History Of Alcohol Use Disorder Research Articles

S1428 Outcomes of Pyogenic Liver Abscess (PLA) on Mortality and Hospitalization Cost Amongst Patients With History of Alcohol Use Disorder (AUD): Retrospective Study Using NIS (2016 – 2019)

Introduction: Liver is the most common site for intra-abdominal abscess. Pyogenic liver abscess is more common in men compared to women. Risk factors include diabetes mellitus and chronic hepatobiliary disease. Alcohol abuse is known to cause bone marrow suppression and compromised immune system. Limited data are available regarding clinical outcomes in patients with history of alcohol use disorder who are admitted with pyogenic liver abscess. Methods: Using National Inpatient Sample databases from 2016 to 2019. We identified patients presenting with pyogenic liver abscess, the population were then divided based on the presence and absence of alcohol use disorder using appropriate ICD-10-CM/PCS codes. STATA 16.0 software was used for the analysis. Pearson’s Chi-Square test was used to analyze categorical variable, whereas the student t-test was used to analyze continuous variables. Univariate and multivariate logistic regression was used to adjust for potential confounders. Primary outcome was in hospital mortality due to Pyogenic liver abscess in patients with alcohol use disorder. Results: Amongst total of 19,830 patients admitted with pyogenic liver abscess, 1,090 patients had history of alcohol use disorder and 18,740 patients did not. Both groups consisted predominantly of white male patients. Mean LOS was higher in alcohol use disorder group (8±6.08 days) than in non-alcohol use disorder group (7.35±6.34 days ) (P=< 0.001 ). Mean total hospitalization charges were higher in AUD group ($ 20,968) than in the non-AUD group ($ 18,994) (P= < 0.001) Conclusion: Patient with Pyogenic liver abscess with alcohol use disorder history had higher resource utilization, but less odds of mortality. (Table) Table 1. - In-patient outcome comparison of patients with history of alcohol use disorder presenting with pyogenic liver abscess PLA WITH AUD, N(%) PLA WITHOUT AUD, N(%) P value Total 1090(8.92) 18740(91.07) Primary Outcome OR 95 CI P value Mortality 0.511 0.067 - 3.86 < 0.001 Secondary Outcomes Mean Mean P value LOS(days) 8+/-6.08 7.35+/-6.34 < 0.001 Charges(US$) 20968 18994 < 0.001 Demographics Mean Age 57.65+/- 11.45 61.47+/-15.65 Female(%) 205(18.81) 7404(41)

S2542 A Rare Case of Renal Cell Carcinoma Diagnosed on EGD

Introduction: Neoplasms of the duodenum account for a fraction of overall gastrointestinal tumors. Even when a lesion is found in the duodenum, it is more likely to be of secondary neoplastic origin than primary. Here we present a unique case of primary renal cell carcinoma (RCC) diagnosed on EGD. Case Description/Methods: A 55-year-old male with a history of alcohol use disorder presented to the emergency department for lightheadedness, fatigue, and 100-pound unintentional weight loss over 3 months. On exam, the patient was found to be hypotensive, tachycardic, and jaundiced. Laboratory values were pertinent for a Hemoglobin of 4.4 g/dl. After adequate resuscitation, esophagogastroduodenoscopy (EGD) was performed that showed a large partially obstructive, infiltrative, and ulcerated mass with no bleeding in the second part of the duodenum. Histology from the duodenal mass biopsy revealed clear cell carcinoma of renal origin with mucosal ulceration. An abdominal computerized tomography (CT) scan showed a heterogeneous, centrally necrotic right renal mass causing mass effect on the second and third portions of the duodenum, right hemicolon, and hepatic flexure. The scan was also suggestive of duodenal invasion by the mass. Solid pulmonary nodule biopsy was unequivocal for metastasis. The patient was discussed in tumor board and deemed to be a candidate for cytoreductive surgery with partial duodenal resection and systemic immunotherapy if metastasis was confirmed on future biopsies (Figure). Discussion: Duodenal metastasis from RCC is very rare and poses a diagnostic challenge. The most common presentation is with upper gastrointestinal hemorrhage or obstruction, though sometimes it can present with perforation, intussusception, or obstructive jaundice. Duodenal involvement is often from direct infiltration or metastatic spread. Delay in care and large tumor size are the likely reasons for the rare presentation seen in this patient. This case highlights the importance of considering all neoplasms of extraintestinal origin when duodenal lesions are identified endoscopically.Figure 1.: Left: 2nd portion of duodenum. Right: CT Abdomen/Pelvis.

