Fátima Ismail

Hospital de Santa Maria, Lisboa, Lisbon, Portugal

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Publications (13)17.04 Total impact

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    ABSTRACT: Objective: The current nosological classifications may describe a syndrome of "alcoholism" that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. Method: This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. Results: The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. Conclusions: Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.
    Full-text · Article · Feb 2015 · International Journal of Psychiatry in Clinical Practice
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    ABSTRACT: Objective: Alcohol abusers are vulnerable to emotional disabilities. Studies have shown that alexithymia is significantly associated with alcohol dependence and many other phenotypic descriptors. Given the high phenotypic heterogeneity that characterizes the alcohol depend-ence syndrome, the study aims to assess alexithymia features according to a multivariate classification scheme of alcoholism – the Lesch Alcoholism Typology (LAT). Methods: A total of 274 alcohol dependence outpatients (DSM diagnosis) were recruited from the Alcoholism Unit of the Psychiatric Service of Santa Maria University Hospital. After a detailed clinical observation, subjects were evaluated with the alcoholism classification system (LAT) and self-rated alexithymia with the Toronto Alexithymic Scale – 20 items (TAS-20). Results: Data showed that almost half of the alcohol-dependent individuals were defined as alexithymic cases (48.5%). ''Organic'' alcohol-dependent patients (type IV of Lesch classification) presented higher scores in TAS-20 when compared to other subtypes, even after controlling for potential confounding factors. Furthermore, the TAS-20 scores were related to educational level and family history of alcoholism. Conclusions: Results indicate that the alexithymia construct is an important psychological dimension in the characterization of alcohol dependence, especially the alcohol-dependent phenotypes that are more likely to present co-existing organic complications.
    Full-text · Article · Aug 2014 · Addiction Research and Theory
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    ABSTRACT: The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.
    Full-text · Article · Apr 2014 · Psychiatry Research
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    ABSTRACT: The pharmacological trials in alcohol dependence has raised the question of whether individual characteristics of the subjects influence the biological variability in terms of better or worse response to certain therapies. The study aims to perform a critical review of pharmacological trials in alcohol dependence within the paradigm of alcoholism typologies. The revision included a bibliographic search with the following terms: alcohol dependence, alcoholism typologies, pharmacotherapies, therapies, alcoholic subtypes. The analysis was made on the basis of "primary measures" - demonstrated efficacy in the reduction of alcohol consumption or maintenance of alcohol abstinence. Only were included randomized, double-blind, placebo controlled articles. Published until September of 2013. Eighteen trials met the inclusion criteria. We observe clinical results in relation to serotonergic and anti-craving medications and related to Cloninger, Babor and Lesch typologies. These findings consider, to some extent, that the definition of subgroups of alcohol dependent patients can bring medication therapy nearby a better fundamentally intervention. It is intended that AT can enhance the diagnostic classification and thus facilitate optimal clinical decisions, for example, the placement of patients according to different methods and intensity of treatment.
    Full-text · Article · Nov 2013 · Revista de Psiquiatria Clínica
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    ABSTRACT: The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. Correlational study CONCLUSIONS: CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.
    Full-text · Article · Sep 2013 · Journal of Affective Disorders
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    ABSTRACT: Objective. To validate NAT (NETER's alcoholic typology), taking into account the differentiated distribution of the measures used as external criteria in alcohol-dependent sub-groups and its relationship with Lesch's alcoholic typology (LAT). Method. A sample of 133 alcohol-dependent patients integrated in the alcoholism unit of the Psychiatric Service of Santa Maria University Hospital were included in the study. Results and Conclusions. Convergent validity was assured by the agreement between the subtypes of the two typologies (NAT and Lesch), considering the same underlying model of alcoholism development: anxiopathic subtype of NAT and Type II (model of anxiety, alcohol as conflict solution) of Lesch and the tymopathic subtype of NAT and type III (model of depression, alcohol as antidepressant) of Lesch. Discriminant analysis (external criteria) showed significant differences between the subtypes in the following variables: gender; tobacco; beer and whisky consumption; daily average of drinks; clinical conditions such as delirium tremens, alcoholic blackouts and seizures; severity of alcohol-related problems; psychological dimensions such as psychological maturity and extroversion; and suicidal ideation during the alcohol consumption period. A more exhaustive description of alcoholic sub-groups may improve genetic studies of alcoholism and provide the alcoholic patient with an adequate specific therapeutic protocol.
    Full-text · Article · Jul 2009 · International Journal of Psychiatry in Clinical Practice
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    ABSTRACT: Genetic factors of alcoholism influence the phenotypic heterogeneity of alcohol dependence, allowing the higher or lower expression of related aggressive behaviours. The pathogenesis of alcoholism and anti-social behaviour has been connected to serotonergic system dysfunction, given support to examine the association with 44-basepair insertion/deletion polymorphism of serotonin gene transporter (5-HTT). The study aims to assess the relationship between 5-HHTLPR polymorphism, aggressive behaviour and alcohol consumption pattern. There were recruited 97 alcohol dependent patients from the alcoholism unit (Etilo-Risco) of the Psychiatric Service of Santa Maria Hospital. Blood for DNA extraction and clinical and behavioural information was collected during the therapeutic program. Regarding 5-HTTLPR polymorphism prevalence in alcoholic population, 30.7% were homozygotic to l allele, 19.8% were homozygotic to s allele and 49.5% were heterozygotic l/s. Alcoholic patients carrying the l allele from 5-HTTLPR genotype showed significant