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Alpha/theta neurofeedback training is supposed to enhance cognitive performance as well as alleviate psychiatric disorders. Sleep during this training is regarded a confounding factor, although it is usually not controlled. Here, the amount of sleep, the impact of sleep on frequency results and the validity of subjective judgments of having fallen asleep were investigated. 40 healthy young subjects participated in 31 training units of real or mock feedback. It turned out that stage 2 sleep occurred in 10-14 % of training time, in 95 % of the subjects and in 1/3 of all training units. Sleep significantly influenced the theta/alpha ratio and theta but not alpha amplitudes. Only about 2/3 of the subjective judgements were correct and no more than 13 % of the participants could reliably identify sleep. These data demonstrate that sleep can easily occur during alpha/theta neurofeedback training and should be controlled by objective means.

Objective This study was conducted to evaluate the effectiveness of a cognitive behavioral self-help program (SHP) in combination with pharmacotherapy in patients with primary insomnia in general practice. Participants Patients were recruited from 31 general practitioners (GPs) in the Hamburg area, who were randomly assigned to the two different study conditions. Eighty patients completed the study. They had suffered from insomnia for several years and showed a high impairment according to the Pittsburgh Sleep Quality Index. Intervention According to assignment of their GP the patients either received a progressively reduced 4-week pharmacotherapy or a combination of pharmacotherapy and a SHP consisting of six chapters on progressive muscle relaxation, cognitive relaxation, modified stimulus control, thought stopping, and cognitive restructuring. Measures and results After study enrollment patients had short weekly consultations with their GPs during treatment to receive sleep medication and questionnaires. They completed questionnaires measuring general sleep quality and sleep-disruptive beliefs and also sleep diaries before treatment, during treatment, immediately following treatment, and at a 6-week and 6-month follow-up time point. For collection of changes in mood the Beck Depression Inventory was used. The whole sample showed reductions of sleep onset latency and time awake after sleep onset. Total sleep time increased and mood improved. Patients additionally working with the SHP showed significantly more improvements in sleep quality and negative sleep-related cognitions like ruminating and focusing on sleep. Treatment effects were significant at the end of therapy and remained stable at the six-week and six-month follow-up. Conclusion This study supports the use of a cognitive-behavioral SHP on primary insomnia in the setting of a general practice and should be investigated in more detail. Also, regular appointments and the utilization of sleep logs seem to have a positive influence on sleep disorders.

