Alcohol dependence is one of the most frequent comorbidities in depression. Multiple environmental and neurobiological factors are directly involved in these diseases. In particular, impulsivity is present in many patients with dual pathology and may play a relevant role in its causes, clinical manifestations and prognosis.

To review the relationship between impulsive traits and dual pathology in patients with depression and alcohol dependence.

Presentation of a clinical case supported by a non- systematic review of literature containing the key-words “impulsivity”, “depression” and “alcohol dependence”.

This is a case report of a 43-year-old male with a known history of alcohol dependence and recurrent depression. Interestingly, the patient has a family history of bipolar disorder and alcohol abuse disorder on the paternal side, and frontotemporal dementia on the maternal side. He currently presents a depressive episode associates associated with a significant increase in alcohol consumption. The patient has presented prominent impulsive traits since adolescence that have been aggravated in recent years. This lack of impulse control is described as one of the most relevant factors in relapses in alcohol consumption. Multiple studies correlate the lack of impulse control with a worse prognosis in both alcohol dependence (greater probability of relapses and resistance to treatment) and depression (increased suicide risk). Likewise, an increase in cognitive impulsivity has been observed during depressive episodes, characterized by an inability to inhibit behaviors that have already begun and poor planning capacity, which could lead to a worsening of alcohol abuse.

Impulsivity traits are related to a worse prognosis in dual pathology due to alcohol and depression, and may present common etiopathogenic mechanisms.

No significant relationships.

Gene-environment interactions (GxE) are considered to make a substantial impact on the risk of alcohol dependence (AD).

The aim of the study: to test the associations between the functional polymorphism Val158Met (rs6265) in the catechol-O-methyl transferase (COMT) gene, affecting dopamine neurotransmission, and adverse childhood experiences (ACE) and their GxE interactions with AD risk.

The study included 149 AD inpatients (mean age 29.9 (SD=3.91), 16.1% females) and 201 healthy volunteers (23.3 (2.48), 30.1% females). The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used for assessing ACE. COMT Val158Met polymorphism was detected by RT-PCR.

First, COMT Val158Met polymorphism was associated only with adverse childhood experience referring o parental relationship (ACE-IQ), but differently in two groups. Healthy minor Met158 carriers have lower scores on the subscale “relationship with parents/guardians” (P) (p=0.025) and “physical neglect” (PN) (p=0.059) vs. homozygous Val158 carriers. However, AD patients - Met158carriers have a tendency to a higher score on the subscale “one or no parents, parental separation or divorce” (PSD) (p=0.078). Then logistic regression revealed associations of these ACE scores with increased AD risk: P (p=0.001, OR=1.186, 95%CI [1.069-1.315]), PN (p=0.024, OR=1.254, 95%CI [1.030-1.526]), and PSD (p=0.016, OR=1.499, 95%CI [1.080-2.082]). No associations of COMT Val158Met alone or in interactions with these ACE-IQ scores with the AD risk were found.

Adverse childhood experience referring to parental relationship is associated with alcohol dependence risk and separately with COMT Val158Met, but no clear interactions in frame of GxE has been supported.

No significant relationships.

The first stage of the psychological intervention is related to diagnostics

Purpose of the study was to explore features of mental self-regulation processes in patients with diagnosis “Mental and behavioral disorders due to use of alcohol”.

The study involved 39 male patients with alcohol dependence, the average age of 43.6 ± 6 years. The experimental group (20 patients) was taking part in in-patient rehabilitation program, the duration of rehabilitation ranged 4-6 months. The control group included 19 patients of the in-patient addiction treatment department, with average duration of treatment 21 days. To assess self-regulation processes, questionnaires “Style of behavior self-regulation” (Morosanova V.) and questionnaire of volitional self-control (Zverkov A., Eydman E.) were used. To compare differences between two independent groups Mann-Whitney U-test was used

There was a significant difference for the subscale “Persistence and perseverance” in “Volitional self-control” test (p≤0.05) for the control and experimental groups. Patients, involved in clinical rehabilitation program, have higher ranks comparing to patients got clinical treatment (22.2 and 17.7). The comparison of the results of the questionnaire “Style of behavior self-regulation” showed that there is a significant difference for subscales “Modeling of significant conditions” and “Independence” (p≤0.05); participants from the experimental group had higher mean rank in both cases.

Patients who took part in the long-term in-patient rehabilitation program had more stable motivation to achieve their goals, better self-regulation and activity planning skills, higher independence and self-confidence, they were less dependent on opinion of others. The identified features can be used in psychological programs aimed at improving planning skills, reducing behavioral rigidity, stabilizing self-esteem and improving adaptive capacity.

No significant relationships.

Alcohol withdrawal delirium is severe complication of alcohol withdrawal leading to high mortality. Early identification of severe course of psychosis and complications threatening the patient’s life is the most important problem in the treatment of these patients.

