RORA Polymorphism Interacts with Childhood Maltreatment in Determining Anxiety Sensitivity by Sex: A Preliminary Study in Healthy Young Adults

OBJECTIVE: Recent studies have reported associations of retinoid-related orphan receptor alpha (RORA) gene single nucleotide polymorphisms (SNPs) with depression and anxiety disorders. Based on these, we attempt to test whether RORA polymorphism is associated with anxiety sensitivity (AS), the intermediate phenotype of depression and anxiety disorders. Considering gene-environment interactions and sex differences in AS, childhood maltreatment (CM) and sex were considered as confounders. METHODS: Two-hundred and five healthy young Korean adults (female: 98, male: 107; age, 23.0±3.2 years) completed genotyping for the RORA SNP rs11071547, as well as measures for AS and CM. Generalized linear models were used to examine the main and interaction effects of RORA genotype, CM, and sex in determining AS. RESULTS: The main effect of RORA polymorphisms was not found (p=0.760) whereas the main effect of CM and interaction effects among sex, genotype, and maltreatment were significant on AS. In separate analyses by sex, the interaction effect between RORA genotype and maltreatment was significant only in males (p < 0.001). In females, the main effects of genotype and CM were significant (both were p < 0.001), in which both a history of CM and C genotype tended to be associated with higher AS. CONCLUSION: The association between RORA polymorphism and AS might differ by sex. The interaction between RORA polymorphism and CM was significant only in males whereas RORA genotype and CM independently associated with AS in females. Further studies are encouraged to confirm the relationship between RORA polymorphism and AS.

Menopause and Cognitive Function : Hospitalized Female Patients with Depression

OBJECTIVES: Although forgetfulness is a common complaint among menopausal depressed women, there is still a debate about the relationship between memory impairment and menopause. The aim of this study is to examine whether menopause is related to cognitive decline among women with depressive disorders. We hypothesized that postmenopausal depressed women show generally poorer performance than premenopausal depressed women on various cognitive function tests. METHODS: With a retrospective chart review, we identified a total of 87 female patients (45 premenopausal patients and 42 postmenopausal patients) who were hospitalized with depressive disorders from 2000 to 2016. Demographic and clinical variables and cognitive test results were compared between two groups. RESULTS: ducation year is longer in premenopausal group than postmenopausal group whereas clinical characteristics (illness duration, recurrence, and symptom severity) and mean Intelligence Quotient (IQ) were similar between two groups. The postmenopausal group took longer time for Bender-Gestalt Test (BGT) recall, Trail Making Test (TMT)-A, and TMT-B than the premenopausal group. After controlling for age and education, significant difference was remained for BGT recall (p = 0.029). CONCLUSIONS: Postmenopausal state may be related with decline of visuospatial memory function, in particular, among depressed female patients. Other areas of cognitive function including complex attention, verbal memory, auditory memory, and working memory might be interpreted while considering age and education level.

Mental health status of people isolated due to Middle East Respiratory Syndrome / 한국역학회지

OBJECTIVES: Isolation due to the management of infectious diseases is thought to affect mental health, but the effects are still unknown. We examined the prevalence of anxiety symptoms and anger in persons isolated during the Middle East Respiratory Syndrome (MERS) epidemic both at isolation period and at four to six months after release from isolation. We also determined risk factors associated with these symptoms at four to six months. METHODS: Of 14,992 individuals isolated for 2-week due to having contact with MERS patients in 2015, when MERS was introduced to Korea, 1,692 individuals were included in this study. Anxiety symptoms were evaluated with the Generalized Anxiety Disorder 7-item scale and anger was assessed with the State-Trait Anger Expression Inventory at four to six months after release from isolation for MERS. RESULTS: Of 1,692 who came in contact with MERS patients, 1,656 were not diagnosed with MERS. Among 1,656, anxiety symptoms showed 7.6% (95% confidence interval [CI], 6.3 to 8.9%) and feelings of anger were present in 16.6% (95% CI, 14.8 to 18.4%) during the isolation period. At four to six months after release from isolation, anxiety symptoms were observed in 3.0% (95%CI, 2.2 to 3.9%). Feelings of anger were present in 6.4% (95% CI, 5.2 to 7.6%). Risk factors for experiencing anxiety symptoms and anger at four to six months after release included symptoms related to MERS during isolation, inadequate supplies (food, clothes, accommodation), social networking activities (email, text, Internet), history of psychiatric illnesses, and financial loss. CONCLUSIONS: Mental health problems at four to six month after release from isolation might be prevented by providing mental health support to individuals with vulnerable mental health, and providing accurate information as well as appropriate supplies, including food, clothes, and accommodation.