S3590 Emphysematous Gastritis

Introduction: Emphysematous gastritis is a rare and severe condition characterized by the presence of air and bacteria in the gastric wall. It usually presents with severe abdominal pain and diagnosed by presence of gas within the gastric wall on imaging. It has a high mortality rate of about 60-80%. Conservative management is the mainstay of treatment. Case Description/Methods: A 36-year-old male with a past medical history of alcohol use disorder and major depressive disorder presented with severe diffuse abdominal pain with post-prandial worsening, intractable nausea, and vomiting. This was preceded by binge drinking of alcohol. He reported poor appetite over one month associated with 17lb weight loss and early satiety. No history of liver disease, peptic ulcer disease, excessive NSAID or aspirin use. He was tachycardic and normotensive. No signs or symptoms of overt GI bleeds. Physical exam was negative for guarding or tenderness. Labs were remarkable for lactic acidosis of 3.6 mmol/L with an anion gap of 21. Lipase and LFTs were normal. CT abdomen showed gastric emphysema and mild diffuse circumferential thickening with fat deposition through the cecum and sigmoid colon, suggestive of emphysematous gastritis. General surgery was consulted but recommended no acute surgical intervention. He was started on a clear liquid diet, pantoprazole drip, empiric IV Piperacillin-Tazobactam, pain medications, and IV fluids. EGD showed moderate gastritis, no necrosis, mild duodenitis. Biopsy showed mild chronic gastritis. Patient improved clinically and repeat CT abdomen in 2 days showed improvement in gastric emphysema. He was discharged with a 7-day course of oral Amoxicillin-Clavulanate and indefinite pantoprazole 40mg BID (Figure). Discussion: Emphysematous gastritis starts with disruption of the integrity of gastric mucosa with secondary infection. Isolated organisms include Streptococci, S. Aureus Enterococci, Clostridium, Klebsiella, Pseudomonas, E.Coli, Enterobacter. Ischemia is an inciting event as seen in volvulus, SMA occlusion, acute gastric dilation. Mechanical causes include forceful emesis, gastric outlet obstruction, malignancy, and iatrogenic causes like gastrostomy or NG tube insertion, myotomy and biliary stents. Risk factors are alcohol use, NSAID and steroid use, cytotoxins, diabetes, abdominal surgery, and burns. Optimal conservative management with diet management, IV fluids, antibiotics has good outcomes as demonstrated by the above case and additional recent cases in literature.Figure 1.: A- Gastric emphysema and mild diffuse circumferential thickening with fat deposition through the cecum and sigmoid colon, suggestive of emphysematous gastritis B- Significantly decreased air locules along the periphery of the proximal gastric mucosa.

S1783 Noncirrhotic Portal Hypertension and Pancreaticogastric Fistula Complicating Acute Pancreatitis With Fluid Collections

Introduction: Noncirrhotic portal hypertension constitutes an increase in pressure of the portal venous system in the absence of cirrhosis. This is a rare condition; however, it is insufficiently acknowledged given its decreased prevalence in North America and Europe compared to other nations. We present a rare case of noncirrhotic portal hypertension and pancreatico-gastric fistula complicating acute pancreatitis with an acute fluid collection and resultant portal vein narrowing. Case Description/Methods: A 55-year-old man with history of alcohol use disorder presented to the emergency department with worsening abdominal pain 2 weeks after discharge for uncomplicated acute pancreatitis. Lipase was 48 IU/L (normal 11-82 IU/L). CT abdomen showed increasing peripancreatic fluid collection with marked narrowing of the main portal vein, which appeared near threadlike, and narrowing of the bifurcation of the portal vein extending into the left portal vein. The splenic vein was also severely narrowed (Figure A). He was discharged home with outpatient follow-up, however, returned to the ED for intractable pain one month later. A CT abdomen showed florid changes of pancreatitis with pseudocyst formation with new foci of air within the collection concerning for fistulous tract formation with the gastric lumen (Figure B). The portal vein and splenic vein narrowing improved, but the narrowing of the right and left portal veins worsened. He underwent upper endoscopy which showed a small area of White "milky" base in the posterior wall of the incisura angularis which was suggestive of fistulous opening in the area (Figure C). Four columns of small distal esophageal varices were also noted. During admission, paracentesis was performed for ascites. Serum ascites albumin gradient was over 1.1 consistent with ascites due to portal hypertension – likely due to the portal vein narrowing. Patient was discharged in stable, improved condition. Discussion: Although portal hypertension normally presents in cirrhotic patients, it may rarely present in the absence of cirrhosis by conditions such as portal vein thrombosis or portosinusoidal vascular disease. Compression of the portal vein from an acute pancreatic fluid collection is an extremely rare cause of noncirrhotic portal hypertension. Clinicians should have a high index of suspicion for complications related to portal hypertension such as ascites or varices in patients with a prolonged course of acute pancreatitis without cirrhosis.Figure 1.: (A) Contrast CT abdomen showing marked narrowing of the main portal vein, which appears near threadlike. (B) One of 2 foci of air in the collection at the anterior superior aspect of the pancreatic body. Appears inseparable from the posterior wall of the gastric body, concerning for fistulous involvement. (C) Area of White “milky” base in the posterior wall of the incisura angularis. This area was rinsed, however re-accumulated despite no obvious opening seen.

