Alcohol Disorders Research Articles

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration.

Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined. To compare active duty U.S. Army service members with chronic pain who did/did not receive NPT in the Military Health System (MHS) and describe the association between receiving NPT and adverse outcomes after transitioning to the Veterans Health Administration (VHA). A longitudinal cohort study of active duty Army service members whose MHS healthcare records indicated presence of chronic pain after an index deployment to Iraq or Afghanistan in the years 2008-2014 (N = 142,539). Propensity score-weighted multivariable Cox proportional hazard models tested for differences in adverse outcomes between the NPT group and No-NPT group. NPT received in the MHS included acupuncture/dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports. Primary outcomes were propensity score-weighted proportional hazards for the following adverse outcomes: (a) diagnoses of alcohol and/or drug disorders; (b) poisoning with opioids, related narcotics, barbiturates, or sedatives; (c) suicide ideation; and (d) self-inflicted injuries including suicide attempts. Outcomes were determined based on ICD-9 and ICD-10 diagnoses recorded in VHA healthcare records from the start of utilization until fiscal year 2018. The propensity score-weighted proportional hazards for the NPT group compared to the No-NPT group were 0.92 (95% CI 0.90-0.94, P < 0.001) for alcohol and/or drug use disorders; 0.65 (95% CI 0.51-0.83, P < 0.001) for accidental poisoning with opioids, related narcotics, barbiturates, or sedatives; 0.88 (95% CI 0.84-0.91, P < 0.001) for suicide ideation; and 0.83 (95% CI 0.77-0.90, P < 0.001) for self-inflicted injuries including suicide attempts. NPT provided in the MHS to service members with chronic pain may reduce risk of long-term adverse outcomes.

REGIONAL EPIDEMIOLOGY OF ALCOHOLIC DEPENDENCE SYNDROME

Introduction. There are variable patterns of alcohol consumption in Russia that differ significantly between the regions. Awareness and knowledge of those regional differences are key to the effectiveness of measures to prevent and minimise possible damage to public health caused by alcohol consumption. The purpose. To identify regional characteristics of the dynamics of alcoholism and alcoholic psychosis and dependencies with indicators of the implementation and consumption of alcohol in Mari El in 2006-2017. Material and methods. In a retrospective analysis, they included state statistics and bulletins of the Office of Rospotrebnadzor on RME on the primary incidence and prevalence of alcohol dependence syndrome, chronic alcoholism, AP, acute alcohol poisoning, sales of alcohol through a distribution network in 2006-2017. Results. In the reported period of 2006-2017 there was a decline in determination coefficient (R2) from 0.76 to 0.96 for newly diagnosed cases of alcohol dependence in general, alcoholic psychosis and alcoholism in Mari El. There was a significant decline from 221.6 to 47.5 per 100 thousand in the range of values between regions, but higher rates remained among the rural and urban areas (p = 0.0002). The dynamics of the prevalence of alcoholic psychotic disorders and alcoholism were also on decline. Conclusion. The direction and extent of changes in the medical consequences of alcohol consumption (such as primary morbidity and prevalence of alcohol dependence syndrome, alcoholic psychosis and alcoholism, average duration of the course, number of alcoholic psychosis) in the region and indicators of the implementation and consumption of alcoholic beverages in the reported period can be evaluated as positive. It is crucial to ensure the positive trend in the alcohol consumption pattern and impact on public health in the region becomes a long-lasting one. At the same time, it is necessary to increase attention to the assistance and treatment provided to drug users patient.

