Male Alcohol-dependent Inpatients Research Articles

Basic Human Body Dimensions Relate to Alcohol Dependence and Predict Hospital Readmission.

Alcohol dependence is a severe mental illness and there is a need for more effective preventive and therapeutic strategies. Translational research suggests that intrauterine sex hormone exposure modulates the risk and course of alcohol dependence during adulthood. During development, sex hormones permanently shape sexually dimorphic body dimensions. Thus, these dimensions may provide insight into sex hormone organization. Here, we compared body measurements (absolute, relative to, and residualized on height) between 200 alcohol-dependent in-patients and 240 age-matched healthy control subjects and investigated how these measurements associate with the patients’ prospective 12- and 24-month outcome. The results show that alcohol dependence is related to lower absolute, relative, and residualized body measurements for height and weight, head circumference, bitragion head arc, lip-chin distance, hip, thigh, and calf circumference, and foot length and breadth. In male alcohol-dependent in-patients, higher risk, shorter latency, and more alcohol-related readmissions were predicted by higher absolute, relative, and residualized thigh and calf circumferences. The second-to-fourth finger length ratio, a putative proxy for prenatal sex hormone organization, was not convincingly correlated with the body dimensions, suggesting that the results represent pubertal (or later) effects. The study’s findings have implications for further research. The body measurements’ high accessibility may facilitate the future transition into clinical settings.

Combining gray matter volume in the cuneus and the cuneus-prefrontal connectivity may predict early relapse in abstinent alcohol-dependent patients.

BackgroundDeveloping more effective strategies to prevent relapse remains one of the major challenges of treating substance dependence. Previous studies have identified brain abnormalities in abstinent alcoholics. However, whether these persistent brain deficits in abstinence could predict early relapse to alcohol use has not been well established. This study aimed to identify biomarkers of relapse vulnerability by investigating persistent brain abnormalities in abstinent alcohol-dependent patients.MethodsBrain imaging and impulsive behavior data were collected from 56 abstinent alcohol-dependent male inpatients and 33 age-matched male healthy controls. Voxel-based morphometry was used to investigate the differences of grey matter volume between the groups. The resting-state functional connectivity was examined using brain areas with gray matter deficits as seed regions. A preliminary prospective study design was used to classify patients into abstainers and relapsers after a 62-day average abstinence period.ResultsCompared with healthy controls, both relapsers and abstainers exhibited significantly reduced gray matter volume in the cuneus. Functional connectivity analysis revealed that relapsers relative to abstainers demonstrated increased cuneus-centered negative functional connectivity within a network of brain regions which are involved in executive control and salience. Abnormal gray matter volume in the left cuneus and the functional connectivity between the right cuneus and bilateral dorsolateral prefrontal cortex could successfully predict relapse during the 3-month follow-up period.ConclusionsFindings suggest that the abnormal gray matter volume in the cuneus and resting-state cuneus-prefrontal functional connectivity may play an important role in poor treatment outcomes in alcoholics and serve as useful neural markers of relapse vulnerability.

Alcohol use disorder and emotional abuse: the mediating role of early maladaptive schemas

Objective: Studies have shown a relationship between the development of alcohol use disorder (AUD) and the existence of childhood traumas (CT). In this study, in order to gain a better understanding of the association between CT and AUD, the relationship between CT and AUD was analyzed. Further, it was investigated whether Early Maladaptive Schemas (EMS) play a mediating role in the relationship between emotional abuse (EA) and AUD. Methods: The participants were consecutively admitted male alcohol-dependent inpatients (n=220) and healthy controls (n=108). The participants were investigated with the Childhood Trauma Questionnaire (CTQ-28), Young Schema Questionnaire-Short Form (YSQ-SF) and Michigan Alcoholism Screening Test (MAST). Mediation ana-lyses were conducted in order to evaluate the mediating effect of EMS between the relationship of AUD and CT. Results: The difference between CT total score and the EA score between the control group and the AUD group were statistically significant. An analysis of different types of traumas in the correlation with AUD revealed EA as the main predictor of AUD both directly and through its mediating effect with the EMS. In addition, it was determined that in the relationship between EA and AUD, EMS such as Enmeshment, Emotional Inhibition, Dependence and Insufficient Self-Control had mediating effect. Discussion: CT, especially EA are quite common in male inpatients with AUD and the negative effects of EA may play an important role in the development of AUD by causing EMS. Our findings imply that those with EA history in childhood may be particularly vulnerable to the development of AUD in adulthood. Therefore, in the prevention of the development and in the treatment of AUD, it may be useful to take into consideration EA experiences, to screen EMS that may mediate such relationship through scales and to conduct interventions in this regard.

