An investigation of predictors of nicotine abstinence in a smoking cessation treatment study of smokers with a past history of alcohol dependence.

This study investigated predictors for smoking abstinence at 12-week follow-up among 85 smokers with a past history of alcohol dependence enrolled in a smoking cessation trial. Length of alcohol abstinence at time of enrollment and longest previous period of smoking abstinence were significantly associated with smoking status at follow-up. Multiple logistic regression with these variables entered as predictors suggested that longest previous period of smoking abstinence partially mediated the relationship between length of alcohol abstinence at enrollment and smoking status at follow-up. Additional research is warranted to identify predictors of nicotine abstinence and smoking relapse in this population and to understand the factors that mediate the relationship between length of alcohol abstinence at enrollment and smoking outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Open trial of nefazodone for combat-related posttraumatic stress disorder

BACKGROUND: Because of its ability to block 5-HT2 receptors postsynaptically and inhibit 5-HT reuptake presynaptically and/or its enhancement of sleep quality, nefazodone may be useful for symptom management in posttraumatic stress disorder (PTSD) patients. METHOD: Ten patients with combat-related DSM-IV posttraumatic stress disorder (PTSD) entered an open-label 12-week trial of nefazodone with a 4-week follow-up, beginning with 100 mg/day and increasing as necessary to achieve a maximal response or until reaching a maximum dosage of 600 mg/day. RESULTS: Nefazodone was well tolerated, and no significant changes in sexual function were reported. Based on Clinical Global Impressions-Improvement scores, all 10 patients were rated as much improved. All PTSD symptoms (except self-reported PTSD reexperiencing symptoms), sleep, and clinician-rated depression significantly improved at week 12. At follow-up, significant changes were maintained, and self-reported PTSD reexperiencing symptoms had also significantly improved. Effect sizes for all changed symptoms were moderate to large at week 12 and at follow-up. Self-reported and clinician-rated anger significantly improved. Self-reported depression failed to improve. Improvement in social and occupational functioning was minimal. CONCLUSION: These preliminary data suggest that nefazodone may be effective in reducing the 3 primary PTSD symptom clusters and may be particularly helpful in improving sleep and decreasing anger.     

Comorbidity and course of psychiatric disorders in a community sample of former prisoners of war

OBJECTIVE: The authors assessed DSM-III-R disorders among American former prisoners of war. Comorbidity, time of onset, and the relationship of trauma severity to complicated versus uncomplicated posttraumatic stress disorder (PTSD) were examined. METHOD: A community sample (N=262) of men exposed to combat and imprisonment was assessed by clinicians using the Structured Clinical Interview for DSM-III-R. RESULTS: The rates of comorbidity among the men with PTSD were lower than rates from community samples assessed by lay interviewers. Over one-third of the cases of lifetime PTSD were uncomplicated by another axis I disorder; over one-half of the cases of current PTSD were uncomplicated. PTSD almost always emerged soon after exposure to trauma. Lifetime PTSD was associated with increased risk of lifetime panic disorder, major depression, alcohol abuse/dependence, and social phobia. Current PTSD was associated with increased risk of current panic disorder, dysthymia, social phobia, major depression, and generalized anxiety disorder. Relative to PTSD, the onset of the comorbid disorders was as follows: major depression, predominantly secondary; alcohol abuse/dependence and agoraphobia, predominantly concurrent (same year); social phobia, equal proportions primary and concurrent; and panic disorder, equal proportions concurrent and secondary. Trauma exposure was comparable in the subjects with complicated and uncomplicated PTSD. CONCLUSIONS: The types of comorbid diagnoses and their patterns of onset were comparable to the diagnoses and patterns observed in other community samples. The findings support the validity of the PTSD construct; PTSD can be distinguished from comorbid disorders. Uncomplicated PTSD may be more common than previous studies suggest, particularly in clinician-assessed subjects exposed to severe trauma.     

