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Biomedical subjects

C Veltrup

Publications and source records attributed to C Veltrup.

14 recordsLinked to original sources

Acceptance of pharmacotherapy for relapse prevention by chronic alcoholics.

The willingness to take medication is a major prerequisite for compliance with biological treatment approaches in psychiatric disorders. The aim of this study was to investigate the willingness of alcoholics to improve relapse prevention using drug therapy, since there has been little information about the acceptance of such a medication as yet. 261 chronic alcoholics consecutively referred for detoxification completed a newly developed questionnaire containing items on drinking history, recent treatments, and beliefs about drug therapy for relapse prevention. In order to draw comparisons, 67 self-help group attendees and 29 alcoholics consulting an outpatient advice service were also recruited. 67.8% of the recently detoxified alcoholics were prepared to take medication for relapse prevention, if prescribed, while 60% the self-help group attendees refused drug therapy. There was no correlation between the acceptance of drug treatment and duration of dependence. Subjects willing to take a medication more often believed their alcoholism to be curable, and they reported a higher craving frequency. 55% of those willing to take a medication were willing to pay for the drugs, but in most cases, at a level lower than the equivalent of 5 beers. As drug therapy acceptance is a crucial part of compliance with, and success of medical relapse prevention, our results underscore the necessity of a thorough exploration into the health beliefs of the patient and joint development of a treatment rationale prior to prescription.

Adult↗

Craving shift in chronic alcoholics.

In order to investigate changes in the consumption of substances that stimulate the reward system, 222 recently detoxified alcoholics were asked about their consumptional habits before as compared to after detoxification (mixed prospective and retrospective design). Seventy-eight point two percent reported an increase in consumption of coffee, cigarettes, chocolate and other sweets, while 34.9% managed to reduce at least one of these substances. The increase was significant for coffee, chocolate and other sweets. The desire for consumption of these substances was correlated with the maximum ever experienced desire for alcohol (0.232 for coffee, 0.213 for cigarettes, 0.193 for chocolate and 0.176 for other sweets), and the actual consumption of coffee, cigarettes and sweets was correlated with the actual desire for alcohol (0.172, 0.157 and 0.245, respectively). The results lend some support to the hypothesis that psychotropic substances might serve as a kind of self-regulation against craving in this group. A possible link to biochemical theories is discussed.

Adult↗

[Cost-efficacy analysis of clinically evaluated therapeutic programs. An expanded withdrawal therapy in alcohol dependence].

BACKGROUND: Cost-effectiveness analyses complete clinical evaluation studies and thereby support the a well based estimation of therapy efficiency. AIM: A qualified (extended) alcohol withdrawal treatment programme (II), which was previously described and evaluated by face-to-face follow-up studies, was analyzed with regard to cost-effectiveness. SAMPLE: 57 alcohol-dependent patients, which had undergone programme II, were compared with 37 patients after a medical detoxification programme (I). METHODS: Health insurance data (number and length of all hospitalizations, days of incapacity to work, days of financial substitution for incapacity to work) were assessed for the five years before and after index therapy and for each year, separately. RESULTS: While there were no substantial differences for the time before index therapy, programme II patients were hospitalized after index therapy (i) less frequently (3.5 + 4.4 vs. 7.3 + 11.3 times), (ii) for fewer days (66 + 75 vs. 136 + 167) than programme I patients, and they received financial support for fewer days (67 +/- 73 vs 220 +/- 187 days). CONCLUSION: Considering a somewhat better clinical outcome of programme II vs. programme I patients (14% greater abstinence rate within one year) the significantly lower rates and fewer days of follow-up hospitalisations support a sufficient efficiency of the extended alcohol withdrawal treatment programme.

Adult↗

Psychiatric co-morbidity, suicidal behaviour and suicidal ideation in alcoholics seeking treatment.