Cloninger Type 2 Score and Lesch Typology Predict Hospital Readmission of Female and Male Alcohol-Dependent Inpatients During a 24-Month Follow-Up.

Relapse after detoxification treatment is a common problem in alcohol dependence. However, its prediction still lacks reliability. We here investigated whether the easily accessible clinical Cloninger and Lesch classifications predict alcohol-related hospital readmission following inpatient withdrawal treatment. In this bicentric prospective clinical study, 67 female and 84 male alcohol-dependent inpatients were characterized according to the Cloninger items and the Lesch typology. The patients' records were followed for 24months. Because of the well-established sex differences in alcohol dependence, we studied females and males separately. Overall, 54% of the female patients and 67% of the male patients sustained at least 1 alcohol-related hospital readmission during the follow-up. Readmission was related to a higher Cloninger type 2 score than nonreadmission (females, p=0.007, males p=0.044). In females, the Cloninger type 2 score correlated with the number of readmissions (ρ=0.384, p=0.001) and the days to first readmission (ρ=-0.333, p=0.006). The effects were stronger in patients with age at onset of alcohol dependence over 25years. We found gender dimorphisms concerning the Cloninger items. In female patients, the 4 Lesch subtypes differed in their risk (p=0.010), the number (p=0.040), and the days to first readmission (p=0.031). Lesch type 1 was associated with an increased risk (OR=4.83, p=0.041) and Lesch type 2 with a reduced risk (OR=0.07, p=0.004). In addition, the number of previous inpatient alcohol withdrawals predicted the patients' outcomes (p<0.05). The Cloninger type 2 score and the Lesch typology are promising tools for the prediction of alcohol-related readmissions. Our findings provide the basis to optimize relapse prevention in alcohol dependence.

The impact of appetite regulating peptides on substance use disorders

BackgroundPreclinical and clinical data suggest modulating effects of the appetite regulating peptide ghrelin on food intake. Recent data suggest that in food intake the “endostatic” energy-homeostatic systems of the lateral hypothalamus (LH) and the motivational, mesolimbic reward system operate in dynamic interplay with each other. Ghrelin receptors have been detected in the ventral tegmentum of the midbrain (VTA), where they modulate the activity of dopaminergic neurons projecting to the NAc. Assuming that Ghrelin modulate mesolimbic reactivity, the question remains: is this only the case in response to food cues? Or is this the case in response to reward-associated cues in general (including those related to nicotine and alcohol)?MethodsStudy 1: a consecutive sample of 61 alcohol-dependent male inpatients was included. Blood was drawn at onset of withdrawal 12-24 hours after admission, and following 14 days of controlled abstinence in order to assess plasma concentrations of both active and total ghrelin. In parallel, we assessed alcohol craving applying the Obsessive Compulsive Drinking Scale (OCDS) as well as symptoms of depression (Beck Depression Inventory [BDI]) and anxiety (State Trait Anxiety Inventory [STAI]). The severity of alcohol dependence was assessed with the Alcohol Dependence Scale (ADS). Study 2: 54 non-treatment seeking smokers and 30 healthy controls with normal eating behavior, as measured by the Three Factor Eating Questionnaire (TFEQ) participated in this study. We measured plasma concentrations of both active and total ghrelin, using a blood sample taken two hours after a standardized meal during early nicotine abstinence in the smoking group. Additionally we quantified severity of addiction in the smoking group using the number of cigarettes smoked per day, cotinine plasma concentration and the Fagerström Test for Nicotine Dependence (FTND).ResultsStudy1: we found a significant positive correlation between the plasma concentration of active ghrelin and alcohol craving in both blood samples. Plasma concentrations of active ghrelin increased significantly during early abstinence. In a linear regression model, the plasma concentration of active ghrelin on day one, the scores of the ADS, and the BDI explained 36% of the variance in OCDS sum score (P &lt; 0001). By day 14, these same factors accounted for 54% (P &lt; 0.0001). We did not detect any association between the plasma concentration of total ghrelin and patients’ alcohol cravings. Study 2: plasma concentration of acetylated ghrelin but not total ghrelin was significantly higher in smokers than in non-smokers. Moreover, we found significant negative correlations between acetylated ghrelin and all measures of the severity of nicotine dependence.DiscussionIn conclusion, both studies supports the general idea that ghrelin's central effects go beyond the endostatic regulation of energy homeostasis, also involving pathways underlying reward expectation and craving. Physiologic factors modulating the reactivity of mesolimbic pathways represent an important research topic for developing pharmacologic treatments for disorders characterized by altered reward-related behaviors, such as substance use disorders and behavioral addictions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Integrated Cognitive Behavioral Intervention Reduces Intimate Partner Violence Among Alcohol Dependent Men, and Improves Mental Health Outcomes in their Spouses: A Clinic Based Randomized Controlled Trial from South India