S2358 Black Esophagus: A Case of Acute Esophageal Necrosis Secondary to Binge Drinking

Introduction: Acute esophageal necrosis (AEN) is a rare, potentially life threating and under-diagnosed syndrome that presents most commonly with upper GI bleeding, hematemesis, and abdominal pain. Here we present a case of an otherwise healthy, middle-aged man with coffee ground emesis who had classic findings of black, necrotic, ulcerative esophageal mucosa on esophagogastroduodenoscopy (EGD) after presenting in the setting of binge drinking. Case Description/Methods: A 47-year-old man with a history of alcohol use disorder presented to the hospital with multiple episodes of coffee ground emesis and epigastric pain. He recently restarted drinking alcohol. He denied any blood thinner use. He was hypertensive and tachycardic on arrival. His physical exam was overall non focal. His relevant lab work included a BUN 24, lactate of 8.3, lipase 11, Hgb 14.5 g/dL; AST, ALT, platelets, and INR were all normal. The patient was treated with IV fluids and started on a PPI drip. A CT scan of the abdomen/pelvis was performed and it was remarkable for nonspecific wall thickening of the thoracic esophagus. The GI service was consulted and an EGD was performed showing a 4 cm hiatal hernia and black mucosal necrosis in the mid and distal esophagus (Figure). The patient was made NPO, continued PPI therapy, and cardiothoracic surgery (CTS) was consulted. After gradual symptomatic improvement, he was discharged on lansoprazole, sucralfate, and morphine. He was maintained on a clear liquid diet until outpatient follow up with CTS, at which point his diet was gradually advanced without complications. Discussion: AEN is a rare condition with an incidence of 0.01-0.28% of patients undergoing EGD. The pathophysiology is usually multifactorial due to ischemic injury, gastric acid exposure and impaired mucosal repair mechanisms. Multiple medical comorbidities such as diabetes, hypotension, and alcohol abuse have been associated with an increased risk of developing AEN. In our case, binge drinking, and emesis likely contributed to AEN in an otherwise healthy patient. Management is largely supportive with hydration and acid suppression but can include surgery or balloon dilation if the course is complicated by perforation or stricture formation. Prompt performance of an EGD with timely referral to CTS is recommended for risk stratification and to guide follow up management. Repeat EGD is warranted after a month to document healing.Figure 1.: Esophagogastroduodenoscopy of the mid and distal esophagus.

S3656 Primary Diagnosis of Metastatic Breast Cancer via Esophagogastroduodenoscopy With Gastric Biopsies

Introduction: Gastric metastases are a rare manifestation of breast cancer and previous case reports suggest they typically occur in patients with a long standing history of breast cancer. We present a case of a patient whose primary diagnosis of breast cancer was made via gastric biopsies taken during esophagogastroduodenoscopy (EGD) after the patient presented to the hospital with symptoms of persistent nausea and vomiting. Case Description/Methods: The patient is a 58-year-old female with a reported history of alcohol use disorder who presented to the emergency department with intractable nausea and vomiting. On arrival, the patient’s vitals were stable and labs were only significant for a mildly elevated creatinine of 1.40, which normalized with IV fluids. Computed tomography (CT) of the abdomen and pelvis showed diffuse gastric wall thickening. Following the results of the CT, an EGD was performed which revealed diffuse gastritis with friable mucosa and concern for malignancy or ischemia. Gastric biopsies were suggestive of adenocarcinoma with likely primary being breast cancer. Immunohistochemical staining was positive for CDK7, GATA3, mammaglobin, and 80-90% estrogen receptor. Following consideration of both the pathologic appearance and immunohistochemical staining, the diagnosis was made of metastatic lobular carcinoma. Due to the patient's poor support system and functional status, the patient elected to pursue hospice, and therefore further workup was not performed (Figure 1). Discussion: Breast cancer is the second most common malignancy in women in the United States, with metastasis of breast cancer classically spreading to lungs, liver, bone, soft tissue, and adrenal glands. Metastasis to the gastrointestinal (GI) tract is rare, with lobular breast cancer having higher predilection over ductal carcinoma. The average time for breast cancer to metastasize to GI tract has been previously reported as many years after primary diagnosis. Here we present a case of breast cancer where the primary diagnosis was made after EGD assisted gastric biopsies. After extensive literature review, there is sparse information on early gastric metastasis of breast cancer. While our patient's previous history of breast cancer screening is unknown, she had no prior knowledge of her breast cancer diagnosis. This case signifies the importance of endoscopic evaluation and gastric biopsies in patients with nonspecific symptoms, especially with abnormal imaging findings suggestive of gastritis.Figure 1.: Endoscopic appearance of the gastric mucosa.

