Faculty Bibliography

Basal plasma levels of cortisol and its suppression by dexamethasone were measured in 60 inpatient alcoholics 12-13 days after detoxification. Both hypothalamic-pituitary adrenal system parameters were essentially within normal limits in most patients--those who did not meet criteria for major depressive disorder (n = 43) as well as those who met criteria for MDD per their episode (n-17). Basal levels of cortisol below 7 micrograms/dl distinguished alcoholics without MDD from those who met criteria for MDD per current episodes

Alcohol abuse, alcohol withdrawal, and deterioration of hepatic function have been associated with abnormal dexamethasone suppression test (DST) results. Chronic alcohol abuse may also directly alter the pharmacokinetic disposition of dexamethasone. Plasma dexamethasone concentrations following a DST were determined in 53 detoxified alcoholics. Those with abnormal liver function had higher 4 p.m. plasma dexamethasone concentrations and lower DST cortisol concentrations. Those with normal liver function had lower plasma dexamethasone and higher DST cortisol concentrations consistent with induction of hepatic metabolic enzymes from chronic use of alcohol. The data indicate that liver function is one of the variables influencing dexamethasone disposition and DST cortisol suppression

In a controlled study of Recovery, Inc., a self-help program for people with psychiatric problems, the author found a decline in both symptoms and concomitant psychiatric treatment after subjects had joined the group. Scores for neurotic distress reported after joining were considerably lower than those reported for the period before joining. Scores for psychological well-being of longstanding Recovery members were no different from those of community control subjects, and fewer long-term members than recent members were being treated with psychotropic medication and psychotherapy. The author concludes that peer-led self-help groups have value as an adjunct to psychiatric treatment

The purpose of the present study was to determine whether ethnic differences existed among detoxifying alcoholic inpatients regarding drinking practices, psychosocial variables and cognitive impairment. Patients of Puerto Rican extraction (Hispanics) were found to be more often afflicted than Whites and Blacks by cognitive impairment, daily drinking, heaviest average amount drunk, unemployment and lack of residence. Whites were less affected by these variables than the other two ethnic groups. Amount and frequency of drinking predicted the occurrence of cognitive impairment to a degree that approached significance. Cognitive impairment was defined as inability to score less than 5 points in the Blessed Orientation-Memory-Concentration test. In a follow-up study, nearly all CT scans obtained on a similar group of 20 detoxifying alcoholics (mean age 40), who had cognitive impairment as defined in the first study, were found to demonstrate brain atrophy. Contrasting drinking practices rather than ethnicity may have accounted for the different rates of cognitive impairment observed among the three ethnic groups

This paper reviews the literature on patients presenting for general psychiatric treatment who are also substance abusers. Place of presentation, diagnosis, and treatment are considered. A considerable portion of patients seen in emergency rooms, as much as half in some settings, are substance abusers, and over a third of general psychiatry admissions have been found to have their presenting problems materially influenced or precipitated by substance abuse. Substance abuse is also frequently found among psychiatric inpatients. Diagnostically, the differentiation of general psychiatric and addictive syndromes can be difficult: primary and secondary affective disorder from consequences of long-term substance abuse; and self-medication patterns from primary general psychiatric syndromes. Treatment studies are often focused on concomitant psychotherapeutic management for patient being treated for addiction. Often, emphasis is placed on pharmacotherapy for enhancing outcome in the dually diagnosed. Qualitatively, new options tailored to this population still remain to be studied, however, as do the changes necessary in the treatment system to assure proper long-term management