Liepmann's test and its specific significance in the alcoholic delirium]

The perceptional characteristics of hallucinatory events and the phenomenal forms of artificially produced hallucinations were studied on a total of 210 patients (144 patients with delirium tremens, alcoholic hallucinosis, abstention from alcoholic beverages freedom from abstinence symptoms and 66 subjects with schizophrenia, symptomatic epilepsy, general paralysis, neuroses, and conditions of intoxication). The results of our studies show that Liepmann's test may be used to reliably diagnose genuine hallucinoses. They are usually preceded by a number of different stages, these being the stages of stability of development and full development of prehallucinatory phenomena, simultaneous and suggestive periods of geniune hallucinations. Liepmann's test is specifically distinctive of psychopathological disorders associated with delirium tremens.     

Simulated alcoholic delirium

Of 200 diagnosed cases of alcoholic delirium 5 (= 2.5%) involved, from the differential diagnostic viewpoint, simulation of alcoholic delirium with all the symptoms involved. The symptoms of the simulation case are compared with the acute symptoms, and points in common to all simulation cases are presented: Definite alcoholic anamnesis, wide experience of treatment for alcohol abuse, dynamics of a pronounced purposeful action when social complications are imminent and course of the symptoms when the interview turns to simulation. In connection with therapy, special attention is drawn to Distraneurin treatment, which is not indicated in such cases.     

Collegiate COAs and Alcohol Abuse: Problem Drinking in Relation to Assessments of Parent and Grandparent Alcoholism

In a survey of college students (N = 860), significantly greater problem drinking was indicated by students who reported having a parent or grandparent diagnosed or treated for alcoholism. The highest rates of problem drinking were found among students who reported both an alcoholic parent and grandparent. Students who had experienced distress and family discord from parental alcohol abuse, though without a diagnosed alcoholic parent, also indicated greater problem drinking. The increased alcohol problems of students without a diagnosed alcoholic parent, however, were somewhat different from other children of alcoholics (COAs). Thus, different types of COAs must be considered in research, treatment, and prevention programs.     

Psychometric vs. attentional correlates of early onset alcohol and substance abuse

Adolescent inpatients with a diagnosis of alcohol abuse (n=28), nonalcohol substance abuse disorders (n=15), or psychiatric disorders without substance abuse (n=46) were examined on measures of attentional, intellectual, and personality functioning. High scores on a personality measure, the Substance Abuse Proclivity Scale (SAP), was the best predictor of substance abuse in general. Alcohol abusers were differentiated from other substance abusers by their increased impairment on the Continuous Performance Test. Adolescents with alcohol abuse did not manifest the types of cognitive impairments associated with chronic alcoholism. These data suggest that certain attentional impairments may be associated with early onset alcohol abuse and that earlier conceptions of the role of attentional impairments in risk prediction for alcohol abuse are supported.This research was supported by the Four Winds Foundation.     

Electrolyte disorders, EEG changes and epileptic seizures in alcohol withdrawal delirium

For 180 patients suffering alcohol-withdrawal induced delirium, electrolytic concentration in the serum of Na, K, Ca, and Mg was determined in the early withdrawal phase, and the electroencephalograms of 95 delirium patients evaluated in respect of local and diffuse changes and epileptic activity, and compared in delirium patients with and without initial seizures. Delirium patients who had initial seizures suffered significantly longer-lasting periods of delirium and significantly more frequent electrolytic changes in the form of hypomagnesemia and hypopotassemia (hypokalemia). There was no significant difference in the EEG changes. A temporary metabolic disorder in the initial phase of the two-phase withdrawal process should be assumed to be the cause of seizures during alcohol withdrawal, and the pathogenetic significance of hypomagnesemia and hypopotassemia should be taken into consideration.     

