Differences of Photographs Inducing Craving Between Alcoholics and Non-alcoholics

Many researchers have used cue reactivity paradigm to study alcohol craving. But the difference of craving response to drinks between alcoholic patients and social drinkers was little evaluated. To investigate characteristics of alcohol-related visual cues which induce alcohol craving in alcoholism, we examined the response of subjects to alcohol-related cues considering qualitative aspects. The authors developed 27 photographs related to alcohol as candidate visual cues. Thirty five patients with alcohol dependence, 35 heavy drinkers and 35 social drinkers were shown these pictures and asked to rate these 6 pictures in order of inducing alcohol craving the most. 'A glass of Soju' and 'A Party scene' were chosen as the alcohol-related visual cues which induced craving the most in the patients and heavy drinkers, respectively. The results suggest that the patients with alcohol dependence are more absorbed by alcohol without drinking context such as an atmosphere or situation involving drinking. Heavy drinkers may experience craving in anticipation of being in a drinking situation.

Prediction of the Development of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.

Prediction of the Development of Alcohol Withdrawal Delirium / 신경정신의학

OBJECTIVES: Alcohol withdrawal delirium is a serious clinical condition with high mortality rate if not treated. This study was to examine whether readily available clinical variables can predict the development of alcohol withdrawal delirium. METHODS: The authors performed a retrospective study by reviewing charts of 566 patients who had been admitted for alcohol dependence. The cases were divided into two groups: delirium group (n=40) and control group (n=40). We compared baseline characteristics and serum analysis data at admission between two groups. We used logistic regression to predict risk factors for alcohol withdrawal delirium among potential risk factors. RESULTS: The delirium group had significantly lower hemoglobin, hematocrit, platelet counts, and potassium level than countrol group. Presence of previous withdrawal delirium history, AST, GGTP, and bilirubin level of delirium group were significantly higher than those of control group. Among potential risk factors, past history of withdrawal delirium, decreased hemoglobin, elevated bilirubin level, and number of previous detoxification were predictable factors of the development of alcohol withdrawal delirium by 72.5%. CONCLUSION: Our results suggest that the infomation obtained at admission can be useful to predict the development of alcohol withdrawal delirium. Also, it makes the individualization of detoxification strategies possible.

Neurophysiological Measurement of Alcohol Craving Using Visual Event-Related Potential / 신경정신의학

OBJECTIVES: Alcohol craving, is not only the most common symptom but the key element in alcohol dependence. The aim of this study is to measure ERPs, especially P3 elicted by alcohol related photographs in order to assess the craving in alcohol dependent patients. METHODS: Based on the result of previous study, 6 alcohol related photographs and 6 control photographs were chosen as visual stimuli. Each stimuli set consisted of alcohol related or control photographs as target stimuli and the same sized checkerboards as non-targets. Stimuli were presented using oddball paradigm for 300 msec with an inter-stimulus interval of 1000 msec in 12 normal controls and 16 abstinent alcohol dependent patients. One session consisted of three blocks; exercise block, control block, alcohol craving block. RESULTS: The amplitudes of P3 elicited by alcohol related visual stimuli were significantly larger than those of P3 elicited by control stimuli in alcohol dependent patients while there was no significant difference in normal controls. CONCLUSION: Consistent with the hypothesis, only alcohol-dependent patients were characterized by increased P3 amplitude associated with alcohol-realted visual stimuli compared with control stimuli. The results suggest the ERPs can be used as a neurophysiological correlate of alcohol craving in alcohol dependent patients. Future investigations will be needed to assess the relapse in the patients included in this study in order to elucidate the meaning of the increased P3 amplitude.

The Study on Reliability and Validity of Korean Versions of Obsessive Compulsive Drinking Scale for Outpatient of Alcohol Dependence / 신경정신의학

OBJECTIVES: This study is to examine the efficacy and the limitation of translated Korean version of the Obsessive-compulsive Drinking Scale. The Korean version of the scale is to be used for treatment and research on alcoholism. METHODS: This study was carried out to examine reliability and validity of the translated Korean version of the Obsessive-compulsive Drinking Scale. One hundred forty two out-patient alcohol dependence subjects were measured of their cognitive and behavioral aspects of craving with this scale. RESULTS: For 142 tested alcoholic subjects, internal consistency among 14 items of the Obsessive-compulsive Drinking Scale was 0.8947(Crohnbach's alpha). For 40 detoxified alcoholics, test-retest reliability of total score of the Korean version of the Obsessive-compulsive Drinking Scale was 0.76 (correlation coefficient, p<0.01). In 131 alcoholic subjects, validity of total score of the Korean version of the Obsessive-compulsive Drinking Scale was examined by correlation analysis with visual analogue scale (VAS). Correlation coefficient was 0.52 with VAS. Especially, correlation coefficient of compulsive subscale of the Korean version of the Obsessive-compulsive Drinking Scale was 0.61 with VAS. The total score of the Korean version of the Obsessive-compulsive Drinking Scale which was analyzed by repeated measure analyses of variance during 8 weeks was significantly different between the relapse group and the abstinence group. CONCLUSION: The Korean version of the Obsessive-compulsive Drinking Scale shows very similar psychometric performance to the original Obsessive-compulsive Drinking Scale developed by Anton. The Korean version, therefore, is an useful instrument that reflects characteristic drinking behaviors of alcoholics.