Double-blind comparison of bupropion sustained release and sertraline in depressed outpatients

BACKGROUND: A sustained-release formulation of bupropion (bupropion SR), developed with an improved pharmacokinetic profile to permit less frequent dosing than the immediate-release form, has not been evaluated in active comparator trials. This randomized, double-blind, parallel-group trial was conducted to compare the efficacy and safety of bupropion SR and sertraline. METHOD: Outpatients with moderate to severe major depressive disorder (DSM-IV) received bupropion SR (100-300 mg/day) or sertraline (50-200 mg/day) for 16 weeks. Psychiatric evaluations, including the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Clinical Global Impressions scale for Severity of Illness (CGI-S), and for Improvement (CGI-I) were completed, and adverse events were assessed in the clinic periodically throughout treatment. Patients' orgasm function was also assessed. RESULTS: Mean HAM-D, HAM-A, CGI-I, and CGI-S scores improved over the course of treatment in both the bupropion SR group and the sertraline group; no between-group differences were observed on any of the scales. Orgasm dysfunction was significantly (p < .001) more common in sertraline-treated patients compared with bupropion SR-treated patients. The adverse events of nausea, diarrhea, somnolence, and sweating were also experienced more frequently (p < .05) in sertraline-treated patients. No differences were noted between the two treatments for vital signs and weight. CONCLUSION: This double-blind comparison of bupropion SR and sertraline demonstrates that bupropion and sertraline are similarly effective for the treatment of depression. Both compounds were relatively well tolerated, and orgasm dysfunction, nausea, diarrhea, somnolence, and sweating were reported more frequently in sertraline-treated patients.     

Fluoxetine in depressed alcoholics. A double-blind, placebo-controlled trial

BACKGROUND: The selective serotonergic medication fluoxetine has demonstrated efficacy in the treatment of major depression and has suggested efficacy in the treatment of alcoholism. However, no completed trials with any selective serotonergic medication have been reported in patients who display both major depression and alcoholism, despite previous observations that both depression and alcoholism are associated with low serotonergic functioning. METHODS: Fifty-one patients diagnosed as having comorbid major depressive disorder and alcohol dependence were randomized to receive fluoxetine (n = 25) or placebo (n = 26) in a 12-week, double-blind, parallel-group trial. Weekly ratings of depression and alcohol consumption were obtained throughout the 12-week course of the study. RESULTS: The improvement in depressive symptoms during the medication trial was significantly greater in the fluoxetine group than in the placebo group. Total alcohol consumption during the trial was significantly lower in the fluoxetine group than in the placebo group. CONCLUSIONS: Fluoxetine is effective in reducing the depressive symptoms and the alcohol consumption of patients with comorbid major depressive disorder and alcohol dependence. It is unknown whether these results generalize to the treatment of less depressed and less suicidal alcoholics.     

Hopelessness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence, or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

Which relapse criteria best predict the mortality risk of treated alcoholics?

We examined which relapse criteria best predict the mortality risk of treated male alcoholics. The subjects were 172 male alcoholics who had previously been hospitalized. Using three criteria which defined relapse as failure to maintain abstinence from alcohol, alcohol abuse, or dependence, the relapse of each subject had been evaluated during a previous 3-year outcome study. Relative mortality risks in the next 3 years classified by the three relapse criteria were compared. The follow-up rate was 93.6% and 31 subjects died. The age-corrected relative mortality risk for subjects failing to maintain abstinence compared with abstainers was 5.32, while the relative mortality risks for the group abusing alcohol and for the group suffering alcohol dependence were 2.23 and 2.56, respectively. These results suggest that relapse defined as failure to maintain abstinence predicts a higher relative mortality risk than do criteria defining in terms of alcohol abuse and alcohol dependence.     

Trial of trazodone for posttraumatic stress disorder using a multiple baseline group design

Six patients with combat-related posttraumatic stress disorder (PTSD) entered a multiple-baseline trial of trazodone, beginning with 50 mg/day and increasing to 400 mg/day until response was maximal. Total Clinician-Administered PTSD Scale scores decreased from a mean of 92 at baseline to 79 at end point, and self-reported PTSD symptoms as measured by the Davidson Trauma Scale paralleled these results (mean of 102 at baseline to 88 at end point). Based on clinician global improvement scores, four patients were rated as much improved and two were rated to be minimally improved. Improvement in social and occupational functioning, and depression was minimal. Available follow-up scores for PTSD symptoms indicated that gains were maintained. Sleep was the first symptom to improve at 2 to 3 months. No dropouts during the treatment period occurred, and reported side effects were quite low. These preliminary data suggest that trazodone may be effective in reducing the three primary clusters of symptoms of PTSD. These findings should be confirmed by using a larger sample in a double-blind, placebo-controlled study.     