Effects of alcohol abuse and familial alcoholism on physical health in men and women

Detoxified alcoholic men (n = 76) and women (n = 72) and nonalcoholic control men (n = 50) and women (n = 51) were given a structured interview that assessed five categories of physical health: medical history, alcohol-related disorders, trauma history, drug use history, and, for females, female-related disorders. Approximately half the subjects in each group were family history positive for alcoholism. Significant differences between alcoholics and controls were found for all five categories; family history effects were significant for four of the five categories, and sex differences were present in two categories. The results indicate that (a) alcoholics suffer pervasive physical health difficulties, (b) a family history of alcoholism is predictive of health problems in both alcoholics and controls, (c) the effects of alcohol abuse and family history of alcoholism on health appear to be independent and additive, and (d) women may be more "illness prone" than men and exhibit an increased vulnerability to the adverse effects of alcoholism.     

MMPI Profiles of Liver and Heart Transplant Candidates With and Without Significant Histories of Heavy Alcohol Use

This study compared the Minnesota Multiphasic Personality Inventory (MMPI) profiles of liver and heart transplant candidates with (n = 104) and without (n = 253) significant histories of heavy alcohol consumption. The alcohol and nonalcohol groups had similar overall mean profiles with significant or marginally significant (i.e., T 69) clinical elevations on Scales 1, 2, and 3. However, significantly higher proportions of those in the liver transplant group than in the heart transplant group scored within the clinical range on Scales F, 4, 6, and 8. In addition, the proportions of respondents obtaining clinically elevated scores were significantly higher for the alcohol than for the nonalcohol group on Scale 4 and the MacAndrew Scale; the proportion was higher for the nonalcohol than for the alcohol group on Scale K. The overall similarity of the mean profiles indicates that candidates for liver or heart transplantation with and without histories of heavy alcohol use generally display similar psychological presentations. The observed differences between the liver and the heart transplant groups may reflect impairments in mental status among liver transplant candidates due to metabolic consequences of liver disease. The differences between the alcohol and the nonalcohol groups may be more a reflection of past behavioral patterns than present psychological status.     

Stress and stereotypic behaviour in mink (Mustela vison): a focus on adrenocortical activity

We examined whether female mink with low (LS) and high (HS) occurrence of stereotypic behaviour differ in their adrenocortical activity in baseline conditions or in response to immobilisation (Experiment 1), handling, adrenocorticotropic hormone (ACTH) challenge (Experiment 2) and excretion of circulating cortisol (Experiment 3). Faeces are the predominating excretory route of cortisol (83%), with peak concentrations after 4.2 h (urine: 3.4 h). Faecal cortisol metabolites (FCMs) reflected changes in relation to handling/ACTH challenge. In Experiment 1 (n = 162), HS mink had approximately 54% higher baseline level of FCM than LS mink (P < 0.001), with markedly elevated FCM on the days after an immobilisation stressor. In Experiment 2 (n = 48), LS and HS mink did not differ in adrenocortical activity after an ACTH challenge. However, HS mink reacted more in response to handling, evident in the FCM level 4-20 h after the handling (P = 0.001). In Experiment 3 (n = 16), the excretion of infused (3)H-cortisol did not differ between LS and HS mink. Stereotypic behaviour is concurrent with higher baseline concentrations of FCM, which cannot be explained by a greater adrenocortical reactivity or a different excretion of the circulating cortisol. Instead, we conclude that mink with a high level of stereotypic behaviour have a greater perception of stress, or increased sensitivity to stressors at the pituitary level.     

Mental disorders and communication of intent to die in indigenous suicide cases, Queensland, Australia

In comparing Indigenous to non-Indigenous suicide in Australia, this study focussed on the frequency of the association between some psychiatric conditions, such as depression and alcohol abuse, and some aspect of suicidality, in particular communication of suicide intent. Logistic regression was implemented to analyze cases of Indigenous (n = 471) versus non-Indigenous suicides (n = 6,655), using the Queensland Suicide Register as a data source. Compared to non-Indigenous suicides, Indigenous cases had lower odds of being diagnosed with unipolar depression, seeking treatment for psychiatric conditions or leaving a suicide note. Indigenous suicides had greater odds of verbally communicating suicide intent and having a history of alcohol and substance use. The magnitude of these differences is remarkable, underscoring the need for culturally sensitive suicide prevention efforts.     

