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M Soyka

Publications and source records attributed to M Soyka.

At least 19 recordsLinked to original sources
PubMed2000

Serotonin transporter gene regulatory region polymorphism (5-HTTLPR), [3H]paroxetine binding in healthy control subjects and alcohol-dependent patients and their relationships to impulsivity.

The aim of this study was to investigate [3H]paroxetine binding and impulsivity in alcohol-dependent and age-matched control subjects in relation to a 5'-promoter region serotonin transporter (5-HTT) polymorphism (5-HTTLPR). Alcohol-dependent subjects were hypothesized to show a decreased number of bindings sites and a lower dissociation constant. 5-HTTLPR S-genotype carriers in both alcohol-dependent and control subjects were expected to show significantly fewer binding sites and a lower dissociation constant. Influences of impulsive traits, chronic daily alcohol intake, duration of alcohol dependence, age of onset and age on [3H]paroxetine binding were also investigated. Inpatients meeting DSM IV alcohol dependence criteria and of German descent were recruited to avoid ethnic stratification effects. One hundred and seventeen control subjects of similar social status were recruited from a town community. Blood samples were taken from both alcohol-dependent and control subjects to determine 5-HTTLPR genotypes using PCR of lymphocyte DNA, and to perform platelet [3H]paroxetine binding (binding capacity: B(max); and dissociation constant: K(D)). Impulsivity was assessed using the Barratt impulsiveness scale version 5 (BIS-5) in alcohol-dependent subjects only. Alcohol-dependent subjects were subdivided into low or high impulsivity groups using a median-split of the BIS-5 scale. The control group was slightly older than the alcohol-dependent group (not statistically significant). [3H]paroxetine binding was investigated in 72 control subjects and 72 patients, of which five patients met type 2 alcohol dependence criteria. Genotyping was carried out in all patients and control subjects. A significant influence of duration of alcohol dependence was found on the [3H]paroxetine binding K(D) but not B(max.) Neither alcohol-dependent nor control subjects showed any differences in B(max) or K(D). S-allele carriers did not show a decreased binding or lower dissociation constant. Furthermore, no significant interaction between B(max) and K(D) with either 5-HTTLPR genotype or impulsivity was revealed. This was the first study to investigate platelet [3H]paroxetine binding in alcohol-dependent and age-matched control subjects in relation to the 5-HTTLPR genotype. No differences concerning 5-HTTLPR-alleles were found in these groups Furthermore, no significant interaction between these parameters and impulsivity was shown in alcohol-dependent subjects. These results do not support previous results of altered [3H]paroxetine binding sites in alcohol-dependent subjects or 5-HTTLPR S-allele carriers. K(D) might be influenced by duration of alcohol dependence, but not sufficiently to yield differences between alcohol-dependent and control subjects.

Adult↗
PubMed2000

[Ambulatory detoxification of alcoholic patients. Results of a model project].

At present, institutions in Germany that concern themselves with the detoxification of alcoholics on an outpatient basis are few and far between, despite the fact that such an approach is quite common in other countries such as the USA. Problems are associated both with the careful diagnostic work-up of the patient aimed at assessing possible risks, and with the pharmacotherapy that might be needed. The present article describes a model project, which was initiated in 1998 under the scientific and clinical supervision of the Department of Psychiatry of the University Hospital in Munich. The concept behind the project and the clinical results achieved with the first 47 detoxified patients are presented and discussed.

Alcoholism↗
PubMed2000

NMDA receptor challenge with dextromethorphan - subjective response, neuroendocrinological findings and possible clinical implications.

Glutamatergic NMDA receptors are believed to play a major role in the pathophysiology of numerous neuropsychiatric disorders including substance use and schizophrenia. Neuropharmacological studies measuring subjective response, psychopathology and biological parameters are helpful in studying pathophysiology of these disorders. We report preliminary data of a placebo-controlled double-blind challenge study in recently detoxified alcoholics (n = 20) and healthy controls (n = 10) using the non-competitive NMDA antagonist dextromethorphan. Findings suggest that dextrometorphan can produce ethanol-like subjective effects in both alcoholics and controls and induce a mild form of craving in alcoholics only. The results of this study give further support to the hypothesis of glutamatergic NMDA receptors mediating much of ethanol's psychotropic effects. Possible clinical implications of these findings are discussed.

Adult↗
PubMed2000

Flupenthixol as a potential pharmacotreatment of alcohol and cocaine abuse/dependence.

