Self-concept deficits in massively multiplayer online role-playing games addiction.

BACKGROUND: Previous studies on Internet addiction point towards a particular constellation of personality traits and deficits in social competence of players addicted to massively multiplayer online role-playing games (MMORPGs), which are hypothesized to result from impairments in self-concept. The aim of this study was to examine differences in self-concept and degree of avatar identification in World of Warcraft addicted, non-addicted and naive (nonexperienced) participants. METHODS: Participants (n = 45) completed interviews and self-report questionnaires on social, emotional and physical aspects of self-concept. Attributes of participants' 'actual self', 'ideal self' and their avatar were assessed using the Giessen test. The extent of avatar identification was examined by assessing differences between 'ideal self' and avatar evaluations. RESULTS: In contrast to nonaddicted and naive participants, addicted players showed a more negative body appraisal and lower self-esteem as well as lower permeability, social response, general mood and social potency on the Giessen test subscales. They further showed significantly lower discrepancies between 'ideal self' and avatar ratings on nearly all Giessen test subscales. DISCUSSION: The results point towards impairments in self-concept and a higher degree in avatar identification in addicted MMORPG players compared to the remaining participants. These results could have important implications for the treatment of addicted MMORPG players.

[Pregabalin for the reduction of opiate withdrawal symptoms]. / Pregabalin zur Reduktion von Opiatentzugssymptomen.

Pregabalin is a substance which modulates monoamine release in "hyper-excited" neurons. It binds potently to the α2-δ subunit of calcium channels. Pilotstudies on alcohol- and benzodiazepine dependent patients reported a reduction of withdrawal symptoms through Pregabalin. To our knowledge, no studies have been conducted so far assessing this effect in opiate dependent patients. We report the case of a 43-year-old patient with Pregabalin intake during opiate withdrawal. Multiple inpatient and outpatient detoxifications from maintenance replacement therapy with Buprenorphine in order to reach complete abstinence did not show success because of extended withdrawal symptoms and repeated drug intake. Finally he disrupted his heroine intake with a simultaneously self administration of 300  mg Pregabaline per day and was able to control the withdrawal symptoms. In this time we did control the Pregabalin level in serum and urine in our outpatient clinic. In the course the patient reported that he could treat further relapse with opiate or opioids with Pregabalin successful. This case shows first details for Pregabalin to relief withdrawal symptoms in opiate withdrawal.

Effects of alcoholism and continued abstinence on brain volumes in both genders.

BACKGROUND: Alcohol abuse has detrimental effects on cerebral function, metabolism, and volume. Some of these effects were found to be at least partially reversible with continued abstinence. Furthermore, it has been reported that there are different effects of alcohol on brain volumes for women compared with men, but the results concerning the interaction between alcohol dependence and gender are inconsistent. With this study, we aimed to further investigate this question by examining the global gray matter (GM) and white matter (WM) changes as well as regional and local GM changes detected by voxel-based morphometry (VBM) in male and female alcoholic patients a few weeks after detoxification and the corresponding changes in a subgroup of these patients 3 months later. METHODS: A total of 50 patients, consecutively admitted for alcohol withdrawal treatment, participated in this study and were followed up for at least 3 months into abstinence. High-resolution structural images were processed with SPM8 using an optimized VBM protocol. RESULTS: Global cerebrospinal fluid (CSF) volume was increased and WM and GM volume decreased equally in male and female patients. A gender by diagnosis interaction was found neither for global nor for regional volumes or VBM data. VBM whole brain analysis yielded a significant GM volume loss in the patient group in the cingulate gyrus and the insula in both hemispheres. Region of interest analysis for the initial and 3 months follow-up scans yielded significant gains in regional volumes, particularly the cingulate gyrus and the insula in the group of abstinent patients, whereas no volume change at all is found in the patients who had relapsed. CONCLUSIONS: Our study confirms widespread cerebral volume loss in recently detoxified alcoholics. The effects of alcohol dependence seem to have equally adverse effects on brain morphometry in males and females.

Bedouin wives on the home front: living with men serving in the Israel Defense Forces.

This community-based study examined emotional and somatic symptoms of 129 Bedouin women whose husbands serve in the Israel Defense Forces. Wives of men diagnosed with posttraumatic stress disorder (PTSD) reported more symptoms than wives of men diagnosed with other disorders and wives of men with no diagnosis. Findings indicate that not only was PTSD in Bedouin servicemen positively associated with their wives' symptoms of posttraumatic stress and depression and somatic complaints, but that this relationship was fully mediated by husbands' aggression. Unraveling the special circumstances of women from traditional backgrounds faced with the devastating effects of husbands' combat-related posttraumatic pathology may inform an approach to the concept of vicarious trauma that is more specific to non-Western societies.