Testosterone,aggressiveness, and antisocial personality

Testosterone levels were examined in prisoners convicted of violent crimes (n = 13), in men previously convicted of violent crimes but currently not in prison (n = 15), in nonviolent alcoholics (n = 15), and in randomly selected control males (n = 16). Morning, afternoon, and evening testosterone levels were assessed after a minimum alcohol abstinence period of 24 hr. Violent and nonviolent men did not differ in plasma total testosterone level on any sampling occasion. In violent men, however, testosterone levels were significantly correlated with hostility, as measured by the Derogatis Symptom Check List. Most violent men were diagnosed with Antisocial Personality Disorder (ASP) [DSM‐III‐R; 301.70], and the unweighted ASP symptom count also correlated significantly with testosterone levels in these subjects. We suggest that individuals whose life histories involve numerous antisocial behaviors tend to have high testosterone levels even when interpersonal violence is excluded. This, however, does not eliminate the possibility that males who are characterized by high hostility may also have elevated testosterone levels. Violent predisposition and antisocial conduct beginning in early adolescence predict adult aggressive behaviors, which are augmented by power‐related alcohol expectancies and alcohol abuse. Aggr. Behav. 25:113–123, 1999. © 1999 Wiley‐Liss, Inc.     

Marital Interactions of Male versus Female Alcoholics

This study assessed the interactions of 131 alcoholic and nonalcoholic couples as they engaged in discussions of personally relevant problems. For 50 couples, the husband was alcoholic; for 15 couples, the wife was alcoholic; for 16 couples, both spouses were alcoholics; and for 50 couples, neither spouse was alcoholic. Observations were conducted during sessions when alcohol was consumed and in nondrinking sessions. Female alcoholic couples (with nonalcoholic spouses) demonstrated high negativity in the “no-drink” session, which was normalized in the drink session, suggesting an adaptive function to alcohol use. Concordant couples (both members were alcoholic) also demonstrated high negativity in the no-drink session, but exhibited increased negativity in the drink session, suggesting that concordance has a maladaptive impact on marital interaction. All alcoholic groups demonstrated greater negativity and lower positivity and congeniality in their marital interactions compared to nonalcoholic couples. Couples with male alcoholics were the least divergent from normal control couples. Unique female patterns in alcoholism are discussed in terms of adaptive and reinforcing patterns and spousal influences.     

an alcoholic is good and sober: sentiment change in AA

An Alcoholic is a stigmatized, deviant identity. This longitudinal study of 55 Alcoholics Anonymous (AA) participants found that even chronic alcohol abusers viewed alcoholics negatively, in keeping with normative understandings. However, following mandated AA attendance, there was significant change in social sentiments for alcohol-related concepts and meanings for feelings and objects related to drinking, as sentiments became similar to AA subculture understandings. In AA, "an alcoholic" is good. Sentiment change, AA ideology, and the implications for identity and normative behavior are discussed.     

Psychoanalytic patients in the U.S., CANADA,and Australia: I. DSM-III-R disorders,indications, previous treatment,medications, and length of treatment

To determine the demographics, DSM-III-R disorders diagnosed, indications used in recommending psychoanalysis, previous treatment histories, use of medication, and length of treatment in patients in psychoanalysis in the U.S., Canada, and Australia, a mail survey of practice was sent to every other active member of the American Psychoanalytic Association and every member of the Australian Psychoanalytical Society. This supplemented an earlier survey sent to all Ontario psychoanalysts. The response rates were 40.1 % (n = 342) for the U.S., 67.2% (n = 117) for Canada, and 73.9% (n = 51) for Australia. Respondents supplied data on 1,718 patients. The employment rate for patients increases as analysis progresses (p < .0001). The mean number of concurrent categories of disorders (Axis I, Axis II, and Disorders First Evident in Childhood) per patient at the start of treatment is 5.01 (SD = 3.66; median = 4; mode = 3). There are no statistically significant differences across countries. Mood, anxiety, sexual dysfunction, and personality disorders are most common. American Psychiatric Association / American Psychoanalytic Association peer review criteria for indicating psychoanalysis are followed for 86.5% of patients. Over 80% of patients in all three countries had undergone previous treatments prior to analysis. In the U.S., 18.2% of analysands are on concurrent psychoactive medication; in Australia, 9.6%. The mean length of analyses conducted in the U.S. is 5.7 years, in Australia 6.6, and in Canada 4.8. Psychoanalytic patients in all three countries have similar rates of DSM-III-R psychopathology, and many indications of chronicity.     