Background and aimAlcohol abuse has been associated with intimate partner violence (IPV). The current study examined the effectiveness of an integrated cognitive–behavioral intervention (ICBI) in reducing intimate partner violence (IPV) perpetration among alcohol dependent men, and improving mental health outcomes among their wives and children. MethodsOne hundred seventy-seven alcohol dependent male inpatients who screened positive for IPV perpetration in the last 6months were randomly assigned to receive ICBI which addressed both the alcohol use and IPV (n=88), or TAU (TAU: treatment as usual) (n=89). The ICBI sessions were attended by the patients alone. All patients and their spouses were followed up over 3months following discharge from the treatment centre. ResultsCompared to TAU participants in the ICBI group reported significantly lower IPV perpetration, and their wives scored significantly lower on depression, anxiety, and stress levels at 3-month follow up. Alcohol consumption in the men and emotional and behavioral problems in their children were not significantly different between the groups, from baseline to follow up. ConclusionsFindings demonstrate the feasibility and effectiveness of an ICBI which addressed both the IPV and alcohol use in a coordinated manner in a vulnerable sample.

Prevalence of sexual dysfunction in cases of alcohol dependence syndrome

Background: The prevalence of sexual dysfunction in those people who consume alcohol has been known to occur frequently. The etiology of this dysfunction needs to be considered. The most common condition reported in our study was decreased sexual drive followed closely by erectile dysfunction. Methods: A total of 50 alcohol dependent male inpatients were recruited for this study. Scales using AUDIT, HAM-D, HAM-A, BSF, IIEF, and IIP were used. Results: The prevalence of sexual dysfunction reported by the subjects was 72%.Mean scores of different types of sexual dysfunction was statistically significant compared to the control group. There was an association observed between years of drinking and all domains of sexual function on all the scales. Conclusions: The chances of developing sexual dysfunctions appear to increase with increasing years of alcohol consumed. This study has focused on the prevalence of sexual dysfunction in chronic alcohol consumers fulfilling the diagnostic criteria for alcohol dependence syndrome.

P.6.b.007 Relation of factors associated with childhood and adolescence to the development of alcohol dependence