S1843 The Path of Least Resistance: A Case of the Lemmel

Introduction: Lemmel Syndrome is defined as obstructive jaundice caused by a periampullary duodenal diverticulum (PAD) compressing the intrapancreatic common bile duct (CBD) with resultant bile duct dilatation and obstruction. Management is based on symptomatology, ranging from conservative management to endoscopic extraction of retained food debris, or surgery. We present a unique case of Lemmel Syndrome in a patient who suffered from recurrent obstructive jaundice and underwent multiple endoscopic and ultimately, surgical interventions Case Description/Methods: A 56-year-old obese female with a history of alcohol use disorder initially presented with right upper quadrant abdominal pain for 2 days. Physical exam was remarkable for right upper quadrant tenderness. Labs revealed total bilirubin 3 mg/dL. Complete blood count was within normal limits. Viral hepatitis panel and CA 19-9 were unremarkable. Ultrasound gallbladder showed cholelithiasis without cholecystitis with mild CBD dilatation. MRCP revealed a large 6 cm multiloculated mass centered near the pancreatic head/ampulla of Vater, with internal heterogeneity and multiple air-fluid levels and internally contiguous with duodenal lumen. She was given broad spectrum antibiotics and an upper endoscopy with endoscopic ultrasound was performed revealing a large, non-bleeding periampullary diverticulum impacted with food debris. The food debris was extracted. Multiple such procedures were needed in a short period of time. She continued to suffer from recurrent obstructive jaundice for several months, requiring a cholecystectomy, Roux-En Y hepaticojejunostomy, and gastric antrum resection with Roux-En Y BillRoth II gastrojejunostomy in an attempt to divert food debris away from the diverticulum. She has now developed stenosis at the hepaticojejunostomy requiring ERCP with dilation of the anastomosis, and stenting, as well as percutaneous transhepatic cholangiography, internal external biliary drain placement, lithotripsy of hepatic duct stones, and covered metal stent placement. (Figure) Discussion: Treatment of Lemmel Syndrome incorporates a variety of modalities. A conservative approach is usually preferred, but invasive intervention may sometimes be required. The most definitive approach would be a Whipple procedure. However, in an obese patient, this would be associated with significant morbidity and mortality risk. Our case portrays an unusual approach which offered the patient a less invasive combined endoscopic, interventional radiology and surgical treatmentFigure 1.: A: Initial MRI which shows duodenal diverticulum with biliary dilation consistent with Lemmel Syndrome B: Initial Cholangiogram: Stent within left hepatic duct as well as central right hepatic duct appearing goblet shaped with stones (as shown with arrows) C: Subsequent imaging reveals right hepatic duct status post stone extraction, appearing relatively normal (compare with Image B).

Sexually Transmitted Infections Among Men and Transgender Women Using HIV Pre-exposure Prophylaxis in a Large Integrated Health System-A Cohort Study.

Sexually transmitted infections (STIs) are common in people using pre-exposure prophylaxis (PrEP). We examined risk and factors associated with STIs in a cohort of PrEP users in an integrated health system in the United States. The Kaiser Permanente Southern California is a large integrated health system that provides comprehensive medical services to approximately 4.7 million demographically diverse members. We identified men and transgender women initiating PrEP between January 1, 2014, and June 1, 2018, and followed through December 31, 2018. Demographic and clinical factors potentially associated with the risk of bacterial STIs during PrEP use were evaluated using Poisson regression models. Among 5042 individuals tested for STIs with 7198 person-years of follow-up, 1709 (33.9%) had at least one new STI. The estimated incidence of STIs was 48.3 per 100 person-years, and the most common STI was rectal chlamydia. Most repeat STIs (61.4%) occurred <180 days apart. In a multivariable analysis, an history of STIs in the prior 6 months through 7 days after the PrEP initiation was the most prominent risk factor of STIs during PrEP use (adjusted risk ratio: 1.78, 95% confidence intervals: 1.65 to 1.93). Other risk factors included younger age (<35 years), being Hispanic, and having a history of alcohol use disorder or drug use disorder. Quarterly STI testing and targeted intervention to mitigate STI risk are warranted for young and racial minority PrEP users, particularly for those with prior history of STIs and substance use disorders.

