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ABSTRACT: Although alcohol-dependent smokers represent an important group for applying smoking interventions, a sufficient pharmacotherapy has not been established in this high-risk group so far.
In order to examine the effect of the acetylcholinesterase inhibitor rivastigmine on tobacco dependence, we performed a 12-week, randomized, placebo-controlled trial. 26 alcohol-dependent smokers were randomized to rivastigmine 6 mg/day (n=14) or placebo (n=12). Assessments on addictive behavior included carbon monoxide (CO), severity of tobacco dependence (FTND), daily smoked cigarettes (diaries), and craving for tobacco (QSU) and alcohol (AUQ).
ANOVA revealed a significant treatment-by-time interaction for tobacco consumption and tobacco craving (each p<0.0001). The rivastigmine group showed a decrease in daily smoked cigarettes (-30%), in exhaled carbon monoxide (-32%) and in tobacco craving (-18%) whereas controls did not show significant changes. ANCOVA revealed rivastigmine effects to be more prominent in smokers suffering from more severe tobacco dependence. None of the patients developed an alcohol relapse or an increase in alcohol craving.
Our preliminary data indicate an effect of rivastigmine on tobacco craving and consumption. This pilot study encourages further investigation of acetylcholinesterase-inhibitors as a promising treatment approach regarding tobacco dependence.
Pharmacopsychiatry 06/2009; 42(3):89-94. · 2.07 Impact Factor
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ABSTRACT: Quetiapine is a novel antipsychotic, which is efficacious in the treatment of positive and negative symptoms in schizophrenia. Research has shown that atypical antipsychotic also reduce the craving and consumption for stimulants and alcohol. Due to Quetiapine's particulars and the promising receptor profile concerning addiction medicine, we set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from craving and affective symptoms.
Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. The patients were treated with quetiapine as relapse prevention and we followed them up in our outpatient clinic.
Eight out of nine patients were abstinent under quetiapine over a period of 2-7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninth patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of (mean+/-S.D.) 24.5+/-18.1 days. The overall tolerability was considered to be very good; however, initial sleepiness appeared in four patients.
Although uncontrolled case observations can only be interpreted with caution quetiapine seems to deserve further investigation and may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above-mentioned symptoms.
European Psychiatry 01/2007; 21(8):570-3. · 2.77 Impact Factor
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ABSTRACT: Side effects from a high-dose clozapine treatment for a schizophrenic patient led to massive compliance problems. The dose of clozapine could be halved without recurrence of an acute psychotic symptomatology by concomitantly administering amisulpride. The side effects, especially hypersalivation, disappeared almost entirely, which in turn led to good compliance. In a short review we would like to present the pathophysiology and therapeutic options of clozapine-induced hypersalivation.
Pharmacopsychiatry 02/2005; 38(1):38-9. · 2.07 Impact Factor
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ABSTRACT: We report on an 11-year-old pupil who present-ed to a neurological practice in the company of his parents because of migraine and strong headaches. Precise anamnesis of drugs yielded the diagnosis of a drug-induced headache with underlying migraine disease. The boy was afflict-ed with a hereditary taint, as both parents also suffered from migraine. The mother was also continuously in treatment because of a chronic pain disorder. Therapy with up to 50 mg per day of amitriptyline enabled the boy to stop consuming analgesics without suffering from head-aches. Moreover, under 47.5 mg per day of metoprolol, the migraine symptoms did not re-occur.
Der Nervenarzt 06/2004; 75(5):489-91. · 0.68 Impact Factor
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ABSTRACT: Wir berichten ber einen 11-jhrigen Schler, der sich wegen Migrne und starker Kopfschmerzen in einer nervenfachrztlichen Praxis in Heidelberg in Begleitung seiner Eltern vorstellte. Eine genaue Medikamentenanamnese ergab die Diagnose eines arzneimittelinduzierten Kopfschmerzes (ICD-10: G44.4) bei zugrunde liegender Migrneerkrankung (ICD-10: G43.0). Der Schler war durch beide Eltern bezglich Migrne vorbelastet, darber hinaus war die Mutter wegen einer anhaltenden somatoformen Schmerzstrung (ICD-10: F45.3) in Behandlung. Unter einer Therapie mit Amitriptylin bis 50mg/Tag konnte der 11-Jhrige auf die Schmerzmittel verzichten, ohne dass es zu weiteren qulenden Kopfschmerzen kam. Unter Metoprolol 47,5mg/Tag kam es darber hinaus zu einem Sistieren der Migrnesymptomatik.We report on an 11-year-old pupil who presented to a neurological practice in the company of his parents because of migraine and strong headaches. Precise anamnesis of drugs yielded the diagnosis of a drug-induced headache with underlying migraine disease. The boy was afflicted with a hereditary taint, as both parents also suffered from migraine. The mother was also continuously in treatment because of a chronic pain disorder. Therapy with up to 50mg per day of amitriptyline enabled the boy to stop consuming analgesics without suffering from headaches. Moreover, under 47.5mg per day of metoprolol, the migraine symptoms did not reocur.