AIMS: To estimate the impact of co-morbid disorders for suicidal ideas in alcohol-dependent subjects seeking treatment. DESIGN: Life-time psychiatric co-morbidity and previous suicidal behaviours were assessed retrospectively after detoxification (t1). In addition, suicidal behaviours were assessed 12 months after discharge (t2). SETTING: An inpatient detoxification treatment unit. PARTICIPANTS: Two hundred and fifty dependent inpatients were studied after detoxification. One hundred and forty-nine of them participated in the follow-up face-to-face interviews. MEASUREMENTS: Using two extended standardized interviews (CIDI and IPDE) psychiatric co-morbidity (DSM-III-R, Axes I and II) was assessed at t1; suicide attempts were reported at t1 and t2, and suicidal ideas were assessed at t2. FINDINGS: A history of suicide attempts was reported by 29.2% at t1, and suicidal ideas by 14.1% and suicide attempts by 5.4% at the follow-up (t2). One female patient committed suicide within 6 months of discharge from hospital. The following co-morbidity patterns were associated with the greatest risk for suicidal ideas. Anxiety and depressive disorders, Axes I and 11 disorders, and a history of suicide attempt (for suicidal ideas at (t2). CONCLUSION. Our results underline the importance of psychiatric co-morbidity for the suicidal risk in alcohol-dependent patients, while alcoholism itself appears to be only a moderate risk factor.

Adult↗

Axis I and axis II comorbidity in alcohol dependence and the two types of alcoholism.

BACKGROUND: Although high prevalence rates of psychiatric comorbidity were reported in alcoholism, there is a lack of studies covering the whole spectrum of DSM Axes I and II disorders. The relation of comorbid psychopathology and Cloninger's and Babor's types of alcoholism still remained unclear. METHODS: Psychiatric comorbidity in 250 hospitalized alcohol-dependent patients without additional substance-related disorders was assessed by the Composite International Diagnostic Interview and the International Personality Disorder Examination. Information about the course and severity of alcoholism was obtained from several sources. RESULTS: Additional Axis I disorders only were found in 24.0%, Axis II disorders only in 16.4%, and concurrent Axis I and Axis II disorders in 17.2% (total comorbidity rate: 57.6%). Two clusters of alcohol dependence were found that substantially overlap with Cloninger's and Babor's types of alcoholism. The majority of type A subjects were found to be either not comorbid at all, or to be Axis I comorbid only. Type B, on the other hand, was preferably associated with personality disorders (mainly Clusters A and B) and dimensional scores of personality pathology (schizoid, schizotypal, all Cluster B, and passive-aggressive). CONCLUSIONS: The entire spectrum of personality pathology should be assessed in the comorbidity research of alcoholism. The two types of alcoholism differ on a variety of alcohol-related and comorbid personality characteristics, but further research is needed to clarify the underlying psychological and biological associations.

Adult↗

[Craving--an adequately defined concept?].

Many addicts report on craving--a strong desire to consume the drugs again. Craving is attributed by many addicts to be the main reason for relapse or for the failure to become abstinent. In the recent years some drugs with an "anti-craving" effect have been developed. In this context a review of the complex concept "craving" seems to be urgent. In this paper the psychological conditions of craving and biochemical phenomena possibly underlying craving are reviewed. Basing on the recently available data a new psychobiological concept of craving with two prototypes (craving in early withdrawal and craving during abstinence) has been developed. This model is discussed with regards to possible therapeutic implications.

Alcoholism↗

[Motivational work with alcohol dependent patients].

Motivational work is secondary preventive work. The aim is to increase activity for maintaining long-term abstinence. The principles and structure of a secondary preventive program with several opportunities of intervention in the frame of detoxification treatment are presented.

Alcoholism↗

Clinical predictors of alcohol withdrawal delirium.

Up to now, clinical predictors for the course of the alcohol withdrawal syndrome, especially for the occurrence of a delirium, are lacking. Thus, this study was undertaken to examine whether clinical routine investigations at admission before the withdrawal syndrome can reveal factors indicating a higher risk for the development of a delirium. Our results showed that decreased serum electrolyte concentrations (i.e., chloride and potassium), elevated ALT, and gamma-glutamyltransferase serum levels, as well as ataxia and polyneuropathy at the neurological examination, indicate a higher risk for the development of an alcohol withdrawal delirium.

Adult↗

[Assessment of "craving" in alcoholic patients using a new questionnaire (Lübeck Craving-Recurrence Risk Questionnaire)].

This paper describes the development of a new instrument for measurement of craving in alcohol dependent patients. Craving is measured by self-statements. 146 alcoholics were examined. The results show that craving depends on situational factors, varying with the time of day and place. The severity of craving 30 days before inpatient treatment is shown. Four empirically substantiated subscales of psychological craving are presented. In the discussion the quality of the new questionnaire is assessed and connections to research on relapse are established. Finally, the importance of coping with craving in the prevention of relapse is pointed out.

Adult↗

[The implications of age at onset of chronic alcoholism--an overview].