Alcohol dependence (AD) is the most serious form of alcohol-use disorder. AD is associated with intense mental, physical, and functional impairment; high societal costs; and long-term suffering by both the dependent individual and the individual’s family members (e.g., Caetano, Nelson, & Cunradi, 2001). However, AD is also fairly widespread, with a 12-month prevalence rate of nearly 4% in the general population (Hasin, Stinson, Ogburn, & Grant, 2007). Despite the development and implementation of several empirically supported treatments, only about 25% of clients have been found to remain abstinent during the first year following treatment termination (Miller, Walters, & Bennett, 2001). Thus, there is a strong and pressing need to improve the efficacy of treatment for AD. According to the relapse prevention model proposed by Marlatt and colleagues (Marlatt & Witkiewitz, 2005), relapse is likely to occur when at-risk individuals are confronted with high-risk situations and lack the coping skills necessary to deal with such situations effectively. Consistent with this model, a number of studies have focused on identifying specific high-risk situations. Extensive evidence from these studies has shown that negative affect is one of the most prominent factors associated with relapse to maladaptive drinking. First, AD is highly associated with affect-related disorders, such as anxiety, depression, and borderline personality disorder (Gregory et al., 2008; Hasin et al., 2007), and individuals with co-occurring symptoms of these disorders display significantly higher rates of relapse after treatment (Bradizza, Stasiewicz, & Paas, 2006). Second, the majority of clients retrospectively attribute relapse to negative affective states (Lowman, Allen, & Stout, 1996; Zywiak, Connors, Maisto, & Westerberg, 1996). Third, negative affect -- such as stress/nervousness, anxiety, anger, dysphoric/depressed mood, feelings of loneliness/uselessness/boredom -- predicts subsequent desire to drink/drinking-level in epidemiological studies and relapse in treatment-outcome studies (Falk, Yi & Hilton, 2008; Gamble et al., 2010; Hodgins, el-Guebaly, & Armstrong, 1995; Swendsen et al., 2000; Willinger et al., 2002). Fourth, in laboratory paradigms, the induction of negative affect was shown to predict increased urges to drink and increased expectancies of relief after drinking (Cooney, Litt, Morse, Bauer & Gaupp, 1997; Birch et al., 2004; Sinha et al., 2009). Fifth, interventions focusing on the reduction of depressed mood or anxiety symptoms have been shown to decrease relapse and severity of alcohol use disorders (Brown, Evans, Miller, Burgess, & Mueller, 1997; Watt, Stewart, Birch, & Bernier, 2006), and interventions with a strong focus on emotion-regulation skills, such as dialectical behavioral therapy (Linehan, 1993a) have been shown to reduce substance use (including alcohol) in clients suffering from borderline personality disorder (Harned et al., 2008; Linehan et al., 2002). Finally, evidence suggests that although alcohol may initially reduce negative affect to some extent (Armeli et al., 2003; Kushner et al., 1996; Swendsen et al., 2000), maladaptive use eventually leads to the continuation and potential increase of such affect, thereby generating a vicious cycle contributing to the chronic and escalating nature of AD (Heinz et al., 1998; Koob & Le Moal, 2001; Witkiewitz & Villarroel, 2009). In line with these findings, a number of theories contend that affect regulation is a primary motive for alcohol use; such models include the affective processing model (Baker, Piper, McCarthy, Majeskie, & Fiore, 2004), the motivational model of alcohol use (Cox & Klinger, 1988; Cooper, Frone, Russel, & Mudar, 1995), the stress and negative affect model (Colder & Chassin, 1993), the self-medication model (Khantzian, 1997), the stress response dampening theory (Levenson, Sher, Grossman, Newman, & Newlin, 1980), and the tension reduction hypothesis (Conger, 1956). The implication of these models is that emotion-regulation skills (i.e., skills relevant for “monitoring, evaluating, and modifying emotional reactions, especially their intensive and temporal features, to accomplish one’s goals”; Thompson, 1994, pp. 27-28), should be important -- if not essential -- for preventing relapse in AD. This hypothesis received preliminary support from studies demonstrating that trait emotional intelligence (defined as the ability to be aware of emotions, identify emotions correctly and modify emotions effectively) was negatively associated with alcohol-related problems (Riley & Schutte, 2003) and that emotional intelligence moderated the association between negative emotions and craving for alcohol in AD patients (Cordovil de Sousa Uva et al., 2010). Additional research has shown that abstinent alcoholics report more difficulty effectively regulating their emotions than do social drinkers (Fox, Hong, & Sinha, 2008). However, research has yet to investigate the predictive effects of emotion-regulation skills on alcohol use during and after treatment. To facilitate the utilization of the emotion-regulation framework for clinical purposes, Berking (2010) has synthesized and expanded upon previous theories (e.g., Gross, 1998; Larsen, 2000; Saarni, 1999; Greenberg, 2002) and proposed a skill-based model of emotion regulation. According to the Adaptive Coping with Emotions (ACE) Model (Berking, 2010), effective emotion regulation can be conceptualized as the situation-adapted interplay of the abilities to (a) be aware of emotions, (b) identify and label emotions, (c) correctly interpret emotion-related body sensations, (d) understand the prompts of emotions, (e) actively modify negative emotions to feel better, (f) accept negative emotions when necessary, (g) tolerate negative emotions when they cannot be changed, (h) confront (vs. avoid) distressing situations in order to attain important goals, and (i) compassionately support (encourage, self-soothe) oneself in emotionally distressing situations (in order to counterbalance potential short-term negative effects that engagement in the other skills may have on one’s emotions). Empirical studies have shown that all skills included in the ACE model are significantly associated with various indicators of mental health in clinical and at-risk populations (Berking et al., 2010; Berking, Meier, & Wupperman, 2010; Berking, Orth, Wupperman, Meier, & Caspar, 2008; Berking, Wupperman, et al. 2008; Berking & Znoj, 2008). However, research has not yet investigated whether these skills are associated with AD and whether they facilitate abstinence during or after treatment for AD. In addition, as deficient emotion-regulation skills are likely to be associated with other potential predictors of relapse, such as symptom severity (Langenbucher, Sulesund, Chung, & Morgenstern, 1996), degree of comorbidity (Tate, Brown, Unrod, & Ramo, 2004), cognitive abilities (Blume, Schmaling, & Marlatt, 2005), and negative mood (Hodgins et al., 1995), it is important to investigate whether emotion-regulation skills predict alcohol use beyond these additional factors. Moreover, there is a lack of research comparing the emotion-regulation skills of populations with alcohol-use disorders with those of other clinical populations. Although some evidence exists for the transdiagnostic nature of emotion-regulation skills (Aldao, Nolen-Hoeksema, & Schweizer, 2010), deficits in these skills may be more integral to some disorders than to others. For example, in the emotional disorders (i.e. depression and anxiety) the inability to effectively regulate dysfunctional emotions can be conceptualized as the core of these disorders (Moses & Barlow, 2006); whereas in disorders such as AD, deficits in these skills might be seen as one relevant factor among many that contribute to the onset and maintenance of the disorder (Marlatt & Donovan, 2005). Finally, few studies have assessed a broad range of emotion-regulation skills in order to identify the skills most strongly associated with (changes in) psychopathological symptoms (e.g. Berking, Wupperman, et al., 2008) -- and thus the skills that should be considered important targets in treatment. At this point, no such study is available for AD. Therefore, the major aim of the present study was to test the primary hypotheses that (1) more effective pretreatment emotion-regulation skills would negatively predict alcohol use during treatment and (2) more effective posttreatment emotion-regulation skills would negatively predict alcohol use during the three months following termination of treatment; even when controlling for other predictors potentially related to emotion regulation. Additionally, we investigated whether, (a) more effective pretreatment emotion-regulation skills would be associated with lower pretreatment AD symptom severity, (b) AD patients would report less successful emotion-regulation than did non-clinical controls, but more successful emotion-regulation than did patients meeting criteria for major depressive disorder (MDD), and (c) specific emotion-regulation skills could be identified as particularly important in negatively predicting alcohol use during and after treatment for AD.