Attachment Orientations and Adult Alcohol Use Among Those With Childhood Adversities

Abstract. Adverse psychological consequences have been associated with both alcohol abstinence and alcohol disorders. The current study considers those who have experienced childhood adversities and examines whether secure attachment orientation represents a protective factor against an increased likelihood of either abstinence/rare alcohol consumption or alcohol disorder diagnosis. Data were used from the National Comorbidity Survey-Revised (NCS-R) ( N = 5,692), a random sample representative of the American population. Adult personal alcohol use was considered in terms of abstinence/rare alcohol use, regular alcohol use, and alcohol disorder diagnosis. Analyses focused on those who had experienced childhood adversities ( N = 2,182) and assessed attachment orientation as a predictor of alcohol use. Within those who had experienced childhood adversities, in comparison with securely attached individuals, both anxiously attached individuals and avoidant attached individuals had a significantly increased likelihood of being in the alcohol disorder diagnosis group as opposed to the regular alcohol consumption group. Avoidant individuals also had a significantly increased likelihood of being in the abstinence/rare alcohol use group. Results are discussed in terms of subgroups (vulnerable individuals and families) that may benefit from supportive interventions, and what format these interventions might take.

967 Sex Differences in the Utilization of Bariatric Operation for NAFLD

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in the developed world. Bariatric surgery is the most validated method for achieving significant, sustained weight loss and has shown to decrease the grade of steatosis. METHODS: We utilized the Nationwide Inpatient Sample database from 2004 to 2014 to identify all hospitalized adult patients with a history of NAFLD and patients who underwent bariatric surgery. We excluded NAFLD patients who had a diagnosis code for cirrhosis, alcoholism, viral hepatitis, or metabolic liver disorders. Age, race, insurance, and hospital characters were computed on the basis of sex. RESULTS: Our study included 92,293 NAFLD‐related hospitalizations, of which 36787 patients (39.8%) were female. A total of 710 bariatric surgeries were performed from 2004–2014 on patients with NAFLD. Of these, 590 (83.1%) were women. In the general population without NAFLD too, the procedure was more common in females (76.09%, n = 956,186) than males (23.91%, n = 300,500). In the patient population of NAFLD patients undergoing the surgery, females were less likely to have coexisting weight-related illnesses such as hyperlipidemia (46.5% vs 49.0%, P = 0.02), hypertension (49.2% vs 63.7%, P = 0.00), sleep apnea (46.1% vs 53.0%, P = 0.00), hypertension (51.7% vs 44.6%, P = 0.486). Demographic data showed that the female subgroup was significantly younger (43.0 vs 49.7 years, P = 0.01), and more commonly admitted in Midwest (21.5% vs 16.8%) and Western states (29.3% vs 15.2%). No significant differences were noted in the race, income quartile or insurance of the patients. The odds ratio for being a female NAFLD patient versus a male undergoing the procedure was +5.84 (P = 0.00). In the whole study period, only 5 patients died during the hospitalization for bariatric surgery. CONCLUSION: Results from our study show that bariatric surgery is more popular amongst females with NAFLD versus males with NAFLD when adjusted for other factors. This discrepancy is even starker than the general bariatric population without NAFLD, where females are more prevalent too. Female patients with NAFLD were more likely to be younger and having lesser weight-related comorbidities than males at the time of the surgery. The increased utilization of bariatric surgery in the female NAFLD population could be driven by cultural factors and self-consciousness. Bariatric surgery has low mortality in NAFLD patients.

A preference for alcohol

Epigenetics As we age, we tend to become more and more like our parents in many ways because we emulate parental behavior. But future behavior can also be affected before birth. Studies using model organisms, such as the fruit fly Drosophila melanogaster , are illuminating molecular mechanisms. Fruit fly females prefer to lay eggs in ethanol-containing food substrates when exposed to endoparasitoid wasps, and this preference lasts several generations. Bozler et al. find that transgenerational ethanol preference involves the inhibition of neuropeptide F (NPF), which in turn activates germline caspases. Low NPF expression in the brain and a preference for alcohol was inherited by flies for five generations. Because mammalian NPF homologs are implicated in drug and alcohol disorders, the findings in flies may have some relevance to human transgenerational inheritance. eLife 8 , e45391 (2019).

Factors related to hospital utilisation for people living with schizophrenia: Examining Allen's Cognitive Level Scores, recommended supports and routinely collected variables.