The aim of this study was to investigate the relationship between self-mutilation (SM) and posttraumatic stress disorder (PTSD) in male alcohol-dependent inpatients, and to examine whether there is something unique about self-mutilaters with the PTSD/alcohol-dependence co-morbidity, compared with self-mutilaters without PTSD in this population. Participants were 156 consecutively admitted male alcohol-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire (SMBQ), the Traumatic Experiences Checklist (TEC), the Clinician Administered PTSD Scale (CAPS), the Symptom Checklist-Revised (SCL-90-R) and the Michigan Alcoholism Screening Test (MAST). Among alcohol-dependent inpatients, 34.0% (n = 53) were considered as group with SM. Rate of being unemployed, history of any trauma, history of suicide attempt and lifetime PTSD diagnosis were higher, whereas being married, current age, age at onset of regular alcohol use and duration of education were lower in the group with SM. Mean scores of SCL-90 subscales, TEC and MAST were higher in the SM group. Although SM might be related with PTSD among male alcohol-dependent inpatients, predictors of SM were age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and hostility. Age at onset of regular alcohol use, history of suicide attempt, anxiety, depression and somatisation predicted SM in the subgroup of patients without PTSD, whereas hostility predicted SM alone in the subgroup of patients with PTSD. Results support the anti-suicide and the affect-regulation models of SM in the non-PTSD group, whereas they support the hostility model of SM in the subgroup with PTSD in alcohol-dependent inpatients. Thus, to reduce self-mutilative behaviour (SMB)among alcohol-dependent patients, clinicians must address different subjects in different subgroup patients; that is, focussing hostility in those with PTSD co-morbidity.

EPA-0489 - Status of impulsivity in 12 month follow-up among male alcohol dependent inpatients

It was suggested that impulsivity is a temperamental risk factor for alcohol use and may be a fundamental mechanism in both the onset of excessive alcohol use and the relapse to alcohol use. Aim of this study was to evaluate the changes in impulsivity scores among alcohol dependents 12 month after inpatient treatment. Among 78 consecutively admitted male alcohol dependents, 58 were examined by face to face interview 12 months after discharge from hospital. Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11) (10) both at the baseline and at the end of 12 months. Among 58 alcohol dependent inpatients 61.8% (n=32) were considered as relapsed to heroin use during 12 month follow-up. Sociodemographic variables did not differ between the groups. Mean impulsivity scores did not differ between remission and relapsed groups at baseline, whereas only non-planning impulsivity was higher in relapsed group at follow-up. Impulsivity score decreased during 12 month follow-up in remission group, whereas increased in relapsed group. Among dimensions of impulsivity non-planning impulsivity decreased in remission group, whereas attentional impulsivity increased. Results of the present study may suggest that while attentional impulsiveness may be the cause of alcohol use, non-planning impulsiveness may also be a vulnerability factor for alcohol dependency and relapse.

EPA-1133 – Relationship of temperament, character and severity of psychopathology with aggression in alcohol dependent inpatient men

Aggression is suggested to be a predictive factor for alcohol use but the casual relationship between aggression and alcohol dependence is complex. Early aggressive acts are a risk factor for early onset alcohol dependence and aggression is suggested to be a long term individual characteristic which is probably in association with personality traits preexisting before the alcohol use. The aim of this study was to evaluate the relationship of personality dimensions with aggression among alcohol dependent inpatients and to control the effect of psychiatric symptom severity on this relationship. Participants were consecutively admitted male alcohol (n=94) dependent inpatients. Patients were investigated with the Buss–Perry Aggression Questionnaire (BPAQ), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R). Character dimensions self-directedness (SD) and cooperativeness (C) were negatively and severity of psychiatric symptoms was positively correlated with severity of aggression and its dimensions. Low SD and C, which are indicative of a personality disorder, were predictors of aggression. When severity of psychiatric symptoms was included in analyses as an independent variable, it became the main predictor. Consistent with the hypothesis that aggression is an expression of poor character development, aggression was found to be more closely related with character compared to temperament dimensions. Nevertheless, our findings also suggest that the relationship between the aggression and character dimensions may be indirect through psychopathology. Therefore, when the aggression is the main problem, it is important to evaluate alcohol dependents for the personality dimensions and severity of psychiatric symptoms.

