Severe Alcoholics Research Articles

Physical illness in severe depressives and psychiatric alcoholics in Gothenburg, Sweden

The entire middle-aged male urban population of a Swedish city, as defined by a census in November 1969, was assessed for any mental hospital hospitalization during a 3-year period (1978–1980), as well as for any general hospital hospitalization during a 10-year period (1970–1979) within the catchment area. Inpatients of the mental hospital population belonging to the cohort and put in the categories ‘Psychiatric alcoholic spectrum’ and ‘Severe depression’ were studied for diagnoses of physical illness during any general hospital hospitalization. The psychiatric alcoholic spectrum was associated positively with infections, injuries, alcohol intoxication, pancreatitis, liver cirrhosis, arthritis/rheumatic diseases and duodenal peptic ulcer; and negatively with malignant neoplasms, myocardial infarction, gallstone disease and urolithiasis. Severe depression was associated positively with infections, myocardial infarction, asthma and alcohol intoxication. A nosologic taxonomy, aimed at explaining the epidemiological associations recorded, is suggested.

Premature aging in female alcoholics. A neuropsychological study.

The hypothesis of premature aging in middle-aged female alcoholics was tested by comparing their level pattern of neuropsychological test performance with age-equated nonalcoholic females and elderly nonalcoholic women. Alcoholics had significantly poorer performance on the tests than nonalcoholic peers but performed significantly better than the elderly. A subsample of more severe alcoholics was not significantly different from the elderly in level of performance although they were approximately 20 years younger. However, there were no differences among the groups in pattern of test performance. The data on level of performance partially support the hypothesis of premature aging in alcoholics. Stronger support would be attained if it were demonstrated that the alcoholics and elderly have a similar impairment in the neuropsychological processes eventuating in lowered performance.

Alcohol and special populations.

ROSS-FERTILIZATION between anthropology and psychiatry has not been terribly impressive in the past. In a review of English-language mental health journals from 1925-1974, Oman and I discerned about 3600 articles which had anthropological or cross-cultural themes (1). Particularly notable, however, were the observations that, first, a holistic focus on culture in the anthropological sense was lacking in most articles and, second, in only a few articles was material synthesized. It appeared that psychiatrists and psychologists intuitively knew that culture was significant, but they were unfamiliar with the anthropological literature and with anthropological methodology. In discussing alcohol, psychiatrists and anthropologists, although mutually interested in the subject, have different approaches. Most psychiatrists, like other physicians, think in eric1 terms of alcoholism. Emphasis is on individual psychopathology and pathophysiology. In contrast, most anthropologists hink in e•nicl terms of cultural drinking patterns. The term integrarive drinking, for example, rarely appears in the psychiatric literature. Psychiatrists learn their trade primarily in the hospital, while anthropologists work in the field. Thus culture is more alive for the anthropologist than for the psychiatrist whose patients are transplanted into an institutional setting. Another professional difference arises from the type of drinker seen by each. The anthropologist is likely to come into contact with a wide range of individuals, from teetotalers to severe alcoholics. The psychiatrist is more likely to

Slow tremor and delayed brainstem auditory evoked responses in alcoholics.

Interpeak intervals of the auditory brainstem evoked electric response (ABR) were measured in 13 patients showing a characteristic slow rhythmic tremor and a more or less marked chronic cerebellar ataxia. Eleven of these patients were advanced alcoholics; two were less severe alcoholics. The tremor appeared primarily in the legs, and displayed distinctive features when examined in appropriate postures. Ten of the patients displayed a significant increase of the I-V interval of the ABR. The occurrence of the slow tremor with abnormal electric brainstem responses may provide objective evidence of lesions affecting extracerebellar regions of the CNS.

The Effect of Fructose on Alcohol Metabolism

The blood level of alcohol reflects the tissue levels throughout the body, and in a general way indicates the degree of impairment of the individual with drunkenness. The blood level is most importantly determined by the size of the person and the amount of alcohol ingested, for it is distributed throughout the total body water. The removal of alcohol is remarkably constant in a given person, although severe alcoholics have a substantially higher rate of removal than abstinent persons or modest drinkers.¹ The proneness of the heavy drinker to head trauma, automobile accidents, and unusual infections, and the frequency with which detailed mental and neurological evaluations are needed in a somewhat intoxicated and often very uncooperative subject, are within the experience of every physician. The desirability of a rapid means to bring about sobriety to facilitate these evaluations and provide better care for the alcoholic is apparent. Most adults

The place of irradiation in the management of the primary lesion in head and neck cancers.

Lesions of the skin are best excised except for specific locations where surgical excision would not likely produce disease-free margins and/or would require extensive plastic repair. A control rate of 90% for T1 lesions and 80% for T2 lesions is obtained with irradiation in the squamous cell carcinomas of the upper respiratory and digestive tract. Heavy smokers and/or severe alcoholics may be preferably treated surgically. The control rates in the T3 and T4 lesions are unsatisfactory with either irradiation or surgery alone. Pre- or postoperative irradiation combined with the appropriate surgical procedure improves the local control rates and to some extent the survival rates. Postoperative irradiation for the highly malignant tumors of the salivary gland reduces the local failure rate from 36% to 11%. The facial nerve can be preserved unless it is grossly involved.

Some effects of DRUGS on NUTRITION

In the broadest sense, the word “drug” has come to mean the same as “medicine”, that is, a substance that is used in medical treatment because it has some action on the functioning of the body or on disease. Food and drugs can interact in several ways and in some instances there is a very hazy borderline between what is a food and what is a drug. Take alcohol for example. When taken in large quantities, it has a marked effect on the higher nerve centres, so alcohol is clearly a drug. Yet being a source of energy, alcohol is also a food. One gram of alcohol supplies 29 kJ and the average adult in the U.K. takes about four per cent of his total energy intake as alcohol. (In France and other wine producing countries, alcohol supplies about 14 per cent of the total adult energy intake.) A variety of effects on nutrition can be caused by alcohol. In social drinkers the commonest is a contribution to obesity. Some wines — not only “tonic wines” — are rich in iron. This is, at first sight, a good thing because iron deficiency is common all over the world. But those who take generous amounts of wine are not necessarily those who are short of iron and a state of iron overload can sometimes occur. Severe alcoholics, whose life becomes so disorganised that they eat very poorly, can have a variety of nutritional deficiencies. The most serious is thiamin deficiency which can occur in those alcoholics who drink heavily and eat very little food over a few weeks. The result is either brain disturbance, Wernicke‐Korsakoff disease, or heart failure. These respond dramatically to large doses of thiamin, provided the condition is recognised quickly. Occasional cases have been reported from British hospitals in recent years.