音乐疗法治疗酒精使用障碍的研究进展

酒精使用障碍是一种常见的物质相关障碍。在非药物治疗方面,常用的干预手段包括动机增强、认知行为疗法、12步疗法等以调整认知及行为为核心的疗法。这类患者存在情绪问题甚至共病心境障碍的比率相当高。这不仅带来诊断治疗上的复杂与困难,还会促使复饮几率大幅增加。音乐治疗作为一种新兴的临床治疗技术,对缓解情绪有较好的效果,开始获得更多关注。本文就国内外对于音乐治疗在酒精使用障碍治疗领域的研究做一综述。     

酒精相关内分泌障碍及肝脏疾病

目的:介绍酒精所致的内分泌障碍及酒精性肝病(ALD)的机制及治疗进展。方法:对近年文献进行复习。结果:本文对酒精对内分泌系统的影响及所致的功能障碍(尤其是对HPA轴、HPT轴及性腺轴的影响)的机制、治疗的进展,酒精性肝病的发生机制、分类及治疗进展进行了介绍。结论:酒精可导致内分泌系统功能障碍及肝功能障碍,酒精引起的障碍早期或可通过戒酒逆转,但晚期病变(如肝硬化)则很难逆转。对晚期患者,除戒酒之外,支持治疗是主要的手段。     

酒精相关障碍的药物治疗

酒的滥用日益严重,由此而产生的相关障碍增多.美国国家患病调查（NCS）发现酒依赖已成为第二大最常见的精神疾病.研究发现过量使用酒精与癌症、肝病、心脏病的发生有关,成为第三大常见的导致死亡的原因,美国流调研究（ECA）发现酒依赖者中36.6%至少合并有一种精神障碍.     

酒精使用障碍的发生机制、诊疗建议及预防策略

酒精是全球疾病发生的主要因素之一,长期酗酒者容易受到酒精的直接毒性作用影响,罹患各种继发性疾病以及其他共病精神疾病.酒精使用障碍是一种慢性复发性障碍,为最常见的物质使用障碍之一,包括强迫性的酒精寻求和失去控制的酒精摄入,以及在戒酒期间出现消极情绪状态和躯体适应不良等.酒精使用障碍发生机制比较复杂,涉及遗传因素、各种神经...     

微小RNA在酒精使用障碍中的研究进展

酒精使用障碍是一种由于长时间饮酒导致的慢性复发性精神疾病,包括酒精滥用和酒精依赖,是重要的公共卫生问题。微小RNA(miRNA)是一类长度约为21～23个核苷酸的非编码RNA,主要参与mRNA的稳定以及翻译水平的调节。酒精暴露是酒精使用障碍最为核心的危险因素,近年来,在临床、动物及细胞研究中均表明,酒精暴露使血清、脑区及细胞中的miRNA表达水平发生变化。也有研究表明,miRNA多态性及与miRNA合成相关的基因的多态性和酒精使用障碍密切相关。本文综述了近年来miRNA在酒精使用障碍中的研究进展,以期阐明其在酒精使用障碍发生发展中的作用机制,为探明酒精使用障碍新的治疗靶点提供参考。     

果蝇模型在酒精使用障碍研究中的优势与应用前景

酒精使用障碍(alcohol use disorder, AUD)是一种包括酒精依赖与酒精滥用的慢性复发性疾病,主要表现为对酒精的渴求、依赖、耐受及戒断后复饮。由于AUD涉及许多重要的脑区及神经环路,对AUD发病机制及疾病发生发展的探索具有很大挑战。中药已被广泛用于治疗AUD,但有待于进一步研究其有效成分和作用机制。果蝇具有生命周期短暂、易操作以及表型易于观察等优点,目前广泛应用在人类AUD调控机制的研究中。本文从基因水平、神经系统和行为表型等方面概述果蝇在AUD研究中的应用,以期为国内AUD机制研究和中药筛选提供参考。     