Aggression and Impulsivity in Different Groups of Alcohol and Heroin Dependent Inpatient Men

Objective: The aim of this study was to evaluate the aggression and impulsivity in two different groups of men with alcohol or heroin dependency.Methods: Participants were consecutively admitted male alcohol (n=94) or heroin (n=78) dependent inpatients and healthy controls (n=63). Patients and healthy controls were investigated with the Buss-Perry Aggression Questionnaire and the Barratt Impulsiveness Scale, version 11.Results: Aggression and impulsivity scores were higher among both the alcohol and the heroin dependent groups than the healthy controls. Verbal aggression was the only subscale, which did not show significant differences between groups. Severity of impulsivity and aggression discriminated both alcohol dependents and heroin dependents from healthy controls. When subscales of aggression and impulsivity were taken as independent variables, current age, hostility and motor impulsiveness discriminated alcohol dependents, whereas physical aggression and non-planning impulsiveness discriminated heroin dependents from healthy controls. Thus, although aggression and impulsivity did not discriminate alcohol and heroin dependents from each other, and both aggression and impulsivity discriminated these groups from healthy controls, different dimensions of aggression and impulsivity discriminated these groups from healthy controls. Our study sample being restricted to male treatment-seeking patients and the cross-sectional nature of the study, which may interfere with the identification of causal relationships between impulsivity, aggression and substance dependency, must be taken into consideration, when assessing these results.Conclusion: The results suggest that both aggression and impulsivity are important constructs on which to focus in the treatment of substance dependents, but different dimensions might be the center of attention for patients with different substances of dependence.

Relationships of personality dimensions with impulsivity in alcohol-dependent inpatient men

Background: Impulsivity is closely related to substance use and abuse, both as a contributor to use and as a consequence of use. Particular dimensions of temperament and character were reported to be associated with trait impulsivity in different populations. Aim: The aim of the present study was to evaluate the relationship of personality dimensions with impulsivity among men with alcohol dependence. Also we wanted to control the effect of depression and anxiety symptoms on this relationship. Methods: Participants were consecutively admitted male alcohol-dependent inpatients (n = 94) and healthy controls (n = 63). Patients were investigated with the Barratt Impulsiveness Scale, version 11 (BIS-11), the Temperament and Character Inventory (TCI) and the Symptom Checklist-Revised (SCL-90-R). Results: Severity of impulsivity and dimensions of impulsivity were higher in alcohol-dependent inpatients than in healthy controls. Impulsivity was negatively correlated with reward dependence, persistence, self-directedness and cooperativeness, but positively correlated with novelty seeking, harm avoidance, depression and anxiety. Although high depression and temperament dimensions (high novelty seeking, harm avoidance and low reward dependence) predicted impulsivity, combinations of personality dimensions that predict dimensions of impulsivity differed. Conclusions: Results may suggest that together with depression when impulsivity is the problem, both dimensions of impulsivity and personality must be evaluated and the treatment should be shaped accordingly for alcohol-dependent inpatients.

S15 * ALCOHOL DEPENDENCE AND NEUROENDOCRINOLOGY - NEW FINDINGS AND PERSPECTIVES

S15 * ALCOHOL DEPENDENCE AND NEUROENDOCRINOLOGY - NEW FINDINGS AND PERSPECTIVES

Association Between Childhood Adversities and Suicide Attempts Among Alcoholic Inpatients in Taiwan

Alcohol dependence is frequently associated with suicide attempts. A history of adverse childhood experiences (ACEs) increases the risk of emotional and behavioral problems in adulthood. Child abuse is reported to increase suicide risk among alcohol-dependent patients. However, other types of ACEs, including ACEs related to family dysfunction that may have exceptional impact among the Chinese, are rarely explored. The contribution of a broad spectrum of ACEs to lifetime risk of suicide attempts among alcoholic inpatients in Taiwan was examined. Family Health History Questionnaires were used to assess ACEs among 194 male alcohol-dependent inpatients admitted for alcohol detoxification. Logistic regression analysis was applied to examine the prediction of ACEs for lifetime risk of suicide attempts. The rate of attempted suicide in this cohort was 27.4%. The prevalence of ACEs was high, with around 90% of participants reporting at least one type of ACE. In the regression analysis, after adjusting for lifetime depression, illicit drug use, and severity of alcohol dependence, having had a battered mother (odds ratio [OR] = 3.99, 95% CI [1.40, 11.34]) and having parents who were separated/divorced (OR = 7.35, 95% CI [1.56, 34.72]) were associated with the risk of suicide attempts, but having experienced physical and sexual abuse were not. A 1-unit increase in childhood adversity raised the likelihood of a suicide attempt by 61% (OR = 1.61, 95% CI [1.16, 2.25]). There is a direct and graded relationship between childhood adversities and lifetime risk of suicide attempts among male alcoholic patients. In Chinese societies, adversities related to parental separation, divorce, and interparental violence may have a specific effect in aggravating suicide risk.