Background. The importance of sleep for memory consolidation has become a major focus of research. While it is known that abstaining alcohol-dependent patients often have sleep disorders and that there is some cognitive impairment during early abstention a possible interaction of disturbed sleep with overnight memory consolidation has not been addressed in a study as yet. Methods. Twenty-four alcohol-dependent patients with a short abstention period (mean 21.9 ± 7.6 days) were compared with 12 patients with an abstention period of several months (115.7 ± 43.8 days). Groups did not differ with respect to daily alcohol consumption before treatment, duration of alcohol dependence, and age. Before sleep all patients learned a list of semantically associated word pairs and a face name association task to a fixed criterion (at least 60% of correct recall) and they performed a mirror tracing task. After a polysomnographically registered night the patients were tested for retention of the learned declarative material by cued recall and had to perform the mirror tracing task again. Results. The groups did not differ with respect to sleep parameters or sleep-associated memory consolidation. Across both groups the duration of alcohol dependence correlated negatively with the amount of non-REM sleep and recall in the face name association task correlated negatively with daily alcohol consumption before abstention. Among the longer-term abstainers the duration of abstention correlated with the amount of slow wave sleep. Conclusions. Our data support the hypothesis that chronic and high alcohol consumption negatively affects sleep and declarative memory consolidation during the first months of abstention. Between an abstention period of a few weeks and of several months no change in sleep parameters and nightly memory consolidation could be demonstrated, however.

Background: Ghrelin is a 28-amino acid gut-brain peptide, mainly secreted by the gastric mucosa. Its effects are linked to energy homeostasis and particularly seem to increase hunger and food intake. In recent years, studies suggested that appetite-regulating peptides, such as ghrelin play a relevant role in alcoholism. Since data published to date on the potential role of ghrelin as state and/or trait marker in alcoholism and the association with craving are controversial, we aimed at further elucidating these aspects. Patients and Methods: One-hundred nine alcohol-dependent abstinent patients after withdrawal (27 f, 82 m), (ICD 10 F 10.25) and 45 healthy volunteers (12 f, 33 m) were included. Laboratory testing (Ghrelin RIA 90, Mediagnost Inc., Germany) was performed and several craving scales [Obsessive Compulsive Drinking Scale, Alcohol Urge Questionnaire and Visual Analogue Scale (VAS)] were applied at the beginning and at the end of the 3-week rehabilitation program. Results: (1) Ghrelin levels are significantly higher in female alcohol-dependent patients as compared to controls, not, however, in men alcoholics. (2) In several statistical subanalyses, an association of craving and ghrelin was found. The results, however, remain heterogeneous. Conclusion: The data suggest gender-dependent ghrelin levels in alcohol-dependent patients. We therefore conclude, that it might be useful to perform statistical analyses gender-specific. With regard to a potential correlation of ghrelin and craving the results seem to depend on gender, duration of the abstinence period and the instrument used.

Hypothalamo-pituitary-adrenocorticoid (HPA)-axis reactivity to psychosocial or pharmacological stimulants is diminished in alcohol-dependent patients during early abstinence but recovers after several months of abstention. In order to assess the physiological reactivity in the morning we used the cortisol awakening response (CAR) in saliva to compare 24 early abstainers (mean 21.9+/-7.6, range 10-36 days) with 12 alcohol-dependent patients with longer abstention periods (mean 116.8+/-45.7, range 59-230 days) and looked for an association with sleep, especially rapid eye movement (REM) sleep of the preceding night. Both groups did not differ with respect to age, duration of alcohol dependence, daily drinking dosage before detoxification, body mass index, depressivity, level of anxiety, daily cigarette consumption or sleep quality during the preceding 14 days. Sleep in the night before cortisol assessment did not differ with respect to total sleep time (412.4+/-35.9 vs. 407.0+/-38.7 min). Immediately upon awakening and 15, 30, 45 and 60 min later, specimens of salivary cortisol were collected. While starting from equal levels upon awakening longer abstaining patients with alcohol dependence showed a stronger CAR (ANOVA with repeated measurement, time x group effect: F=4.33, p0.01) with distinctly higher cortisol levels 45 and 60 min after awakening (T=3.79, p0.001 and T=3.06, p0.005, respectively). Across both groups the time spent in REM-sleep only correlated with cortisol levels upon awakening (r=0.33, p0.05). Our data indicate that CAR is a useful tool for investigating alterations in the HPA-axis regulation in abstaining alcohol-dependent patients.