Under supervision were 690 men, dependent on alcohol, in the state of withdrawal with acute psychotic disorder (primary hospitalization in the framework of this study); the average age - (39,9 ± 3,4 years), the average age of alcohol abuse - (9,7 ± 1, 1 years). The patients were examined in a dynamics after a re-hospitalization after 5-7 years. This allowed us to verify the differential diagnostic approach to acute psychotic disorders in a state of abandonment, to investigate the impact of chronic acute psychotic disorders on the course of alcohol dependence, including the formation of deficits.

clinical, clinical and psychopathological, methods of quantified scales and mathematical statistics.

There were estimated factors influencing the severity of alcohol withdrawal with delirium: total amount of alcohol consumed per week, drunken alcoholics, persistent alcohol abuse, social disadaptation, cognitive impairment, psychological disorders, reducing the quality of alcohol consumed, food pattern characterized total calorie mostly due to alcohol, life trajectory, severe or chronic somatic diseases, rate of progression of alcohol dependence.

The severity of acute psychotic disorder in the state of alcohol withdrawal mostly depended situational factors such as the number of days of severe drinking before a psychotic disorder, the pattern of nutrition, the quality and quantity of alcohol consumed, the presence of acute somatic diseases.

No significant relationships.

Alcohol dependence and depression are often combined, patients with comorbid pathology have a more severe course of the disease, a high risk of suicide and therapeutic resistance. Enzyme dopamine-beta-hydroxylase (DBH) is a key player in a link between dopamine and norepinephrine neuromediations and may be involved in alcohol dependence and depression comorbidity and genetic markers in DBH gene may be associated with the risk of comorbid state.

To test an association of DBH gene polymorphisms rs161111580 and rs1108580 with depression risk in alcohol-dependent patients.

Our sample consisted of 104 inpatients diagnosed by ICD-10 criteria: 40 with alcohol dependence (AD group) (age 45.6 (SD 10.853), 5% females), 64 with depression and alcoholism comorbidity (AD+D group) (age 41.2 (SD 9.903), 22% females) and 112 healthy controls (age 35.5 (SD 8.286), 15% females). rs1108580 and rs1611115 were detected by RT-PCR.

For rs161111580, frequencies of minor T allele (p=0.031) and ТТ genotype (p=0.017) was higher, СС genotype (p=0.042) was lower in AD group vs. controls. rs161111580 T allele and TT genotype increases the risk of AD (OR=3.715, 95%CI [1.728-7.986], P=0.001 and OR=4.009, 95%CI [1.502-10.699], P=0.006). For rs161111580, frequency of ТТ genotype (p=0.009) was higher in AD+D group vs. controls. For rs1108580, frequency of major А allele (p=0.059, trend) was higher in AD+D, then in AD group. Major А allele rs1108580 increases the risk of depression in alcohol-dependent patients (OR=2.74, 95%CI [1.283-5.855], P=0.001).

It was shown that the DBH rs1108580 increases the risk of depression in patients with alcohol dependence.

No significant relationships.

Eating disorders are stigmatised. Little is known about whether stigma has decreased over time and which groups hold more stigmatising beliefs.

To explore whether stigma towards eating disorders has changed between 1998 and 2008 and whether it varies by sociodemographic characteristics.

We used the Office for National Statistics Omnibus surveys 1998 and 2008. As outcomes, we selected four questions eliciting participants’ views on issues of blame and ability to recover, and compared their mean scores across eating disorders, depression and alcohol dependence in both years. We used multivariable linear regressions to investigate associations between sociodemographic characteristics and each stigma domain.

In total, 2720 participants had data on all variables of interest. Compared with 1998, in 2008 stigmatising views towards eating disorders improved. In both years, participants believed it was easier to recover from eating disorders than depression or alcohol dependence. Respondents believed people with eating disorders were more to blame for their condition than those with depression, but less than those with alcohol dependence. Men, those with less formal education, and those from ethnic minority backgrounds were more likely to place greater blame on individuals for their mental illness. Men were more likely than women to think it was possible to recover from an eating disorder.

Stigmatising attitudes towards people with eating disorders have improved over time, but are still greater than those observed for other mental illnesses. Improving eating disorder mental health literacy could help to reduce these negative views and lead to improved quality of life, greater help-seeking and better prognosis.

Severe acute psychosis significantly alters patient’s quality of life in patients with alcohol dependence. The aim of the investigation were examination value quality of the life patients with alcohol dependence who have recently suffered of acute psychotic disorder. The factor influencing the quality of life is the psychoorganic syndrome after acute psychosis.

120 patients with alcohol dependence who had recent history of acute psychosis were examined.

Psychopathological.

The psychorganic syndromes at these patients were investigated. The Index quality of the life in these patients was assessed due to type of the psychorganic syndromes. The dynamics of the Index quality of the life at patients with psychorganic syndrome during the treatment were described. The subjective assessment of their condition in patients with hard psychorganic syndrome was dissociated from the assessment of doctors and relatives. The explaining the characteristics of the consequences of the transferred psychotic disorder to the patients turned out to be important for overcoming anosognosia. The Index quality of the life in these patients was assessed repeatedly at the same time, there was a significant decrease in the difference in the assessment of the quality of life by patients with relatives.