1632 – Risk factors for parasuicidal behavior among alcoholics

Introduction It is well recognized that alcohol dependence is among the major risk factors that are associated with suicidal behavior. Objectives This study was design to extend our understanding of alcohol-parasuicide relationship by examining some of the socio-demographic and mental health characteristics of alcohol dependent suicide attempters. Methods The relationship between alcohol dependence and parasuicide was studied among patients admitted to a Gomel regional psychiatric hospital (Belarus). A total 117 male alcohol dependent in-patients (ADPS) and a comparison group of 128 non-alcohol dependent parasuicidal in-patients (NADPS) were investigated. The socio-demographic and mental health profile of each group was analyzed. Results Risk factors for parasuicide were acute alcohol intoxication, social dysfunction and psychiatric symptoms. Results show that, compared with NADPS patients, those with an alcohol dependence were older (32.1 vs. 29.3; p Conclusions These findings are consistent with previous research indicating a causal role for acute alcohol intoxication in parasuicidal behavior among alcohol dependent individuals.

Heart rate variability during sleep in detoxified alcohol-dependent males: A comparison with healthy controls

Context:Alcohol dependence can lead to autonomic neuropathy resulting in increased cardiac morbidity and mortality. This has previously been evaluated using heart-rate variability.Aims:We compared sleep heart-rate variability of alcohol-dependent patients with that of healthy controls in this study.Settings and Design:This study was conducted at NIMHANS, Bangalore. A case control study design was adopted.Materials and Methods:Sleep heart-rate variability of 20 male alcohol-dependent inpatients was recorded on the 5th day after detoxification. Sleep heart-rate variability was also recorded in 18 age- and gender-matched healthy controls.Statistical Analysis:The groups were compared using t-test for continuous variables and Chi-squared test for discrete variables.Results:Both time and frequency domain measures were significantly lower in the patients as compared to the controls, indicating decreased HRV in alcohol-dependent individuals.Conclusions:Decreased HRV in alcohol dependence indicates potential autonomic neuropathy.

The Chinese version of the Addiction Severity Index (ASI-C): Reliability, validity, and responsiveness in Chinese patients with alcohol dependence

We evaluated the reliability, validity, and responsiveness of the Chinese version of the 5th edition Addiction Severity Index (ASI-C-5) in Chinese male alcohol-dependent inpatients. Three hundred and fifty-four inpatients with alcohol dependence from five regions of China were interviewed in person by five trained interviewers using the ASI-C-5. Responses were then analyzed for internal consistency reliability, discriminant validity, criterion validity, and responsiveness. Forty subjects were re-interviewed 7 days later to assess test–retest reliability. The ASI-C-5 had good internal consistency, with an overall standardized Cronbach's alpha of 0.79. The Cronbach's alpha values for internal consistency of domain CSs ranged from 0.48 to 0.95, and were above 0.60 for six domains. The 7 day test–retest reliability was acceptable as evidenced by high Pearson correlation coefficients (0.75–0.92, p < 0.01) for 6 of 7 domain CSs. Correlation coefficients between the seven domain CSs ranged from 0.007 to 0.390 (p < 0.05 or 0.01 two-sided), indicating strong discriminant validity. The correlation coefficient between the alcohol dependence composite score of ASI-C-5 and the Alcohol Use Disorders Identification Test (AUDIT) was 0.69 (p < 0.01), indicating good criterion validity. The frequency of extreme scores was low, except for significant floor effects in the “Drugs” and “Legal Status” domains. Collectively, these findings suggest that the ASI-C-5 exhibited strong reliability, validity, and responsiveness in Chinese male alcohol-dependent inpatients.