Clinical Usefulness of Aripiprazole and Lamotrigine in Schizoaffective Presentation of Tuberous Sclerosis

Tuberous sclerosis is not as rare as once thought and has high psychiatric comorbidities. However, bipolar or psychotic features associated with tuberous sclerosis have been rarely reported. This report first presents a tuberous sclerosis patient, resembling a schizoaffective disorder of bipolar type. A patient with known tuberous sclerosis displayed mood fluctuation and psychotic features. Her symptoms did not remit along with several psychiatric medications. After hospitalization, the patient responded well with lamotrigine and aripiprazole without exacerbation. As demonstrated in this case, tuberous sclerosis may also encompass bipolar affective or psychotic features. We would like to point out the necessity to consider bipolarity in evaluating and treating tuberous sclerosis.

Reconstruction of Eyelid Defects after Mohs Micrographic Surgery for Skin Cancer of the Eyelid / 대한피부과학회지

BACKGROUND: The reconstruction of eyelid defects is extremely complex because both functional and aesthetic aspects should be considered. Numerous techniques for reconstruction are available for repairing eyelid defects, depending on the size, location, and extent of the defect. OBJECTIVE: This study was aimed at assessing the effectiveness and cosmetic consequences of various reconstruction techniques for eyelid defects after Mohs micrographic surgery. METHODS: Twenty patients who received a diagnosis of skin cancer of the eyelids from November 2005 to August 2009 were analyzed. Among them, 15 patients were treated with a local flap to reconstruct the defective eyelids, and the remaining patients were treated with primary closure. The medical records and photographs were reviewed by two independent physicians, and postoperative results were evaluated. RESULTS: Eyelid defects were reconstructed with various surgical techniques, such as primary closure, transposition flap, subcutaneous island pedicle flap, advancement flap, rotation flap, Tenzel flap, and hard palate mucous membrane graft. The cosmetic results were satisfactory, and 16 of 20 (80%) patients showed good to excellent results. However, one patient developed a sclera show and another patient showed tumor recurrence. CONCLUSION: Many reconstruction techniques can be used for eyelid defects. An optimal choice would be one that is based on the extent, depth, and location of the defect; skin condition and wishes of the patient; and the surgeon's experience. Furthermore, it is important to have an understanding of the anatomy of the eyelid, the basic principles of the reconstruction techniques, and the merits and drawbacks of each technique.

Point Prevalence of Anxiety and Depression among Cancer Inpatients in a General Hospital: A Preliminary Study for the Development of Distress Management Strategies in Cancer Patients / 정신신체의학

OBJECTIVES: This study aimed to examine the point prevalence of anxiety, depression and the associated risk factors in hospitalized patients with cancer. METHODS: A total of 114 patients with cancer who admitted to the Cancer Center in St. Mary's Hospital were enrolled for a day. The patients were asked to complete Hospital Anxiety and Depression Scale(HADS). Sociodemographic and cancer related clinical variables were also evaluated. RESULTS: The point prevalence of anxiety and depression was 10.5% and 34.2%, respectively, as assessed with HADS. Logistic regression models revealed that distant metastasis was significantly associated with anxiety in patients with cancer and previous chemotherapy and Low socioeconomic status were significantly associated with depression. CONCLUSIONS: Our results indicate that more than one third of patients with cancer suffer from either anxiety or depression. In addition, previous chemotherapy as well as low socioeconomic status and distant metastasis were associated risk factors of anxiety and depression, respectively. These findings suggest the need for screening and systematized psychosocial intervention for psychological distress in hospitalized patients with cancer.

Mental Health Promotion and Illness Prevention: A Challenge for Psychiatrists

Mental health is essential for individual and public health. To improve mental health, promotion, prevention, and the treatment of disease are required. These three kinds of interventions are interrelated but independent from one another. Although separate efforts for mental health promotion and prevention are needed as well as the public need of mental health promotion and well-being, psychiatrists usually are not accustomed to mental health promotion and prevention. This review introduces an overview of the concept, subjects according to target populations, and various intervention strategies for mental health promotion and prevention of mental illnesses. Based on literatures to date, understanding of developmental psychology, lifestyle medicine, and biopsychosocial contributors of mental health with a macroscopic perspective might help to practice mental health promotion and illness prevention.