A central cognitive function of sleep is to consolidate newly acquired memories for long-term storage. Here, we investigated whether the overnight consolidation of declarative memory in patients with chronic sleep disturbances is impaired, owing to less slow wave sleep (SWS) and an increased cortisol release.Polysomnographic recordings, serum cortisol concentrations, and overnight memory consolidation in 16 patients with primary insomnia were compared with those of 13 healthy control subjects.Patients displayed distinctly less overnight consolidation of declarative memory (p.05), which was significantly correlated with SWS in the control subjects (r = .69) but with rapid eye movement (REM) sleep in the patients (r = .56), who had a diminished amount of SWS (p.05). Increased cortisol levels in the middle of the night were associated with impaired retrieval of declarative memory after sleep for both control subjects (r = -.52) and patients (r = -.46).Primary insomnia is associated with a diminished sleep-related consolidation of declarative memory. Efficient overnight consolidation of declarative memory is associated with high amounts of SWS and low serum cortisol levels during the early part of the night. Where SWS is decreased, REM sleep might play a partly compensatory role in the consolidation of declarative memory.

Background and purpose To investigate the impact of a short daytime nap on procedural and declarative memory consolidation. Patients and methods Following a normal night's sleep, 34 young healthy subjects were randomly assigned to a nap or wake condition of about 45 min in the early afternoon after learning procedural and declarative memory tasks. Subjects were controlled for alertness and cortisol secretion. Results The afternoon naps were dominated by sleep stage 2 but contained some slow wave sleep (SWS) and rapid eye movement (REM) sleep as well. Naps significantly improved procedural, but not declarative, memory. Females showed more improvement than males in the declarative memory tasks irrespective of nap or wake. There was no difference between groups with respect to cortisol secretion or alertness. Conclusions A short nap is favorable for consolidation of procedural memory. The possibly confounding effect of gender should always be considered in research on sleep and memory.

In obsessive-compulsive disorder (OCD), a dysfunction of neuronal circuits involving prefrontal areas and the basal ganglia is discussed that implies specific oculomotor deficits. Performance during reflexive and predictive saccades, antisaccades and predictive smooth pursuit was compared between patients with OCD (n=22), patients with schizophrenia (n=21) and healthy subjects (n=24). Eye movements were recorded by infrared reflection oculography. In both patient groups, higher frequencies of anticipatory saccades with reduced amplitudes in the predictive saccade task were observed. Additionally, reduced smooth pursuit eye velocity and increased frequencies of saccadic intrusions during smooth pursuit as well as increased error rates in the antisaccade task were demonstrated for patients suffering from schizophrenia. Patients with OCD and schizophrenia revealed different patterns of oculomotor impairment: whereas increased anticipation of predictive saccades provides evidence for a dysfunction of the circuit between the frontal eye field and the basal ganglia in both groups, results from the antisaccade task imply additional deficits involving the dorsolateral prefrontal cortex in schizophrenic patients. Furthermore, the cortical network for smooth pursuit (especially the frontal eye field) is also assumed to be disturbed in schizophrenia.

Thirty male alcohol dependent inpatients without concurrent depressive disorder, 13 of them with a positive family history of alcohol dependence in a first degree relative (PFH), were questioned about their desire and consumption habits with respect to cigarettes, coffee, and sweets while on a three-week inpatient treatment after detoxification from alcohol. Six weeks after discharge from hospital, the patients were reassessed for relapse. Eleven patients (36.6%) had relapsed at follow-up. Relapsers were younger than abstainers. The days until relapse correlated negatively with intensity of desire to drink alcohol, desire to smoke cigarettes, and with a higher consumption of cigarettes. PFH patients did not relapse earlier but they had a stronger desire to drink coffee and eat sweets and had a higher coffee consumption.