Testimony psychotherapy in Bosnian refugees: a pilot study

OBJECTIVE: The authors sought to describe the use of the testimony method of psychotherapy in a group of traumatized adult refugees from genocide in Bosnia-Herzegovina. METHOD: The subjects were 20 Bosnian refugees in Chicago who gave written informed consent to participate in a case series study of testimony psychotherapy. All subjects received testimony psychotherapy, averaging six sessions, approximately 90 minutes, weekly or biweekly. Subjects received standardized instruments for posttraumatic stress disorder (PTSD), depression, traumatic events, global functioning, and prior psychiatric history. The instruments were administered before treatment, at the conclusion of the treatment, and at the 2- and 6-month follow-ups. RESULTS: The posttreatment assessments demonstrated significant decreases in the rate of PTSD diagnosis, PTSD symptom severity, and the severity of reexperiencing, avoidance, and hyperarousal symptom clusters. Depressive symptoms demonstrated a significant decrease, and there was a significant increase in scores on the Global Assessment of Functioning Scale. Two-month and 6-month follow-up assessments demonstrated further significant decreases in all symptoms and an increase in scores on the Global Assessment of Functioning Scale. CONCLUSIONS: This pilot study provides preliminary evidence that testimony psychotherapy may lead to improvements in PTSD and depressive symptoms, as well as to improvement of functioning, in survivors of state-sponsored violence.     

Cocaine abusers with and without alcohol dependence respond equally well to contingency management treatments.

Contingency management (CM) treatments are efficacious in treating cocaine abuse. Despite high prevalence rates of alcohol dependence (AD) among individuals with cocaine use disorders, relatively little data are available regarding whether comorbid AD is associated with poorer treatment outcomes in general, or in response to CM in particular. Using data from 3 randomized trials of CM for cocaine abuse, we compared cocaine abusers (N = 393) with and without AD in terms of abstinence and psychosocial problems during treatment and follow-up. Alcohol dependent participants had more lifetime years of cocaine and alcohol use and greater severity of alcohol and psychiatric problems. CM was positively and significantly associated with longer durations of abstinence, regardless of AD status. Although not significantly associated with abstinence, the presence of AD was related to improvement in medical and alcohol-related problems during treatment, and these gains were maintained posttreatment. The results suggest that cocaine abusers benefit equally well from CM treatments, regardless of AD status. Further, alcohol dependent participants are able to offset greater baseline severity in psychosocial functioning and maintain these improvements with CM. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Randomized Trial of Cognitive-Behavioral Therapy for Chronic Posttraumatic Stress Disorder in Adult Female Survivors of Childhood Sexual Abuse.

The authors conducted a randomized clinical trial of individual psychotherapy for women with posttraumatic stress disorder (PTSD) related to childhood sexual abuse (n = 74), comparing cognitive-behavioral therapy (CBT) with a problem-solving therapy (present-centered therapy; PCT) and to a wait-list (WL). The authors hypothesized that CBT would be more effective than PCT and WL in decreasing PTSD and related symptoms. CBT participants were significantly more likely than PCT participants to no longer meet criteria for a PTSD diagnosis at follow-up assessments. CBT and PCT were superior to WL in decreasing PTSD symptoms and secondary measures. CBT had a significantly greater dropout rate than PCT and WL. Both CBT and PCT were associated with sustained symptom reduction in this sample. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and readiness to quit smoking among cigarette smokers in outpatient alcohol treatment.

The authors examined whether length of alcohol abstinence and depressive symptoms were related to motivational readiness to consider smoking cessation among patients in alcohol treatment. Participants were adults (N = 253) enrolled in a smoking cessation trial. Controlling for gender, depressive symptoms, and nicotine dependence, hierarchical regression analysis of readiness scores revealed a significant interaction of days since last drink and depressive symptoms. It was found that a greater number of days since last drink was associated with greater readiness, but only among patients with low scores on the Center for Epidemiologic Studies Depression Scale (L. S. Radloff, 1977). The findings suggest that alcoholic smokers with low depressive symptoms are more receptive to quitting smoking after sustained alcohol abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Functional associations among trauma, PTSD, and substance-related disorders

This review article presents several potential functional pathways which may explain the frequent co-occurrence of PTSD and substance abuse disorders in traumatized individuals. Emerging empirical studies which have examined these potential pathways are reviewed, including studies on relative order of onset, PTSD patients' perceptions of various drug effects, comparisons of PTSD patients with and without comorbid substance use disorders, and correlational studies examining the relations between severity of specific PTSD symptom clusters and substance disorder symptoms. Research on the acute and chronic effects of alcohol and other drugs on cognitive and physiological variables relevant to PTSD intrusion and arousal symptoms is reviewed to highlight ways in which these two sets of PTSD symptoms might be functionally interrelated with substance abuse. Finally, based on these findings, recommendations are made for the treatment of individuals with comorbid PTSD-substance use disorders.     