Preclinical and clinical studies suggest that the mesolimbic dopamine system plays a major role in mediating the reinforcing effects of drugs of abuse, including alcohol and psychostimulants, and that pharmacological blockade of dopamine D1 and/or D2 receptors may reduce intake of these drugs, as well as relapse rates. The neuroleptic flupenthixol, which has dopamine D1 and D2 receptor antagonist properties and which may be given intramuscularly in order to improve compliance, has been studied as a possible anti-craving drug in substance abuse disorders. Flupenthixol has been shown to attenuate the discriminative stimulus effects of psychostimulants, as well as their intake in animal models of drug abuse. In addition, the compound was found to reduce alcohol intake in a rat model of alcoholism, but the 'anti-alcohol' effect appeared to be only weakly selective and nonspecific. Clinically, the drug has been studied in alcoholics, cocaine addicts and in patients with comorbid psychiatric disorders. Although the data base is still limited and a number of recent trials have not been completely analyzed, these studies suggest that flupenthixol may be useful in decreasing cocaine consumption. Recent studies in alcoholism, however, have shown disappointing results. A number of pilot studies suggest that probably the most promising area may be the treatment of substance abuse/dependence in patients with comorbid psychiatric disorders. Future studies should focus on dosing issues, the differentiation between short- and long-term effects and the identification of subgroups of patients with particular psychopathology.

Alcoholism↗
PubMed2000

[Ambulatory detoxification of alcoholic patients--evaluation of a model project].

We present the concept and first catamnestic results of a model project "outpatient alcohol detoxification" which was initiated in 1998. To date 48 patients (18 female, 29 male, mean age 44.5 years, mean duration of alcohol dependence 10.2 years) entered treatment, 43 (92%) patients could be successfully detoxified. In only 21 (44%) patients a medication was necessary. To avoid drugs with abuse potential, doxepine (34%) and clonidine (19%) were predominantly used. No severe medical complications were observed. A follow-up examination after 6 months showed that 26 (55%) patients were abstinent and still in outpatient treatment. Further implications of this project are discussed.

Adult↗
PubMed2000

Epidemiological evidence for a low abuse potential of zolpidem.

The abuse risk of new non-benzodiazepine hypnotics such as zolpidem has been discussed in a number of recent publications. We performed a Medline analysis which showed that, to date, 15 cases of abuse or dependence have been published. In 6 patients, the abuse was secondary to other forms of abuse or dependence. Other data from medical statistics and pharmacoepidemiological studies suggest the abuse potential of zolpidem to be much lower than that of other hypnotics. We conclude that zolpidem is a relatively safe drug compared to conventional hypnotics. Patients with other substance abuse histories may be considered as risk patients for later abuse of zolpidem.

Adult↗
PubMed2000

[Treatment of cocaine dependence. Intoxication, withdrawal and prevention of relapse].

The aim of this review article is to evaluate the treatment of cocaine-withdrawal, cocaine-intoxication and long-term relapse prevention of cocaine-addicts. Some 25% of police recognized first time drug users in Germany consume cocaine. However, there is an increasing number of cocaine-abusers and -addicts in the USA. The withdrawal of cocaine can be divided into three phases dominated mainly by psychiatric symptoms. Life-threatening condition can occur in cocaine-intoxication mainly in combination with other drug-use. A high risk of relapse is seen in follow-up trials of cocaine-addicts. Intensive craving, high cocaine- and substance-abuse is reported regularly in cocaine-addicts after detoxification therapy. Recommendations in the treatment of cocaine-intoxication, withdrawal and long-term relapse prevention are made. The use of antidepressives, anticonvulsants, dopaminergic and serotonergic medications as well as behavioural, psychoanalytical and combined therapies and their efficacy in clinical and trails is evaluated. A short review of new experimental therapies in the treatment of cocaine-dependence is shown.

Cocaine↗
PubMed2000

[Sexual and physical abuse during early childhood or adolescence and later drug addiction].

UNLABELLED: Sexual or physical abuse of children are discussed as possible causes or risk-factors for psychiatric disorders like posttraumatic stress disorder, alcohol and drug addiction. The aim of this study was to identify possible differences between sexually or physically abused and non-abused patients with polytoxic drug abuse. METHOD: 100 patients with polytoxic drug abuse were interviewed during their therapy about a history of sexual abuse prior to the age of sixteen. Using different questionnaires we tried to find possible differences between drug users being sexually abused or not and risk factors for later drug addiction. RESULTS: 70% of the female and 56% of the male drug users had been sexually abused as children, 40% of the male and 50% of the female participants had a history of severe sexual abuse with sexual intercourse. In over 50% friends or relatives were the perpetrators committed the crime, in no case the parents had. More than 40% showed also a history of physical abuse. Significantly more drug users than alcohol abusers had a sexual trauma. Especially severe sexual abuse was associated with abuse of hard illegal drugs. Furthermore, we could find significantly more symptoms such as autoaggressive and suicidal behaviour, social isolation, reduced emotional binding to others, tendency to be persistently victimized, prostitution and violence against others in the group of sexually abused. Many of these symptoms are not only characteristic of addiction, but can be found also in other psychiatric diseases such as borderline and eating disorder. In conclusion, we could not find a significant correlation between sexual abuse and later drug addiction. 80% of the drug users themselves did not relate the fact of being sexually abused as child to later drug abuse. However, there seems to be a positive correlation between sexual abuse and a more severe addiction to illegal drugs as well as higher rates of symptoms with a negative course of the disease. For this group of patients with an unfavourable prognosis special therapeutic concepts are needed.