The importance of value quality of the life from the point of the patient, relatives of the patient and physician was underlined. The assesment of Index quality of the life is important important to explain the peculiarities of the postpsychotic state to the patients and their relatives in order to develop rehabilitation programs and carrying out psychotherapeutic activities.

Structural variation in subcortical brain regions has been linked to substance use, including the most commonly used substances nicotine and alcohol. Pre-existing differences in subcortical brain volume may affect smoking and alcohol use, but there is also evidence that smoking and alcohol use can lead to structural changes.

We assess the causal nature of the complex relationship of subcortical brain volume with smoking and alcohol use, using bi-directional Mendelian randomisation.

Mendelian randomisation uses genetic variants predictive of a certain ‘exposure’ as instrumental variables to test causal effects on an ‘outcome’. Because of random assortment at meiosis, genetic variants should not be associated with confounders, allowing less biased causal inference. We used summary-level data of genome-wide association studies of subcortical brain volumes (nucleus accumbens, amygdala, caudate, hippocampus, pallidum, putamen and thalamus; n = 50 290) and smoking and alcohol use (smoking initiation, n = 848 460; cigarettes per day, n = 216 590; smoking cessation, n = 378 249; alcoholic drinks per week, n = 630 154; alcohol dependence, n = 46 568). The main analysis, inverse-variance weighted regression, was verified by a wide range of sensitivity methods.

There was strong evidence that liability to alcohol dependence decreased amygdala and hippocampal volume, and smoking more cigarettes per day decreased hippocampal volume. From subcortical brain volumes to substance use, there was no or weak evidence for causal effects.

Our findings suggest that heavy alcohol use and smoking can causally reduce subcortical brain volume. This adds to accumulating evidence that alcohol and smoking affect the brain, and likely mental health, warranting more recognition in public health efforts.

As executive dysfunctions frequently accompany alcohol dependence, we suggest that reports of executive dysfunction in alcoholics are actually due, in some case to a maternal history of alcohol misuse (MHA+). A history of maternal alcohol dependence increases the risk for prenatal alcohol exposure to unborn children. These exposures likely contribute to executive dysfunction in adult alcoholics. To assess this problem, we propose a case-comparison study of alcohol-dependent subjects with and without a MHA.

Ten alcohol-dependent subjects, with a maternal history of alcoholism (MHA) and paternal history of alcoholism (PHA), were matched with 10 alcohol-dependent people with only a paternal history of alcoholism (PHA). Executive functions (cancellation, Stroop, and trail-making A and B tests) and the presence of a history of three mental disorders (attention deficit hyperactivity disorder, violent behavior while intoxicated, and suicidal behavior) were evaluated in both populations.

Alcohol-dependent subjects with MHA showed a significant alteration in executive functions and significantly more disorders related to these functions than PHA subjects. The major measures of executive functioning deficit are duration on task accomplishment in all tests. Rates of ADHD and suicidality were found to be higher in MHA patients compared to the controls.

A history of MHA, because of the high risk of PAE (in spite of the potential confounding factors such as environment) must be scrupulously documented when evaluating mental and cognitive disorders in a general population of alcoholics to ensure a better identification of these disorders. It would be helpful to replicate the study with more subjects.

The CAGE questionnaire is considered a useful screening and case-finding tool for alcohol use disorders in clinical populations. Our objectives were to validate the French version of the CAGE against DSM-IV criteria and to assess performance of each item of the scale.

Data were extracted from a hospital morbidity study conducted in central France. It concerned 5452 patients—48.5% men—in short and medium-stay units. Patients answered the CAGE questionnaire as a past-year assessment. The alcohol use disorders were diagnosed by the physicians using DSM-IV alcohol abuse or dependency criteria.

The CAGE questionnaire for a cut-off of 2 had a sensitivity of 77% and a specificity of 94%. The CAGE test was more sensitive for patients diagnosed as alcohol-dependent than for alcohol abusers (61% vs. 84%) with the same specificity (94%). These values are close to those for the English-language CAGE. The first three items (CAG) were very similar, with sensitivity 70% and specificity 94%. The eye-opening question (E) differentiated sharply between abuse and dependency, with sensitivities of 18% and 46%, respectively. A questionnaire comprising only the CAG questions of the CAGE had properties similar to the full questionnaire.

CAGE is a good screening tool for alcohol abuse or alcohol dependency. Given the frequent—and insufficiently diagnosed—alcohol problems among inpatients, CAGE is indicated as a first-line tool for screening for the most severe alcohol use disorders in hospital. It should ideally be used systematically. A positive reply to any of the first three items should alert the clinician and prompt further investigation.