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Biomedical subjects

Leo Sher

Publications and source records attributed to Leo Sher.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Alcoholism and seasonal affective disorder.

Seasonal changes in mood and behavior (seasonality) may be closely related to alcoholism. Some patients with alcoholism have a seasonal pattern to their alcohol misuse. They may be self-medicating an underlying seasonal affective disorder (SAD) with alcohol or manifesting a seasonal pattern to alcohol-induced depression. Both genetic and environmental factors play a role in the etiology and pathogenesis of alcoholism and SAD, operating, at least in part, through the brain serotonergic system. Family and molecular genetic studies suggest that there may be a genetic link between seasonality and alcoholism. Certain environmental and social factors may contribute to the development of seasonality in patients with alcoholism. The fact that SAD and alcoholism may be comorbid shows the importance of a thorough diagnostic interview. Both mental health and drug and alcohol professionals should be provided with education to assist with appropriate identification, management, and referral of patients presenting with comorbid alcoholism and SAD.

Alcoholism↗
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Alcohol and adolescent suicide.

Adolescent suicide is a major public health problem. In this review, the authors discuss different aspects of the relation between alcohol abuse and suicidal behavior in adolescents, including epidemiology, role of family history, comorbidity, gender differences, neurobiology, treatment, and prevention. In the general population, about 2,000 adolescents in the United States die by suicide each year. Suicide continually ranks as the second or third leading cause of death of persons between the ages of 15 and 34 years old. The suicide rate in young people has more than doubled during the period from 1956 to 1993. This increasing suicide rate has been blamed on the increase of adolescent alcohol abuse. Availability of alcohol and guns at home may contribute to suicide risk in adolescents. Comorbid psychopathology, which is common among adolescent alcohol abusers, substantially increases risk for suicide completions and attempts. Depressed adolescents may use alcohol to self-medicate depressive symptoms. Alcohol abuse and suicidal behavior in adolescents and in adults has been found to have biochemical, genetic, and psychological correlates. Ideally, treatment of adolescents who receive a diagnosis of an alcohol use disorder and co-occurring suicidality should follow an integrated protocol that addresses both conditions. Future studies of psychological and neurobiological mechanisms of suicidality in adolescents with alcohol and/or substance abuse are merited.

Adolescent↗
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Family-based association study of 5-HT(2A) receptor T102C polymorphism and suicidal behavior in Ashkenazi inpatient adolescents.

UNLABELLED: Suicidal behavior runs in families and is partially genetically determined. Since greater serotonin 5-HT(2A) receptor binding has been reported in postmortem brain and platelets of suicide victims, the 5-HT(2A) receptor gene polymorphism T102C became one of the candidate sites in the study of suicide and impulsive-aggressive traits. However, studies that examined the association of this polymorphism with suicidality have contradictory results. This study used a family-based method and one homogenous ethnic group to overcome ethnic stratification in order to test this association. METHODS: Thirty families of inpatient adolescents from Jewish Ashkenazi origin, with a recent suicide attempt, were genotyped. All subjects were interviewed for clinical diagnosis, depressive and impulsive-aggressive traits and demographic data. Allele frequencies were assessed using the Haplotype Relative Risk method for trios. RESULTS: No difference was found in allelic distribution between transmitted and non-transmitted alleles. There was no significant association of genotype with any of the clinical traits CONCLUSIONS: These preliminary results suggest that the 5-HT(2A) T102C polymorphism is unlikely to be associated with suicidal behavior and related traits in adolescent suicide attempters.

Adolescent↗
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Children's Depression Inventory (CDI) and the Children's Depression Rating Scale-Revised (CDRS-R): reliability of the Hebrew version.

The Children's Depression Inventory (CDI) and Children's Depression Rating Scale-Revised (CDRS-R) are two widely used instruments, which measure depression in children and adolescents. This pilot study assessed the reliability of the Hebrew versions of these two instruments. Both CDRS-R and CDI were translated from English into Hebrew and then back translated. Seventeen healthy Israeli bilingual children volunteers were interviewed with both scales with a one day intermission between the interviews. Non-parametric correlations were used to compare scores in the two versions for each item. Results showed high agreement between the two versions for almost all items of the CDI and moderate to high for the CDRS-R. When CDRS-R summary scores for each item were compared, the agreement was high for this instrument as well. It is concluded that both CDI and CDRS-R Hebrew versions are reliable and can be used for studies of depression in the Israeli pediatric population.