Neurocognitive Function Impairment in Alcohol Dependent Patients with Diabetes Mellitus / 신경정신의학

OBJECTIVES: Diabetes and alcohol dependence are considered as independent risk factors for cognitive impairment. This research was to investigate whether cognitive functions in diabetic alcohol dependent patients were more impaired than non-diabetic alcohol dependent patients. METHODS: A cross-sectional study was conducted in alcohol dependence patients (n=138). Patients with alcohol dependence diagnosed by Diagnostic and Statistical Manual of Mental Disorder, 4th edition, Text Revision underwent a 75 g oral glucose tolerance test, to classify to diabetics group and non-diabetics group. In addition to demographic and clinical characteristics, cognitive functions assessed using the Korean-Mini Mental Status Examination (K-MMSE), word list memory test, and word fluency test, word list recall test from Korean version of the consortium to establish a registry for Alzheimer's disease, and block design test, digit span test, and digit symbol test from Korean-Wechsler Adult Intellogence Scale were compared between the two groups. RESULTS: There was no significant difference in demographic and other clinical characteristics between the non-diabetic and diabetic alcoholic patients. Compared to non-diabetic alcoholic patients, diabetic alcoholic patients were more impaired on language of K-MMSE (p=0.028) and digit symbol test (p=0.044). CONCLUSION: These findings suggest the more severe impairment of selective cognitive functions in diabetic alcoholic patients than non-diabetic alcoholic patients. Future replication of these findings in a large population is necessary.

Prevalence and Associated Risk Factors of Psychological Distress in Patients with Gastric Cancer / 정신신체의학

OBJECTIVES: Though gastric cancer is one of the most common cancer in Korea, there have been few studies to explore psychological distress in gastric cancer. The purpose of this study was to investigate the prevalence and associated risk factors of psychological distress among patients with gastric cancer. METHODS: With consecutive sampling, a total of 274 patients with gastric cancer who admitted to a cancer center in a general hospital were recruited and assessed on psychological distress using the Hospital Anxiety and Depression Scale(HADS). Sociodemographic and cancer-related clinical variables were also evaluated. RESULTS: One hundred fifty-three(55.8%) patients with gastric cancer showed psychological distress. Logistic regression models revealed that having alcohol drinking experience[odds ratio(OR)=2.10, p=0,034] and low performance status(OR=2.40 p=0.002) were significantly associated with psychological distress in patients with gastric cancer. CONCLUSIONS: These findings indicate that approximately half of patients with gastric cancer suffered from psychological distress and having alcohol drinking experience and low performance status would be associated risk factors, suggesting the need for distress screening and psychosocial supportive care in patients with gastric cancer.

Temperament and Character in Cannabis and Methamphetamine Abusers

OBJECTIVES: This study aims to identify temperament and characteristics of cannabis and methamphetamine abusers for elucidating psycho-biological variables related to certain substance abuse. METHODS: A total of 320 patients who registered in the 'Hepatitis C cohorts study of intravenous drug users' between March 2006 and March 2010 participated in this study. Data on demographic variables were obtained and the Temperament and Character Inventory (TCI) and measures for nicotine dependence, alcohol dependence, depression and anxiety were assessed. After comparing TCI between cannabis, methamphetamine, and co-abusers, correlations between TCI and other clinical variables were examined. RESULTS: The methamphetamine abuser group showed significantly higher scores in Novelty Seeking (NS2) and Harm Avoidance (HA3) in temperament than the cannabis abuser and co-abuser groups, whereas the cannabis abuser group had higher scores in purposefulness (SD2), congruent second nature (SD5), and self-directedness (SD) in character than the methamphetamine abuser group. In addition, temperaments and characters correlated with various psychiatric symptoms. CONCLUSIONS: We found the differences in temperament and characters among cannabis abusers, methamphetamine abusers. These findings might contribute to further understanding of mechanisms of cannabis and methamphetamine abuse.

