Search PubMed⌕ Search

Biomedical subjects

R E Tarter

Publications and source records attributed to R E Tarter.

At least 73 records · Page 4Linked to original sources
PubMed1991

The role of cirrhosis in memory functioning of alcoholics.

The effects of alcoholism and liver disease on memory functioning in alcoholics were studied by comparing four groups: normal healthy controls, alcoholics without liver disease, alcoholics with biopsy-confirmed cirrhosis, and nonalcoholics with postnecrotic cirrhosis. Memory capacity was evaluated employing the Benton Visual Retention Test (BVRT), the Rey-Osterreith Complex Figure Test, Digit Span, and the Brown Peterson four-word short-term memory test. A 2 x 2 ANOVA revealed significant main effects for both alcohol and cirrhosis on Digits Forward and the total score on the Brown Peterson test. Additionally, there were significant main effects for cirrhosis on the BVRT. The Brown Peterson test was analyzed using a repeated measures 2 x 2 ANOVA. Significant effects for cirrhosis were observed at all three interpolation periods. The effects for alcohol approached significance at the 30-sec (most difficult) interpolation period. Analysis of error patterns on the Brown Peterson test indicated that overall omission errors were most commonly made among all groups. Significant effects were found for alcohol on omissions and intrusion, while the cirrhosis factor yielded significant effects for phonemic, perseverative, and omission errors. This study demonstrates the importance of liver disease underlying the etiology of memory impairments in alcoholics. The results confirm our earlier findings that neuropsychologic deficits seen in alcoholics may be the result of the combination of alcohol abuse and liver disease.

Adult↗
PubMed1991

Improvement in cognitive functioning of alcoholics following orthotopic liver transplantation.

Cognitive functioning in alcoholic cirrhotics before and 1 year following orthotopic liver transplantation was compared with age- and sex-matched normal subjects. The alcoholic group improved significantly following transplantation on tests measuring psychomotor, visuopractic and abstracting abilities whereas the performance of normal controls remained virtually unchanged. In contrast, memory capacity in alcoholics with cirrhosis did not statistically improve following successful transplantation. Further investigation, using more sophisticated measures of memory function, are required to determine whether memory deficits are either associated with alcohol neurotoxicity or an irreversible component of hepatic encephalopathy. These findings suggest that a reversible hepatic encephalopathy underlies many of the neuropsychologic deficits observed in cirrhotic alcoholics and can be ameliorated following successful liver transplantation.

Adult↗
PubMed1991

The Teen-Addiction Severity Index: rationale and reliability.

There is an urgent need for a reliable method of evaluating the severity of adolescent chemical abuse and problems related to chemical abuse. The lack of an appropriate rating scale to fill this objective hampers the design and the assessment of objective treatment outcome and follow-up of adolescent chemical abusers. The Teen-Addiction Severity Index (T-ASI) is a structured interview which was developed to assess the seven following domains: chemical use, school status, employment-support status, family relationships, peer-social relationships, legal status, and psychiatric status. This paper discusses the rationale for the design of the T-ASI and presents a preliminary study indicating satisfactory interrater reliability of the rating scale.

Adolescent↗
PubMed1991

Vulnerability to alcoholic liver disease.

Epidemiological evidence suggests a direct relationship between alcohol consumption and the prevalence of cirrhosis. However, the observation that only 8-30% of alcoholics develop cirrhosis illustrates that individual susceptibility mediates the relationship between alcohol consumption and cirrhosis. This chapter examines the factors that may influence individual risk for alcoholic liver disease. These factors include individual differences in alcohol metabolism and consumption patterns, gender, HLA antigens, family alcoholism history, and immune responsiveness. Important methodological issues in each of these areas are addressed also. From the available evidence, the hypothesis is advanced that there is an underlying vulnerability to liver disease in some individuals, and that alcohol use, although a necessary condition, is not sufficient to trigger disease in all individuals.

Alcohol Drinking↗
PubMed1991

Hepatic encephalopathy coexistent with alcoholism.

Although it is well established that the majority of alcoholics are neurologically compromised, little is known about the etiological factors underlying the central nervous system (CNS) disturbances. Without doubt, ethanol is a neurotoxin; however, the complex array of factors presaging drinking onset and factors concomitant to a lifestyle of alcohol abuse probably also influence the risk for neurologic injury. This chapter reviews the emerging evidence linking liver disease to the neurologic pathology manifested by chronic alcoholics. The observation that the pattern and severity of cognitive deficits is similar between alcoholics and nonalcoholics with cirrhosis, combined with the demonstration that biochemical indices of liver injury correlate with cognitive test performance in alcoholics, illustrates the important role of liver disease as a codeterminant of the CNS disturbance. In addition, the findings from developing research indicating that liver transplantation can reverse the deficits on neuropsychological tests further underscore the importance of advanced liver disease as a determinant of the CNS pathology, and the results suggest the need for aggressive treatment of alcoholic liver disease for restoring the alcoholic's functional cognitive abilities, which, in turn, may improve the prognosis for psychosocial adjustment.