Adolescent↗
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Relation between rates of suicide in 15-24-year-olds and per capita consumption of alcohol beverages in European countries.

Suicide in adolescents and young adults is a serious medical and social problem. One factor that has been consistently implicated in suicide is alcohol use. This study examined the relation between rates of suicide in 15-24-year-olds and per capita consumption of alcohol beverages in European countries. Data on suicide rates in 15-24-year-olds and per capita consumption of alcohol beverages were obtained from the World Health Organization databases. Correlations were computed to examine relationships between suicide rates in 15-24-year-old males and females and per capita consumption of beer, wine, and spirits in the general population in 34 European countries. Suicide rates in males and females were compared using t-test. There was a negative correlation between suicide rates in 15-24-year-old males and per capita consumption of wine. There was also a trend towards a negative correlation between suicide rates in 15-24-year-old females and per capita consumption of wine. No correlations between suicide rates in 15-24-year-olds and per capita consumption of beer or spirits were found. As expected, suicide rates in males were significantly higher than in females. Lower suicide rates in 15-24-year-olds are associated with higher per capita consumption of wine in the general population. It is possible that the observed relationship is a result of a third factor affecting both suicide rates in 15-24-year-olds and consumption of wine. Further studies are necessary to clarify the relation between suicide rates in different age groups and consumption of alcohol beverages.

Adolescent↗
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Supportive short-term family therapy by nursing staff in the inpatient unit: preventing dependence and rehospitalization in the acutely ill and suicidal adolescent.

Adolescents with acute mental illness or suicidal behavior are almost always hospitalized for safety and evaluation purposes. The tendency towards long-term or repeated hospitalizations has many adverse effects such as dependency on the mental health care system and increased chronicity of illness. The causes for these phenomena may be prevented in the early stages of hospitalization. We suggest a therapeutic model of supportive short-term family therapy. The family therapy component aims to enhance the quality of interaction and the level of support among family members. The therapy component dealing with the individual targets the patient's anxiety symptoms and coping strategies, and focuses on return to a healthy state. The child is encouraged to return home to a supportive family as soon as the treatment team feels this to be advisable. This paper discusses a case which highlights how a patient reacts in crisis, and ways in which a supportive environment can help bring about therapeutic success with reduced hospitalization.

Acute Disease↗
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Modified dexamethasone suppression-corticotropin-releasing hormone stimulation test: A pilot study of young healthy volunteers and implications for alcoholism research in adolescents and young adults.

The key neuroendocrine component of a response to stress is the hypothalamic-pituitary-adrenocortical (HPA) system. Abnormalities in the HPA system have been implicated in the pathophysiology of psychiatric disorders such as depression, post-traumatic stress disorder, alcoholism and suicide. The dexamethasone suppression test (DST) is the most frequently used test to assess HPA-system function in psychiatric disorders. This neuroendocrine test consists of the administration of a low dose of dexamethasone at 11 pm and the measurement of cortisol levels at one or more time points on the following day. After corticotropin-releasing hormone (CRH) became available for clinical studies, the DST was combined with CRH administration. In this test, patients are pretreated with a single dose of dexamethasone at 11 pm and receive human CRH intravenously at 3 pm the following day. The resulting DST-CRH test proved to be much more sensitive in detecting HPA system alterations than the DST. We have modified the DST-CRH test and used ovine CRH instead of human CRH in a pilot study of a group of young healthy volunteers. Results indicated that it produces results similar to the results obtained with human CRH. This suggests that ovine CRH can be used in psychiatric research. Alcoholism is associated with abnormalities in HPA function. Nonalcoholic subjects with a family history of alcoholism exhibit lower plasma ACTH and beta-endorphin as well as lower ACTH, cortisol, and beta-endorphin responses to psychological stress and CRH stimulation. This suggests that in children of alcoholics, alterations in the mechanisms that regulate HPA axis activity predate the development of alcohol dependence and may be considered inherited traits. Therefore, studies of the HPA system in persons at risk for alcoholism may help understand the neurobiological mechanisms of predisposition to alcoholism.

Adolescent↗
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Impulsive-aggressive traits and suicidal adolescents and young adults with alcoholism.

