Oxcarbazepine in combination with Tiaprid in inpatient alcohol-withdrawal--a RCT.

INTRODUCTION: Oxcarbazepine (OXC), a derivative of Carbamazepine (CBZ), may represent a solution to metabolic and side effects of CBZ treatment due to the fact that renal excretion is its major route of elimination. The goal of the study is to compare the efficacy and tolerability of OXC/Tiaprid (TIA) combination therapy to the well established Clomethiazole (CLO) therapy in an inpatient setting. METHODS: To investigate the efficacy of OXC/TIA in terms of lower alcohol withdrawal symptoms and better tolerability, 56 alcohol-dependent patients participated in a randomized open-label trial, where OXC/TIA and CLO treatments were compared. RESULTS: Following admission, we observed that severity of alcohol withdrawal syndrome was comparable between OXC/TIA and CLO-patients. Overall tolerability was good. However, significantly more patients in the OXC/TIA-group (48.1%) displayed no AE compared to the CLO-group (24.1%). We found no significant differences between groups regarding total number of recorded adverse events (AEs). DISCUSSION: OXC/TIA inpatient therapy proved to be as effective and participants demonstrated the same tolerance as with CLO. In medication-based alcohol withdrawal, OXC/TIA could have the potential to become a promising alternative for alcohol dependent patients unable to undergo inpatient withdrawal therapy with CLO. Our findings further indicate that it could be worthwhile testing OXC/TIA in alcohol withdrawal in daily care units and outpatient settings. This is an important question for national health care services, since outpatient therapy is more and more asked for as alternative to inpatient settings.

[Treatment outcome after inpatient alcohol withdrawal: impact of motivational interventions: a comparative study]. / Behandlungserfolg nach qualifiziertem Alkoholentzug: Vergleichsstudie zum Einfluss motivationaler Interventionen.

AIMS: The aim of the present study was to evaluate whether attending an extended inpatient detoxification treatment programme for alcohol-dependent patients providing psychotherapeutic interventions and coping skills training (QE) is associated with higher aftercare treatment attendance and higher abstinence rates compared with conventional detoxification treatment (KE). METHODS: A total of 117 patients were investigated. (QE sample n=61, KE sample n=56). Patients were followed up for at least 2 months and attendance at different aftercare treatment facilities and drinking behaviour were assessed. RESULTS: At discharge from inpatient treatment patients receiving QE report an increased perceived ability to stay abstinent when confronted with high-risk situations in the future. At follow-up, a higher abstinence rate and a higher frequency of self-help group attendance and outpatient psychotherapeutic treatment were reported in the QE sample. A regression analysis supports the chosen treatment as the main factor for success and rules out a potential sampling bias. CONCLUSIONS: Although methodological limitations have to be taken into account, our results suggest that QE provides better chances of treatment success than KE.

[Questionnaire for the evaluation of drug preventive intervention programmes at the workplace (FEBSI)]. / Der Fragebogen zur Evaluation betrieblicher suchtpräventiver Interventionsmassnahmen (FEBSI).

OBJECTIVES: At present, only a few studies have assessed the efficacy of intervention programmes that focus on drug prevention at the workplace, and there is only little information available with respect to the development and evaluation of suitable instruments for the evaluation of such prevention programs. Questionnaire procedures, nevertheless, seem to be basically suitable. We developed and evaluated the questionnaire for the evaluation of drug preventive intervention programs at the workplace (FEBSI) to provide a suitable instrument to assess the effectiveness of programmes that focus on drug prevention at the workplace. METHODS: We assessed and analysed data for the evaluation of this questionnaire in the context of a prevention programme in two large industrial companies. RESULTS: We found a three-factor solution with satisfying reliability scores for each factor. The extracted factors of the questionnaire reflect the following areas: consequences of substance use at work, compliance with employment agreements, and knowledge and behaviour. Programme participants could be reliably distinguished from non-participants by using the FEBSI. CONCLUSIONS: So far, the questionnaire seems to be a suitable and reliable instrument for the evaluation of drug prevention programmes.

[Substance abuse prevention in the workplace: theoretical knowledge and expertise after interventions]. / Betriebliche Suchtprävention: Theoretisches Wissen vs. Handlungskompetenz durch Schulungsmassnahmen.

