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Biomedical subjects

M Soyka

Publications and source records attributed to M Soyka.

At least 55 records · Page 3Linked to original sources
PubMed2002

Impulsivity and aggression as predictors of suicide attempts in alcoholics.

INTRODUCTION: The aim of this study was to assess the potential role of impulsive and aggressive behavior in the pathogenesis of suicide attempts in alcoholics. Impulsive and aggressive behavior as well as a psychiatric comorbidity with depressive conditions and personality disorders have been reported to be significant risk factors for suicide attempts in alcoholics. We hypothesized that alcoholics with a history of violent suicide attempts show an increased level of impulsive and aggressive behavior. Furthermore, the potential influence of concurrent personality disorders and depressive conditions were assessed. MATERIAL AND METHODS: 182 detoxified alcohol-dependent subjects were enrolled into the study. Impulsive and aggressive traits were assessed using the Buss-Durkee Hostility Inventory and the Brown-Goodwin Assessment for Lifetime History of Aggression, personality disorders using the SCID II. Characteristics of alcohol dependence and suicide attempts were evaluated using the Semi-Structured Assessment on Genetics in Alcoholism (SSAGA). RESULTS: Alcohol-dependent subjects with a history of suicidal behavior show a profile with higher impulsive and aggressive behavior. No significant association between these traits and concurrent borderline and antisocial personality disorder was found. Subjects with suicide attempts tended to have a significantly higher rate of depressive disorders. DISCUSSION: These results suggest that impulsive and aggressive traits might contribute significantly to the risk of suicide attempts in alcoholics.

Adult↗
PubMed2002

Psychopathology in dual-diagnosis and nonaddicted schizophrenics: are there differences?

Analysis of 447 schizophrenic inpatients found a lifetime prevalence for substance use of 42.9% (3-month prevalence 29%). While the overall differences were small between schizophrenics using (dual diagnosis) and those not using substances, dual-diagnosis patients in general reported more positive symptoms, especially more intense hallucinations. These differences were observed in patients with current (3-month) substance use on admission but not on discharge, possibly as a result of substance use. The most marked differences were in previous suicide attempts and delinquency, which were more prevalent in dual-diagnosis schizophrenics. These findings indicate that patients with dual diagnosis are more disturbed than other schizophrenics. We discuss the implications for the self-medication hypothesis for substance use in schizophrenia and future research in this area are discussed.

Journal Article↗
PubMed2002

[Psychiatric examination of accused for the "United Nations International Tribunal for the prosecution of persons responsible for serious violations of International Humanitarian Law committed in the territory of the former Yugoslavia" (ICTY)].

Psychiatric examination of accused for the International Tribunal is a new and challenging task for expert medical witness and forensic psychiatry. After a brief description of a case report relevant aspects of psychiatric evaluation of persons responsible for war crimes are outlined and possible implications for forensic research are discussed.

Adult↗
PubMed2002

[Aggressiveness in schizophrenia: prevalence, psychopathological and sociodemographic correlates].

In a retrospective study we evaluated the patient files of all schizophrenic patients (ICD-criteria) admitted to the psychiatric hospital of the university of Munich between 1990 - 1995 (N = 2093). Relevant sociodemographic, clinical and psychopathological data as assessed by means of the AMDP protocol were studied. 292 (14 %) of patients fullfilled the criterion aggression on admission. While there were few differences concerning many sociodemographic variables including, male schizophrenics were rated significantly more often to be aggressive than female schizophrenics. With respect to schizophrenic subtype disorganized patients were most likely to be aggressive. Psychopathological symptoms significantly associated with aggression were e.p. delusional ideas and disorganized thinking. Possible risk factors for aggression in schizophrenia and clinical implications are discussed.

Adult↗
PubMed2002

[Combined outpatient alcoholism therapy and occupational rehabilitation on welfare recipients--results of a pilot study].

This study tested the feasibility of outpatient abstinence treatment among alcohol dependent subjects on welfare. Patients had a long history of alcohol dependence and prolonged unemployment. Over a period of six months a total of 250 patients were approached by the social welfare office and asked to participate in the program. The program involved detoxification and a three month combined alcohol treatment and personal job training. Of the 250 persons approached 96 patients (about 40 %) appeared for the initial examination, 19 patients (13 %) finished detoxification and a total of 5 patients completed the program. The majority of a group of patients considered to be highly therapy resistant did not complete the program. Still it was important to demonstrate that a subgroup of patients did successfully complete this program. We consider this pilot project a successful starting point for further development of treatment approaches targeted more specifically at this group of patients.

Adult↗
PubMed2002

Chronological relationship between antisocial personality disorder and alcohol dependence.

Personality disorders, and particularly antisocial personality disorder (ASPD), frequently co-occur with alcohol dependence. ASPD is considered to be an important cofactor in the pathogenesis and clinical course of alcohol dependence. The chronological relationship between the onset of symptoms of ASPD and alcohol-dependence characteristics has not yet been studied in great detail and the role of ASPD in classification schemes of alcohol dependence as suggested by Cloninger and Schuckit has yet to be determined. We studied 55 alcohol-dependent patients to assess the prevalence and age at manifestation of ASPD, conduct disorder characteristics as well as alcohol dependence by employing the Semi-Structured Assessment for the Genetics of Alcoholism and the Structured Clinical Interview for DSM-III-R. Results indicate that the onset of ASPD characteristics precede that of alcohol dependence by some 4 years. This finding suggests that in patients with ASPD, alcohol dependence might be a secondary syndrome as suggested by previous research.