A-173 Grey Matter Volume, Psychotic Disorders, And Heredity of Alcohol Use Disorder: Reconceptualization by B-SNIP Biotypes

Abstract Objective: Bipolar and Schizophrenia Network for Intermediate Phenotypes (B-SNIP) researchers have proposed three Biotypes that show advantages of a dimensional approach to classification, revealing different levels of dysfunction severity through EEG and various forms of cognitive testing. Although preliminary work has been done showing neuroanatomical differences among the biotypes and patterns of heredity, more research is required to investigate the contribution of significant co-morbid factors such as alcohol misuse. Objective. Neuroanatomical data were used to further understand the biomarker of grey matter volume (GMV) in relation to the B-SNIP Biotypes and the interacting influence of family history of alcohol use disorder (FH-AUD). Method. Biotype, FH-AUD, and demographic variables (age, sex, education, and ethnicity) were used in hierarchical regression analyses for prediction of total volume and two key regions (superior parietal cortex and posterior cingulate cortex) in stable probands (n = 347) and their healthy first-degree relatives (n = 346) separately. Prediction was also analyzed in the context of conventional diagnosis of psychotic disorders (schizophrenia, schizoaffective disorder, and bipolar disorder with psychotic features). Structural data were analyzed using FreeSurfer. Results. Biotype was shown to be a more robust predictor of GMV than diagnosis both generally and specifically in relevant regions (p &amp;lt; .05). A pattern of GMV reduction based on severity was observed both in probands and relatives. Effects of FH-AUD and its interaction with Biotype were occasionally observed. Conclusions. This study contributes to the efforts of psychobiological research to establish a more valid conceptualization of psychological disorders through biological mechanisms.

Pharmacodynamic determinants of hangover: An intravenous alcohol self-administration study in non-dependent drinkers

Alcohol hangover refers to the combination of negative mental and physical symptoms that can be experienced after an episode of alcohol consumption, typically emerging as blood alcohol concentration (BAC) approaches zero. Hangover has been associated with heavy drinking and may be relevant in the transition to alcohol use disorder (AUD). Our aim was to examine hangover prevalence and associated symptoms following intravenous alcohol self-administration (IV-ASA), and to identify possible predictors of hangover in non-dependent drinkers.Ninety-five drinkers without AUD completed an IV-ASA session. Pharmacodynamic measures of alcohol consumption included peak and average breath alcohol concentrations. Subjective measures of alcohol response included the Drug Effects Questionnaire and Biphasic Effects of Alcohol Scale. The Alcohol Hangover Scale assessed hangover symptoms from the end of the session until the following morning.78% of participants endorsed at least one hangover symptom following IV-ASA. There was no association between hangover scores and IV-ASA measures of alcohol consumption. Additional mediation and moderation analysis revealed that self-reported intoxication was a significant mediator of the relationship between recent drinking and hangover symptoms.Hangover symptoms may be an early marker of the relationship between subjective response to alcohol and heavy drinking for those with no prior history of AUD. In particular, the effects of hangover go beyond exposure to alcohol and the individual’s subjective response to this exposure is associated with their experience of hangover. Future studies should further characterize the determinants of hangover across different populations of drinkers to better understand the risk for AUD and inform prevention methods.

Association of topiramate prescribed for any indication with reduced alcohol consumption in electronic health record data.