Australian occupational therapists working on mental health inpatient wards are often requested to assess a person's function and, based on that assessment, recommend the best support environments for that person post-discharge. The Allen Cognitive Level Screen (ACLS) is a tool used by some therapists to screen cognitive functioning as a basis with which to make support recommendations. There is limited examination of the outcomes for people post-discharge if the ACLS score-based support recommendations are followed. A retrospective cohort design involved quantitative analysis of archival data for 150 adult (18-65years old) consumers with a primary diagnosis of schizophrenia and an ACLS completed pre-discharge. Data up to 12months post-discharge from hospital were studied. Outcomes examined included re-presentations or readmission to hospital, length of time in community prior to re-presentation and length of stay in hospital if readmitted. Being younger, male, receiving formal supports, having a drug and alcohol disorder comorbidity, living in public housing and having a lower cognitive level as measured by the ACLS were significant univariate factors associated with higher hospital utilisation for one or more of the outcome variables. Multivariate analyses revealed fewer significant relationships, with being younger and receiving formal supports significantly associated with greater likelihood of return to hospital. This research contributes to evidence of the complexity of living with schizophrenia in the community and supporting people to stay out of hospital. More research regarding how the ACLS score-aligned support recommendations are carried out and the impact on hospital utilisation is needed in order to enhance occupational therapists confidence in their use and prescription.

Gender, diagnosis and involuntary psychiatry admission in Ireland: A report from the Dublin Involuntary Admission Study (DIAS)

Involuntary admission and treatment are common, long-standing features of psychiatry but the relationships between gender, diagnosis and other features of involuntary treatment are not clear. We studied all voluntary and involuntary psychiatry admissions at Tallaght University Hospital, Dublin over 2 years (n = 1230). Admission rates in Tallaght were lower than national rates for all admissions (224.9 admissions per 100,000 population per year in Tallaght versus 376.8 nationally), voluntary admissions (194.0 versus 328.4) and involuntary admissions (30.9 versus 48.4). Compared to men, proportionately fewer admissions of admissions of women were involuntary (11% versus 16%) and women were more commonly diagnosed with affective (mood) disorders (29.5% of women versus 22.6% of men), neuroses (anxiety disorders) (14.0% versus 8.8%) and personality and behavioural disorders (18.0% versus 9.2%), and less commonly diagnosed with schizophrenia group disorders (21.8% versus 32.0%), alcohol disorders (2.9% versus 4.3%) and drug disorders (3.6% versus 8.1%). Schizophrenia group disorders accounted for a greater proportion of male (63.2%) than female (55.6%) involuntary admissions, and affective disorders accounted for a greater proportion of female (17.5%) than male (12.3%) involuntary admissions. Duration of admission was independently associated with, in order of strength of association, involuntary status, schizophrenia group disorders and increasing age, but duration of involuntary care was not associated with any of these factors. The chief gender-related features of involuntary psychiatry admission are that (a) proportionately fewer admissions of admissions of women are involuntary compared to men, and (b) diagnoses of affective disorders are more common in women, and schizophrenia group diagnoses more common in men. Future research could usefully explore gender differences in grounds for involuntary detention and police involvement in the involuntary admission process. Future research is also warranted into whether gender associations differ in older compared to younger involuntary patients.

Depression in the nursing home: a cluster-randomized stepped-wedge study to probe the effectiveness of a novel case management approach to improve treatment (the DAVOS project)

BackgroundDepression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking deficit in health care and might result not only in lower quality of life among those concerned but also in poor physical functioning, premature mortality, and increased hospitalization rates.MethodsThe aims of the interdisciplinary research project DAVOS are to implement an innovative and stepped structural case management program to improve depression treatment for nursing home residents by a modularized intervention and to assess it in terms of its effectiveness. Intervention modules are in line with recommendations given by the German national treatment guidelines for depression (S3 guidelines). Ten nursing homes in Frankfurt, Germany, will participate in the project, which aims to recruit a study population of 380. The recruitment will continue throughout the trial (open cohort). Persons (>60 years) who live in a nursing home, have no medical diagnosis of dementia, and can provide their informed consent to participate are eligible for inclusion in the study. Residents with a clinical diagnosis of dementia, alcohol or substance-related disorders, or other serious psychiatric illnesses will be excluded. DAVOS is a controlled cluster-randomized study that employs a stepped-wedge design.DiscussionOur main hypothesis is that the implementation of the intervention will lead to a decline in the prevalence of depression and a reduction in depression symptoms among the home residents. In addition, we expect the intervention to have a positive impact on secondary outcomes such as level of functioning, quality of life, and social participation. The project’s results can make an important contribution toward improving the health care of nursing home residents who have late-life depression.Trial registrationDRKS, DRKS00015686, Oct. 10, 2018.