Although several companies are requesting interventions for substance abuse prevention at the workplace and a wide variety of interventions is successfully introduced into practice, empirical studies investigating the efficacy of such interventions are rare. In the present study 100 executive managers of a German chemical company, who had participated in an intervention to prevent substance consumption at the workplace one year before, were applied a questionnaire to assess effects of the intervention. Data from 22 managers, who had so far not received such an intervention, were collected to serve as a control condition. The intervention itself was designed as a theory oriented half a day course and was conducted in groups of 10 to 12 executive managers of the company. By comparing participants and non-participants, we found significant differences with respect to the knowledge how to deal with substance-related problems of staff members. For example, participants reported more frequently to know the company agreement about addiction. Further, participants reported less frequently to wait until such problems were solved anyway. However, we found no evidence for transfer of theoretical knowledge into practice. For example, we detected no significant group differences with respect to the number of appraisal interviews conducted because of substance-related problems. Taken together, the results of our study indicate, that the implementation of a company agreement about addiction and its introduction into practice based on theoretical courses is not sufficient to produce considerable effects. As an alternative, based on previous experiences we propose a series of workshops with role-plays and feedback to establish expertise in interviewing techniques with substance-related problems.

[Long-term follow-up on alcohol use in a big company after brief intervention by a company physician]. / Längsschnittuntersuchung alkoholauffälliger Mitarbeiter in einem Grossbetrieb nach werksärztlicher Kurzintervention.

BACKGROUND: Many examinations have shown that brief medical interventions are useful when seeking to influence the drinking behavior of problem drinkers and alcohol-dependent subjects. The working environment is particularly useful when trying to influence problematic drinking behavior. Our report is about the long-term effects on alcoholic employees. METHODS: The drinking behavior of 100 employees was categorized according to WHO criteria. By motivational interviewing, the employees were asked to reduce their alcohol consumption or quit completely and then come back at a later control date. The data collected was: drinking behavior (TLFB, time-line follow-back), biological markers (GGT, CDT, MCV), changes in personal situations, and the factors and reasons involved. RESULTS: Forty-five percent of the employees went to their company physician after recommendation by their supervisors, and 24% went on their own initiative. Of the employees examined, 82% were diagnosed as being alcohol-dependent, 4% as harmful abusers, 6% as risky drinkers, and 8% as questionably risky drinkers. At the time of catamnesis, 78% of the employees that were originally diagnosed as alcohol-dependent were abstinent. Of those participants, 17% that were initially classified as not dependent were abstinent, and the overall quantity of alcohol consumed was also reduced significantly by 79.3%. Personal realms especially concerning happiness in life, happiness at work, and physical health improved. CONCLUSION: The results show that a brief medical intervention conducted by a company physician is suited to influencing the drinking behavior of employees effectively and efficiently. The fear of demotion at work and job loss may prove to be a helpful influence on changing drinking behavior.

[Compulsive shopping--current considerations on classification and therapy]. / Kaufsucht--Aktuelle Uberlegungen zur Klassifikation und Therapie.

Compulsive shopping is classified by ICD-10 (F63.8) as an "impulse control disorder, not otherwise classified". Several authors consider compulsive shopping rather as a variety of dependence disorder. It is characterized by the impulsive or compulsive buying of unneeded things, personal distress, impaired social and vocational functioning, and/or financial problems. In this case, we discuss a two-way therapy consisting of addiction-specific psychological education and high dose selective serotonin reuptake inhibitors (SSRIs). We further point to compliance problems caused by SSRI side effects.

[Carbamazepine intoxication. Complication of alcohol detoxification with combined carbamazepine and tiapride]. / Carbamazepin-Intoxikation. Komplikation der Kombinationsbehandlung aus Carbamazepin und Tiaprid zur Alkoholentgiftung.

The advantages of alcohol detoxification treatment with combined carbamazepine and tiapride compared to benzodiazepines or clomethiazole is a lower level of sedation and lack of addictive potential. We report a case of carbamazepine intoxication with serum levels up to 19 mg/l in an otherwise healthy 45-year-old alcohol-dependent male after treatment with 600 mg carbamazepine and 600 mg tiapride per day. Medication was discontinued immediately and a purgative was administered. We were able to combat the intoxication but the assumed good tolerance of the combined treatment with carbamazepine and tiapride for alcohol detoxification still has to be proven.