Cognitive Abilities and Auditory Event Related Potentials in Patients with Schizophrenia

OBJECTIVES: Event-related potentials have been suggested as an objective marker for brain functions in psychiatric disorders. This study was aimed to investigate the relationships between P300, the mismatch negativity (MMN), the loudness dependence of the auditory evoked potential (LDAEP), demographic and clinical variables including neurocognitive abilities in patients with schizophrenia. METHODS: P300, the MMN, and the LDAEP were measured and the Korean Stroop color-word test (K-stroop test) and the Wisconsin Card Sorting Test (WCST) were performed in 43 patients with schizophrenia. The relationship of the latency and amplitude of P300 and the MMN as well as regression slope of the LDAEP with demographic and clinical variables were analyzed by t-test and correlation analyses for categorical and continuous variables, respectively. RESULTS: After controlling for age, the latency of central (Cz) and parietal (Pz) P300 posivitively correlated with GAF at admission (Cz ; gamma = 0.385, p = 0.047, Pz ; gamma = 0.421, p = 0.029). The amplitude of parietal P300 correlated with the correction rate of the K-stroop test (gamma = 0.575, p = 0.002). In addition, the frontal (Fz) P300 latency tended to negatively correlated with the correction rate of the WCST (gamma = -0.371, p = 0.057). CONCLUSIONS: Our findings suggest that the values of P300 latency and amplitude might be correlated with GAF at admission and working memory measured by the K-Stroop test and the WCST. Meanwhile, the MMN and the LDAEP did not correlate with demographic and clinical variables. These results support the results of previous studies showing associations with P300 and impaired cognitive ability.

Resilience as a Possible Predictor for Psychological Distress in Chronic Spinal Cord Injured Patients Living in the Community

OBJECTIVE: To investigate whether higher resilience level predicts low levels of psychological distress in chronic SCI patients living in the community. METHOD: Thirty seven patients (mean age 41.5+/-10.9, male : female=28 : 9) with chronic spinal cord injury (duration 8.35+/-7.0 years) living in the community are included, who were hospitalized for annual checkups from November, 2010 to May, 2011. First, their spinal cord injury level, completeness and complications were evaluated. The patients completed questionnaires about their educational status, religion, employment status, marital status, medical and psychological history and also the following questionnaires: Hospital Anxiety and Depression Scale (HADS), Connor-Davidson Resilience Scale (CD-RISC), Alcohol Use Disorders Identification Test-alcohol consumption questions (AUDIT-C) and Health-related quality of life (EQ-5D). The patients were divided into two subgroups: patients with HADS > or =13 are classified as high psychological distress group and others as low psychological distress group. We compared the two groups to find statistically significant differences among the variables. RESULTS: CD-RISC, EQ-5D and employment status are significantly different between two groups (p<0.05). In a forward stepwise regression, we found that EQ-5D had a greater contribution than CD-RISC to the psychological distress level. CONCLUSION: In addition to health-related quality of life, resilience can be suggested as a possible predictor of psychological distress in chronic SCI patients.

Psychiatric Evaluation and Intervention in a Weight Loss Surgery Program: A Review / 신경정신의학

OBJECTIVES: Weight loss surgery (WLS) is an effective treatment for morbidly obese patients. A pre- and postoperative multimodal team-based approach is essential for maximizing the efficacy of WLS. Although there is currently no standard psychiatric approach in WLS programs, this paper summarizes the value and methods of assessment and intervention suggested in the literature. METHODS: A Pubmed search of English-language reports (1985 to 2010) and a manual search of bibliographies of related papers were reviewed. Relevant clinical information was extracted. RESULTS: Patients receiving WLS show a substantial prevalence of psychopathology, including depression, anxiety, and eating disorders, and also impaired quality of life. Most psychiatric symptoms and impaired psychosocial functioning tend to be improved after WLS, and this improvement is one of the important goals of WLS besides weight loss. However, outcomes are not promising in all patients, and the literature suggests that some psychiatric variables have prognostic value. One of the most widely researched poor prognostic factors is postoperative binge eating disorder. The identification of vulnerable patients and the offer of an appropriate intervention may be critical for their future full recovery. CONCLUSION: There are several reasons why psychiatric evaluation and intervention are worthwhile in a WLS program. Further researches will be required for the establishment of prognostic psychological factors, their biological mechanisms, and clinical guidelines for psychiatric assessment and intervention.

