornos mentais e comportamentais devidos ao uso de álcool se reduziram, no Brasil e em suas macrorregiões.

Perceived discrimination and alcohol consumption in an indigenous population / Discriminación percibida y consumo de alcohol en una población indígena

Abstract Introduction Indigenous populations are considered a vulnerable minority and have characteristics such as poverty, difficulties to access food, housing, and educational backwardness; these conditions make them prone to alcohol consumption problems. Dependence on alcohol consumption probably arises as a symbol of protest, challenge, and response to social anguish, which has in turn repercussions in marginal population sectors that have conditions of fragility due to exploitation and discrimination, such as indigenous people. Objective To know the effect of perceived discrimination on alcohol consumption in Mexican indigenous population. Method Research design was descriptive, correlational check-model, with a sample of 362 adults from two indigenous communities. Results A simple linear regression model was performed, which shows a significant effect in the entire model (F[248] = 78.312, p = .001), which explains 49% of the variance of alcohol consumption. A significant positive influence was also found from the perceived discrimination variable (β = .626, p < .001) on alcohol consumption. Discussion and conclusion The studied indigenous communities had characteristics that the literature highlights as risk factors for developing addictive behaviors of alcohol consumption. These results coincide with those of the National Commission for the Development of Indigenous Peoples. Indigenous population present discrimination problems that are associated with alcohol consumption problems.

Resumen Introducción Las poblaciones indígenas se consideran minoritarias y vulnerables, y se caracterizan por su pobreza, dificultad para acceder a la alimentación, la vivienda y el rezago educativo. Estas condiciones los vuelven propensos a presentar problemas de consumo de alcohol. La dependencia al consumo de alcohol surge probablemente como símbolo de protesta, reto y respuesta a la angustia social, lo cual repercute en los sectores poblacionales marginales que poseen condiciones de fragilidad por la explotación y discriminación como los pueblos indígenas. Objetivo Conocer el efecto de la discriminación percibida en el consumo de alcohol en poblaciones indígenas mexicanas. Método El diseño del estudio fue descriptivo, correlacional de comprobación de modelo, con una muestra de 362 adultos de dos comunidades indígenas. Resultados Se realizó el modelo de regresión lineal simple el cual muestra efecto significativo en la totalidad del modelo (F[248] = 78.312, p = .001), explica el 49% de la varianza del consumo de alcohol, además se encontró influencia positiva significativa de la variable discriminación percibida (β = .626, p < .001) sobre el consumo de alcohol. Discusión y conclusión Las comunidades indígenas estudiadas poseen características que la literatura destaca como factores de riesgo para desarrollar conductas adictivas de consumo de alcohol, estos resultados coinciden con lo expuesto por la Comisión Nacional para el Desarrollo de los Pueblos Indígenas. Las poblaciones indígenas presentan problemas de discriminación que se asocian con los problemas de consumo de alcohol.

Research progress on mechanism of comorbid alcohol use disorder and depressive disorder / 四川精神卫生

In this paper， the latest research progress on the mechanism of comorbid alcohol use disorder and depressive disorder at home and abroad is elucidated from genetic， neurochemical， neuroendocrine and neuroimmunologic perspectives. It aims to identify the gaps in current research and predict future research directions， providing a further basis for the clinical management of comorbid alcohol use disorder and depressive disorder.

Contingency Management applied to Alcohol Use Disorder: Systematic Review / Manejo de Contingência Aplicado ao Transtorno por Uso de Álcool: Revisão Sistemática

Abstract This systematic review evaluated the efficacy of applying Contingency Management (CM) to Alcohol Use Disorder. We followed the PRISMA recommendation and consulted the following databases: Cochrane Library, MEDLINE Complete, PsycINFO and Pubmed. A total of eight randomized controlled trials were included in this review, all of them with good methodological quality. In seven of these, CM was more effica​cious in promoting continuous abstinence. Both trials that evaluated treatment retention found statistically significant results favorable to CM. On two of the three trials presenting follow-up results, CM was more efficacious in promoting abstinence. The large-scale application of CM can promote substantial public health improvements and should be encouraged.