WHEN WOMEN IMBIBE

The present research examines how alcohol, or even the illusion of imbibing alcohol, affects women's perceived self-efficacy for avoiding HIV. Women ( N = 82) were randomly assigned to one of four conditions in a 2 (alcohol or no alcohol) X 2 (expect alcohol or not) balanced placebo design. After consuming alcoholic or nonalcoholic beverages, participants assessed their self-efficacy for HIV risk prevention. Both alcohol consumption and alcohol expectancy increased women's confidence that they could detect whether a potential partner was HIV positive simply by interacting with the potential partner.     

Assumptions in borderline personality disorder: specificity, stability and relationship with etiological factors.

The specificity and stability of a set of assumptions hypothesized to be characteristic of Borderline Personality Disorder (BPD) was investigated. BPD patients (n = 16) were compared to cluster-C personality disorder patients (n = 12) and to normal controls (n = 15). All subjects were female and diagnosed with SCID-I and -II. Subjects rated a short version of the Personality Disorder Beliefs Questionnaire (PDBQ), with six sets of 20 assumptions each, hypothesized to be characteristic of avoidant, dependent, obsessive-compulsive, paranoid, histrionic and borderline personality disorder. The BPD assumptions (Cronbach alpha = 0.95) proved to be the most specific to BPD patients. Subjects rated the shortened PDBQ again after viewing an emotional video fragment one week later. Despite increased negative emotions, the PDBQ ratings remained relatively stable. Confirming the cognitive hypothesis, regression analyses indicated that the BPD assumptions mediate the relationship between self-reported etiological factors from childhood (sexual abuse and emotional/physical abuse) and BPD pathology assessed with the SCID-II. It is suggested that a set of assumptions is characteristic of BPD, and is relatively stable despite the instability of the behaviour of people diagnosed as having BPD.     

Contingent reinforcement of lowered blood-alcohol levels in an outpatient chronic alcoholic

Recently. the proposition that alcohol abuse is an operant behavior and thus functionally related to its consequences has been investigated under experimental conditions. In controlled laboratory settings, in which inpatient chronic alcoholics are allowed access to alcoholic beverages, alcohol consumption has been markedly altered via operant strategies. Monetary rewards (Cohen et al., 1971), the opportunity to participate in an enriched environment (Cohen et al., 1971). and visits to a girlfriend (Bigelow et al., 1973) have been used as reinforcers for decreased drinking.Other investigators (Sulzer, 1965; Miller, 1972: Hunt and Azrin, 1973) have successfully applied similar contingency management techniques to alcoholics in the natural environment. However, failure to control for the influence of extraneous therapeutic variables (e.g., attention-placebo factors, job counseling) together with reliance on self-report measures of drinking behavior seriously limit the conclusiveness of these results. Objective assessment is particularly essential with operant techniques since consequent events must be systematically scheduled upon the occurrence or non-occurrence of drinking. Documentation of drinking in the natural environment is a difficult task since the alcoholic frequently consumes alcohol when he is alone. In lieu of direct observation, blood alcohol concentrations are an obvious means of objective assessment. Such data are most conveniently obtained via breath tests similar to the ones that law enforcement officers utilize to identify intoxicated motorists.The purpose of the present study was to investigate the influence of reinforcement contingencies on lowering blood alcohol concentrations obtained in an alcoholic's natural environment.     