Older adult controlled drinkers and abstainers

Little is known about the lifetime course of alcohol problems, especially during late adulthood. Many individuals with a history of alcohol problems achieve remission of their symptoms through abstinence or controlled drinking. This study examined 135 older adults with a prior history of alcohol diagnoses who were symptom free for at least the past year. Two groups were identified based on their alcohol consumption within the past year: abstinent individuals (n = 92) and controlled drinkers (n = 43). The groups did not differ in age, racial composition, education, income, or years since their last alcohol-related symptom, but they did differ in gender composition, indices of alcoholism severity, history of formal and informal treatment, as well as lifetime alcohol consumption patterns. Abstinent individuals had more severe alcohol problems, consumed higher amounts of alcohol on drinking days, had more years of heavy alcohol consumption, and were more likely to have attended alcohol treatment and Alcoholics Anonymous (AA). The controlled drinkers had a longer history of moderate social drinking, and their current consumption habits appeared to be similar to symptom-free older adult drinkers. The results suggest that gender, alcoholism severity, history of formal and informal treatment, and past consumption patterns are associated with whether older adults with histories of alcoholism attain successful outcomes through abstinence or controlled drinking.     

Caffeine dependence in schoolchildren?

Schoolchildren (N?=?289) kept a log and calculated their habitual caffeine consumption (principally in soft drinks). On 2 successive days, they completed a 20-item checklist adapted from the Profile of Moods Scale. On Day 2, they abstained from caffeine. Complete data were obtained for 175 children. A low-consumption group (10 mg or less daily) was compared with a high-consumption group (50 mg or more daily). The high-consumption group reported more stimulation than did the low-consumption group on Day 1 and more dysphoric symptoms during abstinence on Day 2. The results of this open-label pilot trial suggest that a large-scale double-blind placebo-controlled trial would be worthwhile. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties and validity of the obsessive-compulsive drinking scale

Abstinent alcoholics' self-reports of distressing alcohol-associated thoughts and compulsions to drink were evaluated by the Obsessive-Compulsive Drinking Scale (OCDS). Exploratory and confirmatory factor analyses on separate subject samples revealed that subjects' OCDS responses were best described by four correlated dimensions: alcohol obsessions, alcohol consumption, automaticity, and interference due to drinking. The validity of this four-factor solution was supported by the pattern of associations with drinking and coping style measures. In particular, alcohol obsessions were positively associated with alcohol dependence and use of passive/ avoidant coping. Automaticity was positively associated with the intensity and salience of drinking, and inversely associated with use of active/approach coping, as well as abstinence duration. The obsession and automaticity subscales of the OCDS may be useful in evaluating cognitive-motivational processes associated with recovery from alcoholism.     

Dawn simulation treatment of abstinent alcoholics with winter depression

BACKGROUND: Recent data suggest that winter depression (seasonal affective disorder [SAD]) may be a subtype of affective disorder that is closely related to alcoholism. Dawn simulation has been shown in controlled trials to be effective in SAD. The present study examined the effectiveness of dawn simulation in abstinent alcoholics who met DSM-III-R criteria for major depression, or bipolar disorder, depressed with seasonal pattern. METHOD: All 12 subjects with winter depression had a history of either alcohol dependence or alcohol abuse according to DSM-III-R and had been abstinent from alcohol for at least 6 months. They also fulfilled criteria for SAD according to Rosenthal and were hypersomnic and drug free. After a 1-week baseline period, the subjects were randomly assigned to a 1-week treatment period at home with either a white 1.5-hour dawn from 4:30 a.m. to 6:00 a.m. peaking at 250 lux or a red 1.5-hour dawn from 4:30 a.m. to 6:00 a.m. peaking at 2 lux. The subjects were told that they would receive daily either a red or a white dawn reaching the same illuminance, an illuminance that would be much dimmer than standard bright light treatment. At the end of each week, the subjects were blindly assessed by a psychiatrist using the Structured Interview Guide for the Hamilton Depression Rating Scale-Seasonal Affective Disorder version (SIGH-SAD). RESULTS: For the 6 subjects completing the white dawn treatment, the mean SIGH-SAD score decreased from 33.0 at baseline to 15.8 after treatment. For the 6 subjects completing the dim red dawn treatment, the mean SIGH-SAD score decreased from 34.3 to 32.7. The mean post-dawn SIGH-SAD score was significantly lower after the white dawn treatment than after the dim red dawn treatment (ANCOVA with baseline SIGH-SAD as the covariate, F = 12.95, p < .01). Superiority of the white dawn was also found by analogous analyses for the Hamilton Rating Scale for Depression (HAM-D) (p < .01) and the SAD Subscale (p < .05). CONCLUSION: The present study suggest that dawn simulation may be helpful in decreasing depression in abstinent alcoholics with SAD. Further study is necessary to confirm these preliminary findings and to determine whether dawn simulation might be helpful in preventing relapse in abstinent alcoholics who have SAD.     

