Symposium 15 Monday Sept. 24th 1.30 pm–3.00 pm; Room: Lecture Hall 3
Typologies in alcohol dependence—second part: basic and clinical results: Chairpersons: Bleich S (Germany), Walter H (Austria)
; |
Abstract |
|---|
Presentation S15-1
Phenotypes relevant for DSM V and ICD 11
Lesch OM (Austria)
Aims. Alcohol abuse is a very heterogeneous phenomenon and therefore until now internationally accepted treatment programs for abuse are still lacking. In alcohol dependence more than 80 treatment approaches are used but most of them being not effective in relapse prevention. Some of them even increase relapse rates in subgroups of alcohol dependence and only few of them decrease relapse rates. Anticraving medications affecting different transmitter systems (glutamate, serotonine, dopamine, opiates, etc.) have been developed, but all these compounds are only effective in subgroups of alcohol dependence, e.g. acamprosate increases sobriety rates in type I and type II alcohol dependent patients according to Lesch and naltrexone reduces amount and duration of alcohol intake in a drinking alcohol dependent population (type III and type IV according to Lesch) (Hester andMiller 2003, Kiefer et al. 2005).
Results. The literature for predictors of responses to anticraving medications revealed gender, age of onset, comorbidity, anti-social personality disorder and typologies according to Babor, Cloninger and Lesch as relevant. Nowadays a 4 Cluster subgrouping is well accepted and following these results we would suggest for DSM V and ICD11 the following procedure:
Conclusions. These above mentioned categories should be included in the classification system of DSM V and ICD 11. The categories should be defined by well accepted severity degrees (e.g. no withdrawal, mild withdrawal, severe withdrawal or no epileptic seizures—epileptic seizures only during withdrawal—epileptic seizures outside of withdrawal states). In the new classification systems a bottom-up procedure using these categories should be possible and it should be allowed to combine these categories in different ways according to the topic the diagnosis is used for (for epidemiological research or to translate animal data in clinical trials).
Presentation S15-2
Protective effect against alcohol dependence of the thermolabile variant of MTHFR
Benyamina A, Saffroy R, Pham P, Marill C, Karila L, Debuire B, Reynaud M, Lemoine A (France)
Aims. Hyperhomocysteinemia is frequently observed in alcohol-dependent subjects particularly in those with marked withdrawal symptoms. The common C677T transition on the methylenetetrahydrofolate reductase (MTHFR) gene influences homocysteinemia. Our objective was to study the prevalence of the MTHFR C677T polymorphism in alcohol-dependent subjects as well as the influence of this polymorphism on symptoms associated with alcoholism.
Methods. Hepatic biological parameters in the control MTHFR C677T polymorphisms were determined in 93 control subjects and 242 alcohol-dependent subjects. Serum homocysteine, folate and vitamin B12 levels were determined in the group of alcohol-dependent subjects.
Results. Hyperhomocysteinemia is frequently observed in alcohol-dependent subjects, particularly in those with marked withdrawal symptoms. Alcohol-dependent subjects showed a significant decrease in MTHFR 677TT prevalence (9%, 21/242) compared to controls (18%, 17/93) (p < 0.02). The relative risk estimated as an odds ratio for alcoholism in subjects with the TT genotype is 0.42 (Odd Ratio 95% confidence interval, 0.21–0.83). Moreover, drinkers with TT genotype presented lower values for markers of alcohol misuse (p < 0.05), better liver function tests, a lower frequency of relapses and no marked withdrawal symptoms as assessed by the Lesch typology.
Conclusions. MTHFR 677TT genotype could play a protective role against alcohol dependence. Moreover, when subjects with MTHFR 677TT genotype become dependent to alcohol, they seem to constitute a subgroup of alcoholic patients with a decreased risk for developing neurotoxic withdrawal symptoms and hepatic toxicity.
Presentation S15-3
Pupillometric assessment in the validation procedure of subgroups of alcohol dependence using the method of Grunberger
Gruenberger J, Dvorak A, Frottier P, Stoehr H-G, Walter H, Thau K (Austria)
Aims. The definition of subgroups of alcohol dependent patients has become an undisputable interest of a large amount of studies dealing with this diagnosis. At our centre we have used the method of pupillometry to further validate different subtypes of alcohol dependency as assessed by the Typology of Lesch.
Methods. Pupillometry has shown to be a reliable source of information concerning various biological parameters. Using the Tropicamide receptor test according to Gruenberger it also has found its use in prognostical questions such as risk to relapse on account of cognitive impairment. The chronic intake of alcohol in harmful amounts leads to a shift in the balance of all neurotransmission systems in the central nerve system. For instance an overexprimation of acetylcholinesterasis sensitive muscarinergic receptors leads to an increase of apoptosis in the cholinergic basal frontal lobe. After the ingestion of psychotropic substances cholinergic receptors induce a miosis of the pupil, whereas sympathic receptors lead to a dilatation (mydriasis) of the pupil. The Receptortest used in pupillometry is a noninvasive method to evaluate an occurring deficit of acetylcholinesterasis and the resulting cognitive impairment of the patient assessed. During this examination drops of tropicamide (a potent anticholinergic and mydriatic substance) are applied to one of the eyes of the patient leading to maximal pupil dilatation. The diameter of the pupil is then recorded over a certain period of time. Earlier studies showed, that alcohol-dependent patients usually show a greater dilatary reaction compared to baseline as can be found in control-groups. These aberrations are never as high as seen in patients suffering from Alzheimer's disease. As the quantity of cognitive impairment in alcohol-dependents stands in direct correlation to their risk to relapse, this examination method can be used to better assess the probability of an upcoming relapse and also the further course of the individual patient's dependence. In our trial we performed the receptor-test on 300 alcohol dependent patients according to DSM IV between the 2nd and 4th day of withdrawal. 247 could be assessed with the computerized assessment procedure for Lesch typology (40 patients type I, 72 patients type II, 92 patients type III and 43 patients type IV). Additionally biological parameters (such as for example severity of withdrawal symptoms, blood tests, onset of addiction) and the Typology of Lesch were performed.
Results. The results showed significant differences in the dynamic pupillometry according to Lesch typology. The Tropicamide receptor test showed also significant differences between the different types and these results fit very well with a published recent paper by Walter et al. showing different kindling mechanisms between different types according to Lesch.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. Pombo and O. M. Lesch The Alcoholic Phenotypes among Different Multidimensional Typologies: Similarities and Their Classification Procedures Alcohol Alcohol., October 1, 2008; (2008) agn080v1. [Abstract] [Full Text] [PDF]
|
|