Consumer perceptions of integrated trauma-informed services among women with co-occurring disorders.

As part of a national, multi-site treatment outcome study, an instrument was designed to assess consumers' perceptions of key services integrating trauma, mental health, and substance abuse issues, the Consumer Perceptions of Care (CPC). This study evaluates the psychometric properties of this instrument and analyzes consumers' perceptions of the services they received. The results suggest that the measure has four factors: services integration, choice in services, trauma-informed assessment, and respect for cultural identity. These factors demonstrated adequate reliability, and the overall results suggested that the measure is a reliable, sensitive, and valid reflection of consumers' perceptions of their services and their providers for diverse racial and ethnic groups. Women in the intervention programs perceived their services as more highly integrated for trauma, mental health, and substance use than women in the services as usual or comparison programs, supporting its utility as a measure of programs designed to provide integrated services.

Further evidence for altered cerebellar neuronal integrity in schizophrenia.

OBJECTIVE: The authors' goal was to investigate the distribution of metabolites and voxel composition in the pons and three cerebellar subregions and compare metabolite integral values and differences in voxel composition between patients with schizophrenia and healthy subjects. METHOD: Proton magnetic resonance spectroscopic imaging was used to study the cerebellum and pons of 14 patients with schizophrenia and 14 healthy comparison subjects. RESULTS: The voxel composition was not significantly different between the groups, but the patients with schizophrenia had significantly lower N-acetylaspartate levels in the cerebellar cortex and vermis. CONCLUSIONS: The lower integral value of N-acetylaspartate in the cerebellar cortex and the vermis of patients with schizophrenia supports the theory of a dysfunctional corticocerebellar-thalamic-cortical circuit in schizophrenia.

Relational systems change: implementing a model of change in integrating services for women with substance abuse and mental health disorders and histories of trauma.

This article describes the "relational systems change" model developed by the Institute for Health and Recovery, and the implementation of the model in Massachusetts from 1998-2002 to facilitate systems change to support the delivery of integrated and trauma-informed services for women with co-occurring substance abuse and mental health disorders and histories of violence and empirical evidence of resulting systems changes. The federally funded Women Embracing Life and Living (WELL) Project utilized relational strategies to facilitate systems change within and across 3 systems levels: local treatment providers, community (or region), and state. The WELL Project demonstrates that a highly collaborative, inclusive, and facilitated change process can effect services integration within agencies (intra-agency), strengthen integration within a regional network of agencies (interagency), and foster state support for services integration.

The assessment of trauma history in women with co-occurring substance abuse and mental disorders and a history of interpersonal violence.

The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a large (N = 2729) multisite study of the effectiveness of integrated and trauma-informed services for women with substance use and mental health disorders and a history of interpersonal violence (physical or sexual abuse). Study participants' exposure to lifetime and current traumatic events was assessed at baseline and follow-up via in-person interviews. This article describes the choice of the Life Stressor Checklist-Revised (LSC-R) to assess trauma history to meet the WCDVS's research aims and to respond to consumer input. Quantitative data address the breadth and prevalence of potentially traumatic events in the past and current lives of study participants, the formation and properties of summary measures, and test-retest reliability. Qualitative data address tolerance of the instrument by interviewers and respondents and the generalizability of quantitative findings about trauma prevalence. Finally, recommendations are offered for improvements to the WCDVS version of the LSC-R for use in future research.

Physical health burdens of women with trauma histories and co-occurring substance abuse and mental disorders.

This article documents the physical health burdens of participants in a large, federally funded cross-site study of specialized services for women with histories of trauma (physical or sexual abuse) and co-occurring substance abuse and mental health disorders. Nearly half of the 2729 women in the study (48%) reported serious physical illnesses that frequently limited their daily life activities or required them to use special equipment. Nearly half (46%) rated their health status as only fair or poor. Given the prevalence of physical illnesses in this population, behavioral service providers should discuss with clients their overall health and how it might hinder their participation in treatment for trauma, substance abuse, and mental illness, and policymakers should consider this need when designing behavioral health requirements, setting reimbursement rates, and allocating funds.