Resumo Esta revisão sistemática avaliou a eficácia do Manejo de Contingência (MC) no tratamento do Transtorno por Uso de Álcool. Para isso, foi utilizada a recomendação PRISMA e consultadas as bases de dados: Cochrane Library, MEDLINE Complete, PsycINFO e Pubmed. Foram incluídos oito ensaios clínicos randomizados nesta revisão. Em sete, o MC foi mais eficaz em promover abstinência continuada. Dos dois que avaliaram a retenção no tratamento, ambos encontraram resultados estatisticamente favoráveis ao MC. Dos três que apresentaram resultados de avaliação de seguimento, em dois o MC foi mais eficaz em promover abstinência. Todos apresentaram boa qualidade metodológica. A aplicação do MC em larga escala pode promover melhorias substanciais para a saúde pública e deve ser encorajada.

Effects of repetitive transcranial magnetic stimulation on attention to the cues for male patients with alcohol use disorder after acute withdrawal / 中华行为医学与脑科学杂志

Objective:To investigate the effect of high-frequency repetitive transcranial magnetic stimulation(rTMS)on cue attention in male patients with alcohol use disorder (AUD) after the acute withdrawal.Methods:A total of 90 male patients AUD who were hospitalized in the Second Affiliated Hospital of Kunming Medical University and Psychiatric Hospital of Yunnan province from May 2020 to December 2020 were enrolled, then they were divided into study group and control group using random number table.Because 18 cases fell out during the study, 36 cases were included in each of the two groups.After the alcohol withdrawal syndrome eliminated, the study group received high-frequency rTMS at 10 Hz for 14 consecutive days, and the control group was administrated by sham rTMS.At baseline and after true or sham rTMS, the cognitive psychology experiment Oddball paradigm was completed, and the behavioral data of the subjects were collected.Paired-sample t-test was used to compare the changes of the two groups before and after treatment.Data analysis were conducted using SPSS 21.0 software. Results:There was no statistical difference between the study group and the control group in terms of drinking level, cognition level and demographic data(all P>0.05). In the Oddball paradigm, compared with the control group((526.72±75.30)ms, (0.98±0.02))the reaction time((497.93±64.51)ms, t=3.145, P=0.008) and accuracy rate((0.99±0.01), t=-2.803, P=0.016) in alcohol-related cues were significantly improved in the study group after rTMS intervention, but in the control group, there were no statistical differences(both P>0.05), whether the cue was alcohol related or not. Conclusion:The results suggest that the rTMS can enhance the attention bias of alcohol-related cues and change the impulse process partly.

The Relation between Behavioral, Emotional and Cognitive Apathy and Everyday Executive Dysfunction in Alcoholic Korsakoff's Syndrome

ABSTRACT Background: Apathy is an important neuropsychiatric symptom in alcohol-related cognitive impairment in general, and Korsakoff's syndrome in specific. However, research in patients with Korsakoff's syndrome on the multifaceted nature of apathy is lacking. Objectives: Aim of the current study was to examine behavioral, cognitive and emotional apathy in alcoholic Korsakoff patients, also investigating the association with overall cognitive and executive dysfunction. Methods: We studied 43 patients with Korsakoff's syndrome (mean age 60.9, SD=6.5, range 38-70) using the Apathy Evaluation Scale - Informant Version (AES-I) and also administered the Montreal Cognitive Assessment and the Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) as a measure of daily executive problems. Results: In our sample, 76% of the Korsakoff patients were classified as being apathetic. AES-I scores correlated with overall cognitive function and were related to observer-rated daily executive problems. Discussion: Apathy is highly prevalent in Korsakoff patients and related to overall cognitive dysfunction and everyday executive problems. Our results stress the need to further examine underlying mechanisms of apathy in Korsakoff patients and the need for interventions aimed at reducing apathy.