Galantamine reduces smoking in alcohol-dependent patients: a randomized, placebo-controlled trial.

INTRODUCTION: The high morbidity and mortality caused by smoking highlights the importance of investigating new strategies for smoking cessation or reduction. Galantamine is an acetylcholinesterase inhibitor that increases the effect of acetylcholine (ACh). The nicotinic ACh receptor is activated via positive allosteric modulation (APL). METHODS: We investigated whether galantamine reduces smoking by performing a 24-week randomized, placebo-controlled, multicentric clinical trial in recently detoxified alcohol-dependent patients. We included all study subjects irrespective of an intention or motivation to abstain from nicotine. Specific treatment for cessation or reduction of smoking was not provided. Smoking behavior was assessed by means of patients' diaries. The nicotine metabolite cotinine was measured to verify the number of smoked cigarettes as documented in the patient's diary. RESULTS: 114 randomized smokers received galantamine (n = 56) or placebo (n = 58) for 12 weeks. Follow-up examinations were terminated after an additional 12 weeks without treatment. Smoking behavior did not differ between both groups at baseline. After treatment, the intention-to-treat analysis revealed significant differences with a 20% lower cumulative number of smoked cigarettes and a 15% lower number of smoking days in the galantamine group compared to placebo. The average number of smoked cigarettes per smoking day as well as the cotinine values decreased about 10%. Cotinine values showed a positive correlation with the number of documented cigarettes, validating the patients' diaries. CONCLUSION: Our tentative data indicate that galantamine reduces smoking behavior even without any additional specific intervention. We suggest introducing the term "substitution therapy" into the treatment of smoking. This result could open up a new treatment approach for groups of patients which usually have a low motivation for change.

Quetiapine in relapse prevention in alcoholics suffering from craving and affective symptoms: a case series.

PURPOSE: Quetiapine is a novel antipsychotic, which is efficacious in the treatment of positive and negative symptoms in schizophrenia. Research has shown that atypical antipsychotic also reduce the craving and consumption for stimulants and alcohol. Due to Quetiapine's particulars and the promising receptor profile concerning addiction medicine, we set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from craving and affective symptoms. SUBJECTS AND METHODS: Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. The patients were treated with quetiapine as relapse prevention and we followed them up in our outpatient clinic. RESULTS: Eight out of nine patients were abstinent under quetiapine over a period of 2-7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninth patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of (mean+/-S.D.) 24.5+/-18.1 days. The overall tolerability was considered to be very good; however, initial sleepiness appeared in four patients. CONCLUSION: Although uncontrolled case observations can only be interpreted with caution quetiapine seems to deserve further investigation and may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above-mentioned symptoms.

Galantamine: a cholinergic patch in the treatment of alcoholism: a randomized, placebo-controlled trial.

OBJECTIVES: The involvement of the central cholinergic system in alcohol abuse behavior is well known. It is possible that the reinforcing effects of ethanol are partially mediated by nicotinic receptors, which modulate neurotransmitter release. It was demonstrated that the application of a cholinesterase inhibitor reduces alcohol consumption in alcohol-preferring rats. This suggests that galantamine (GAL), a cholinesterase inhibitor, could be effective when seeking to prolong abstinence in recently detoxified alcoholics. This study represents the first reported clinical trial of a cholinergic drug in alcohol-relapse prevention. PATIENTS AND METHODS: We investigated the efficacy and safety of GAL by conducting a 24-week randomized, placebo-controlled, multicentric clinical trial on 149 recently detoxified alcoholics. Survival analyses (Kaplan-Meier) were performed to reveal evidence of prolonged abstinence periods in patients who received GAL. RESULTS: Our findings did not support our hypothesis. GAL did not extend the time to first severe relapse. However, additional post hoc analyses suggest that relapsed patients treated with GAL consume less ethanol per drinking day than patients treated with placebo. CONCLUSIONS: GAL seems to be ineffective when used in relapse prevention of detoxified alcoholics. It is possible that alcohol needs to be "on board" for GAL to be beneficial. This could explain why our post hoc analysis showed that GAL possibly reduces the alcohol consumption of relapsers. If confirmed, GAL could play a role in the reduction of harmful alcohol use and at-risk consumption.

Scheme-based benzodiazepine detoxification with oxcarbazepine -- a case report.

