Substance-induced psychotic disorders: 13-year data from a de-addiction centre and their clinical implications.

The relationship between substance use and psychotic disorder has been complex. Alcohol, cannabis, amphetamines, hallucinogens, and phencyclidine have been implicated as a causative factor for psychotic disorders. It is important to differentiate substance induced psychotic disorders (SIPDs) from primary psychotic disorders as management of the two conditions is different. There is paucity of research in the area of SIPD particularly from Asia. The present study was a retrospective study and it determines retrospectively the incidence rate and clinical characteristics of the SIPDs over a period of 13 years. The incidence of SIPDs was found to be 1.4% and all the subjects were males. In the present study, only alcohol and cannabis were implicated as causative agents for SIPDs. The most common type of psychosis was schizophrenia like psychosis, being more common in the cannabis group. The other forms of psychosis included delusional type, hallucinatory type and affective psychosis. 20% of the subjects had a change in diagnosis to either schizophrenia or affective psychosis on follow-up. The present study showed that the presentation of SIPDs is similar to the primary psychotic disorder and this has management implication.

Deterioro cognitivo asociado al consumo de diferentes sustancias psicoactivas / Cognitive deterioration associated with the use of different psychoactive substances

Introducción. El estudio de los déficits neuropsicológicos asociados al consumo de sustancias tóxicas ha cobrado gran relevancia en los últimos años debido a las graves repercusiones de salud física y psicológica de los consumidores. Metodología. En el presente trabajo se evaluaron los posibles déficits de memoria y el deterioro de las funciones ejecutivas, en una muestra de 54 sujetos que se encuentran realizando un tratamiento de desintoxicación y deshabituación. Para ello se aplicaron diversos test neuro-psicológicos (la Escala de Memoria de Wechsler, Wisconsin Card SortingTest, Test de Stroop, Test de fluidez verbal y el Test de Construcción de Senderos). Resultados. reflejaron la presencia de un mayor déficit en la memoria de trabajo en sujetos con una mayor duración de consumo de alcohol y/o cannabis. Los sujetos con un consumo prolongado de cannabis reflejaban también mayores carencias en la memoria inmediata mostrando más conservada la memoria demorada, así como una peor capacidad a la interferencia, es decir, muestran una menor inhibición a las respuestas automáticas. También se observa que poseen una atención alterante disminuida, necesitando más tiempo para realizar actividades que requieren un pensamiento lógico y secuencial. El estudio también reflejó la importancia de la duración del consumo como una variable significativa en el aumento de los déficits de memoria. Conclusiones. El tiempo y tipo de consumo son determinantes en el deterioro cerebral producido por las drogas (AU)

Introduction. The study of the neuropsychological deficits associated with substance abuse has become highly relevant in recent years due to the serious impact they have on the physical and mental health of users. Methodology. The possible memory deficits and deterioration of executive functions were studied in a sample of 54 subjects undergoing drug detoxification and rehabilitation. Several neuropsychological tests were applied (Wechsler Memory Scale, Wisconsin Card Sorting Test, Stroop Test, Verbal Fluency Test and the Trail-Making Test). Results. Subjects with a more prolonged history of alcohol and/or cannabis use had a greater deficit in working memory. Subjects with prolonged cannabis use also showed greater deficiencies in immediate, or short term, memory and better conserved long-term memory, as well as less interference capacity, i.e., less inhibition of automatic responses. They also had impaired alternating attention and needed more time to execute activities that required logical and sequential thought. The study also reflected the importance of duration of use as a significant variable in the increase in memory deficits. Conclusions. The duration and type of substance abuse are determinants in drug-induced cerebral deterioration (AU)

[Alcohol brain disease: systematization of metalcohol psychoses].

Based on the own clinical observations, the author analyzes pathogenetic hypotheses and contemporary typology of metalcohol psychoses, proposes a concept of alcohol brain disease, including typical and atypical forms. It is suggested that typical forms rest on specific neurometabolic disturbances while the constitutional predisposition plays a main role in the forming of atypical variants. The principles of effective treatment of alcohol brain disease are considered.

[Validity of assessment of schizophrenic basic symptoms]. / Validität der Erfassung schizophrener Basissymptome.

A study on the concept and measurement of the basic disorders of schizophrenia is presented. A total of 151 male adult psychiatric inpatients (51 with a dual diagnosis of schizophrenia and alcoholism, 50 schizophrenics and 50 alcoholics) were included. The aims of this study were: (1) the replication of the previous finding that the Frankfurt Complaint Questionnaire (FBF) contains items that discriminate between schizophrenia and alcoholism; (2) an empirical comparison between FBF and the Bonn Scale for the Assessment of Basic Symptoms (BSABS); (3) testing the relationship between basic and negative versus positive symptoms, as measured by the Positive and Negative Syndrome Scale (PANSS). Regarding (1), the former result was replicated. Regarding (2), FBF subscales and BSABS categories were shown to be significantly but weakly related, even if identical symptoms were included in the inquiry. Regarding (3), FBF and BSABS were found to be more closely related to negative than to positive PANSS items. Theoretical implications and consequences for further research are discussed.

Psicosis alcohólicas en Honduras / Alcoholic psychosis in Honduras

Una investigación en un hospital psiquiátrico de Honduras, América central, encuentra 60 casos de psicosis alcohólica en un período de cinco meses. se usa la clasificación de Marconi y se hace una investigación pormenorizada de seudopercepciones escenográficas e ideas delirantes en los pacientes. (AU)

Psicosis alcohólicas en Honduras / Alcoholic psychosis in Honduras

Una investigación en un hospital psiquiátrico de Honduras, América central, encuentra 60 casos de psicosis alcohólica en un período de cinco meses. se usa la clasificación de Marconi y se hace una investigación pormenorizada de seudopercepciones escenográficas e ideas delirantes en los pacientes.