Alcoholism↗
PubMed1991

Developmental behavior-genetic perspective of alcoholism etiology.

Gene-environment interactions underlying the etiology of alcoholism are amenable to investigation from a behavior-genetic perspective. The organismic characteristics that most frequently and reliably have been found to predispose to alcoholism are behavioral traits. Certain behavioral traits, viz., temperaments, have a substantial heritable contribution and comprise the elements from which complex habit patterns and personality traits develop. The unique interaction between the individual possessing certain extreme deviations in temperament traits with environmental contingencies occurring during the course of psychosocial development and throughout adulthood is hypothesized to determine the risk during any period of the lifespan for an alcoholism outcome.

Adolescent↗
PubMed1991

Quality of life before and after orthotopic hepatic transplantation.

Fifty-three nonalcoholic patients were evaluated prior to liver transplantation and again approximately 3 years after surgery using the Sickness Impact Profile and Social Behavior Adjustment Schedule. Test-retest scores reflected significant improvement across all health and psychosocial scales of the Sickness Impact Profile. On the Social Behavior Adjustment Schedule, significant improvement was observed on scales measuring disturbed behavior, social role performance, and burden. Comparisons between groups indicated that the liver transplant patients were still impaired on eight of the Sickness Impact Profile scales after transplant; however, the severity of disturbance was not considered to be clinically significant. No between-group differences were noted on the Social Behavior Adjustment Schedule. These results indicate that liver transplantation is associated with substantial improvement in life quality, although as a group, the patients undergoing this surgery do not recover to the level of functioning demonstrated by normal individuals.

Adult↗
PubMed1990

Plasma GABA-like activity in response to ethanol challenge in men at high risk for alcoholism.

Sons of alcoholic fathers (high risk, HR) and matched control men from families without alcoholism (low risk, LR) were administered, in a randomized double-blind fashion, either a placebo beverage or an isovolemic beverage containing ethanol (0.8 g/kg). Serial blood sampling for determination of plasma gamma-aminobutyric acid (GABA)-like activity, mood, and intoxication ratings were performed. The HR subjects were found to have significantly less plasma GABA-like activity than LR during the placebo condition. The alcoholic beverage condition washed out the differences in plasma GABA between groups. Significant interactions between risk group status and beverage conditions were found with respect to plasma GABA-like activity. Alcohol produced an increase in mean GABA-like activities among HR subjects, whereas a slight decline was noted among LR subjects. Plasma GABA-like activity also had a significant inverse correlation with self-reports of perceived tension in the placebo condition, and tension, confusion, and intoxication in response to the alcoholic drink. Since previous investigators have reported reduced plasma GABA levels in alcoholic individuals, reduced plasma GABA-like activity may be a biological marker for vulnerability to alcoholism or for heightened tension as a behavioral factor that predisposes to alcoholism.

Adult↗
PubMed1990

Orthotopic liver transplantation for alcoholic liver disease.

Alcohol abuse is the most common cause of end-stage liver disease in the United States, but many transplant centers are unwilling to accept alcoholic patients because of their supposed potential for recidivism, poor compliance with the required immunosuppression regimen and resulting failure of the allograft. There is also concern that alcohol-induced injury in other organs will preclude a good result. From July 1, 1982, to April 30, 1988, 73 patients received orthotopic liver transplants at the University of Pittsburgh for end-stage alcoholic liver disease. Fifty-two (71%) of these were alive at 25 +/- 9 mo (mean +/- S.D.) after transplantation, when a phone survey of these patients, their wives/husbands, and their physicians was performed to evaluate their subsequent use of alcohol, current medical condition and employment. Data obtained were compared with those for nonalcoholic patients selected as transplant controls. The recidivism rate has been 11.5%, with most patients drinking only socially. Fifty-four percent of the survivors are employed, 21% classify themselves as homemakers and only 11 (21%) are unable to work. Twenty-one patients died after transplantation; the most frequent cause of death was sepsis (43%), and intraoperative death was the next most common cause (28.6%). These data demonstrate that alcoholic patients can be transplanted successfully and achieve good health not significantly different from that of individuals transplanted for other causes. Thus orthotopic liver transplantation is a therapeutic option that should be considered for individuals with end-stage alcoholic liver disease who desire such therapy.