Hippocampal volumes and cognitive functions in adult alcoholic patients with adolescent-onset

This study investigated hippocampal volumes and cognitive functions in adult alcoholic patients with adolescent- or late-onset alcohol use. Twenty-one male alcohol dependent inpatients and 13 healthy male controls were enrolled in this study. Cranial magnetic resonance imaging to measure hippocampal volumes and neuropsychological tests were performed in week 4 of abstinence in the patients and controls. The patients were divided into two subgroups (adolescent- and late-onset subgroups) according to the onset age of alcohol use. Alcoholic patients in general had significantly smaller right hippocampal volumes than the healthy controls. Patients' immediate memory, attention, acquisition and working memory subtest scores were inferior to those of the controls. The right hippocampus was significantly smaller in adult alcoholic patients with adolescent-onset use compared to the controls and the late-onset group. There was no significant correlation between neuropsychological test scores and hippocampal volumes. Our results suggest that hippocampal volume loss might be a feature of adolescent-onset alcoholic patients rather than of late-onset ones.

Yatarak Tedavi Gören Alkol Bağımlılarında Kendini Yaralama Davranışı ve Özkıyım Girişimi Öyküsü ile İlişkili Savunma Biçimleri / Defense Styles That Are Related With History Of Self-Mutilation And Suicide Attempt In Alcohol Dependent Inpatients

Defense styles that are related with history of self-mutilation and suicide attempt in alcohol dependent inpatients Objective: The aim of this study was to investigate the relationship of defense styles with history of selfmutilation (SM) and suicide attempt (SA) in alcohol dependent inpatients. Method: Participants were consecutively admitted 118 male alcohol dependent inpatients. Patients were investigated with the Self-Mutilative Behavior Questionnaire (SMBQ) and the Defense Style Questionnaire (DSQ). Results: Acting-out was higher in alcohol dependent patients with a history of SM (n=53, 44.92%) and predicted SM in this group, together with being younger. On the other hand, sublimation, anticipation and suppression (and total mature defense style score) were lower in alcohol dependent patients with suicide attempt history (n=31, 28.44%), but only low anticipation predicted suicide attempt history in this group together with being younger. Conclusion: These results show that to reduce self-mutilative behaviors and SAs among young alcohol dependent inpatients, therapies should focus on increasing the use of mature defense styles and decreasing the use of immature defense styles.

Relationship between defense styles, alexithymia, and personality in alcohol-dependent inpatients

In the present study, the defense styles were assessed in alcohol-dependent patients to verify whether they used less adaptive defense mechanisms compared with healthy controls and to evaluate if immature defense styles (IDSs) are related with alexithymia, while controlling the effect of age, temperament, and character on this relationship in male alcohol-dependent inpatients. Participants were consecutively admitted 118 male alcohol-dependent inpatients and 60 healthy controls. Patients were investigated with the Defense Style Questionnaire, the Toronto Alexithymia Scale, and the Temperament and Character Inventory. The alcohol-dependent patients were using neurotic defense style, some IDSs (projection, acting out, splitting, and somatization) more, and the mature defense style humor less than the control group. Together with higher age, IDS discriminated alcohol dependents from the control group (higher age, acting out, and splitting and lower humor in the second regression model). Immature defense style was positively correlated with novelty seeking, harm avoidance, self-transcendence, difficulty in identifying feelings (DIF), difficulty in describing feelings, external oriented thinking, and total alexithymia score in the present study, whereas it was negatively correlated with self-directedness and cooperativeness. Mean scores of neurotic and IDS were higher in the alexithymic group than the nonalexithymic group, and alexithymia was correlated with some IDSs. Higher difficulty in describing feelings predicted mature defense style, higher harm avoidance and DIF predicted neurotic defense style, and lower cooperativeness and self-transcendence and higher DIF predicted IDS. These suggest that alcohol dependents are using maladaptive IDS more, which can be taken into account in the development of therapeutic programs for these patients. In addition, IDS seems to be related with alexithymia, particularly DIF factor, whereas low cooperativeness and high self-transcendence are significant covariants. Thus, these results could indicate the use of specific strategies in the clinical and psychotherapeutic management of patients with alexithymic feature and IDS.