Transgeneratonal inheritance of ethanol preference is caused by maternal NPF repression.

Rapid or even anticipatory adaptation to environmental conditions can provide a decisive fitness advantage to an organism. The memory of recurring conditions could also benefit future generations; however, neuronally-encoded behavior isn't thought to be inherited across generations. We tested the possibility that environmentally triggered modifications could allow 'memory' of parental experiences to be inherited. In Drosophila melanogaster, exposure to predatory wasps leads to inheritance of a predisposition for ethanol-rich food for five generations. Inhibition of Neuropeptide-F (NPF) activates germline caspases required for transgenerational ethanol preference. Further, inheritance of low NPF expression in specific regions of F1 brains is required for the transmission of this food preference: a maternally derived NPF locus is necessary for this phenomenon, implicating a maternal epigenetic mechanism of NPF-repression. Given the conserved signaling functions of NPF and its mammalian NPY homolog in drug and alcohol disorders, these observations raise the intriguing possibility of NPY-related transgenerational effects in humans.

Factors associated with Healthcare Effectiveness Data and Information Set (HEDIS) alcohol and other drug measure performance in 2014–2015

Background: Only 10% of patients with alcohol and other drug (AOD) disorders receive treatment. The AOD Initiation and Engagement in Treatment (AOD-IET) measure was added to the national Healthcare Effectiveness Data and Information Set (HEDIS) to improve access to care. This study identifies factors related to improving AOD-IET rates. Methods: We include data from 7 health systems with differing geographic, patient demographic, and organizational characteristics; all used a common Virtual Data Warehouse containing electronic health records and insurance claims data. Multilevel logistic regression models examined AOD-IET among adults (18+). Results: A total of 86,565 patients had an AOD diagnosis qualifying for the HEDIS denominator. The overall initiation rate was 27.9% with wide variation; the overall engagement rate was 11.5% and varied from 4.5% to 17.9%. Women versus men (odds ratio [OR] = 0.81, 95% confidence interval [CI] = 0.76–0.86); Hispanics (OR = 0.85, 95% CI = 0.79–0.91), black/African Americans (OR = 0.82, 95% CI = 0.75–0.90), and Asian Americans (OR = 0.83, 95% CI = 0.72–0.95) versus whites; and patients aged 65+ versus 18–29 (OR = 0.82, 95% CI = 0.74–0.90) had lower odds of initiation. Patients aged 30–49 versus 18–29 (OR = 1.11, 95% CI = 1.04–1.19) and those with prior psychiatric (OR = 1.26, 95% CI = 1.18–1.35) and medical conditions (OR = 1.18, 95% CI = 1.10–1.26) had higher odds of initiation. Identification in primary care versus other departments was related to lower odds of initiation (emergency department [ED]: OR = 1.55, 95% CI = 1.45–1.66; psychiatry/AOD treatment: OR = 3.58, 95% CI = 3.33–3.84; other outpatient: OR = 1.19, 95% CI = 1.06–1.32). Patients aged 30–49 versus 18–29 had higher odds of engagement (OR = 1.26, 95% CI = 1.10–1.43). Patients aged 65+ versus 18–29 (OR = 0.51, 95% CI = 0.43–0.62) and black/African Americans versus whites (OR = 0.64, 95% CI = 0.53–0.77) had lower odds. Those initiating treatment in psychiatry/AOD treatment versus primary care (OR = 7.02, 95% CI = 5.93–8.31) had higher odds of engagement; those in inpatient (OR = 0.40, 95% CI = 0.32–0.50) or other outpatient (OR = 0.73, 95% CI = 0.59–0.91) settings had lower odds. Discussion: Rates of initiation and engagement varied but were low. Findings identified age, race/ethnicity, co-occurring conditions, and department of identification as key factors associated with AOD-IET. Focusing on these could help programs develop interventions that facilitate AOD-IET for those less likely to receive care.