The correlation of HDAC2 polymorphisms with alcohol use disorder in male people of Han nationality / 中华行为医学与脑科学杂志

Objective:To explore the association between polymorphism of Histone Deacetylase 2 (HDAC2) gene and alcohol use disorder (AUD) in male people of Han nationality for seeking suitable single nucleotide loci(SNP), and provide reference for early diagnosis and intervention of alcohol use disorder(AUD).Methods:A total of 194 male AUD patients of Han nationality (case group) and 310 normal men of Han nationality (control group) were selected for the study. The genomic DNA of peripheral blood of the subjects in the two groups was extracted, and 13 SNP loci of HDAC2 gene were obtained from HapMap database. The subjects in the two groups were genotyped by Agena MassARRAY SNP genotyping method.SPSS 25.0 was used to statistically analyze the differences of genotype frequency and allele frequency between the two groups, and Haploview 4.2 software was used for linkage disequilibrium and haploid analysis. The multiple test correction was carried out by the replacement test with 50 000 replacement times.Results:The genotype frequency of the 3 SNP loci(rs9481408, rs6568819, rs9488289) of HDAC2 gene were statistically significant different between the case group and the control group (all P<0.05). Further analysis found that the three loci were significantly correlated with AUD in the recessive genetic model between case group and control group(T/T vs C/C-C/T: OR=1.78, 95% CI: 1.05-3.03, P=0.033; T/T vs C/C-C/T: OR=1.79, 95% CI: 1.05-3.03, P=0.032; G/G vs C/C-C/G: OR=1.85, 95% CI: 1.09-3.13, P=0.022). Seven SNP haplotypes were constructed and the association odds ratio of GATCTGCAATAA between the case group and control group was 2.44, and the difference was statistically significant ( P<0.05). Conclusion:The SNP loci rs9481408, rs6568819, rs9488289 in the HDAC2 gene and haplotype GATCTGCCAATAA are associate with AUD in male people of Han nationality. These results indicated that the HDAC2 gene is one of the susceptibility genes of AUD.

Associated Factors Of Alcohol Use Disorder Among Men Who Have Sex With Men

@#Introduction: Considerable evidence exists that Man who have Sex with Men (MSM) experiences worse health disparities compared to the general population across the globe including higher rates of alcohol use disorder. This review summarized the available primary research information to provide a comprehensive understanding of the factors associated with Alcohol Use Disorder among MSM. Methods: A literature review of PubMed articles was done. A total of 85 papers about the MSM population were displayed. Twelve articles about Alcohol Use Disorder among MSM were reviewed to extract its associated factors. Afterward, these factors were arranged by themes. Results: The associated factors of Alcohol Use Disorder among the MSM were social and demographic factors, abuses, sexual behaviors, HIV-related factors, other mental health conditions, and previous Alcohol Use Disorder treatment. Conclusions: Some of the factors associated with Alcohol Use Disorder among MSM may be similar to the general population, while others may be unique to the MSM population. The associations between Alcohol Use Disorder and these factors may be explained by Alcohol’s biological factors, adverse social experiences based on their sexual minority background, cultural differences, and coping styles. These factors may also increase the risk of MSM for other

Associações entre polimorfismos genéticos da álcool: desidrogenase e o transtorno por uso de álcool / Associations between genetic polymorphisms of alcohol: dehydrogenase and alcohol use disorder