lower scores of aggressivity during acute alcohol consumption, and alcoholic patients carrying the s allele showed significant higher scores of aggressivity (during acute alcohol consumption and abstinence), however, the results were not significant. The association between the functional nature of the s allele of 5-HTTLPR polymorphism with aggressive behaviour is in agreement with the general models of aggressivity that report low levels of central serotonergic activity related to impulsive and anti-social behaviours. The results demonstrate an association between 5-HTTLPR polymorphism and the auto and heteroaggressive behaviour in alcohol dependent population, particularly when aggressivity appears under acute alcohol consumption. During acute alcohol consumption stage, the presence of the l allele may act as a protective factor of aggressive behaviour risk, whereas the results tendency showed the s allele as susceptibility factor. Data suggests that the presence of s allele may confer a genetic vulnerability factor to the development of aggressive behaviour in alcohol dependent subjects, specially, in interaction with acute alcohol consumption stage.
    Full-text · Article · Nov 2008 · Acta medica portuguesa
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    ABSTRACT: To explore neuropsychological function in two differentiated patterns of platelet monoamine oxidase B (MAO B) activity in alcoholic patients. Neuropsychological examination and platelet MAO B activity extracted from blood were collected from 42 alcohol-dependent patients recruited in the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital. Alcoholics presented significantly low levels of platelet MAO B activity, when compared with control subjects; platelet MAO B activity in alcoholics classified as "under average subgroup" showed significant lower scores in the Raven Progressive Matrix and higher scores in hostility dimension, when compared with platelet MAO B activity in "above average subgroup." Results suggested platelet MAO B as a trait marker also to type I alcohol-dependent patients and the two observed associations between platelet MAO B activity with neurocognitive measures of executive functions (nonverbal reasoning) and psychopathological dimension such as hostility may support the notion about the effect of platelet MAO B activity in the further development of an impulsive cognitive style.
    Full-text · Article · Feb 2008 · Alcohol and Alcoholism
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    ABSTRACT: Alcoholization Denial defines the notion of the drinker refusal to acknowledge his pathological alcohol use or minimizing the relation between alcohol consumption and his psychological, organic and social problems.
    Full-text · Article · Jan 2008 · Analise Psicologica
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    ABSTRACT: To establish an alcohol-dependent drinker's clinical typology, based on patients attending the Alcoholism Unit of Santa Maria's General Hospital in Lisbon, Portugal. A multivariate statistical analysis was used to extract the typology solution. We obtained five factors: Anxiopathic, typifies anxious functioning; Heredopathic, congregates familiar and genetic influences on alcoholism; Thimopathic, typified by affective symptomatology; Sociopathic, characterized by disruptive behaviours under alcohol influence; and Adictopathic, isolates younger individuals who consume alcohol and other types of psychoactive substances. There are increasingly alcoholic polymorphic subtypes derived from the interactive complexity between genetic/family and psychosocial factors.
    Full-text · Article · Mar 2006 · Alcohol and Alcoholism
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    ABSTRACT: The aim of this study was to construct a typology integrating sociodemographic, clinical and personality data of alcohol-dependent patients. We studied a consecutive population attending an alcohol-dependent outpatient psychiatric department, assessed by instruments that measured psychiatric, psychopathological, personality and sociodemographic characteristics of alcohol-dependent patients. The factorial analysis allowed us to define three main expressions of alcoholism: physical, psychological and social. In the elicited typology, both physical and social appear mixed in their expression. The psychological expression is divided into two main categories: the alexithymic (with a depressive personal and family history) and the psychopathologic type (with actual depression and anxiety). This typology should allow us to correlate these types with neurophysiological and biochemical patterns and could be particularly useful in building an etiologic model of alcohol dependence which could contribute to a better prediction of prognosis and choice of the best therapeutic intervention.
    No preview · Article · Dec 1997 · Acta médica portuguesa
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    G Cardoso · F Ismail · A Barbosa
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    ABSTRACT: It is known that in general hospitals there is an increasingly high percentage of elderly patients that frequently develop psychiatric morbidity during hospital stay. This has lead the authors to perform a comparative study involving patients referred to Consultation/Liaison Psychiatry, in order to establish guidelines for a future approach. The first 1.000 referrals to the Consultation/Liaison Psychiatry Unit of the Santa Maria Hospital were analysed by comparing patients aged 65 or above to other observed patients. The results indicate a clearly lower percentage of elderly patients referred and a longer average length of stay at the moment of referral. Medical diagnoses show a preponderance of cardiologic, malignant and respiratory diseases, whereas intoxication, the prime diagnosis in the younger group, is much less represented above the age of 65. Identically, referrals due to suicide attempt were significantly less frequent in this group. Psychiatric diagnoses show a greater prevalence of organic mental disorders, followed by mood disorders, while in the younger the latter prevail. The post-discharge plan shows a higher percentage of elderly patients referred to general practitioners and medical specialties and a lower one for psychiatric care, as opposed to the younger group. The conclusions point towards the need for programs directed to early detection and treatment of psychopathological disorders (organic and depressive mental disorders) of elderly people admitted to a general hospital. This will be achieved through a close collaboration between C/L psychiatrists and medical staff, families and community facilities.
    Full-text · Article · Dec 1994 · Acta médica portuguesa
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    S. Pombo · F. Ismail · J.M. Neves Cardoso

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