MON-235 ACUTE KIDNEY INJURY IN PATIENTS WITH LIVER CIRRHOSIS: INCIDENCES AND LONG-TERM OUTCOME IN MALAYSIA

Acute kidney injury (AKI) is a predictor of poor prognosis among patients with cirrhosis. However, the incidence of AKI among Malaysian cirrhotic patients are relatively unknown. The objectives of this research are to identify the incidence, progression and outcomes of the cirrhotic patients with AKI at a tertiary hospital. This single-centre, retrospective cohort study was performed among all cirrhotic patients (defined as having histological or radiological evidence of cirrhosis; or evidence of portal hypertension) who were admitted to the Hepatology ward from 1st June 2015 till 31st December 2015. Cirrhotic patients with AKI as defined by KDIGO 2012 AKI criteria were recruited for this study. Demographic data, clinical data, renal outcomes and survival outcomes were collected for all patients admitted during the study period, one year and two years after the AKI episode from the hospital electronic medical records. Estimated glomerular filtration rate (eGFR) was calculated using CKD-EPI equation and chronic kidney disease staging is based on KDIGO 2012 CKD criteria. Results were analyzed using SPSS Version 23. Of a total of 204 patients admitted with cirrhosis, 45 (22.1%) patients had AKI. Thirty two (71.1%) were male and 28 patients (62.2%) were of Malay ethnicity. The mean age of the cirrhotic AKI patients was 57.5±12.8 years. Twelve patients (26.7%) have unknown aetiology, followed by Hepatitis B with 11 patients (24.4%), Hepatitis C with 8 patients (17.8%), and alcoholic use disorder with 6 patients (13.3%). Twenty-five patients (55.6%) have Child Pugh Score C, followed by Child Pugh Score B with 18 patients (40.0%), and only two patients (4.4%) has Child Pugh Score A. Twenty-five (55.6%) patients had Stage 1 AKI, 12 (26.7%) patients had Stage 2 AKI and 8 (17.8%) patients had Stage 3 AKI. Most of Stage 3 AKI patients had Child Pugh Score C with 7 patients (87.5%). In contrast, patients with milder stages of AKI had less number of patients with Child Pugh Score C with 13 patients (52.0%) for Stage 1 AKI, and there were only 5 patients (41.7%) for Stage 2 AKI. There was significantly higher in-hospital mortality among cirrhotic patients with AKI compared those without AKI (13.3% vs 3.1% respectively; p=0.016). The mean eGFR at discharge was 46.4±24.5 ml/min/1.73m2. Three (6.7%) patients progressed to end-stage renal disease (ESRD). Fifteen (33.3%) patients developed recurrent episodes of AKI during subsequent admissions. Of those who were discharged (n=39), only thirty one (79.5%) patients survived beyond one year. The mean eGFR had decreased significantly to 32.3±18.32 ml/min/1.73m2 (p=0.002). Two (5.1%) patients progressed to end-stage renal disease (ESRD). The overall total mortality in cirrhotic patients with AKI in one year was 34.8% (n=16), while 11.1% (n=5) of the subjects had ESRD. The incidence of AKI among cirrhotic in-patients in our centre was 22.1%. Cirrhotic patients with AKI have a high in-hospital mortality rate of 13.3% and one year mortality of 34.8%. Early intensive medical intervention to prevent AKI in hospitalised cirrhotic patients is important to improve patient outcome.