We attempted to evaluate the tolerability and efficacy of the antiepileptic drug oxcarbazepine in benzodiazepine detoxification, by observing several cases. Detoxification followed a predefined dosage scheme. All patients detoxified with oxcarbazepine completed the withdrawal successfully, without withdrawal symptoms. The administration of oxcarbazepine according to the scheme proved to be tolerable. The dosage was sufficient. Though uncontrolled case observations must be interpreted with caution, oxcarbazepine appears to be a promising drug in inpatient benzodiazepine withdrawal. It should be examined in further randomized placebo-controlled studies including long-term follow-ups.

Neuroimaging of gender differences in alcohol dependence: are women more vulnerable?

BACKGROUND: Alcoholic brain damage has been demonstrated in numerous studies using neuropathology and brain imaging techniques. However, gender differences were addressed only in a few studies. Recent research has shown that development, course, and consequences of alcohol dependence may differ between female and male patients. Our investigation was built upon earlier research where we hypothesized that women develop alcoholic brain damage more readily than men do. To further compare the impact of alcohol dependence between men and women, we examined brain atrophy in female and male alcoholics by means of computed tomography (CT). METHODS: The study group consisted of a total of 158 subjects (76 women: 42 patients, 34 healthy controls; 82 age-matched men: 34 patients, 48 healthy controls). All patients had a DSM-IV and ICD-10 diagnosis of alcohol dependence. CT with digital volumetry was performed twice in patients (at the beginning and end of the 6-week inpatient treatment program) and once in controls. RESULTS: Patients of both genders had consumed alcohol very heavily. Although the average alcohol consumption in the year before the study was significantly lower in female alcoholics, this gender difference disappeared when controlled for weight. However, women had a significantly shorter duration of alcohol dependence. Despite this fact, both genders developed brain atrophy to a comparable extent. Brain atrophy was reversible in part after 6 weeks of treatment; it did not reach the level in the control groups. CONCLUSIONS: Gender-specific differences in the onset of alcohol dependence were confirmed. This is in line with the telescoping effect, where a later onset and a more rapid development of dependence in women were described. Under the assumption of a gradual development of consequential organ damage, brain atrophy seems to develop faster in women. As shown in other organs (i.e., heart, muscle, liver), this may confirm a higher vulnerability to alcohol among women.

Reduction of side effects by combining clozapine with amisulpride: case report and short review of clozapine-induced hypersalivation-a case report.

Side effects from a high-dose clozapine treatment for a schizophrenic patient led to massive compliance problems. The dose of clozapine could be halved without recurrence of an acute psychotic symptomatology by concomitantly administering amisulpride. The side effects, especially hypersalivation, disappeared almost entirely, which in turn led to good compliance. In a short review we would like to present the pathophysiology and therapeutic options of clozapine-induced hypersalivation.

[Drug addiction prevention in the workplace--feasibility study in a company from the chemical industry]. / Betriebliche Suchtprävention - Durchführbarkeitsstudie in einem Betrieb der chemischen Industrie.

INTRODUCTION: In recent years drug prevention at the place of work has became increasingly important for programmes focussing on health promotion at the place of work. Drug prevention programmes aim at reducing cost and protecting the employees from physical harm. There are virtually no reliable figures from surveys in companies. To date intervention programme in companies have hardly been verified. In this feasibility study we intended to examine the practicability of an evaluation of an intervention programme in a large chemical company by means of questionnaires and we present preliminary intervention effects. METHODS: In the context of a pilot study we conducted and evaluated a drug prevention programme at the place of work. Focus was on illegal designer drugs. The programme was conducted as a one-day workshop for trainers in superior management positions. We used a feedback form and a detailed questionnaire on drug prevention in the working place. 41 trainers who participated in the seminar were compared with a control group of 12 trainers who did not participate. RESULTS: The intervention programme was well accepted by the participants. Follow-up data demonstrated, that participants in the seminar had far better knowledge of the employment agreement on addiction and drugs and of the possible ways to get help and they were far more active in realising the employment agreement. CONCLUSION: To achieve a long-term improvement of drug abuse in companies it is not enough to include and implement a passage on drug abuse and addiction in the employment agreement. Well-instructed trainers talk far often with colleagues displaying abnormal or addictive behaviour, resulting in more rapid therapeutic interventions.