Suicidal behavior and alcohol use disorders among adolescents and young adults are serious public health problems. In the study of suicidal behavior among young people with alcoholism, it has been shown that aggression and impulsivity are higher among those who attempted suicide. Impulsivity has been related to suicidal and self-destructive behaviors within different psychiatric conditions, i.e. alcohol and substance use disorders, mood disorders, conduct disorder, impulse control disorders, antisocial personality disorder, and borderline personality disorder. The term impulsivity has been used to define different constructs such as (1) personality trait or cognitive style in which disinhibition is the core characteristic, (2) a tendency to act immediately in response to external or internal stimuli, and (3) a group of psychiatric disorders with behavioral dyscontrol. Among adolescents suicidal behavior is transmitted in families independently of psychiatric conditions, but not independently of impulsivity/aggression. Two causal links between impulsiveness and alcoholism have been proposed: (1) adolescents who develop alcoholism possess higher premorbid levels of impulsiveness than those who do not develop alcoholism, and (2) levels of impulsiveness differentiate both populations only after the development of alcoholism, with higher levels of impulsiveness among those adolescents who developed alcoholism. Cognitive behavioral techniques have shown promising results in the treatment of adolescents with alcohol and substance use disorder and suicidality. The relative frequency of suicidal behavior among adolescents and young adults suffering from alcoholism and its subsequent devastating effects on individuals, families and society merits further research and development of prevention strategies.

Adolescent↗
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Prevalence of alcohol misuse among adolescents and young adults evaluated in a primary care setting.

OBJECTIVE: To determine the prevalence of alcohol misuse among older adolescents and young adults evaluated in a primary care setting using the CAGE questionnaire. METHODS: In this crossover descriptive study, a general practitioner, using the CAGE questionnaire, interviewed consecutive primary care patients aged 18-30 years. RESULTS: 29.5% of adolescents and young adults answered "yes" to at least one question of the CAGE questionnaire. However, only 7.4% of study participants gave an affirmative answer to at least two CAGE questions. There were more males than females among subjects who answered "yes" to at least one question. Furthermore, males more commonly gave an affirmative answer to at least two CAGE questions. CONCLUSIONS: A substantial number of older adolescents and young adults evaluated at a primary care center may have alcohol misuse. Instruments with higher sensitivity may be preferable in screening procedures for alcohol misuse. Responses suggestive of problematic drinking should be confirmed during the second post-screening stage with a more detailed discussion about patterns of use, problems related to drinking, and symptoms of alcohol use disorder. Further studies of prevention interventions in adolescents and young adults are needed.

Adolescent↗
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The constitutionality of random drug and alcohol testing of students in secondary schools.

Adolescent drug and alcohol use is a major public health problem. Multiple studies indicate that substance use is a risk factor for physical and mental disorders in adolescents. Secondary schools and the communities they serve have been facing a long-standing problem of substance abuse. American adolescents have become quite accustomed to drug prevention being a part of their curriculum. However, some policy decisions made by school administrators have been legally challenged. In 1989, Vernonia School District serving a small community in Oregon, instituted a random drug testing policy of its athletes. In 1991, the parents of a seventh grader refused to give their consent for random drug testing. The seventh grader was denied participation in the sport and sued the School District arguing that the school policy violated the Fourth and Fourteenth Amendments to the United States Constitution, and Article I, Section 9 of the Oregon Constitution. In 1995, on appeal to the Supreme Court of the United States, the School District won the case. The Vernonia School District versus Acton case became a landmark case, but random drug and alcohol testing in secondary schools has been a subject of multiple court cases. The authors discuss three of them. Both Federal and State Courts have recognized that a secondary school environment in itself represents "a special need," for which suspicionless searches are sometimes necessary to maintain order, safety, and discipline. Drug and alcohol testing programs in secondary schools may still be challenged on its legality. Therefore, examining court sanctioned programs and their long-term efficacy statistics is recommended.

Adolescent↗
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Functional magnetic resonance imaging in studies of neurocognitive effects of alcohol use on adolescents and young adults.