The future role of fMRI neurofeedback in depression treatment and research

Alcohol Use Disorder (AUD) has a disconcertingly high relapse rate (70–80% within a year following withdrawal). Preventing relapse or minimizing its extent is hence a challenging goal for long-term successful management of AUD. New perspectives that rely on diverse neuromodulation tools have been developed in this regard as care supports. This paper focuses on electroencephalogram-neurofeedback (EEG-NF), which is a tool that has experienced renewed interest in both clinical and research areas. We review the literature on EEG-based neurofeedback studies investigating the efficacy in AUD and including at least 10 neurofeedback training sessions. As neurofeedback is a form of biofeedback in which a measure of brain activity is provided as feedback in real-time to a subject, the high degree of temporal resolution of the EEG interface supports optimal learning. By offering a wide range of brain oscillation targets (alpha, beta, theta, delta, gamma, and SMR) the EEG-NF procedure increases the scope of possible investigations through a multitude of experimental protocols that can be considered to reinforce or inhibit specific forms of EEG activity associated with AUD-related cognitive impairments. The present review provides an overview of the EEG-NF protocols that have been used in AUD and it highlights the current paucity of robust evidence. Within this framework, this review presents the arguments in favor of the application of EEG-NF as an add-on tool in the management of alcohol disorders to enhance the cognitive abilities required to maintain abstinence more specifically, with a focus on inhibition and attentional skills.

Differences in alcohol use between younger and older people: Results from a general population study

BackgroundPrevention of problematic alcohol use is mainly focused on younger adults, while heavy drinking in middle-aged and older adults might be more frequent with more impact on functioning and health care use. Therefore, alcohol use and alcohol disorder in both age groups was compared. To facilitate age-specific prevention, it was examined whether risk factors of heavy drinking and impact on functioning and health care use differs across the life-span. MethodsData of people (23–70 years) were used from the Netherlands Mental Health Survey and Incidence Study-2 (N = 4618), a general population-based cohort. Heavy alcohol use was defined as >14 drinks/week for women and >21 drinks/week for men. Alcohol disorder was defined as DSM-IV disorder of alcohol abuse and/or alcohol dependence. (Multinomial) logistic regression analyses were used to study risk factors of alcohol use and associations between alcohol use and health care use and functioning. ResultsThe past-year prevalence of heavy alcohol was higher in older (55–70 years) compared to younger people (6.7% versus 3.8%), whereas alcohol disorder was less prevalent (1.3% versus 3.9%). Heavy alcohol use was associated with higher level of education in older adults compared to younger adults. Other characteristics of problematic alcohol use and its impact on functioning and health care use did not differ between age groups. ConclusionsHeavy drinking is more prevalent among middle-aged and older people. Contrary to younger adults, prevention of heavy alcohol use in those aged 55–70 should focus on higher educated people.

Combined Effects of Alcohol and Metabolic Disorders in Patients With Chronic Liver Disease

Alcoholic liver disease (ALD) and nonalcoholic fatty liver disease (NAFLD) are the major causes for nonviral liver cirrhosis in the population. Whereas the typical NAFLD patient is one with abdominal obesity, metabolic syndrome (MetS), and no or minimal alcohol use, the patient with pure alcoholic liver cirrhosis has, according to cohort studies, typically consumed >5-10 daily alcohol drinks for several years.1 However, both alcohol use and components of the MetS are continuous variables and, as such, not dichotomic. Recent evidence suggests harmful synergistic effects of obesity, MetS, and alcohol intake for the risk of future liver disease.2 Consequently, given an increasing population prevalence of overweight and obese alcohol users, expectedly, there will be many patients that do not fit either the typical NAFLD or typical ALD phenotype, but share features of both disease entities. Current case-finding strategies focusing on either pure NAFLD or pure ALD3,4 may underestimate the true risk in individuals who will develop liver disease as the result of interaction between alcohol and metabolic disorders.1.

Big Five personality traits and alcohol, nicotine, cannabis, and gambling disorder comorbidity.