Alanine Transaminase↗
PubMed1990

Vitamin E deficiency and psychomotor dysfunction in adults with primary biliary cirrhosis.

The purpose of this study was to determine the prevalence of vitamin E deficiency in adults with chronic cholestatic liver disease and to quantify the association between their psychomotor performance and vitamin E status. In 42 female patients with primary biliary cirrhosis, 43.5% met two standard criteria for vitamin E deficiency. Vitamin E-deficient patients performed less well than did healthy control subjects on six of eight neuropsychologic tests of psychomotor capacity (p less than 0.01). Vitamin E-sufficient patients did not differ significantly from normal control subjects. Serum vitamin E concentrations were significantly lower in the group classified as significantly psychomotor-impaired by two independent neuropsychologists (blind to vitamin E status) whereas liver-injury measures failed to distinguish between these two groups. Patients with low serum vitamin E exhibited clinically evident neurologic abnormalities. These data suggest that vitamin E deficiency may, in part, underlie psychomotor and neurologic disturbance found in adult patients with chronic cholestatic liver disease.

Adult↗
PubMed1990

Drug abuse severity in adolescents is associated with magnitude of deviation in temperament traits.

Substance abusing adolescents were discriminated from normal controls on seven of the nine scales comprising the revised Dimensions of Temperament Scales. However, upon aggregating the scales into orthogonal dimensions using factor analysis, it was found that only activity level was associated with drug use severity. This behavioural trait was correlated with seven of 10 scales comprising the Drug Use Screening Inventory, including severity of substance use, behavior problems, psychiatric disorder, work, peer relationships and leisure activities.

Adolescent↗
PubMed1990

Early onset of nonalcoholic cirrhosis in patients with familial alcoholism.

The etiology of many forms of liver disease is largely unknown. Recent research has identified certain immunogenetic factors which may play a role in the progression of alcoholic cirrhosis as well as autoimmune forms of cirrhosis. In this study we examined the role of familial alcoholism and HLA status in determining age of liver disease onset. Patients with biopsy-proven nonalcoholic autoimmune cirrhosis and having a history of familial alcoholism experience an earlier age of onset of liver disease than patients without a family history of alcoholism. The same result was true for patients with alcoholic liver disease. This effect may be more prominent in females. Subjects with HLA B-8 also had a younger age of onset of nonalcoholic autoimmune liver disease. The presence of a family history of alcoholism in conjunction with the presence of HLA B-8 and DR-3 also was related to an earlier age of disease onset. These findings suggest that the susceptibility to develop alcoholism and nonalcoholic autoimmune liver disease may be transmitted conjointly and point to potential fruitful areas of research for identifying individuals at risk for developing cirrhosis as well as detecting genetic markers for alcoholism.

Adolescent↗
PubMed1990

Temperament deviation and risk for alcoholism.

Sons of alcoholics and nonalcoholics drawn from a community sample were compared across multiple dimensions of temperament. Sons of alcoholics scored higher on only behavioral activity level. This trait score was found to be unrelated to family environment. The implications of these findings for clarifying alcoholism vulnerability are discussed.

Adolescent↗
PubMed1990

Effect of liver transplantation on the hypothalamic-pituitary-gonadal axis of chronic alcoholic men with advanced liver disease.

The hormones testosterone, follicle stimulating hormone (FSH), and luteinizing hormone (LH) were assayed in blood obtained from men with alcoholic liver disease before and after successful liver transplantation. The frequency and severity of self reported impotence, intercourse, and paternity were assessed before and 18 +/- 3 months post-transplantation. The results obtained were compared with those of age-matched males transplanted within the same month by the same surgical teams for advanced hepatocellular disease other than alcoholism. Little change for any parameter assessed pre- and post-transplantation was noted for the nonalcoholics. In contrast, the FSH, LH, and testosterone levels of the alcoholic men all increased significantly following successful transplantation. These data suggest that the liver disease associated with alcoholism contributes to some of the endocrine effects of alcohol-associated cirrhosis but not all. Because the transplanted alcoholics remain less adequate than controls, it is further suggested that some residual alcohol-induced injury to the hypothalamic-pituitary-gonadal axis persists despite successful liver transplantation.

Follicle Stimulating Hormone↗
PubMed1990

Evaluation and treatment of adolescent substance abuse: a decision tree method.

A procedure for systematically evaluating and treating adolescents with known or suspected substance abuse is described. Integrating assessment with intervention affords the opportunity to comprehensively characterize the adolescent's problems and to quantitatively monitor treatment progress and outcome.

Adaptation, Psychological↗