Adult↗
PubMed2000

Platelet monoamine oxidase activity in alcoholics with and without a family history of alcoholism.

A number of studies point at platelet monoamine oxidase (MAO) activity being reduced in alcoholics with a family history of drinking, this being a possible vulnerability marker for alcoholism. To test this hypothesis, we examined a group of recently detoxified alcoholics with high (n = 25) and low genetic loading for alcoholism (n = 28) and a group of healthy controls (n = 21). Clinical assessments were made using the SCID II interview for psychiatric disorders, the Family History Assessment Module and the Semi-Structural Assessment of Genetics in Alcoholism, a questionnaire especially designed for genetic studies. Platelet MAO activity with and without ethanol stimulation and the percentage of MAO activity with ethanol did not differ between groups. The only significant difference was a lower inhibition of MAO activity with ethanol in alcoholics both with and without a family history compared to controls. In patients with antisocial personality traits, platelet MAO activity was also not found to be different from other alcoholics. Our findings question the hypothesis of reduced platelet MAO activity to be a possible vulnerability marker for alcoholism.

Adult↗
PubMed2000

Dementia associated with vitamin B(12) deficiency: presentation of two cases and review of the literature.

Vitamin B(12) deficiency has long been associated with a wide variety of hematological, neurological, and psychiatric disorders. The role of vitamin B(12) deficiency as one of the few treatable causes of dementia, however, is still controversial. The authors report on 2 elderly patients suffering from cognitive impairment and psychotic symptomatology probably related to cobalamin deficiency, who showed improvement after parenteral vitamin B(12) substitution. The literature concerning the pathophysiology and the diagnostic and therapeutic aspects of cobalamin deficiency is reviewed.

Aged↗
PubMed2000

Substance misuse, psychiatric disorder and violent and disturbed behaviour.

BACKGROUND: Epidemiological studies suggest schizophrenia and substance misuse to be associated with a higher rate of violence and crime. AIMS: The literature was evaluated to assess whether people with schizophrenia who use substances have an increased risk for violence and disturbed behaviour. METHOD: A detailed Medline analysis was performed and relevant studies were reviewed. RESULTS: A large number of studies have linked substance misuse in schizophrenia with male gender, high incidence of homelessness, more pronounced psychotic symptoms, non-adherence with medication, poor prognosis, violence and aggression. The latter has been proved by clinical, epidemiological and longitudinal prospective studies of unselected birth cohorts. The increased risk for aggression and violent acts cannot be interpreted only as a result of poor social integration. Male gender, more severe psychopathology, a primary antisocial personality, repeated intoxications and non-adherence with treatment are important confounding variables. CONCLUSION: Substance misuse has been shown consistently to be a significant risk factor for violence and disturbed behaviour. Future research should try to evaluate possible pharmacological and psychosocial treatment approaches.

Crime↗
PubMed1999

[Confusion syndrome in alcoholism. Faulty assessment can produce deleterious course].

Confusion is a frequent syndrome in alcoholism caused by a large number of neuropsychiatric and somatic disorders with severe alcohol intoxication, pathological intoxication, alcohol dementia and hepatic encephalopathy among them. Possible pathophysiologic mechanisms involved and therapeutic strategies are discussed.

Alcohol-Induced Disorders, Nervous System↗
PubMed1999

Late auditory evoked potentials (P300) do not discriminate between subgroups of alcohol-dependent patients defined by family history and antisocial personality traits.

Alcohol dependent patients with a family history of alcoholism and with antisocial personality traits were supposed to have frontal brain dysfunction. Late evoked potentials may be useful to discriminate these patients from patients without family history or antisocial behavior. We investigated 56 abstinent patients hypothesizing that four subgroups of abstinent alcoholics with regard to family history (FHP: family history positive, FHN: family history negative) and antisocial behavior (ASP: antisocial traits present, ASN: antisocial traits not present) would exhibit differences in P300, particularly when recorded by frontal electrodes. FHP/ASP patients were expected to show the lowest P300 amplitudes in frontal electrode sites. Beside single electrode recordings, a new method in analyzing P300 scalp data by dipole source analysis (BESA: Brain electric signal analysis) was used. No difference in the P300 values was observed between the FHP/FHN and ASP/ASN groups. Similar results were found by analyzing ASP/ASN and FHP/FHN groups separately. The findings of single electrode recordings were consistent with BESA-dipole results. In conclusion, auditory P300 had a low discriminative power with regards to subgroups of inpatient alcoholics defined by family history and antisocial personality traits. Reasons for the negative findings in this study are discussed.

Adult↗