The Diagnostic and Statistical Manual of Mental Disorders (DSM; 5th ed.) reassignment of gambling disorder as an addictive disorder alongside the substance-related addictive disorders encourages research into their shared etiologies. The aims of this study were to examine: (a) the associations of Big Five personality dimensions with alcohol, nicotine, cannabis, and gambling disorders, (b) the comorbidity between these disorders, (c) the extent to which common personality underpinnings explain comorbidity, (d) whether results differed for men and women, and (e) the magnitude of personality differences corresponding to the 4 disorders. Participants were 3,785 twins and siblings (1,365 men, 2,420 women; Mage = 32 years, range = 21-46 years) from the Australian Twin Registry who completed psychiatric interviews and Big Five personality inventories. The personality profile of high neuroticism, low agreeableness, and low conscientiousness was associated with all 4 addictive disorders. All but 1 of the pairwise associations between the disorders were significant. After accounting for Big Five traits, the associations were attenuated to varying degrees but remained significant. The results were generally similar for men and women. The results suggest that the Big Five traits of neuroticism, agreeableness, and conscientiousness are associated with the general propensity to develop an addictive disorder and may in part explain their co-occurrence; however, they may be more broadly associated with the propensity for any psychiatric disorder. The effect sizes of the personality associations suggest that the diagnosis of gambling disorder as operationalized by the DSM may be more severe than the other addictive disorders. Calibration of the diagnosis of gambling disorder to the other addictive disorders may be warranted. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The value procalcitonin and C-reactive protein as early markers of bacteraemia among patients with hematological malignancies receiving chemotherapy: A cross-sectional study

Involuntary admission and treatment are common, long-standing features of psychiatry but the relationships between gender, diagnosis and other features of involuntary treatment are not clear. We studied all voluntary and involuntary psychiatry admissions at Tallaght University Hospital, Dublin over 2 years (n = 1230). Admission rates in Tallaght were lower than national rates for all admissions (224.9 admissions per 100,000 population per year in Tallaght versus 376.8 nationally), voluntary admissions (194.0 versus 328.4) and involuntary admissions (30.9 versus 48.4). Compared to men, proportionately fewer admissions of admissions of women were involuntary (11% versus 16%) and women were more commonly diagnosed with affective (mood) disorders (29.5% of women versus 22.6% of men), neuroses (anxiety disorders) (14.0% versus 8.8%) and personality and behavioural disorders (18.0% versus 9.2%), and less commonly diagnosed with schizophrenia group disorders (21.8% versus 32.0%), alcohol disorders (2.9% versus 4.3%) and drug disorders (3.6% versus 8.1%). Schizophrenia group disorders accounted for a greater proportion of male (63.2%) than female (55.6%) involuntary admissions, and affective disorders accounted for a greater proportion of female (17.5%) than male (12.3%) involuntary admissions. Duration of admission was independently associated with, in order of strength of association, involuntary status, schizophrenia group disorders and increasing age, but duration of involuntary care was not associated with any of these factors. The chief gender-related features of involuntary psychiatry admission are that (a) proportionately fewer admissions of admissions of women are involuntary compared to men, and (b) diagnoses of affective disorders are more common in women, and schizophrenia group diagnoses more common in men. Future research could usefully explore gender differences in grounds for involuntary detention and police involvement in the involuntary admission process. Future research is also warranted into whether gender associations differ in older compared to younger involuntary patients.

Mito-Nuclear Communication in Hepatocellular Carcinoma Metabolic Rewiring.

As the main metabolic and detoxification organ, the liver constantly adapts its activity to fulfill the energy requirements of the whole body. Despite the remarkable adaptive capacity of the liver, prolonged exposure to noxious stimuli such as alcohol, viruses and metabolic disorders results in the development of chronic liver disease that can progress to hepatocellular carcinoma (HCC), which is currently the second leading cause of cancer-related death worldwide. Metabolic rewiring is a common feature of cancers, including HCC. Altered mito-nuclear communication is emerging as a driving force in the metabolic reprogramming of cancer cells, affecting all aspects of cancer biology from neoplastic transformation to acquired drug resistance. Here, we explore relevant aspects (and discuss recent findings) of mito-nuclear crosstalk in the metabolic reprogramming of hepatocellular carcinoma.

Increased Aluminum Content in Certain Brain Structures is Correlated with Higher Silicon Concentration in Alcoholic Use Disorder.