Background: Alcohol abuse is associated with several gastrointestinal diseases, such as esophageal carcinoma, chronic alcoholic pancreatitis, and liver cirrhosis. Increased mean corpuscular volume (MCV) has been recognized as a biomarker for alcohol abuse and heavy drinkers. Recent studies from Japan revealed that macrocytosis is related to ALDH-2/2 genotype, leading to increased acetaldehyde accumulation. It has also demonstrated that increased MCV values could also be an independent biomarker for esophageal cancer in Asians. Therefore, the aim of the current study was to investigate possible associations of MCV value with polymorphisms of ADH1C in white patients with alcohol-associated esophageal carcinoma, chronic alcoholic pancreatitis, and alcoholic cirrhosis as well as in heavy drinkers without organ damage. Methods: In this study, a total of 510 alcoholic patients were enrolled with esophageal cancer (n= 98), chronic pancreatitis (n= 98), alcoholic liver cirrhosis (n= 151), and alcohol abuse without gastrointestinal disease (n= 163). ADH1C genotyping was performed by PCR-based restriction fragment length polymorphism (PCR-RFLP) analysis from whole blood. The relation between MCV and ADH1C gene polymorphisms (ADH1C*1 and 1C*2) controlled for the amount of drinking, smoking, and age were investigated using both univariate and multivariate analysis. Results: In univariate analysis, higher alcohol consumption was associated with increased MCV. Other variables were not associated with macrocytosis. In multiple linear regression analysis, after adjustment for age and smoking, higher alcohol consumption and female sex were independently associated with higher MCV values. No other variables, including which alcohol-associated disease the patient had, had an independent effect. Adding ADH genotype rendered no independent significant effect on MCV value. Conclusions: In a white population, MCV values were not associated with genotype polymorphisms of ADH1C. In contrast to findings in Asians, macrocytosis does not seem to be an independent biomarker for esophageal cancer. The role of ADH1C polymorphism in increasing MCV and the potential use of MCV as a marker for esophageal carcinoma are still pending.

Aims: To test whether the risk of relapse in alcohol dependence is predicted by the subjective experience of cue exposure (CE) and/or cortisol reactivity to alcohol cues. Methods: Salivary cortisol and self-ratings of 'tension' and 'desire to drink' were measured in 32 detoxified alcohol-dependent inpatients during CE sessions conducted in the first and third week of motivation enhancement therapy. Subjects completed the Toronto Alexithymia Scale (TAS-20) and the Abbreviated Alcohol Expectancy Questionnaire (B-AEQ) towards the end of the inpatient treatment to measure emotional self-awareness and the expected positive effects of alcohol. Results: Six weeks after the end of the inpatient treatment, 15 patients were abstinent. Relapse was verified or was presumed for 17 patients. Those who had relapsed had shown an attenuated response to CE in the third week as an inpatient but did not differ from abstainers in terms of subjective reaction to cues. Subjective ratings of CE were not related to salivary cortisol or relapse but showed several associations with factors one and two of the TAS-20. The expectancy of enhanced social contacts by using alcohol (factor 1 of the B-AEQ) correlated negatively with the decline in salivary cortisol during the CE session in the third week of treatment. Subjective ratings of CE correlated with Alexithymiascores. Conclusions: Alcoholic patients who use alcohol to enhance their social contacts typically lack hypothalamo-hypophyscal-pituitary-adrenocortical (HPA) reactivity in the early period of abstention. They are at an increased risk of early relapse and perhaps use alcohol to increase cortisol secretion again.

Morning and evening salivary cortisol levels were correlated with sleep parameters in 14 patients with primary insomnia and 15 healthy controls. Salivary cortisol was sampled immediately after awakening (T1), 15 min later (T2), and immediately before going to bed (T3) for 1 week at home. In parallel with this, subjects estimated parameters of sleep in a daily sleep log. Patients and controls were all non-smokers who did not differ regarding morning awakening time or bedtime. Cortisol after awakening was significantly decreased in primary insomnia. Salivary cortisol at the time of awakening correlated negatively with the subjective estimation of sleep quality, i.e. a low salivary cortisol level directly after awakening correlated with a higher frequency of nightly awakenings (r = -0.50), a diminished sleep quality (r = -0.34) and a decreased feeling of recovery after awakening (r = -0.35; all p < 0.05). Furthermore, awakening cortisol was negatively correlated with the Pittsburgh Sleep Quality Index (r = -0.43) and with a questionnaire on sleep-related cognitions with the subscales rumination in bed (r = -0.56 ) and focusing on sleep-related thoughts (r = -0.46; all p < 0.05).

Background After dementia the group of depressive disorders is considered to be the second most common psychiatric disorder in the elderly. There is dispute regarding whether depression in the elderly differs from depression in the younger age groups by a longer duration of inpatient treatment, a more frequent occurrence of delusions, more cognitive impairment or by a more frequent co-occurrence of physical disease. This study aimed to compare younger with older inpatients with respect to these aspects. Methods Retrospective chart review of all admissions to the psychiatric department of a General University Hospital (n=9400) and review of the documentation of 15 348 psychiatric consultations in the years 1990–1998. The clinical diagnoses were made according to the ICD-10 criteria. Results 15.5% of the psychiatric inpatients in this period suffered from depressive episodes (ICD-10 F31.3–31.5,32,33). The proportion of depressive episodes increased with age, making up 5.4% in the age group below 30 years and 37.4% in the age group of 70–79 years. On the basis of the ICD-10 criteria for the severity of depressive episodes no significant differences could be demonstrated between the younger (

Objective: Psychometric evaluation of the Pittsburgh Sleep Quality Index (PSQI) for primary insomnia. Methods: The study sample consisted of 80 patients with primary insomnia (DSM-IV). The length of the test–retest interval was either 2 days or several weeks. Validity analyses were calculated for PSQI data and data from sleep diaries, as well as polysomnography. To evaluate the specificity of the PSQI, insomnia patients were compared with a control group of 45 healthy subjects. Results: In primary insomnia patients, the overall PSQI global score correlation coefficient for test–retest reliability was .87. Validity analyses showed high correlations between PSQI and sleep log data and lower correlations with polysomnography data. A PSQI global score >5 resulted in a sensitivity of 98.7 and specificity of 84.4 as a marker for sleep disturbances in insomnia patients versus controls. Conclusion: The PSQI has a high test–retest reliability and a good validity for patients with primary insomnia. D 2002 Elsevier Science Inc. All rights reserved.