美国精神病学会：物质使用障碍病人治疗指南（摘译）

一．物质滥用诊断标准 见表l。二．物质依赖诊断标准 见表2。三．物质使用障碍的评估。“物质使用障碍”术语包含许多不同的物质和障碍数目（例如,滥用、依赖、中毒、戒断以及由物质使用造成的精神病综合征和障碍）。物质滥用和物质依赖是我们经常遇到的两种障碍,而且它们的标准适用于多种物质。     

家庭功能、健康促进生活方式与酒精使用障碍的关系

目的 探讨家庭功能、健康促进生活方式与酒精使用障碍的关系。方法 采用便利抽样法连续入组80例酒精使用障碍患者(研究组)和80例健康者(对照组),施测家庭关怀度指数、健康促进生活方式量表、饮酒问卷。结果 除营养因子外,病例组APGAR总分、HPLP-ⅡR其他因子分显著低于对照组(P<0.05或0.01)。APGAR总分、HPLP-ⅡR各因子分与AUQ总分显著负相关(P<0.01);多元回归分析显示,APGAR、健康责任对病例组酒精使用障碍有显著预测效应(P<0.05或0.01)。由直接效应到中介模型,APGAR对AUQ无显著预测效应(P=0.053)。结论 家庭功能、健康促进生活方式是酒精使用障碍的预测因子,健康促进生活方式在家庭功能、酒精使用障碍之间起完全中介效应。     

抗抑郁药物与临床治疗——来自《中国抑郁障碍防治指南》的建议

中国精神卫生工作规划(2002—2010年)将精神分裂症，抑郁症、老年性痴呆确定为今后10年我国精神卫生工作的重点精神疾病。由卫生部疾病控制司中国疾病预防控制中心精神卫生中心、中华医学会精神病学分会和北京大学精神卫生研究所牵头，于2003年10月完成了《中国抑郁障碍防治指南》的编写，为工作在精神卫生领域第一线的专科医师、全科医师、综合医院心理科医师和临床社工师和精神卫生管理人员工作提供重要参考意见。     

重症酒精性肝炎临床治疗进展

重症酒精性肝炎是一种由酒精导致的、潜在威胁生命的急性肝损伤,死亡率高,临床治疗面临巨大挑战。本文从营养支持治疗以及糖皮质激素、抗细胞因子应用等几个方面综述重症酒精性肝炎的临床治疗进展。     

Investigational drugs for alcohol use disorders: a review of preclinical data

Introduction: Alcohol use disorders (AUDs) are one of the leading causes of preventable death in the developed world. In the U.S., only three FDA-approved pharmacotherapies for AUDs currently exist, but at a population level they display poor efficacy, low compliance rates, and adverse side effects. Therefore, identifying novel neurobiological targets for pharmacological treatment of AUDs is of urgent concern.

Areas covered: We discuss recent preclinical data on investigational drugs that have been assessed for their therapeutic potential in AUDs. We focus on three neurobiological domains underlying AUDs: neuropeptide systems, neuroinflammatory/neuroimmune mediators, and epigenetic modifications. We iterate the therapeutic potential of ghrelin receptor antagonists, oxytocin, neurokinin 1 receptor antagonists, and glucagon-like peptide-1 receptor agonists. In the context of neuroinflammatory/neuroimmune modulators, we draw attention to P2X4 receptor positive allosteric modulators and phosphodiesterase inhibitors. Finally, we highlight the prospects of histone deacetylase inhibitors and DNA methyltransferases that modulate the dysregulated epigenetic landscape in alcohol dependence.

Expert opinion: We propose that several of the compounds discussed may be suitable to be repurposed for AUD treatment. We allude to the possibility of combined pharmacotherapy for AUDs and anticipate the efforts that must be enacted to advance the field of personalised medicine for the treatment of this devastating condition.     