Adult↗
PubMed2001

Association between suicide attempts and 5-HTTLPR-S-allele in alcohol-dependent and control subjects: further evidence from a German alcohol-dependent inpatient sample.

BACKGROUND: Genetically-mediated alterations in serotonergic transmission have been implicated in both the pathogenesis of alcoholism and suicidal behavior. Thus, the identification of vulnerability genes could uncover pathophysiological links for both syndromes. A significant association between suicide attempts and the 5-HTT promoter polymorphisms (5-HTTLPR) S-allele has been reported in a sample of French alcohol-dependent subjects, and this paper evaluates this phenomenon in a German sample. METHODS: One hundred and sixty-three patients meeting DSM-IV criteria for alcohol dependence and 117 healthy controls were investigated. Blood samples were taken to genotype the 5-HTTLPR by using polymerase chain reaction (PCR) of lymphocyte DNA. RESULTS: 5-HTTLPR-S alleles were seen more frequently in suicidal compared to nonsuicidal alcohol-dependent subjects. Furthermore, significant effects from suicide attempts on the number of S-alleles were found. CONCLUSIONS: The results are consistent with an association between the 5-HTTLPR-S-allele and suicide attempts in alcohol-dependent subjects.

Adult↗
PubMed2001

[The "qualified outpatient detoxification" model project].

In 1998, a model project of outpatient detoxification in alcoholics was initiated in a German outpatient clinic. Inclusion and exclusion criteria of this project, which is supported by local health care providers, are presented. Between August 1998 and June 2000, 205 patients were screened. Psychotherapeutically motivating elements are integrated, so that this may be termed a "qualified" detoxification program. One hundred forty-one patients entered the program, of whom 127 (90%) successfully finished treatment. No serious medical complications were observed. Of those who completed treatment, 121 entered further alcoholic rehabilitation programs. Some preliminary data of an ongoing catamnestic study suggest that, after a mean of 10 months post-detoxification, 61 (50%) of these patients are still abstinent and in rehabilitation programs. The findings suggest that outpatient alcohol detoxification is safe and efficient, at least for a subgroup of patients, and also indicate the possible efficacy of concomitant psychotherapeutic interventions during this mode of treatment.

Adult↗
PubMed2001

Psychopathology in dual diagnosis and non-addicted schizophrenics--are there differences?

In a previous publication we reported lifetime and 3-month prevalence estimates for substance use in two large samples of schizophrenic inpatients (Soyka et al. 1993). A subsequent analysis of psychopathological findings assessed by means of the AMDP Manual (Guy and Ban 1982) in schizophrenic in-patients of the Haar Mental State Hospital (N=447), in whom a lifetime prevalence for substance use of 42.9% (3-month prevalence 29%) had been reported, was performed. While the overall differences between substance using (dual diagnosis) and nonusing schizophrenics were small, dual diagnosis patients in general reported more positive symptoms, especially more intense hallucinations. These differences could basically be demonstrated in patients with current (3-month) substance use on admission but not on discharge possibly as a result of substance use. Most marked and highly significant results were found with respect to previous suicide attempts and delinquency which were more prevalent in dual diagnosis schizophrenics. Results of this study indicate that dual diagnosis patients compared to other schizophrenics represent a more disturbed patient group. Implications for the self-medication hypothesis for substance use in schizophrenia and future research in this area are discussed.

Adult↗
PubMed2001

[Therapeutic strategies and help in chronic alcoholism].

Chronical alcoholics are a challenge in therapy, especially if they have an adverse course of illness and treatment as well as multiple resulting somatical and neurological diseases. In German treatment of alcoholics the term 'chronisch mehrfach geschädigte Alkoholkranke' (chronically multiple affected alcoholics) has been established, describing patients with severe somatical and psychological disorders as well as social, professional, financial or legal problems. Permanent or even temporary abstinence is hard to achieve for these patients. They are usually found in psychiatric hospitals rather than in addiction wards, but also in social services or even prisons. Rehabilitation is possible in mental state hospitals that accept patients with dual diagnosis, sometimes even in special wards. Psychiatric co-morbidity in alcoholics is often underestimated. This is most important for psychotic illness, as well as other psychic diseases. A special problem is posed by delinquent patients that often have to be treated while in a penal institution. Some of the follow-up studies done on that have shown relatively good results in patients in penal institutions, but further studies are needed. As of yet, recent treatment options in pharmacotherapy to prevent alcoholic relapse are not sufficiently used. Anti-dipsotropics or so-called anti-craving-agents like acamprosate and naltrexone are primarily given to increase the rate of abstinence but could successfully be used in a harm reduction strategy (less drinking, shorter relapses).

Alcoholism↗
PubMed2001

Elevated serum levels of S-100B reflect the extent of brain injury in alcohol intoxicated patients after mild head trauma.