Age has been considered to contribute to the severity of the alcohol withdrawal syndrome (AWS). To evaluate the relationship between age and the severity of the AWS, we examined 723 alcoholics [518 males, 205 females, mean age (+/- SD): 42.8 +/- 10.5 years, mean duration of alcohol dependence: 11.0 +/- 8.0 years] consecutively referred to a unit for detoxification of alcoholics in a general hospital. The severity of the AWS was assessed by the AWS scale of Wetterling et al. (1997; Alcohol and Alcoholism 32, 753-760). The history of alcohol abuse as well as drinking behaviour in the last 6 months was assessed by a semi-structured interview. There were 41 alcoholics agedor =60 years; they were compared with younger patients. The average severity of AWS did not differ between age groups. Daily alcohol intake and frequency of drinking were higher in younger alcoholics, but even when adjustment was made for this, severity of AWS was equal in both age groups. A relationship between severity of AWS and age was not detected.

A reduced gain of smooth pursuit eye velocity has frequently been reported in schizophrenic patients. With respect to predictable stimuli, this could be due to a deficit in predicting the target path. To determine this contribution to smooth pursuit eye movement performance, we analyzed the ocular smooth pursuit response to a sinusoidally moving target that was suddenly stopped after some cycles of regular movement. Horizontal eye movements were recorded with infrared reflection oculography in a group of 17 schizophrenic in-patients and 16 age-matched healthy subjects for controls. The patients exhibited a reduced gain of smooth pursuit velocity, but phase lag was not different from the control group. After the unpredictable stop of target movement, predictive sinusoidal smooth pursuit was maintained for 150 to 200 ms in both groups. The resulting maximal position and velocity error was larger in the patient group. In conclusion, schizophrenic patients were able to generate a normal anticipatory component of smooth pursuit and to switch it off in response to external demands. They showed, however, an increased velocity of anticipatory pursuit, which might be used to compensate for the primary deficit of smooth pursuit velocity frequently found in schizophrenics.

Aims: The assessment of relapses is widely used as an outcome measure of alcohol dependence treatment. However, the methods of assessing relapses range from questionnairesto biological markers of alcohol for different time spans. The aim of this study was to compare the relapse rates of weekend home stays during long-term alcohol dependence treatment, assessed by ethyl glucuronide (EtG), breath alcohol tests and self-reports. Methods: Two hundred and ninety-seven alcohol-dependent patients receiving a long-term inpatient treatment programme participated. After a weekend at home (Friday to Sunday) they were evaluated for relapse by personal interviews and with breath alcohol tests. A concomitantly collected urine sample was later assessed for EtG with liquid chromatography-tandem mass spectrometry (LC-MS/MS analysis). Results: Of the total, 37.7% of the patients were positive for EtG at least once. Breath alcohol tests had been positive in only 4.4% and in personal interviews only 5.7% of the patients had admitted relapse. 15.6% of EtG tests were positive, but breath alcohol tests were negative (Cohen's kappa=0.056). Ninety-three per cent of the relapses were only detected by EtG. Conclusion: In addition to breath alcohol tests and interviews, urinary EtG can clearly improve the verification of relapse in inpatient treat- ment programmes allowing for weekend stays at home. Without EtG testing, a high amount of relapses will stay undetected.

While there is mounting evidence for the importance of sleep for declarative memory consolidation in adults, so far this issue has not been investigated in children despite considerable differences in sleep duration and sleep architecture between children and adults. Here, 27 children (aged between 9 and 12yr) were examined on two conditions: on the Sleep-Wake condition, subjects learned word pairs in the evening and delayed recall was tested first in the next morning after sleep and then again in the following evening after daytime wakefulness. On the Wake-Sleep condition, learning took place in the morning and delayed recall was tested in the evening of the same day and again in the next morning after sleep. In both conditions retention of declarative memory was significantly increased only after an interval of sleep that either followed immediately after learning (as in the Sleep-Wake condition) or that followed after daytime wakefulness (as in the Wake-Sleep condition), respectively. The results support the hypothesis that sleep plays an active role in declarative memory consolidation even if delayed and further show for the first time the importance of sleep for declarative memory consolidation during childhood.