O transtorno por uso de álcool (TUA) é influenciado pela genética, principalmente na metabolização do etanol. Os genes da álcool desidrogenase (ADH1B/ADH1C), enzima que transforma o etanol, apresentam SNPs (single nucleotide polymorphisms) que resultam em isoenzimas com diferentes taxas catalíticas. Estudos demonstraram que os SNPs Arg48His, Arg370Cys, Arg272Gln e Ile350Val contribuem para o TUA. Este artigo revisou os estudos que investigaram SNPs em ADH1B (Arg48His/Arg370Cys) e ADH1C (Arg272Gln/Ile350Val), bem como avaliou as variações nas frequências alélicas desses genes e a influência no TUA nas diferentes populações no mundo. As frequências alélicas dos polimorfismos foram comparadas pelos testes qui-quadrado de Pearson e exato de Fisher (p < 0,05). O SNP Arg48His confere proteção para o TUA em euroamericanos, latino-americanos, europeus, brasileiros, asiáticos e australianos. O SNP Arg370Cys confere proteção para o TUA em afrodescendentes. Os SNPs Arg272Gln e Ile350Val predispõem o TUA principalmente em europeus. Os SNPs Arg48His, Arg370Cys e Arg272Gln/Ile350Val foram mais frequentes em amostras de leste-asiáticos (69,7%), africanos (19,1%) e europeus (40,5%), respectivamente (p < 0,01). Os diferentes alelos dos genes ADH1B/ADH1C devido a SNPs têm uma importante contribuição no TUA. As frequências desses alelos variam conforme a população, resultando em diferentes efeitos no TUA. (AU)

Alcohol use disorder (AUD) is influenced by genetics, especially in the metabolism of ethanol. The ethanol dehydrogenase genes (ADH1B/ADH1C), which convert ethanol, have single nucleotide polymorphisms (SNPs) that result in isoenzymes with different catalytic rates. Studies have shown that the Arg48His, Arg370Cys, Arg272Gln, and Ile350Val SNPs contribute to AUD. This article reviewed the studies that investigated SNPs in ADH1B (Arg48His/Arg370Cys) and ADH1C (Arg272Gln/Ile350Val) and evaluated variations in the allele frequencies of these genes and their influence on AUD in different populations worldwide. The allele frequencies of the polymorphisms were compared by Pearson's chi-square and Fisher's exact tests (p < 0.05). The Arg48His SNP provides protection against AUD in Euro-Americans, Latin Americans, Europeans, Brazilians, Asians, and Australians. The Arg370Cys SNP provides protection against AUD in Afro-descendants. The Arg272Gln and Ile350Val SNPs predispose to AUD mainly in Europeans. The Arg48His, Arg370Cys, and Arg272Gln/Ile350Val SNPs were more frequent in East Asians (69.7%), Africans (19.1%), and Europeans (40.5%), respectively (p < 0.01). The different alleles of the ADH1B/ADH1C genes due to SNPs make an important contribution to AUD. The frequencies of these alleles vary among different populations, resulting in different effects on AUD..(AU)

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.

Neurobiological Basis of Craving and Anti-Craving Medications / 신경정신의학

Clinical studies published over the past two decades have consistently demonstrated the therapeutic efficacy and safety of anti-craving medications. To use anti-craving agents more effectively in clinical settings, it is important to set clear treatment goals. Because alcoholic patients have lost control of drinking alcohol, it is recommended to set ‘abstinence’ as a goal rather than ‘controlled drinking’. Indeed, the therapeutic effects of anti-craving medication are higher when abstinence is set as the target. On the other hand, if abstinence is the sole criterion, it is difficult to elicit the motivation of a patient who lacks motivation in clinical practice. In the case of patients who have not yet gained insight, the initial goal might be set to gradually reduce the amount of alcohol consumed and prevent at-risk heavy drinking. Even in this case, anti-craving can help clinically. To increase the effectiveness of anti-craving medications, it is best to start at least four to seven days after the patient has stopped drinking. If the patient has alcohol withdrawal symptoms, they should be treated first.

Motivational Enhancement Therapy and Cognitive Behavioral Therapy for Alcohol Use Disorders / 신경정신의학

Alcohol use disorder (AUD) has the highest prevalence and lowest treatment rate of all mental disorders in Korea. Over the last 30 years, there has been significant progress in the development and validation of cognitive behavioral treatments and motivational enhancement approaches for AUD. The goal of psychosocial treatment is to help patients control their urges to use alcohol and remain abstinent by preventing relapse. This review explored first, motivation enhancement therapy, which is an approach to help people with alcohol problems and improve their motivation for change, and second, cognitive behavioral theories for AUD, including practical therapeutic effects, treatment principles, and various treatment methods and techniques. These treatment modalities are particularly useful for patients with AUDs with insufficient or poor compliance. In addition, these treatment models, which enhance the motivation of patients with chronic psychiatric illness, including AUDs and improve the efficacy and effectiveness through a clear intervention approach to the targeted problems, have been transformed into various other forms. Recently, there have been many studies on various online platforms, such as web-based and virtual reality, which are easy to access, and these treatment models are likely to become more important in the psychiatric field in the future.