Topiramate is a medication that is widely prescribed to treat a variety of conditions, including alcohol use disorder (AUD). We used electronic health record (EHR) data to measure topiramate's effects on drinking in individuals differentiated by a history of AUD. Parallel-groups comparison of patients prescribed topiramate and a propensity score-matched comparison group. A large US integrated health-care system. Patients with Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) scores prior to and after a minimum of 180 days of topiramate prescription for any indication and a propensity score-matched group. The sample included 5918 patients with an electronic health record diagnosis of alcohol use disorder at any time (AUD-hx-pos) (1738 topiramate-exposed and 4180 controls) and 23 614 patients with no EHR diagnosis of AUD (AUD-hx-neg) (6324 topiramate-exposed and 17 290 controls). Regression analyses compared difference-in-difference (DiD) estimates, separately by AUD history. DiD estimates represent exposure-group (i.e. topiramate versus control) differences on the pre-post difference in AUDIT-C score. Effects of baseline AUDIT-C score and daily topiramate dosage were also tested. AUD-hx-neg patients who received topiramate had a greater reduction in AUDIT-C score (-0.11) than matched controls (-0.04). This yielded a DiD score of -0.07 [95% confidence interval (CI) = -0.11,-0.03; P = 0.002], with the greatest effect among AUD-hx-neg patients with a baseline AUDIT-C score of 4+ (DiD = -0.35, 95% CI = -0.49, -0.21; P < 0.0001) and those prescribed > 150 mg/day of the medication (DiD = -0.15, 95%CI = -0.23, -0.07; P < 0.001). Among individuals with no history of alcohol use disorder, topiramate appears to be associated with reduced drinking. This small effect is most evident among patients with higher baseline drinking levels and at a higher average daily topiramate dosage.

Alcohol-related liver disease and liver transplantation

Alcohol-related liver disease (ALD) has become the major cause of liver transplantation (LT) in Korea, and is currently the most common cause of LT in Europe and the United States. Although, ALD is one of the most common indications for LT, it is traditionally not considered as an option for patients with ALD due to organ shortages and concerns about relapse. To select patients with terminal liver disease due to ALD for transplants, most LT centers in the United States and European countries require a 6-month sober period before transplantation. However, Korea has a different social and cultural background than Western countries, and most organ transplants are made from living donors, who account for approximately twice as many procedures as deceased donors. Most LT centers in Korea do not require a specific period of sobriety before transplantation in patients with ALD. As per the literature, 8%–20% of patients resume alcohol consumption 1 year after LT, and this proportion increases to 30%–40% at 5 years post-LT, among which 10%–15% of patients resume heavy drinking. According to previous studies, the risk factors for alcohol relapse after LT are as follows: young age, poor familial and social support, family history of alcohol use disorder, previous history of alcohol-related treatment, shorter abstinence before LT, smoking, psychiatric disorders, irregular follow-up, and unemployment. Recognition of the risk factors, early detection of alcohol consumption after LT, and regular follow-up by a multidisciplinary team are important for improving the short- and long-term outcomes of LT patients with ALD.

Origins of spousal cross-concordance for psychiatric disorders: a test of the social stress theory for alcohol use disorder.

The authors sought to clarify the impact of spousal psychiatric disorders of differing severity [major depression or anxiety disorders (DAD) v. bipolar disorder or nonaffective psychosis (BPN)] on proband risk for alcohol use disorder (AUD) during marriage. In a Swedish cohort (N = 744 628), associations between spousal DAD and BPN and proband AUD were estimated with Cox proportional hazards; associations between parental AUD, proband premarital AUD, and spousal lifetime DAD and BPN were estimated with logistic regression; and whether spousal DAD or BPN causally increased risk for AUD was evaluated with frailty models. Spousal premarital DAD, spousal marital-onset DAD, and spousal BPN (premarital or marital-onset) were associated with proband AUD during marriage [hazard ratios (HR) range 1.44-3.72]. Those with a parental or premarital history of AUD (v. without) were more likely to marry a spouse with DAD or BPN (odds ratios 1.22-2.77). Moving from an unaffected first spouse to a DAD-affected second spouse increased AUD risk in males (HR 2.90). Moving from an unaffected first spouse to a BPN-affected second spouse increased AUD risk (HRmales 3.96; HRfemales 5.64). Moving to an unaffected second spouse from a DAD-affected first spouse decreased AUD risk, with stronger evidence in females compared to males (HRmales 0.59; HRfemales 0.28). Associations between spousal DAD or BPN and proband AUD reflect both selection and causal effects. Marriage to a BPN-affected spouse has a particularly strong effect on AUD risk, with more modest effects for spousal DAD.