Der Nervenarzt 04/2004; 75(5):489-491. · 0.68 Impact Factor
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Pharmacopsychiatry 04/2004; 37(2):90-2. · 2.07 Impact Factor
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ABSTRACT: The objective of this study was to develop new standardized alcohol-associated cues and assess their effects on brain activation with functional magnetic resonance imaging (fMRI). Pictures of alcoholic and neutral beverages and affectively neutral pictures were presented to 44 abstinent alcoholics and 37 age-matched healthy control subjects. We assessed the skin conductance response, and the elicited arousal and valence. Alcoholics and control subjects did not differ in arousal, valence or skin conductance response evoked by alcohol-associated and affectively neutral stimuli, while nonalcoholic beverages were rated as more unpleasant and arousing by alcoholics compared with control subjects. In the fMRI pilot study, alcohol and abstract pictures were presented to six abstinent alcoholics and induced a significant activation of brain areas associated with visual emotional processes such as the fusiform gyrus, parts of the brain reward system (basal ganglia and orbitofrontal gyrus) and further brain regions in the frontal and parietal cortices associated with the attention network. These observations suggest that standardized pictures of alcoholic beverages can be used to assess brain circuits involved in the processing and evaluation of alcohol cues.
European Psychiatry 10/2002; 17(5):287-91. · 2.77 Impact Factor
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ABSTRACT: Alcohol-associated cues may act as conditioned stimuli that activate the brain reward system and motivate alcohol intake in alcoholics. Alcohol-associated visual stimuli were presented during functional magnetic resonance imaging. An activation of the ventral putamen was observed in alcoholics but not in control subjects. Patients with a strong activation of the ventral putamen relapsed during the next three months. This observation supports the hypothesis that alcohol use affects areas involved in brain reward circuits and that their stimulus-induced activation may be associated with an increased risk for relapse.
Acta Neurovegetativa 02/2001; 108(7):887-94. · 2.73 Impact Factor
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ABSTRACT: The past 100 years witnessed the formation of a disease concept of alcoholism and a rapid increase in the knowledge of its aetiopathology and treatment options. In the first half of the century, public sanctions aimed at the abolition of alcoholism. In the United States, alcohol prohibition was revoked in the economic turmoil of the Great Depression. In Germany, proposed medical procedures to reduce the fertility of alcoholics had catastrophic consequences during the fascist dictatorship. A revived focus on alcoholics as patients with a right to medical treatment came out of self-organized groups, such as Alcoholics Anonymous. The current disease concept includes the psychosocial and neurobiological foundations and consequences of alcoholism. Neurobiological research points to the dispositional factor of monoaminergic dysfunction and indicates that neuroadaptation and sensitization may play a role in the maintenance of addictive behaviour. New treatment options include pharmacological approaches and indicate that behaviour and motivational therapy and the attendance of patient groups may equally reduce the relapse risk. The task of the future will be to apply scientific discoveries in the best interest of the patients and to support their efforts to be respected like subjects suffering from other diseases.
Alcohol and Alcoholism 02/2000; 35(1):10-5. · 2.95 Impact Factor
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ABSTRACT: Background: Perceived stigmatization of drug addicts may interact with negative mood states and thus may contribute to the maintenance of addictive behavior. Methods: Opiate maintenance patients (n = 106) and an unselected comparison group (n = 144) rated self-report questionnaires about perceived stigmatization, quality of life (QoL), depressiveness, anxiety, self-esteem, addiction characteristics, and social support. Results: 63% of opiate maintenance patients felt discriminated in contrast to 16% of the comparison group. Perceived stigmatization was rated higher by opiate maintenance patients, and all domains of QoL were rated lower, even when statistically controlling depressiveness, anxiety and social factors. Perceived stigmatization was correlated to depressiveness, anxiety, low self-esteem and low QoL, but not addiction characteristics and social support. Structural equation models revealed anxiety and the pathway depressiveness enhancing feelings of being stigmatized resulting in low self-esteem to explain 74% of variance in mental QoL, whereas anxiety and a pathway stigmatization inducing depressiveness leading to low self-esteem explained 49% of variance in physical QoL. Conclusions: A vicious circle of stigmatization, negative affective states and low QoL was confirmed. In addition to societal antistigma campaigns, antidepressive and anxiolytic therapy might have the potential to diminish feelings of being stigmatized and to improve QoL.
European Addiction Research 08/1970; 17(5):241-249. · 2.53 Impact Factor