Introduction: Alcohol overuse may be related to increased aluminum (Al) exposure, the brain accumulation of which contributes to dementia. However, some reports indicate that silicon (Si) may have a protective role over Al-induced toxicity. Still, no study has ever explored the brain content of Al and Si in alcoholic use disorder (AUD). Materials and methods: To fill this gap, the present study employed inductively coupled plasma optical emission spectrometry to investigate levels of Al and Si in 10 brain regions and in the liver of AUD patients (n = 31) and control (n = 32) post-mortem. Results: Al content was detected only in AUD patients at mean ± SD total brain content of 1.59 ± 1.19 mg/kg, with the highest levels in the thalamus (4.05 ± 12.7 mg/kg, FTH), inferior longitudinal fasciculus (3.48 ± 9.67 mg/kg, ILF), insula (2.41 ± 4.10 mg/kg) and superior longitudinal fasciculus (1.08 ± 2.30 mg/kg). Si content displayed no difference between AUD and control, except for FTH. Positive inter-region correlations between the content of both elements were identified in the cingulate cortex, hippocampus, and ILF. Conclusions: The findings of this study suggest that AUD patients may potentially be prone to Al-induced neurodegeneration in their brain—although this hypothesis requires further exploration.

Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy-Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People.

BackgroundThe transition to adulthood is a unique developmental period characterized by numerous personal and social role changes and increased opportunities for alcohol consumption. Using alcohol to cope with anxiety symptoms is commonly reported, and young people with anxiety are at a greater risk of hazardous alcohol use and progression to alcohol use disorder. Anxiety and alcohol use tend to fuel each other in an exacerbating feed-forward cycle, leading to difficult-to-treat chronic problems. The peak in onset of anxiety and alcohol disorders suggests this developmental window represents a promising opportunity for early intervention before these problems become entrenched.ObjectiveThis study aims to evaluate the efficacy of the Inroads program, a therapist-supported, internet-delivered early intervention for young adults that targets alcohol use, anxiety symptoms, and the interconnections between these problems.MethodsA randomized controlled trial will be conducted nationally among young Australians (aged 17-24 years) who experience anxiety symptoms and drink alcohol at hazardous or harmful levels. Participants will be individually randomized on a 1:1 basis to receive the Inroads intervention or assessment plus alcohol guidelines. Participants randomized to the Inroads intervention will receive access to 5 Web-based cognitive behavioral therapy (CBT) modules and weekly therapist support via email and/or phone. The primary outcome assessment will be 8 weeks post baseline, with follow-up assessment 6 months post baseline to determine the sustainability of the intervention effects. Primary outcomes will be the total number of standard drinks consumed in the past month (assessed by the Timeline Follow-Back procedure), severity of alcohol-related harms (assessed by the Brief Young Adult Alcohol Consequences Questionnaire), and anxiety symptoms across multiple disorders (assessed by the Generalized Anxiety Disorder-7). Secondary outcomes will include alcohol outcome expectancies; functional impairment and quality of life; and symptoms of social anxiety, anxious arousal, and depression. Results will be analyzed by intention-to-treat using multilevel mixed effects analysis for repeated measures.ResultsThe study is funded from 2017 to 2020 by Australian Rotary Health. Recruitment is expected to be complete by late-2018, with the 6-month follow-ups to be completed by mid-2019. Results are expected to be published in 2020.ConclusionsThe study will be the first to evaluate the benefits of a youth-focused early intervention that simultaneously targets anxiety and hazardous alcohol use. By explicitly addressing the interconnections between anxiety and alcohol use and enhancing CBT coping skills, the Inroads program has the potential to interrupt the trajectory toward co-occurring anxiety and alcohol use disorders. The Web-based format of the program combined with minimal therapist support means that if effective, the program could be widely disseminated to reach young people who are not currently able or willing to access face-to-face treatment.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12617001609347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372748&isReview=true (Archived by WebCite at http://www.webcitation.org/77Au19jmf)International Registered Report Identifier (IRRID)DERR1-10.2196/12370

THU-263-The demonstration of antibodies to histone 2B of the IgA-type helps to differentiate between alcoholic liver disease and non-alcoholic fatty liver disorder

THU-263-The demonstration of antibodies to histone 2B of the IgA-type helps to differentiate between alcoholic liver disease and non-alcoholic fatty liver disorder