Alcohol use disorders (defined as alcohol abuse or dependence) are prevalent and serious problems among adolescents and young adults. Adolescence is a time of trying new experiences and activities that emphasize socializing with peers, and conforming to peer-group standards. These new activities may place young people at particular risk for initiating and continuing alcohol consumption. Exposing the brain to alcohol during adolescence may interrupt key processes of brain development, leading to cognitive impairment as well as to further escalation of alcohol use. Alcohol-induced adolescent learning impairments could affect academic and occupational achievements. Functional magnetic resonance imaging (fMRI) is a relatively new imaging technique that allows studying neurocognitive function. fMRI aims to determine the neurobiological correlate of behavior by identifying the brain regions that become active during the performance of specific tasks in vivo. The technique is non-invasive and relatively safe. This allows repeated studies to be carried out within a given subject. Several fMRI studies have been performed to evaluate neurocognitive function in adolescents and young adults with alcohol use disorders. Adolescents and young adults with alcohol use disorders had abnormalities in brain response to a working memory task. The results of the studies of cue reactivity and craving responses in young people suggest that the elevated physiological response and altered cognitive reactions to alcohol are involved in the pathogenesis of alcohol dependence in adolescents and young adults. Future fMRI studies may help ascertain the adverse affects of alcohol on brain function during early neurodevelopmental stages. fMRI may be uniquely powerful in the delineation of the underlying pathophysiology of alcohol use disorders in adolescents and young adults.

Adolescent↗
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Alcohol use in adolescents with eating disorders.

Eating disorders, in particular bulimia nervosa and binge eating disorder are associated with co-morbid alcohol and drug abuse. School-based studies have shown significant associations between bulimic behaviors and various measures of alcohol, cigarette and other drug use and abuse. Amongst bulimic adolescents, substance use is related to an increased likeliness of high risk behaviors such as attempted suicide, stealing and sexual intercourse. In contrast with bulimics and binge eaters, restricting anorexics have low rates of co-morbid substance abuse. It appears that restricting anorexics, binge eaters and bulimics represent distinct subgroups within the eating disordered population and binge eaters and bulimics are more prone to alcohol use. It is possible that individuals with eating disorders turn to alcohol use/abuse as a way of coping with the problems caused by their eating disorder. Researchers have proposed that an addictive personality is an underlying trait, which predisposes individuals to both eating disorders and alcohol abuse. Eating disorders are often conceptualized as an addictive disorder. Opioid antagonists, such as naltrexone, may be useful in treating both eating and alcohol use disorders. There is also evidence that serotonin reuptake inhibitors, which are traditionally used to treat major depression, may be an effective treatment. Cognitive-behavioral therapy has been effective in treating alcohol use and eating disorders individually and may be an effective combined treatment for co-morbid eating disorders and alcohol use. Teaching healthy ways to cope with the stressful situations may also help decrease alcohol use and disordered eating behaviors.

Adolescent↗
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The relationship between the frequency of alcohol use and suicide rates in young people.

BACKGROUND: Suicide is an important public health problem and one of the leading causes of death among adolescents. In the United States, the death rate from suicide amongst 15-19 year olds doubled between 1960 and 2001. It has been suggested that alcohol misuse contributed to this increase in suicide rates among young people. We examined the relationship between the percentage of frequently drinking high school students and suicide rates among 15-24 year olds in 17 countries. METHODS: Correlations were computed to examine the relationship between suicide rates in 15-24 year old males and females and the percentage of frequently drinking students in 17 countries. Using median split, countries were divided into two groups according to the percentage of frequently drinking students. Suicide rates in countries with the lower percentage of frequently drinking students were compared to suicide rates in countries with the higher percentage of frequently drinking students using t-test. RESULTS: There was a negative correlation between the percentage of frequently drinking students and suicide rates in both males (n=17, r = -0.51, p = 0.037) and females (n=17, r = -0.55, p = 0.023). The countries with the lower percentage of frequently drinking students had higher suicide rates in both 15-24 year old males (t = 2.25, df=15, p = 0.005) and females (t = 4.03, n=15, p = 0.001). CONCLUSION: Suicide rates among 15-24 year old males and females were lower in the countries with the higher percentage of frequently drinking high school students. Our finding is consistent with the suggestion that "alcoholism tends to protect one against suicide early on, but after 20-25 years (if not earlier) it exacerbates suicide potential" (Maris, 1992). The results of this study should be treated with caution until replicated.

Adolescent↗