Psychiatric Evaluation and Intervention in a Weight Loss Surgery Program: A Review / 신경정신의학

OBJECTIVES: Weight loss surgery (WLS) is an effective treatment for morbidly obese patients. A pre- and postoperative multimodal team-based approach is essential for maximizing the efficacy of WLS. Although there is currently no standard psychiatric approach in WLS programs, this paper summarizes the value and methods of assessment and intervention suggested in the literature. METHODS: A Pubmed search of English-language reports (1985 to 2010) and a manual search of bibliographies of related papers were reviewed. Relevant clinical information was extracted. RESULTS: Patients receiving WLS show a substantial prevalence of psychopathology, including depression, anxiety, and eating disorders, and also impaired quality of life. Most psychiatric symptoms and impaired psychosocial functioning tend to be improved after WLS, and this improvement is one of the important goals of WLS besides weight loss. However, outcomes are not promising in all patients, and the literature suggests that some psychiatric variables have prognostic value. One of the most widely researched poor prognostic factors is postoperative binge eating disorder. The identification of vulnerable patients and the offer of an appropriate intervention may be critical for their future full recovery. CONCLUSION: There are several reasons why psychiatric evaluation and intervention are worthwhile in a WLS program. Further researches will be required for the establishment of prognostic psychological factors, their biological mechanisms, and clinical guidelines for psychiatric assessment and intervention.

The Effects of Horizontal Eye Movement on Mental Health Indices and Psychophysiological Activities in Healthy Subjects

OBJECTIVES: The eye movement (EM) has been reported to play a role in enhancing the retrieval of episodic memories and reducing effects of fearful episodes in the past and worries for the futures. However, it is still unclear in the mechanism of EM in normal subjects. We examined the horizontal eye movement (HEM) effect using an aiding apparatus on mental health indices including negative and positive psychological factors, and psychophysiological measures such as heart rate variability and quantitative electroencepaholography (qEEG) in healthy subjects. METHODS: Twenty eight healthy subjects were recruited and randomly allocated into two groups : active HEM group and control group. The active HEM group conducted the HEM training with usual stress management audio-intervention using the apparatus inducing eye movement once a day for 14 days. The control group also conducted the same training once a day for 14 days, however, the saccadic eye movement was not included in this training. Psychological measurements, neurocognitive function tests, heart rate variability measurement and qEEG were conducted before and after the training in both groups. RESULTS: In the active HEM group, sleep status using Sleep Quality Scale (SQS) positive factors significantly increased after the training. By contrast, scores on the negative items of Psychological Well-Being Scale (PWBS), and negative items of the Life Orientation Test-Revised (LOT-R) were significantly decreased after the training. The percentage of delta amplitude (1-3 Hz) in qEEG significantly decreased after the HEM training. The percentage of alpha amplitude (8-12 Hz) significantly increased after HEM training. The change of delta amplitude in the active HEM group was positively correlated with the change of sleep satisfaction of Visual Analogue Scale (VAS), and the change of alpha amplitude was negatively correlated with depression of VAS, anxiety of VAS and Beck Anxiety Inventory (BAI). CONCLUSIONS: The HEM training improved sleep quality and well-being, and sense of optimism. The HEM training also increased alpha amplitude and decreased delta amplitude in qEEG. The qEEG changes were well correlated with subjective improvement of mental health indices in healthy subjects. These results suggest some evidences that HEM training using the apparatus that induces EM would be helpful in improving subjective mental health in healthy subjects. Further study with larger samples size would be needed.

Erratum: The Effects of Horizontal Eye Movement on Mental Health Indices and Psychophysiological Activities in Healthy Subjects

No abstract available.

Neurobiology of Addiction Based on Neuroimaging Evidence

Substance addiction is a chronically relapsing disorder that has been characterized by a vicious cycle composed of intoxication, craving/anticipation, withdrawal, and response inhibition/bingeing. Here we summarize the findings from neuroimaging studies in addiction according to these behavioral components and suggest the integrated neurobiological model of drug addiction and related brain correlates. The roles of various prefrontal regions, thalamus, memory circuit, anterior cingulated, and insula were also suggested in addition to those of classical mesolimbic dopaminergic system and its responsivity. Limited studies of behavioral addiction demonstrated a similarity with substance addiction on the neurobiological basis. Based on the current understanding of neurobiology of addiction, further researches on interactions of behavioral components and their brain correlates, behavioral addiction, and therapeutic applications will be desired.