Aim: Various factors that may influence the severity of the alcohol withdrawal syndrome (AWS) have been identified. We tested the predictive value of these factors compiled in a newly developed scale, LARS (Luebeck alcohol withdrawal risk scale). Method: A total of 100 individuals (81 males, 19 females, mean age: 47.6 ± 9.9 years) consecutively transferred to inpatient detoxification were included in this prospective study. All fulfilled the ICD-10 criteria for alcohol dependence. The LARS was applied at the time of admission. The course of the AWS was assessed by AWS-scale at least every 4 h. The maximum AWS-score was taken as indicator of the severity of AWS. Results: The mean AWS-scoremax was 6.5 ± 3.3. In all 20% of the patients developed a severe AWS (AWS-scoremax ≥10). The maximum score usually occurred within 36 h after the last drink. A short version, the LARS11, was developed by statistically grounded item reduction. The optimal cut-off of the LARS11 was calculated as 10. The positive predictive value for severe AWS was 76%, while the negative predictive value was 98.7%. The sensitivity and specificity were high (95 or 92.5%, respectively). Conclusion: LARS11 assessed immediately before detoxification appears to provide a useful estimate of mild/moderate versus severe AWS, and is now ready to be validated in an independent sample. ( Received 7 March 2006; first review notified 8 May 2006; in revised form 2 August 2006; accepted 2 August 2006)

Chronic alcohol consumption is associated with an increased risk for upper aerodigestive tract cancer and hepatocellular carcinoma. Increased acetaldehyde production via alcohol dehydrogenase (ADH) has been implicated in the pathogenesis. The allele ADH1C*1 of ADH1C encodes for an enzyme with a high capacity to generate acetaldehyde. So far, the association between the ADH1C*1 allele and alcohol-related cancers among heavy drinkers is controversial. ADH1C genotypes were determined by polymerase chain reaction and restriction fragment length polymorphism in a total of 818 patients with alcohol-associated esophageal (n=123), head and neck (n=84) and hepatocellular cancer (n=86) as well as in patients with alcoholic pancreatitis (n=117), alcoholic liver cirrhosis (n=217), combined liver cirrhosis and pancreatitis (n=17) and in alcoholics without gastrointestinal organ damage (n=174). The ADH1C*1 allele and genotype ADH1C*1/1 were significantly more frequent in patients with alcohol-related cancers than that in individuals with nonmalignant alcohol-related organ damage. Using multivariate analysis, ADH1C*1 allele frequency and rate of homozygosity were significantly associated with an increased risk for alcohol-related cancers (p0.001 in all instances). The odds ratio for genotype ADH1C*1/1 regarding the development of esophageal, hepatocellular and head and neck cancer were 2.93 (CI, 1.84-4.67), 3.56 (CI, 1.33-9.53) and 2.2 (CI, 1.11-4.36), respectively. The data identify genotype ADH1C*1/1 as an independent risk factor for the development of alcohol-associated tumors among heavy drinkers, indicating a genetic predisposition of individuals carrying this genotype.

— Aims: to investigate a possible association of cortisol stress response during early abstention with relapse. Methods: Thirty-six alcohol-dependent males, half of them with a comorbid anxiety disorder, and 15 healthy controls were exposed to a standardized psychosocial stress test. Thirty-one of the patients were assessed for relapse 6 weeks after discharge. Results: The relapsers showed almost no cortisol responses in the stress test. Comorbid anxiety disorder influenced neither stress response nor relapse. Conclusions: During early abstention from alcohol, reduced stress-responsivity of the hypothalamo–pituitary–adrenocortical axis seems to be connected to early relapse.

In the discussion of the increasing costs of health care in Germany the frequent and often times long inpatient treatments of elderly patients are pointed out. Since these patients also suffer from psychiatric disorders very frequently, a psychiatric consultation is required rather often. This study was aimed to evaluate the requirements of a consultation service for elder inpatients. For this purpose all 9363 consultation reports from 1994 to 1998 were evaluated retrospectively. 2152 (31.4 %) of the patients visited by the psychiatric consultation service were over 64 years old. The most frequent diagnoses were organic brain syndrome (ICD-10: F0), particularly senile dementia (ICD-10: F00 - 03), adjustment disorder (ICD-10: F43) and affective disorders, particularly depressive disorders (ICD-10: F3). In 139 patients (6,5 %) a consultation was requested because of a suicidal attempt prior to admission. Our results suggest that in a gerontopsychiatric consultation service predominantly old patients with internal diseases and with the need of psychosocial help are visited and that the specific knowledge of psychopharmacological treatment in multimorbid patients as well as the psychosocial help and legal advice is requested. These aspects should therefore be a special focus in educational programs for a gerontopsychiatric consultation service.