Effects of emotion on oxytocin,prolactin, and ACTH in women

Research on both non-human mammals and humans has raised interest in the role that oxytocin may play in human attachment and attachment-related emotions. This study examined changes in plasma oxytocin, prolactin, and ACTH concentrations in response to laboratory-induced positive and negative emotions related to close, interpersonal relationships. Participants were 32 female volunteers recruited from university communities. During positive emotion induction, oxytocin decreased over time (F(1,3) = 4.41, p < 0.007), prolactin increased (F(1,3) = 4.80, p < 0.004) and ACTH remained constant. During negative emotion induction, prolactin levels increased (F(1,3) = 2.81, p < 0.05), ACTH decreased only after the induction terminated (F(1,3) = 4.02, p < 0.01) and oxytocin remained constant. While oxytocin decreased during positive emotion, this finding contrasted previous research that showed decreases in response to negative emotion. In conclusion, plasma oxytocin levels were not reliably altered by positive or negative emotion induction. While prolactin and ACTH were expected to decrease over time due to diurnal variation, they instead either increased or remained level during emotion induction, or decreased only after the induction. Overall, the degree of change in circulating hormones in response to happy and sad emotions was very small and possibly not functionally significant.     

Relation between cardiovascular and metabolic disease and cognition in very old age: cross-sectional and longitudinal findings from the berlin aging study.

This study documented findings on the relation between cognitive functioning (perceptual speed, memory, fluency, and knowledge) and cardiovascular and metabolic disease in a sample of very old adults (ages 70 and older), both cross-sectionally (n=516) and longitudinally (n=206) in a 4-year follow-up. After age, SES, sex, and dementia status were controlled for, 4 diagnoses were negatively associated with cognition: congestive heart failure, stroke, coronary heart disease, and diabetes mellitus, with a joint effect of 0.47 standard deviations. The impact of disease status was largest on perceptual speed and fluency, memory was impacted only by diabetes, and knowledge was not related to any somatic diagnosis. There was no differential decline in participants diagnosed with 1 of these 4 diseases and those who were not. The only cardiovascular risk factor associated with cognitive performance was alcohol consumption.     

Cognitive deficits in relation to personality type and hypothalamic-pituitary-adrenal (HPA) axis dysfunction in women with stress-related exhaustion

Exhaustion caused by long-term work-related stress may cause cognitive dysfunction. We explored factors that may link chronic stress and cognitive impairment. Personality, psychiatric screening, and behavior were assessed by self-reporting measures in 20 female patients (mean age 39.3 years; range 26-53) with a preliminary diagnosis of stress-related exhaustion and in 16 healthy matched controls. Cognitive performance was investigated with a detailed neuropsychological test battery. Cortisol axis function was assessed by urinary and saliva collections of cortisol, dexamethasone suppression, Synacthen response, and corticotropin-releasing hormone (CRH) tests. Proinflammatory cytokines were measured. Hippocampal volumes were estimated by magnetic resonance imaging. Multivariate and univariate statistical methods were used to explore putative differences between groups and factors linked to cognitive impairment. Cognitive function clearly differed between groups, with decreased attention and visuospatial memory in the patient group, suggesting frontal cortex/medial temporal cortex-network dysfunction. Increased harm avoidance and persistence was present among patients, with lowered self-directedness linked to lower quality of life, increased anxious and depressive tendencies, and experiences of psychosocial stress. Attention was decreased with concomitantly impaired visuospatial memory. The pituitary (adrenocorticotropic hormone, ACTH) response to CRH was decreased in patients, with an increased cortisol/ACTH response to CRH. However, cortisol production rates, diurnal or dexamethasone-suppressed saliva cortisol levels, and the cortisol response to Synacthen were unaltered. Hippocampal volumes did not differ between groups. These findings suggest that cognitive dysfunction in stress-related exhaustion is linked to distinct personality traits, low quality of life, and a decreased ACTH response to CRH.     

Reading times and adaptive styles among patients diagnosed with psychosis as assessed by the Serial Color-Word Test

The present study focuses on how patients diagnosed with psychosis deal with a conflicting situation. In the study, two groups of patients were assessed. One group consisted of patients diagnosed with psychosis (n = 41), while the comparison group (n = 135) consisted of inpatients diagnosed either with anorexia nervosa or with bulimia nervosa. The groups were assessed using the Serial Color Word Test (S-CWT), designed for studying an individual's successive adaptation over time to a conflicting situation. The S-CWT differentiated the two groups regarding both reading time and adaptive styles. Patients diagnosed with psychosis had longer reading times and an adaptive style that was deviant throughout the test, indicating poorer cognitive functioning and more serious psychopathology. These problems may in turn influence functioning in work or study and daily living, all of which are important in treatment planning.