Agomelatine as a Novel Pharmacotherapy of Anxiety Disorders / 대한정신약물학회지

Anxiety disorders are the most common mental health problems and frequently cause functional impairment. Although current pharmacological agents are recognized to be effective, partial or total resistance to drug treatment and distressing side effects have leaded to continued search of a new pharmacotherapy of anxiety disorders. Agomelatine is a novel agent with a melatonergic agonist at MT1 and MT2 receptors and an antagonist at 5HT2C receptors. Despite substantial evidence of its antidepressant properties, the anxiolytic properties of agomelatine have been underscored. Therefore, this article reviews previous studies on anxiolytic properties of agomelatine. In several rat models, agomelatine actively reduces anxiety-related behaviors comparable to benzodiazepine. These anxiolytic properties seem to be mediated by both melatonergic and 5HT2C receptors. Randomized, double-blind, clinical trials demonstrated that agomelatine 25-50 mg/day significantly reduced anxiety symptoms in patients with generalized anxiety disorder as well as major depressive disorder. Recently, cases of panic disorder and social anxiety disorder successfully treated with agomelatine were reported. In addition, the tolerability of agomelatine seems broadly favorable, particularly in sexual dysfunction and discontinuation syndrome. Based on these sound efficacy and tolerability profiles, further studies on the use of agomelatine in anxiety disorders will be required for wider clinical application.

Topical ALA-Photodynamic Therapy for Acne Can Induce Apoptosis of Sebocytes and Down-regulate Their TLR-2 and TLR-4 Expression

BACKGROUND: Although photodynamic therapy (PDT) is widely performed for acne, little is known about its exact therapeutic mechanism. OBJECTIVE: We aimed to estimate the efficacy and safety of PDT on acne and to discover its mode of action. METHODS: We performed PDT on 12 patients with mild to moderate acne. The clinical efficacy was assessed by counting the acne lesions and measuring the sebum secretion before and after PDT. In addition, we took biopsy samples from the peri-lesional areas before and after 3-session of PDT. To examine the degree of apoptosis of the sebaceous follicles, TUNEL assay was performed. To investigate the changes of toll-like receptor (TLR)-2 and TLR-4 expression after PDT, immunohistochemical stainings were also carried out. Finally, we performed TUNEL assay using the cultured sebocytes to confirm the apoptosis of sebocytes in vitro after PDT. RESULTS: There was a significant reduction in the number of inflammatory acne lesions after PDT, compared to baseline (p<0.05). Sebum excretion significantly decreased 2 weeks after the first PDT session except for one patient (p<0.05). The TUNEL positive cells in the peri-lesional sebaceous glands after PDT markedly increased, compared with those of before PDT. A decrease in TLR-2 and TLR-4 expression by sebaceous glands and epidermis after PDT was 50% and 30%, respectively. CONCLUSION: Our results demonstrate that apoptosis of the sebaceous glands is associated with improvement of acne by PDT. PDT has shown to down-regulate TLR-2 and TLR-4 expression in the sebaceous glands and epidermis of acne patients.

Alcohol and brain health: from mechanisms to interventions

Alcohol-related problems are prevalent and lead to substantial economic, physical, and psychological burden. Among the various effects of alcohol, the effect on the brain is a matter of importance. The brain controls drinking behaviors and may be damaged earlier than other organs by alcohol. Moreover, alcohol-related brain pathologies are difficult to treat once they have progressed. Therefore, we overviewed the mechanisms and results of alcohol-induced brain damage and interventions against it in this article. Alcohol exerts neurotoxic effects mediated by various mechanisms, such as acetaldehyde toxicity, glutamate excitotoxicity, increased oxidative stress, and chronic inflammatory responses. In both functional and structural neuroimaging studies, the evidence of alcohol-induced brain damage was observed in various regions of gray and white matter. Brain damage has been known to be more prominent when it begins during the period of brain development and in women. Symptomatically, alcohol hangovers and alcohol-induced blackouts, which are highly prevalent alcohol-related problems, have been suggested to be early signs of alcohol-related brain damage. However, neurological changes induced by alcohol have been reported to be partly recovered by abstinence. The development of effective interventions would be clinically important. Although following the rules of low-risk drinking and abstinence have been the primary approaches up to the present, studies on mechanism-based neuroprotective interventions, such as acamprosate and memantine, have attempted. Further prospective and well-designed studies of neuroprotective interventions against neurotoxic effects of alcohol are required.