Personality disorders and the prediction of alcohol use outcomes for women: Dimensional versus categorical classification

The impending shift in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders from categorical to a hybrid categorical-dimensional diagnosis scheme has generated considerable interest in the relative merits of these respective approaches. This is particularly true for the diagnostically complex category of personality disorders (PDs). The present study assessed whether categorical or dimensional measures better predicted alcohol consumption in a sample of 102 women enrolled in a clinical trial comparing individual cognitive behavioral therapy (CBT) to conjoint CBT for alcohol use disorders (AUDs). Linear regression was used to evaluate whether each PD diagnosis (categorical), or the number of PD symptoms endorsed per PD (dimensional) better predicted percent days drinking over the course of six months of treatment. PD criteria (dimensional) better predicted drinking for Paranoid, Borderline, and Obsessive-Compulsive PDs, while diagnosis (categorical) was a better predictor only for passive-aggressive PD. Both schemes predicted drinking outcomes for avoidant, dependent, and depressive PDs, and neither was predictive for narcissistic PD. These findings suggest that the addition of a dimensional approach for PDs potentially enhances the prediction of alcohol use outcomes.     

Evidence-based guidelines for pediatric clinical trials: focus on StaR Child Health

Clinical trials in children are challenging and filled with important ethical considerations that differ from adults. Given difficulties associated with pediatric clinical trials, off-label prescribing is a common practice in pediatrics, which can lead to adverse safety events and efficacy failures. To overcome these consequences, in the past 15 years, legislation in the USA and Europe has provided incentives to industry and increased government funding to conduct pediatric trials. Pediatric trial networks have also been formed to decrease the knowledge gap. However, challenges to performing pediatric trials and lack of standardization and guidelines regarding studies in children still exist. Standards for Research (StaR) in Child Health, begun in 2009, aims to improve the design, conduct and reporting of pediatric trials. This organization uses a consensus guideline approach involving academic, government and industry stakeholders to identify and disseminate best practices for pediatric trials. Six out of 11 planned standards are currently published.     

Management of co-morbid anxiety and alcohol disorders: parallel treatment of disorders

Co-morbid alcohol-related disorders and anxiety disorders have been found to occur in alcohol treatment populations, anxiety treatment populations and the general community. People suffering from co-occurring alcohol-related and anxiety disorders are more prone to relapse to alcohol abuse, and more likely to re-enter the treatment system for either disorder than sufferers of either disorder without a co-morbid disorder. To review the current state of the management of this disorder, evidence of the prevalence of this co-morbid condition in clinical and community populations is examined, then the theoretical mechanisms that might explain this connection are reviewed. A comparison of the few treatment studies of co-morbid alcohol and anxiety disorders shows a limited number of pharmacological treatment trials and no psychotherapy outcome trials. This review shows that it is no longer sustainable to conceptualize co-morbidity of alcohol and anxiety disorders as a unitary concept, i.e. lumping alcohol-related and anxiety disorders as one global condition, but as separate distinct combinations of particular anxiety disorders, e.g. alcohol dependence and panic disorder, alcohol dependence and generalize anxiety disorder. The recommended treatment approach, supported by the evidence, is to offer separate and parallel therapy for the alcohol-related and anxiety disorder, until empirical evidence from treatment outcome studies suggest otherwise. There is an urgent need to conduct treatment outcome research for the subtypes of co-morbid alcohol and anxiety disorders.     

Rabeprazole: a pharmacologic and clinical review for acid-related disorders

Rabeprazole is a proton pump inhibitor that can be used in the treatment of acid-peptic-related disorders (gastroesophageal reflux disease [GERD], duodenal ulcer, gastric ulcer, gastric acid hypersecretory syndromes) and Helicobacter pylori. Pharmacodynamic data has demonstrated that rabeprazole, with a high pKa of ～ 5.0, can be activated at a higher pH than other proton pump inhibitors. This possibly results in faster onset of action. Owing to its non-enzymatic pathway of metabolism, rabeprazole is also less influenced by genetic polymorphisms of the CYP2C19, which others proton pump inhibitors are dependent on. In a 2-week, placebo-controlled trial, rabeprazole was both rapid and effective in relieving heartburn on day 1 of therapy and improved other GERD-related symptoms including regurgitation, belching, bloating, early satiety and nausea. For oesophageal reflux disease without erosions both 10 and 20 mg of rabeprazole are equivalent and better than placebo at 2 and 4 weeks. An on-demand approach to non-erosive reflux disease with 10 mg of rabeprazole has also been documented as superior to placebo. Some success in the treatment of extra-oesophageal manifestations of GERD, such as asthma and chronic laryngitis, has also been achieved with rabeprazole. Overall, rabeprazole with very few side effects is a safe and efficacious medication for acid suppression therapy.     

Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial

Introduction and Aims. Remote delivery of interventions is needed to address large numbers of people with alcohol use disorders who are spread over large areas. Previous correspondence trials typically examined its effects as stand‐alone treatment. This study aimed to test whether adding postal treatment to general practitioner (GP) support would lower alcohol use more than GP intervention alone. Design and Methods. A single‐blind, randomised controlled trial with a crossover design was conducted over 12 months on 204 people with alcohol use disorders. Participants in an immediate correspondence condition received treatment over the first 3 months; those receiving delayed treatment received it in months 3–6. Results. Few participants were referred from GPs, and little intervention was offered by them. At 3 months, 78% of participants remained in the study. Those in immediate treatment showed greater reductions in alcohol per week, drinking days, anxiety, depression and distress than those in the delayed condition. However, post‐treatment and follow‐up outcomes still showed elevated alcohol use, depression, anxiety and distress. Greater baseline anxiety predicted better alcohol outcomes, although more mental distress at baseline predicted dropout. Discussion and Conclusions. The study gave consistent results with those from previous research on correspondence treatments, and showed that high levels of participant engagement over 3 months can be obtained. Substantial reductions in alcohol use are seen, with indications that they are well maintained. However, many participants continue to show high‐risk alcohol use and psychological distress.[Kavanagh D, Connolly JM. Mailed treatment to augment primary care for alcohol disorders: A randomised controlled trial. Drug Alcohol Rev 2009;28:73–80]     

Women's motivators for seeking treatment for alcohol use disorders

This study examined types of internal and external motivations for seeking treatment and the predictive utility of different types of motivation among 180 women with an alcohol use disorder (AUD) participating in a two-armed trial testing different individual and couple therapies for AUDs. Reasons for seeking treatment were coded for type of internal or external motivation. Most women (97%) cited internal reasons for seeking help, including: concern about progression of AUD (61.1%), health (43.3%), mental health (38.9%), and family (38.3%). Occupational concerns, an internal motivator cited by 6% of women, were associated with better drinking outcomes; interpersonal-family concerns were associated with poorer outcomes. Some motivators for seeking treatment may not be related to sustained changes in drinking, suggesting that understanding motivators for treatment may be inadequate to maintain change. Reasons for help-seeking may need to be addressed in treatment to produce long-lasting change.     

Assessing the efficacy of medical treatments for alcohol use disorders

Alcohol use disorders (AUDs) are common health problems that have a significant impact on society as a whole. There is a need for more effective treatments. In the last two decades, evidence for the efficacy of pharmacological approaches to treatment has increased. Although it has long been clear that medications are needed for the treatment of the alcohol withdrawal syndrome, the important role of medications in the longer-term treatment of AUDs has only recently been appreciated. In particular, naltrexone, acamprosate and topiramate appear to be efficacious treatments, especially when combined with psychosocial interventions that emphasise compliance with medication and encourage treatment retention. The goal of this review is to bring together the existing literature supporting the usefulness of pharmacological treatments for the alcohol withdrawal syndrome, for longer-term treatment of AUDs, and for comorbid AUDs and other psychiatric disorders. In addition, opportunities for future research will be identified.     

78例酒精所致精神障碍病人的心电图分析

目的：了解酒精对心电图变化的影响与心功能之间的关系。方法：对符合CCMD-3酒精所致精神障碍诊断标准的78例酒精所致精神障碍患者进行心电图检查分析。结果：酒精所致精神障碍患者的心电图改变为：窦性心动过速,窦性心律不齐,肢体导联低电压,左心室高电压及左心室肥厚,ST-T改变。结论：过度饮酒对心电图有影响并与心血管损害有关。