Association between Parent-Reported Executive Functions and Self-Reported Emotional Problems among Adolescent Offspring of Fathers with Alcohol-Dependence

Objectives To compare the executive functions in adolescents of fathers with alcohol dependence (AOFADs) with a control group of adolescents without a paternal history of alcohol dependence and examine the association between executive functioning problems and behavioral and emotional problems. Materials and Methods The study included 39 AOFADs and 45 adolescent offspring of fathers without a history of alcohol-use disorders, who were matched for age and sex. They were assessed using standardized measures of executive functions and emotional and behavioral problems. Statistical Analysis A comparison was made between the two groups about the parental report of adolescents' executive functions and adolescents' self-reported emotional and behavioral problems. ANCOVA was performed to understand the covariance of educational and socio-economic status on executive functions. Correlation between executive functions, emotional and behavioral problems, and the duration of father's alcohol dependence was examined with Spearman's rho. Results AOFAD group showed significant impairment on all subdomains of executive functions and emotional and behavioral disturbances ( p < 0.01) but not on the prosocial behavioral dimension ( p < 0.01). The group differences were independent of child's education and family income. Executive functional impairments positively correlated with psychopathology ( p < 0.01). Problems with executive functions and psychopathology correlated with the duration of the father's alcohol dependence. Conclusions AOFADs are at risk for executive function impairments which in turn are strongly associated with emotional and behavioral problems. The association is independent of child's education and family economic status. The duration of alcohol dependence in fathers is associated with these problems. It has implications for targeted interventions for both adolescents and families.

Measurement invariance of the University of Rhode Island Change Assessment Scale in Project MATCH: An exploratory structural equation modeling approach.

Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach. We conducted a secondary analysis of data from Project MATCH (N=1726; Mage =40.2, SD=10.9; 75.7% male; 80% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and post-treatment (3months after baseline). A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit. Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects.

50-Year-Old Man With Epigastric Abdominal Pain

A 50-year-old man with a history of diverticulosis, hypertension, and anxiety presented to the emergency department with acute epigastric abdominal pain over the preceding 6 hours. Pain was described as stabbing in the epigastrium that radiated posteriorly to the mid-back. He had associated decreased appetite and nausea but no vomiting. He had a history of alcohol use disorder and was consuming about 12 beers daily over the past 3 years before presentation.

Differentiating Individuals with and without Alcohol Use Disorder Using Resting-State fMRI Functional Connectivity of Reward Network, Neuropsychological Performance, and Impulsivity Measures.

Individuals with alcohol use disorder (AUD) may manifest an array of neural and behavioral abnormalities, including altered brain networks, impaired neurocognitive functioning, and heightened impulsivity. Using multidomain measures, the current study aimed to identify specific features that can differentiate individuals with AUD from healthy controls (CTL), utilizing a random forests (RF) classification model. Features included fMRI-based resting-state functional connectivity (rsFC) across the reward network, neuropsychological task performance, and behavioral impulsivity scores, collected from thirty abstinent adult males with prior history of AUD and thirty CTL individuals without a history of AUD. It was found that the RF model achieved a classification accuracy of 86.67% (AUC = 93%) and identified key features of FC and impulsivity that significantly contributed to classifying AUD from CTL individuals. Impulsivity scores were the topmost predictors, followed by twelve rsFC features involving seventeen key reward regions in the brain, such as the ventral tegmental area, nucleus accumbens, anterior insula, anterior cingulate cortex, and other cortical and subcortical structures. Individuals with AUD manifested significant differences in impulsivity and alterations in functional connectivity relative to controls. Specifically, AUD showed heightened impulsivity and hypoconnectivity in nine connections across 13 regions and hyperconnectivity in three connections involving six regions. Relative to controls, visuo-spatial short-term working memory was also found to be impaired in AUD. In conclusion, specific multidomain features of brain connectivity, impulsivity, and neuropsychological performance can be used in a machine learning framework to effectively classify AUD individuals from healthy controls.

Association between family history of alcohol use disorder and catamenial epilepsy.

The purpose of this investigation was to determine whether a family history of alcohol use disorder (AUD) might be a risk factor and possible clinical biomarker for catamenial epilepsy. The retrospective case-control data came from 119 women, aged 13-48years, with intractable seizures. We report the relative risk for positive family history of AUD among women with catamenial epilepsy (Group 1) relative to women with noncatamenial epilepsy (Group 2). The risk ratio (RR) for positive AUD history for Group 1 (n=59) relative to Group 2 (n=60) was 3.46 (95% confidence interval = 1.36-8.76, p=.009). The RRs were significant for women who had the (C1) perimenstrual (p=.009) and (C3) entire luteal phase (p=.003) patterns but not the (C2) preovulatory pattern. AUD history had a high specificity of 91.7% (55/60) but relatively low sensitivity of 28.8% (17/59) for the prediction of catamenial epilepsy. The positive predictive value was 77.3% (17/22), whereas the negative predictive value was 56.7% (55/97). AUD history is a highly specific biomarker for catamenial epilepsy but has relatively low sensitivity for its detection. Further investigation may identify additional biomarkers that are more efficient than seizure-menses calendars.