Impairment of Neurocognitive Functions in Young Alcohol Dependent Patients: Problem Solving and Executive Functions / 신경정신의학

OBJECTIVES: The decline in general neurocognitive functions of alcoholics has been previously reported, especially in the area of memory, problem-solving and executive function which are important for occupational performance or adaptation to enviroment. On the other hand, young alcoholics under the age of 40 with relatively short duration of problem drinking were reported of no significant decline in neurocognitive functions consisting of memory, problem-solving and executive function. The objective of this study is to investigate whether there is a decline in neurocognitive functions around memory, problem-solving and executive function in abstinent young alcoholics. METHODS: 24 male and female alcohol dependent patients from the age of 19 to 39 years, who were detoxified in the hospotal were recruited as subjects. Normal control group of 20 males and females who matched for age, sex, educational level were selected. Clinical characteristics of the subjects were examined by demographic variables, alcohol history, Beck's Depression Inventory, Michigan Alcohol Screening Test and Standard Progressive Matrices. Also, subtests of Wechsler Memory Scale-Revised, Block design from the Korean-Wechsler Adult Intelligence, Wisconsin Card Sorting Test were performed in order to evaluate the subjects' neurocognitive functions. RESULTS: Compared to normal controls, significant decline in neurocognitive functions such as memory, problem-solving and executive function were observed in young alcohol dependent patients with an average age of 32. Parts of the neuropsychological tests showed significant correlation with duration of lifetime drinking and lifetime alcohol consumption. CONCLUSION: This study shows that, unlike previous reports, decline in memory, problem-solving and executive function occur in young alcoholics as in chronic alcoholics. This implies that young alcoholics can experience difficulty in occupational performance and adaptation to environment, and may be less responsive to treatment due to neurocognitive damage. The results of this study inclicate the importance of early identification, intervention, and planning therapeutic strategies in young alcoholics.

Development of the Alcohol-Related Visual Stimuli Inducing Alcohol Craving / 신경정신의학

OBJECTIVES: Craving is the subjectively experienced motivational states inducing ongoing drug use in addicts. It also proceeds or precipitates relapse episode in drug addicts. Alcohol craving may be triggered by exposure to an object, environment, or emotion that a person has come to associate with alcohol consumption. Such stimuli are called alcohol-related cues. Among alcohol-related cues, alcohol-related visual stimuli are simple and reliable methods in inducing alcohol craving. The object of this study is to develop alcohol-related visual stimuli which induce alcohol craving reliably and to investigate the characteristics of alcohol-related visual stimuli in alcoholics. METHODS: First, the authors developed 27 alcohol and drinking color photos as candidate stimuli. Then, 3 photos which induce alcohol craving most were chosen as alcohol-related visual stimuli respectively by alcoholics, alcoholism high risk group and normal control group. The authors compared characteristics, situation and complexity of selected alcohol-related visual stimuli among three groups. RESULTS: 1) 'A glass of Soju', 'Drinking together' and 'A glass of beer, a bottle of beer and a sidedish' were chosen as alcohol-related visual stimuli which induce most craving in alcoholics, alcoholism high risk group and normal control group respectively. 2) Alcohol photo(stationary object) induced craving most in alcoholics in contrast with drinking photo(situation) in social drinkers. Alcoholics clung to alcohol per se, not to atmosphere or situation of drinking, and alcoholism high risk group felt craving by the expectation of drinking situation. Normal control group showed no consistent finding in choosing alcohol-related visual stimuli. CONCLUSION: With these results, the author suggests classical conditioning as psychopathological model of alcohol craving with alcoholics. In contrast with alcoholics, alcohol craving of alcoholism high risk group may be related to alcohol specific memory or positive expectancies about alcohol use. These finding may support different neurobiological mechanisms of alcohol craving between alcoholics and social drinkers.

Neurocognitive Function in the Euthymic Bipolar I Disorders / 신경정신의학

OBJECTIVES: The previous assumption that patients with bipolar I disorder make a full recovery of cognitive function in the euthymic phase has been challenged by studies that suggest neuronal changes, and recently persisting neuropsychological dysfunctions beyond episodes of the illness. The aim of the present study was to investigate the impairment of the neurocognitive performance of euthymic bipolar patients, the characteristics of cognitive impairment, and the relationship between cognitive dysfunction and clinical variables of illness in bipolar population. METHODS: 19 bipolar out-patients who had been euthymic for more than 3 months by Hamilton Depression Scale score below 7 and Young Mania Rating Scale score below 6 were compared with age- and education- matched 19 healthy subjects on neurocognitive tests. Patients showing observable extrapyramidal symptoms were excluded with the objective rating. The following tests were administered in according to cognitive domain: Korean-Wechsler Adult Intelligence Scale, subtests among Wechsler Memory Scale-Revised, Wisconsin Card Sorting Test, and Signal Detection/Decision-Reaction Timer/Psychomotor Performances among Vienna Test System. RESULTS: The bipolar group performed significantly lower than the control group on verbal and performance IQ, total IQ, and psychomotor function or coordination. There was no relationship between the cognitive impairment and clinical course of illness, except duration of neuroleptic exposure. CONCLUSIONS: Although our findings did not replicate the recently reported results, especially in the domain of executive function and verbal memory, they suggested the presence of neurocognitive difficulties, in the general ability and visuomotor function in stable bipolar patients. Also, we tailed to identify the influence of clinical course variables on cognitive area with statistically signficant differences.