Effect of kainate on the membrane conductance of hilar glial precursor cells recorded in the perforated-patch configuration

OBJECTIVE: To determine discontinuation effects of ipsapirone, a novel azapirone and partial 5-HTIA agonist that has anxiolytic effects clinically and has not caused dependence or withdrawal symptoms in animals, and to compare these effects with those of the benzodiazepine lorazepam, owing to concern about dependence or withdrawal symptoms following use of these drugs. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Outpatient and inpatient treatment. PARTICIPANTS: Sixty-five healthy male volunteers who had experience with sedative-hypnotics or anxiolytics and did not meet DSM-III-R criteria for abuse or dependence. INTERVENTIONS: Participants were randomized to receive ipsapirone 15 mg per day (n = 17), ipsapirone 22.5 mg per day (n = 16), lorazepam 3 mg per day (n = 16), or placebo (n = 16) as outpatients for 36 days (treatment) followed by single-blind placebo as inpatients for 3 days and as outpatients for 6 days (withdrawal). OUTCOME MEASURES: Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Scale (HAM-D), Spielberger State Anxiety Scale, Sleep Quality Questionnaire, General Symptom Checklist, self-rated intoxication, Clinical Institute Withdrawal Assessment--Benzodiazepines (CIWA-Benzo), psychomotor testing and urine drug screen. RESULTS: Only 45 subjects completed the study; discontinuation rates did not significantly differ among treatment groups. At day 39, fewer and less severe symptoms (e.g., insomnia and fatigue) were found on the CIWA-Benzo scale after treatment with ipsapirone or placebo than after treatment with lorazepam (p < 0.05). Subjects reported longer sleep latency and poorer sleep quality after receiving lorazepam than after receiving ipsapirone or placebo. Scores on the HAM-D, Spielberger State Anxiety and HAM-A scales did not change from baseline. CONCLUSIONS: Withdrawal symptoms were detected after discontinuation of therapeutic doses of lorazepam. Significantly fewer symptoms were observed after withdrawal from anxiolytic doses of ipsapirone.     

Relationship of cocaine and other substance dependence to well-being of high-risk psychiatric patients

OBJECTIVE: The co-occurrence of substance dependence disorders was determined in a sample of 160 frequently hospitalized adults with severe mental illness, and the relationship between substance dependence and psychosocial functioning and well-being was examined. METHODS: A structured interview was used to assess subjects for co-occurring current DSM-III-R substance dependence disorders during an acute psychiatric hospitalization. They were administered a structed interview that included the subscales of the Addiction Severity Index, the Center for Epidemiological Studies-Depression Scale, Lehman's Quality of Life Interview, Rosenberg's Self-Esteem Scale, the Mastery Scale, and questions about service needs. RESULTS: Seventy-eight of the subjects (48.8 percent) were diagnosed as having at least one current substance dependence disorder. Most subjects with comorbid substance dependence were polysubstance dependent (55.1 percent), and almost half (44.9 percent) met criteria for cocaine dependence. Subjects who were substance dependent were significantly overrepresented among those diagnosed with bipolar disorder, psychotic disorder not otherwise specified, and major depression. When the analysis controlled for demographic characteristics and primary diagnosis, comorbidity was related to depressive symptoms, adverse life conditions, and diminished life satisfaction in several domains. Substance-dependent subjects were significantly more likely to have been arrested and jailed than nondependent subjects. Cocaine-dependent subjects were significantly less satisfied than all other subjects with their living situation and personal safety and more likely to request assistance for their drug and alcohol use problems. CONCLUSIONS: The findings corroborate high rates of co-occurring substance dependence disorders among frequently hospitalized patients with severe mental illness. They also reveal a high prevalence of cocaine dependence and a dramatic pattern of negative correlates of cocaine dependence. The findings suggest that successful interventions for substance dependence may improve these patients' life circumstances and that psychiatric patients may be particularly receptive to such interventions during hospitalization.