A study on the attention networks dysfunction and its influencing factors in the patients with alcohol use disorder / 中华行为医学与脑科学杂志

Objective To explore the impairment of attention network function in male patients with alcohol use disorder(AUD) and the main influencing factors of attention network function. Methods Forty-one patients with AUD after withdrawal therapy and 34 healthy controls (HC) matched with their demograph-ic data were selected as subjects of study. Attention function were assessed by attention network test (ANT). Results Compared with the healthy control group((30. 62±19. 74)ms,(98. 59±1. 46)%),there were sig-nificant differences in the reaction time of alerting network(t=-2. 479,P=0. 015) and the correct rate of the attention network test(t=-2. 074,P=0. 044) in the AUD group((17. 02±26. 42)ms,( 95. 07±10. 73)%). Pearson correlation analysis showed the alert network of AUD was negatively correlated with the age of first drinking(r=-0. 316,P=0. 044) and was positively correlated with the score of Penn alcohol craving scale (PACS) (r=0. 364,P=0. 019). The correct rate of attention network function in patients with AUD was negatively correlated with the years for education ( r=-0. 343, P=0. 028) and years for addiction ( r=-0. 337,P=0. 031). Linear regression analysis showed the attention network function of AUD patients was affected by the age of first drinking(β=0. 432,t=2. 079,P=0. 046),the years for addiction(β=-0. 555,t=-3. 127,P=0. 004) and years for uncontrol drinking(β=0. 309,t=2. 074,P=0. 047). Conclusion The AUD patients were demonstrated deficit in the alerting network. The impairment of attention function of AUD patients were influenced by their drinking condition.

Effect of neurokinin-1 receptor antagonist on alcohol reward in juvenile mice / 中华行为医学与脑科学杂志

Objective To examine the effect of NK1 receptor ( NK1R) antagonist L-703,606 on ethanol-induced conditioned place preference (CPP) and levels of NK1R protein in different brain regions in juvenile mice. Methods Four-week-old male C57BL/6 mice were divided into high anxiety group and low anxiety group according to the percentage of time spent in open arms of elevated plus maze(EPM). Then the mice in the two groups were divided into control group and experimental group according to random number table,which were high anxiety control group,high anxiety experimental group,low anxiety control group and low anxiety experimental group,with 11 in each group. L-703,606 was injected intraperitoneally 40 minutes before CPP training in the high and low anxiety experimental group,while the control group received solvent treatment. After CPP test,the anxiety level of four groups of mice was detected by EPM again. The expres-sion of NK1R protein in hippocampus,prefrontal lobe and amygdala of mice was detected by Western blot. Results Compared with the high anxiety control group, the CPP value of the high anxiety experimental group was lower,and the difference was statistically significant ((77. 7 ± 9. 3) s vs (13. 6 ± 13. 0) s,P=0. 002). Compared with the low anxiety control group,the CPP value of the low anxiety experimental group was lower,and the difference was statistically significant ((113. 2±10. 3)s vs (28. 0±9. 6)s,P<0. 01). Af-ter L-703,606 treatment,there was no significant difference in the percentage of open arm time between the control group and experimental group either in high anxiety group or in low anxiety group (both P>0. 05) . Compared with the high anxiety control group,the expression of NK1R increased in hippocampus,prefrontal lobe and amygdala of mice in high anxiety experimental group (all P<0. 05). And the expression of NK1R in the above three brain regions had the same result between the low anxiety control group and the low anxiety experimental group (all P<0. 05). Conclusions L-703,606 can attenuate ethanol-induced CPP but has no effect on anxiety-like behaviors,suggesting the direct effect of NK1R in alcohol reward in juvenile mice.