[Drug-induced headache and pain reduction medication with amitriptyline in an 11-year old pupil]. / Arzneimittelinduzierter Kopfscmertz und Schmerzmittelentzug mit Amitriptylin bei einem 11-jährigen Schüler.

We report on an 11-year-old pupil who present-ed to a neurological practice in the company of his parents because of migraine and strong headaches. Precise anamnesis of drugs yielded the diagnosis of a drug-induced headache with underlying migraine disease. The boy was afflict-ed with a hereditary taint, as both parents also suffered from migraine. The mother was also continuously in treatment because of a chronic pain disorder. Therapy with up to 50 mg per day of amitriptyline enabled the boy to stop consuming analgesics without suffering from head-aches. Moreover, under 47.5 mg per day of metoprolol, the migraine symptoms did not re-occur.

[Outpatient alcohol detoxification]. / Ambulante Alkoholentgiftung.

Increasing significance is being attributed to outpatient detoxification treatment of alcohol-dependent patients. Many patients want to undergo outpatient detoxification or even carry it out without professional supervision. In some Scandinavian countries and in the USA, outpatient detoxification under medical supervision has increased substantially. In these countries,numerous studies describe outpatient alcohol detoxification as a safe and cost-reducing method. These studies vary in many aspects, especially regarding the nature and dose of the withdrawal medication, but also concerning the inclusion criteria of patients. Medications to treat or prevent alcohol withdrawal symptoms are rather heterogeneous. Besides well-known standard medication established in inpatient treatment (e.g.,benzodiazepines and carbamazepine), interesting studies report the application of rather uncommon substances such as physostigmine and psychotropic analgesic nitrous oxide (PAN) for alcohol detoxification. This article provides an overview on outpatient alcohol detoxification and discusses its transfer to practical application.

[Alcohol withdrawal syndrome and its treatment]. / Alkoholentzug und seine Behandlung.

When alcoholics decrease or interrupt alcohol intake abruptly, they will in general experience alcohol withdrawal symptoms. Clinically in most cases it develops a vegetative syndrome with gastroenteropathy, cardiovascular diseases, neurological and psychopathological symptom. Usually alcohol withdrawal symptoms abate after four to seven days, longer courses are rare. Application of drugs is required in approximately one third to one half of the patients. A variety of drugs was suggested for the treatment of alcohol withdrawal. In the first hours of alcohol detoxification, the sensitivity of epinephrine receptors is reduced, but rises afterwards substantially. The number of NMDA-receptors increases during chronic intoxication with ethanol. The standard therapy in Europe (except of Great Britain) is an oral mono therapy with clomethiazole in a dose which depends on the severity of the symptoms. Severe withdrawal symptoms may require treatment on an intensive care unit with infusion therapy, e.g. in the context of a delirium tremens, which represents a life-threatening status. In this case, benzodiazepines have been used successfully as an alternative to clomethiazole.

[Feelings without speech or speech without feelings? Further evidence for the decoupling hypothesis of alexithymia]. / Gefühl ohne Sprache oder Sprache ohne Gefühl? Weitere Hinweise auf die Validität der Entkopplungshypothese der Alexithymie.

The theoretical background of the present investigation was the decoupling hypothesis of alexithymia, which presumes for alexithymic individuals a dissociation of psychophysiological indicators of emotion from verbal cognitive awareness of one's emotional state. To study alterations in reactivity to emotionally distressing stimuli in alexithymic individuals, 12 high-alexithymic and 14 low-alexithymic subjects (separated by TAS) out of a general sample of 54 were investigated. All subjects were exposed to cognitive (CPT) and affect inductive (film sequences) distress. During stimulus exposition electrodermal activity (spontaneous fluctuations) was recorded. After stimulus exposition the subjects assessed their emotional reaction towards the film sequences (DAS). Concerning electrodermal activity no differences were found between high and low alexithymics under cognitive distress. In any case a significant autonomous arousal was registered. However, only the low alexithymic subjects but not the high alexithymics showed a significant increase of spontaneous fluctuations as expression of autonomous arousal during presentation of affect inductive stimuli. The altered psychophysiological reactivity found in high alexithymics in contrast to low alexithymic subjects was revealed specifically for the processing of emotional qualified stimuli. However, there was no difference between the groups in cognitive self assessment of emotional response towards the film sequences. The findings are discussed with reference to neurophysiological and psychodynamic models and the decoupling hypothesis of alexithymia.