Catatonia as the Initial Presentation of Depression in an Older Adult

<h3>Introduction</h3> Background: Catatonia is a neuropsychiatric syndrome characterized by a variety of motor, behavioral, emotional, and autonomic abnormalities. It can be caused by general medical, neurological, or psychiatric disorders, as well as by medications and drugs of abuse . Although there is a high prevalence of catatonia in the geriatric population, there is less data available when compared to other age group. . Among psychiatric disorders, depression is commonly associated with catatonia. And in most instances, there is a known history of depression reported in these catatonic patients. We are presenting a unique case in which an older adult presented with catatonia as the initial presentation of depression. We will then present a review of the literature of catatonia in older adults. Case: Mr. B is a 75 year old man with a history of alcohol use disorder in sustained remission for five years, no other psychiatric history, who was admitted to neurology for encephalopathy developed after a hernia repair surgery. His neurological work up including MRI brain, CSF analysis, Vit B12, TSH, video EEG, all of which were normal. The neurology team considered treating the patient with steroids for possible autoimmune encephalitis. They consulted psychiatry as he demonstrated posturing and echolalia. Upon psychiatric evaluation, his presentation was notable for stupor, mutism and negativism. He showed modest response to an initial lorazepam challenge with improved speech. Upon receiving a second dose of lorazepam, the response was significant, marked by improvement in his speech, thought process, and the ability to verbalize his subjective experience . As his catatonia improved, his depression was unmasked. He demonstrated depressed mood, feelings of guilt, helplessness, hopelessness, ruminations about past alcohol use, paranoia against the hospital staff, auditory hallucinations and referential thinking. His condition did not improve with aripiprazole or olanzapine, so team decided to administer electroconvulsive treatment in addition to escitalopram. Over the course of 7 index sessions, the patient showed minimal improvement. With a switch to bilateral ECT (index sessions #8-15), the patient ultimately showed significant improvement, including complete resolution of catatonia, and remission of depressive and psychotic symptoms. This was evidenced by improved mood, sleep, and consistent denial of AH and paranoia. He was discharged on maintenance ECT, escitalopram, and quetiapine. <h3>Methods</h3> Electronic searches of the standard bibliographic databases PubMed, MEDLINE, EMBASE, and PsycINFO will be performed for papers focusing on catatonia, first episode of depression and older adults. <h3>Results</h3> The literature on catatonia in older adults will be reviewed. The prevalence, complexities in diagnosis, and prognosis will be described, as available in the literature. <h3>Conclusions</h3> In the geriatric population, its crucial to identify and treat the catatonia in early stages to limit overall morbidity and preserve functioning. In some instances, the underlying etiology becomes evident after the treatment of catatonia. <h3>This research was funded by</h3> None

A Double-Blind Placebo-Controlled, Randomized Trial of Divalproex Sodium for Posttraumatic Irritability Greater Than 1 Year After Mild to Moderate Traumatic Brain Injury.

Posttraumatic irritability after traumatic brain injury (TBI) may become a chronic problem and contribute to impaired everyday function, either alone or in combination with alcohol use disorder. The authors hypothesized that divalproex sodium (VPA) would improve posttraumatic irritability and result in lessened alcohol use. This randomized, placebo-controlled double-blind clinical trial recruited participants with an index TBI occurring 1 or more years prior to enrollment, a history of alcohol use disorder, and posttraumatic irritability corroborated by a knowledgeable informant. An 8-item subset of the Agitated Behavior Scale served as the primary outcome measure of VPA efficacy. Doses of VPA were titrated to standard serum concentrations of 50 µg/ml to 100 µg/ml. Forty-eight persons completed this clinical trial (VPA, N=22; placebo, N=26). At baseline, participants rated their posttraumatic irritability as less severe than did their informants (p<0.05). During the trial, informants reported significant and sustained reduction of posttraumatic irritability (p=0.03) in the study participants. Biweekly averages during drug exposure confirmed this (p<0.03, Cohen's d=0.44). Treatment efficacy was not related to measures of anxiety, posttraumatic stress disorder, sedation, or veteran versus nonveteran status. Alcohol use did not change as a result of treatment. There were no serious adverse events. This study demonstrated an effect of VPA on posttraumatic irritability, and VPA was well tolerated. Further definition of treatment efficacy and safety requires a large-scale multisite trial, using a randomized, double-blind placebo-controlled design.