Physicians are obliged to inform all patients about the purpose and risks of therapeutic procedures, also drug treatment. However, although there may be some severe difficulties in informing psychiatric patients only very few data concerning this topic are available as yet. Thus, the aim of this query was to evaluate the patients' opinion of the information about medication.In this investigation 255 psychiatric inpatients were asked to complete a questionnaire.42 % of the patients complained about no or insufficient information of the expected effects of the prescribed medication and 62 % about no or insufficient information of side-effects. An association was found between the willingness to take the medication for a long time and insight in their psychic condition, but not with satisfying informing.This query showed the need of a more precise and satisfying information on medication and the need to develop strategies for a better information about side-effects.

We studied the associations between comorbid anxiety and depressive disorders in treated alcoholics, the course of current anxiety and depression during the early and late post-detoxification periods, and drinking behaviours after discharge. Lifetime psychiatric comorbidity was assessed in 100 alcoholics using the Composite International Diagnostic Interview (CIDI). Three subgroups defined as group DA (comorbid depressive and anxiety disorders, n = 15), group A (anxiety disorder only, n = 23), and group NO (no comorbid disorder, n = 62) were studied. Beginning 21 +/- 13 days after cessation of drinking, state anxiety (STAI-X1), trait anxiety (STAI-X2) and depression (BDI) were assessed once per week (t1 to t4) and once more 6 months after discharge (t5, n = 68). The severity of psychopathology decreased during the first 4 weeks after detoxification in all subgroups. However, trait anxiety remained at higher levels in both the comorbid subgroups from t1 to t4. In the follow-up sample, 60.5% of the non-comorbid subjects remained abstinent, but only 26.7% of all comorbid patients and only 12.5% of those with comorbid depressive disorder plus severe current trait anxiety or depression at t1. Independent of their comorbidity status, relapsers at t5 had already reported more trait anxiety than abstainers at t1. We conclude that severe trait anxiety persisting after 3 weeks of abstinence, comorbid depressive and/or anxiety disorders, and combinations of these with moderate or severe current anxiety and depressive states represent the greatest risks of relapse and therefore may indicate a treatment need.

In order to investigate changes in the consumption of substances that stimulate the reward system, 222 recently detoxified alcoholics were asked about their consumptional habits before as compared to after detoxification (mixed prospective and retrospective design). Seventy-eight point two percent reported an increase in consumption of coffee, cigarettes, chocolate and other sweets, while 34.9% managed to reduce at least one of these substances. The increase was significant for coffee, chocolate and other sweets. The desire for consumption of these substances was correlated with the maximum ever experienced desire for alcohol (0.232 for coffee, 0.213 for cigarettes, 0.193 for chocolate and 0.176 for other sweets), and the actual consumption of coffee, cigarettes and sweets was correlated with the actual desire for alcohol (0.172, 0.157 and 0.245, respectively). The results lend some support to the hypothesis that psychotropic substances might serve as a kind of self-regulation against craving in this group. A possible link to biochemical theories is discussed.

In neuropsychological vulnerability research the visual backward masking task, the Span of Apprehension, the degraded stimulus Continuous Performance Test (dsCPT), and the Wisconsin Card Sorting Test have been described as putative indicators for the predisposition to develop negative (schizophrenic) symptoms. The present study assesses the stability of the association between neuropsychological tests and negative symptoms by examining clinically improved patients. The interdependence between the four cognitive measures and clinical symptomatology was examined in 31 patients with DSM III-R and ICD-10 schizophrenia suffering predominantly from negative symptoms. Backward masking performance was related to affective flattening and anxiety-depression. False alarm rate on dsCPT was associated positively with affective flattening and hallucinations, and negatively with avolition. Card sorting perseverative errors correlated negatively with anhedonia, non-perseverative errors correlated positively with avolition. Correlations notwithstanding, the data provide evidence in support of the relative independence of neuropsychological functions and negative symptoms in clinically improved schizophrenics.

PLoS one 7(12), e50983 (2012). doi:10.1371/journal.pone.0050983, Published by PLoS [u.a.], Lawrence, Kan.

Since the long-term effects of vagotomy on carcinogenesis in the gastrointestinal tract is not known, truncal vagotomy and pyloroplasty was carried out in 59 Wistar rats, while 65 rats served as controls. All rats were fed 4 mg of MNG (N-methyl-N′-nitro-N-nitroso-guanidine) per day for a period of up to 695 days. In the vagotomy and pyloroplasty group, 31 rats survived long enough to develop tumors after a mean time of 430 days. The average total dose of MNG was 1.2 g/animal. In the control group, 37 of 49 rats developed tumors with a mean latency period of 562 days and an average MNG dose of 2.2 g/animal. In the experimental group, 18 tumors arose in the stomach, 10 in the duodenum, and 6 in the jejunum following vagotomy and pyloroplasty. In the control group, there were 19 gastric cancers, 4 duodenal, and 17 jejunal. Therefore, after vagotomy and pyloroplasty, tumors appeared more frequently in the upper part of the bowel than in the control group. This difference is statistically significant (χ2=5.559, σ=5%,p=0.018) and may be the result of the acid reduction produced by vagotomy.