Elevated systemic levels of S-100B are proposed as a potential indicator of brain damage in identifying high-risk patients after mild head trauma (MHT). Although incidence of alcohol intoxication is high in these patients, the influence of alcohol intoxication on S-100B levels is unclear. Therefore, the aim of our study was to investigate serum concentrations of S-100B in intoxicated (group 1) and sober (group 2) patients after MHT in comparison with those of mild (group 3) or severely intoxicated (group 4) individuals without trauma. S-100B was significantly increased in MHT patients exhibiting posttraumatic lesions in initial cranial computed tomography scan. Alcohol intoxication did not elevate S-100B levels in group 3 or 4 subjects. Our data indicate for the first time that alcohol intoxication does not influence the diagnostic value of S-100B measurements in patients after MHT.

Alcohol Drinking↗
PubMed2001

Role of aggressivity on reactivity and craving before and after cue exposure in recently detoxified alcoholics: results from an experimental study.

The role of aggressivity and cue exposure in induction of craving were investigated in a clinical setting. Thirty abstinent alcoholic patients were divided into a low and a high aggressive group based on scores on the physical aggression subscale of the Buss-Durkee Hostility Inventory and exposed to alcohol cues. Craving was measured by means of the Alcohol Craving Questionnaire (ACQ) and Visual Analogue Scales (VAS). Important findings are: (1) main effects of aggressivity on 'emotionality', 'purposefulness' and 'expectancy' of ACQ were very significant; (2) on 'drinking intention' and 'craving for alcohol' of VAS, aggressivity and cue exposure showed a significant interaction; (3) the main effect of cue exposure on heart rate also reached a significance level of 0.007. The results were discussed in the context of the Classical, Operant Conditioning Theory, the Cognitive Craving Theory of Tiffany, Gilbert's STAR Model, and the Self-Medication Hypothesis.

Adult↗
PubMed2001

Impulsive traits and 5-HT2A receptor promoter polymorphism in alcohol dependents: possible association but no influence of personality disorders.

OBJECTIVE: Impulsive behavior in alcoholics puts them at serious risk of severer course of disease and has been related to the serotonergic neurotransmission dysfunction. The aim of this study is to investigate the association between impulsive aggression in alcohol dependents with regard to the G-1438A polymorphism in the promoter region of the 5-HT2A receptor gene. Furthermore, we investigated the statistical interaction between 5-HT2A alleles, antisocial personality disorder (APD) and impulsive aggression in alcohol dependents. Alcohol dependents were investigated because these personality disorders and impulsive behavior are very frequent in alcohol dependence anf of clinical relevance. METHODS: One hundred and thirty-five patients of German descent meeting DSM-IV criteria of alcohol dependence were recruited. Blood samples were taken from alcohol dependents to determine 5-HT2A promoter polymorphisms using PCR (polymerase chain reaction) of lymphocyte DNA. Impulsive aggression was assessed using a German version of the Barratt Impulsiveness Scale which was translated and backtranslated. Alcohol dependents were subdivided into low- or high-impulsivity groups using a median split of the Barratt score. APD and borderline personality disorder (BPD) were assessed using the SCID-II interview. RESULTS: The low-impulsivity group was slightly older and showed a later age at alcoholism onset than the highly impulsive group. Alcohol dependents with high impulsive traits showed a significant association with 5-HT2A 1438 A alleles. After excluding alcohol dependents with APD or BPD from the analysis, this association remained significant. Furthermore, no association between APD, BPD and 5-HT2A alleles was noted. CONCLUSIONS: Inpatient alcohol dependents showed a significant association between 5-HT2A A alleles and impulsive traits, independent of the presence of APD or BPD. No association was noted between personality disorders and the polymorphism. This is the first report about an association of 5-HT2A promoter polymorphism and impulsive behavior in alcohol dependents. This finding may refer only to impulsive traits and may be independent of personality disorders in this sample. These results have to be confirmed in larger samples and in healthy control subjects to determine whether this association is of general validity.

Adult↗
PubMed2001

[Psychotherapy of alcohol addiction--principles and new findings of therapy research].

The psychotherapy of alcohol dependence has for long been neglected by psychiatric research. Meanwhile a number of clinical and experimental studies have been performed to examine the efficacy of different kinds of psychotherapeutic approaches in alcoholism. Most clinical settings follow an integrative concept based on behavioural and coping skills therapy, psychodynamic or psychoanalytic and family therapy. Further therapy elements are self-help groups or muscular relaxation, among others. Most therapies are conducted as group therapy but individual therapy is a well-examined alternative. Early intervention in alcohol dependence is of special relevance. Motivational enhancement is a key goal of alcohol therapy and can already be implemented in early interventions or in the detoxification phase. Results of clinical studies suggest that after inpatient treatment 30-40% of patients remain abstinent. Outpatient treatment of alcoholism has for long been neglected, with only few prospective studies conducted so far. The most ambitious study has been the US Project Match. A difficult question remains the allocation of patients to different treatments. Current concepts of treatment for alcoholics are described and results of different treatment studies are given.

Alcoholism↗