S-41-01

Videotapes exposure of delirium tremens reduce the relapse rate in alcohol dependence

A. Mihai. University Hospital Dept. of Psychiatry, Tg. Mures, Romania

Objective: Patients with Delirium Tremens (DT) present high relapse rate (more than 80%) in spite of detoxification (Project Match, 1999) Objective of this prospective randomized controlled trials study was to find if individually exposure to videotapes of acute phase of DT could reduce the relapse rate and the amount of alcohol intake comparing with the control group.

Methods: 60 patients with DT were videotaped in acute phase of DT, than randomized in two groups: A - with individually exposure at the videotape after recovery before discharge with explanation of symptoms by the clinician underlying the correlation with alcohol dependence - and B control group. Both groups received the same treatment of acute phase and maintenance phase, not received aversive therapy and psychotherapy. All patients were observed 6 months with monthly - manualized visits. (Project Combine) Informed consent was obtained from all patients.

Results: The results show significant differences in percent of relapse rate after after first month 0% vs 20% p<0.001 and also at 6 months 46,66% vs 73,33% p=0.04. The patients of group A experienced less severe relapses, consumed fewer units of alcohol than controls and asked for medical help.

Conclusion: Videotapes exposure of Delirium Tremens reduce the relapse rate and proved to be effective in maintaining the abstinence during 24 weeks. The results are comparable with the results of randomized control trials with aeamprosate, disulfiram or psychotherapy (Tempesta, 2000; Hammarberg, 2004; Mann, 2004)

S-41-02

Cue-exposure treatment for alcohol dependent patients: Analysis of patients' characteristics associated with beneficial treatment effects

S. Löber, B. Croissant, A. Heinz, H. Flor, K. Mann. Dept. of Addictive Behaviour, Mannheim, Germany

Objective: Based on the concept of cue-reactivity, cue exposure treatment techniques have been advocated as potentially effective treatments of addiction and some studies have proved its Objective: Based on the concept of cue-reactivity, cue exposure treatment techniques have been advocated as potentially effective treatments of addiction and some studies have proved its efficacy compared to standard treatment or relaxation training. In contrast, our results of a controlled treatment trial comparing cueexposure therapy (CET) to an established cognitive-behavioral treatment approach (CBT), did not support previous findings since we found no beneficial effects of CET on drinking behavior. As cue-reactivity may be necessary for extinction trials to be effective, we addressed in a post-hoc analysis the question whether there are subgroups of patients with special characteristics who show greater effects of CET than the comparison treatment.

Methods: All patients (N = 57) fulfilled the criteria of alcohol dependence (DSM-IV) and had taken part in a 3-week qualified alcohol detoxification program. Patients had been randomly assigned to CET or CBT. Based on theoretical considerations, we classified patients post-hoe according to “urge-reactivity”, “psychophysiological responding” and degree of dependence. We compared relapse rates and drinking outcome in the six month following discharge.

Results: We found no beneficial effects of CET for patients who show a higher urge-reactivity or psychopyhsiological responding to alcohol cues. However, our results suggest that patients with severe alcohol dependence show better treatment outcome after CET than CBT.

Conclusion: Due to the small sample size of this subgroup of patients, these results need to be viewed with caution, but they are in line with the results of some other studies, which found beneficial effects of CET for patients with severe dependence.

S-41-03

G. Breen. Institue of Psychiatry, Kings, London, United Kingdom

S-41-04

What can imaging studies contribute to illuminate alcohol relapse?

J. Wrase, T. Kienast, T. Siessmeier, P. Bartenstein, D. F. Baus, N. Makris, K. Mann, H. C. Breiter, A. Heinz. Dept. of Psychiatry, Univ. Hos, Berlin, Germany

Objective: Animal experiments have provided evidence that the striatum, the amygdalae and medial prefrontal cortex play a predominant role in the acquisition and maintenance of drag seeking behavior. A reduced amygdala volume was found in cocaine dependent subjects. Alcohol stimulates dopamine release in the nucleus aecumbens and thus reinforces substance intake. This study sought an association of dopaminergic dysfunction, cue-induced BOLD response, volumetric data, alcohol craving and relapse.

Methods: Functional magnetic resonance imaging (fMRI) and visual alcohol-associated and control cues were used to assess brain activation in abstinent alcoholics and control subjects. The radioligand [18F]DOPA and positron emission tomography (PET) was used to measure presynaptic dopamine production in the striatum and the radioligand 18F]desmethoxyfallypride [18F]DMFP for D2 receptor availability. Amygdalae volumes were assessed via segmentation-based morphometry. Alcohol craving was measured with the Alcohol Craving Questionnaire (ACQ). Patients were followed for six months and alcohol intake was recorded.

Results: We observed a close association of a low availability of D2-dopamine receptors and striatal dopamine production in the nc.accumbens, craving and increased functional activation of fronto-cortical and limbic neurocircuits during the presentation of alcohol-associated cues among abstinent alcoholics. Visual alcohol cues activated the putamen, anterior cingulate and adjacent medial prefrontal cortex in alcoholics compared with healthy controls. Cue-induced activation of these brain areas was pronounced in alcoholics who subsequently relapsed during the observation period. The basolateral arnygdala was found to have a significantly diminished volume in relapsed subjects relative to controls and abstinent patients. Baseline craving at the time of study was stronger for relapsed than abstinent patients and correlated inversely with amygdala volume, low presynaptic dopamine production and availability of D2 dopamine receptors. No such relationships were observed in healthy control subjects.

Conclusion: Together, these observations point to a relationship between dopaminergic dysfunction, cue-induced BOLD-response, amygdala volume reduction, alcohol craving and eventual relapse into alcohol consumption. A multimodal approach to illuminate alcohol relapse seems to be promising.

S-41-05

A comparative study of young, and elderly patients suffering from “alcoholism”

H. Shahpesandy. Dept. of Psychiatry, Palucanska, Slovakia

Objective: The aim was to compare manifestation, and complications of alcoholism in the elderly, and young adults.

Methods: 56 elderly (E) (mean age 70.2), and 59 young (Y) patients (mean age 43), diagnosed by ICD-10, and MALT. We focused on biological markers of alcoholism, (AST, GGT, MCV), and complications of alcoholism. Statistical analysis T-test was used.

Results: The family history (FH) is positive in 17.8 % of E and 47 % of Y. AST was elevated in 53.6 % of E, and 84.7 % (p<0.05) of Y, GGT 60.7 % of E, and 91.5 % ofY (p<0.05). MCV in 60.7 % of E, and 74.5 % Y. Somatic disease were found in 60.3 % of E, and 25.7% of Y, psychiatric disorders in 34.6% of E, and 18.26% of Y. By MALT, disease of liver was found in 66% of E, and 93.2% of Y (p<0.05), polyneuropathy in 48.2% of E, and 5% Y (p<0.001), consumption of 300 ml (240 ml for women) once or more a month in 49% of E, and 76.3% of Y (p<0.01). MALT supports the diagnosis of Alcohol Dependence in 98.2% of E, and 100% of Y, but ICD-10, in 92.8% of E, and in 79.7% of Y.

Conclusion: Young alcoholics compared to elderly have more often positive FH, drink significantly bigger amounts of alcohol which reflects in elevation of GGT. On the other hand, elderly subjects have more somatic, and psychiatric complications.