Alcohol-related dementia in the institutionalized elderly.

This study examined the distribution of alcohol-related and other dementias in a sample of 130 cognitively impaired residents of long-term care facilities in a Northern Ontario community. Study procedures entailed standardized psychiatric, neurological, and neuropsychological evaluations. Diagnoses of dementia of the Alzheimer type (DAT) and vascular dementia were based on criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. The diagnosis of alcohol-related dementia (ARD) was based on extensive review of medical history to assess before alcohol abuse and stabilization or improvement in cognitive functioning following institutionalization in conjunction with no other identifiable cause of dementia. ARD comprised 24% of this population compared with DAT (35%), vascular dementia (19%), and other causes (22%). The ARD group was, on average, 10 years younger than the other groups. It had nearly twice the average length of institutionalization and had milder cognitive impairment on both clinical ratings and neuropsychological tests. A diagnosis of ARD was present in the medical records for only 25% of patients in this group. These findings suggest that ARD may be more common than previously suspected in the distribution of dementias in long-term care facilities.

[Clinical and laboratory differentiation of alcohol withdrawal syndrome ("predelirium") and alcoholic delirium]. / Zur klinischen und labortechnischen Differenzierung des Alkoholentzugssyndroms ("Prädelir") und des Alkoholdelirs.

In a retrospective study, data from 99 male and female inpatients with alcohol withdrawal syndrome or alcohol withdrawal delirium, treated between 1977 and 1987, were analyzed. DSM-III criteria were used to assign the diagnosis of either withdrawal delirium (with obligatory clouding of consciousness) or alcohol withdrawal syndrome (without disturbances of consciousness and/or perception). No statistically significant differences between the two groups were found with respect to the red and white blood count, liver enzymes, and electrolytes. Significant differences were found in calcium levels, lymphocyte counts, and in electrophoresis. However, these differences are of no use for diagnostic purpose. Moreover, they are unspecific with respect to etiology. Hence, the distinction between alcohol withdrawal syndrome and alcohol withdrawal delirium can only be made clinically, i.e., it is dependent on the presence or absence of a clouded consciousness. This is in line with the findings published by other investigators. In the light of our metabolic findings, alcohol withdrawal syndrome and alcohol withdrawal delirium represent the two extremes of a continuum rather than two separate nosological entities.

[Clinical variants of neuropsychological disorders during remission in chronic alcoholism]. / Klinicheskie varianty nervno-psikhicheskikh rasstroistv v remissiiakh pri khronicheskom alkogolizme.

To study the psychopathological characteristics of remissions in alcoholism, 142 patients aged 32 to 45 years were examined. The anxious hypochondriac, neurasthenia-like, asthenic-depressive, anxious suspicious, anxious depressive, excitable, euphoric, apathetic, dysphoric syndromal variants are described. Correlation of the indicated syndromal variants with the other clinical characteristics of alcoholism made it possible to distinguish a favourable and relatively unfavourable type of remission, providing a possibility of differentiating between the treatment and rehabilitation measures in patients suffering from alcoholism.

[Clinico-pathogenetic aspects of pathologic premorbid conditions in alcoholic psychoses]. / Kliniko-patogeneticheskie aspekty patologicheskogo premorbida pri alkogol'nykh psikhozakh.

A study was made of the pattern of the clinicopathogenetic correlation of the pathological premorbid condition and alcoholic psychoses in 689 patients. Three degrees of the pathogenicity of the pathological ground and a respective grouping of alcoholic psychoses were distinguished. For correlation analysis purposes 4 most informative factors and 12 parameters mirroring the main tendencies of the pathogenesis of alcoholic psychoses were also distinguished. A regularity was discovered, according to which each of the 4 factors produces a different effect on the clinicopathogenetic mechanisms and formation of the varieties of alcoholic psychoses. The author puts forward a rationale for increased proneness of patients suffering from alcoholism with the pathological premorbid condition to the development of alcoholic psychoses.

Empirically derived classifications of alcohol-related problems.

In recent years a number of investigators have utilized empirical techniques to develop classification schemes for alcohol related problems. This chapter examines this literature, reviewing both dimensional and categorical models that have been proposed. Despite much consistency in the methodologies that have been used, relatively few consistent substantive findings have emerged from these studies. However, increasing sophistication in the use of these empirical techniques over the past decade has produced some interesting results. One such study which yielded a hybrid model for alcoholism incorporating advantages of both categorical and dimensional approaches, is discussed in some detail. Finally, promising directions for future research are outlined with references to the implications of such taxonomy for alcoholism treatment and course.

Alcohol withdrawal syndrome.

The alcohol withdrawal syndrome can be divided into four stages, which should be recognized and treated to prevent progression to the later stages. Delirium tremens, the final stage of withdrawal, is characterized by extreme autonomic hypersensitivity and seizures. Treatment may include prophylactic use of sedatives or acute therapy for the management of seizures. Diazepam and chlordiazepoxide are useful agents.

[Epidemiological problems of schizophrenia]. / Epidemiologicheskie problemy shizofrenii

Epidemiological studies with regard to shizophrenia encounter differences in nozological concepts, refinement of symptomatological description, etc. The WHO international pilot study of schizophrenia has succeeded in providing a reasonalby reliable tool for a unified evaluation of patients' present state. However, the combination of the present state examination with the case history will give better possibilities for a delimitation of a group of schizophrenics which is meaningful for the determination expectancy figures for schizophrenia. Techniques for converting prevalence and incidence figures into expectancies are described.