This paper gives a short review about the available literature concerning the impacts of age of alcoholism onset. Empirical studies of the last twenty years have mainly tried to find differences between onset during youth and the middle age. There are only few reports about specific characteristics of patients, who have developed alcoholism in their older age. Biological and psychosocial findings and therapeutic considerations are described. Their account on further research and practical care are discussed.

Adult↗

[Memory deficits in alcohol dependent patients in the 1st weeks of abstinence].

The aim of the study is to analyse memory deficits of alcohol dependents after detoxification with regard to the degree of recovery since the beginning of abstinence. Four samples include in the whole 168 alcohol dependent in-patients of same age and sex. Psychological tests of verbal as well as visual memory with retention times of a few seconds to 30 minutes were applicated, among others the Auditory-Verbal-Learning-Test, the digit span as well as the Benton-Visual-Retention-Test. The results show that the performance grows with time of abstinence. This increase, however, is nearly finished after seven days. In the discussion the idea of a dichotomization of the detoxification development concerning the memory performance is encouraged according to which in a first stage of about seven days the most pronounced disturbances become less. In a second stage lasting weeks cognitive deficits of a minor degree remain. This is in accordance with other studies in which however the age was not controlled well.

Adult↗

[A multi-stage treatment concept for alcoholics: utilization and results of treatment].

A multistage treatment model for alcoholics that is situated close to their domicile is presented in respect of organisational structure and basic therapeutic principles. Patients are compared with each other in their various stages of treatment (detoxication, counselling, therapy, aftercare) in respect of sociodemographic, alcohol-specific and psychological variables; these variables are examined with regard to their prognostic relevance for the transition to the next stage of their treatment schedule and for the success of the treatment. The resulting consequences for the treatment of alcoholics are pointed out and discussed.

Adult↗

Drinking pattern and alcohol-related medical disorders.

Although heavy alcohol intake is known to be one of the most common causative factors of liver disease, pancreatitis, upper gastrointestinal and neurological disorders, the influence of the drinking pattern is largely unknown. The study investigated the relationship of alcohol-related medical disorders in alcoholics and their drinking pattern. Two hundred and forty-one chronic alcoholics were referred consecutively for detoxification and their drinking pattern was sufficient for them to be included in this study. History of alcohol abuse as well as drinking behaviour in the last 6 months were assessed by a semi-structured interview. Findings included intensive clinical examination with abdominal ultrasound in most subjects. Heavy drinking with frequent inebriation was most often found in our sample (44.4%), whereas continuous heavy alcohol consumption without intoxication (33.6%), and an episodic drinking style (22.0%) were less frequent. The heavy drinkers suffered more often from pancreatitis, oesophageal varices, polyneuropathy or erectile dysfunction than episodic drinkers. They also showed more upper gastrointestinal disorders, although the estimated life-time alcohol intake was comparable to continuous drinkers. No difference relating to withdrawal delirium or seizures could be found between the groups of alcoholics. Frequent heavy drinkers showed a trend to more alcohol-related medical disorders than alcoholics with a different drinking pattern, although they were younger and their estimated life-time alcohol intake was comparable to that of continuous drinkers. Thus, the drinking pattern, particularly frequent inebriation, has an influence on the occurrence of alcohol-related disorders.

Adult↗

Motivational intervention: an individual counselling vs a group treatment approach for alcohol-dependent in-patients.

AIMS: The present study aimed to evaluate whether individual counselling for alcohol-dependent patients in three sessions is as effective as a 2-week group treatment programme as part of an in-patient stay in a psychiatric hospital which was to foster motivation to seek further help and to strengthen the motivation to stay sober. Of particular importance was the external validity of the results, i.e. a 'normal' intake load of in-patients in detoxification and a wide variety of motivation to stop drinking were to be investigated. METHODS: Subjects eligible for the study were all patients with alcohol problems admitted to a psychiatric hospital, but without psychosis, as the main diagnosis, and with a maximum of 10 detoxification treatments in the past. A randomized-controlled trial was conducted with 161 alcohol-dependent in-patients who received three individual counselling sessions on their ward in addition to detoxification treatment and 161 in-patients who received 2 weeks of in-patient treatment and four out-patient group sessions in addition to detoxification. Both interventions followed the principles and strategies of motivational interviewing. RESULTS: Six months after intervention, group-treatment patients showed a higher rate of participation in self-help groups; however, this difference had disappeared 12 months after treatment. The abstinence rate among the former patients did not differ between the two intervention groups. CONCLUSION: Group treatment may lead to a higher rate of participation in self-help groups, but does not increase the abstinence rate 6 months after treatment.

Alcoholism↗