Clinical Correlates of Alcohol Use Disorder in Depressed Patients with Unipolar and Bipolar Disorder

OBJECTIVE: Alcohol use disorder (AUD) is one of the most frequent comorbid conditions in mood disorders. We aimed to examine the relationships between clinical phenotypes of acutely depressed subjects and co-occurring AUD.METHODS: Clinical assessment including diagnosis of mood disorder and co-occurring AUD, the severity of depressive or manic symptoms, and affective temperaments were conducted in 137 subjects suffering from a major depressive episode. According to the presence of AUD, clinical variables were compared between the two groups. Using binary logistic regression models, the effects of mood symptoms and affective temperaments on the risk of AUD were determined.RESULTS: Severity of manic symptoms, suicidal ideation, and childhood trauma were higher in the AUD group than in the non-AUD group. Scores for irritable and hyperthymic temperament were higher and the score for anxious temperament was lower in the AUD group. In regression models adjusting confounders, anxious temperament was an independent protector against AUD. On the other hand, the diagnosis of bipolar disorder and the irritable manic symptom dimension increased the risk of AUD.CONCLUSION: Anxious temperament decreased the AUD risk, whereas irritable manic symptoms increased the risk during depression. AUD in mood disorders may be an expression of manic psychopathology.

Comparison of Psychological Characteristics of Lesch Types 2 (Anxiety Model) and 3 (Depressive Model) Alcoholism / 우울ㆍ조울병

BACKGROUND: Lesch types 2 (L2, anxiety model) and 3 (L3, depressive model) of alcoholism exhibit different responses to anti-craving agents, and most treatment guidelines provide differential treatment strategies for bipolar depression (DEP) and unipolar DEP. We compare the psychological characteristics of L2 and L3 alcoholism and between the unipolar and bipolar subgroups.METHODS: We reviewed medical records of patients who were diagnosed with alcohol use disorder using the DSM-5 diagnostic criteria and classified as L2 and L3 using Lesch Alcohol typology software. All patients completed self-report scales (Alcohol Use Disorders Identification Test [AUDIT], Beck Anxiety Inventory [BAI], Beck Depression Inventory-II [BDI-II], and Korean Symptom Checklist-95 [KSCL95]). The data were analyzed using descriptive statistics, the Wilcoxon Rank-Sum test, and ANOVA.RESULTS: Of the 43 patients, 23 were assigned L2, and 20 were assigned L3. The scores for the KSCL95 subscales fell generally in the increasing order of the L2-unipolar (L2U, n=10), L2-bipolar (L2B, n=13), L3-unipolar (L3U, n=11), and L3-bipolar (L3B, n=9) types. The L3B scores were greater than the L3U scores for most KSCL95 subscales, by contrast with the DEP and BAI scores.CONCLUSION: We found psychological differences between L2 and L3 and identified the unique psychological characteristics for each subgroup by polarity. The psychological characteristics of these subgroups of alcohol use disorder may help improve the treatment success rates through individualized treatment strategies.

Knowledge, Attitude, Practices Of Disulfiram Amongst Relatives Of Patient With Alcohol Use Disorder

KAP (Knowledge, Attitude and Practice) studies are highly focused evaluations to measure changes in response to a specific intervention, usually outreach, demonstration or education. This study was conducted to assess KAP of Disulfiram amongst relatives of patients suffering from alcohol use disorder. Relatives of 100 patients diagnosed as alcohol use disorder were interviewed using a self–designed semi structured proforma. Alcohol use was documented to ascertain the pattern and dependence. On asking if “Heard about disulfiram” 38 respondents stated yes whereas 62 said no.36% said that they have used disulfiram.32% reported good experience.35% showed improved quality of life and achieved abstinence from alcohol.The present study demonstrated poor knowledge among relatives, but good attitudes toward use of disulfiram. The results suggest the need to implement an intervention strategy that reflects specific local circumstances and plan activities that are suited to the population involved.