Seasonality and Delirium Tremens in Hospitalized Patients with Alcohol Dependence Syndrome

Introduction: Due to the high rate of mortality, recognizing the contributing factors of alcohol-related delirium tremens (DT), which is the most severe form of alcohol withdrawal state (AWS) is pivotal in clinical settings. Previous studies suggested relationship between seasonality and other types of delirium; however, to our knowledge, this is the first empirical study which examined the role of seasonality in DT in alcohol dependence syndrome (ADS). Methods: A retrospective study was undertaken between 2008 and 2015; medical records of 1,591 patients were included, which yielded 2,900 hospital appearances. Three groups were formed based on the ICD-10 diagnoses: ADS, AWS, and DT. The characteristics of the groups were analysed with one-way ANOVA and χ2 tests. Multinomial logistic regression was used to explore the potential predictors of DT, including seasonality. Results: The highest incidence of DT was in spring (36.8%; χ2 (3) = 27.666; p 2 (11) = 33.168; p Conclusions: The present study revealed that spring, especially March is a critical period in temperate climate zone regarding DT. This can be interpreted as a late winter effect since the temperature is lower in this month compared to other spring months. Furthermore, higher age and the occurrence of comorbid somatic disorders can be considered as risk factors in case of DT. These results support the need of further clinical studies to better understand the impact of seasonality on DT

Első lépés egy egységes szemlélet felé: az Alkohol Megvonási Skála bevezetése a hazai betegellátási gyakorlatba = The first step towards a unified approach: validation of the Hungarian version of the Clinical Institute Withdrawal Assessment of Alcohol, Revised in Hungarian general hospital settings

Absztrakt: Bevezetés és célkitűzés: Alkoholbetegek egészségügyi ellátása során az alkoholfogyasztás csökkentésével vagy annak elhagyásával alkohol okozta megvonási szindróma alakulhat ki. Jelenleg hazánkban nem áll rendelkezésre olyan standardizált mérőeszköz, amellyel az alkoholmegvonás tünetei mérhetők lennének. A nemzetközi szakirodalom, illetve irányelvek a megvonás tüneteinek monitorozására elsődlegesen a Clinical Institute Withdrawal Assessment of Alcohol, Revised mérőeszközt ajánlják, melynek hazai bevezetése hiánypótlónak tekinthető. A jelen vizsgálat célja a Clinical Institute Withdrawal Assessment of Alcohol, Revised hazai változata (Alkohol Megvonási Skála) pszichometriai mutatóinak feltárása, illetve a mérőeszköz alkalmazásának bemutatása. Módszer: A vizsgálat a Szegedi Tudományegyetem Pszichiátriai Klinikájára alkohol okozta megvonási szindróma iránydiagnózissal osztályra felvett páciensek (n = 30) körében történt, utánkövetéses elrendezésben. Kétnaponta, hat alkalommal került felvételre az Alkohol Megvonási Skála, illetve mellette a Klinikai Globális Összbenyomás – Súlyosság Skála. A felvételek során kapott átlagok összehasonlítása ismételt méréses varianciaanalízissel történt. Belső konzisztenciai mutatók (Cronbach-alfa, tétel-totál korreláció), konvergens és divergens validitási mutatók (Alkohol Megvonási Skála, illetve a Klinikai Globális Összbenyomás – Súlyosság Skála közötti Pearson korrelációs elemzés alapján) kerültek kiszámításra. Eredmények: Szignifikáns csökkenés volt megfigyelhető a 6 adatfelvételi időpontban az Alkohol Megvonási Skála (F = 202,46, p<0,001), illetve a Klinikai Globális Összbenyomás – Súlyosság Skála (F = 503,04, p<0,001) pontszámainak esetében. A Cronbach-alfa-értékek az első 3 mérési napon 0,7 felett voltak. Az egy időben felvett Alkohol Megvonási Skála és a Klinikai Globális Összbenyomás – Súlyosság Skála minden esetben 0,45 feletti korrelációt mutatott. Következtetés: Az Alkohol Megvonási Skála megbízható és érvényes mérőeszköz a megvonási tünetek részletes szimptomatológiai vizsgálatára. Így lehetővé teszi a hazai betegellátási gyakorlatban az alkoholmegvonás tüneteinek felismerését és súlyosságának meghatározását. Orv Hetil. 2019; 160(30): 1184–1192. | Abstract: Introduction and aim: The available literature and protocols have unequivocally suggested that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a psychometric scale for identifying and following the signs of alcohol withdrawal. However, there has not been any validated tool for the identification of withdrawal symptoms in Hungarian general hospital settings. The aim of the present study was to evaluate the validity and the reliability of the Hungarian version of this scale among patients hospitalized with alcohol withdrawal syndrome. Method: The translation of the scale into Hungarian was done by ‘back translation’ method, followed by testing the face validity. The empirical phase was performed in the Department of Psychiatry, University of Szeged. Patients admitted with alcohol withdrawal syndrome (n = 30) were recruited from the inpatient units of the clinic. Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression – Severity Scale were recorded every two days. Statistical comparisons of data were performed with repeated-measures ANOVA. Cronbach’s alpha, item-total correlation, convergent and discriminant validity were determined. Results: Significant decrease of the total scores of Clinical Institute Withdrawal Assessment of Alcohol, Revised and Clinical Global Impression – Severity Scale was observed between the six measurements (F = 202.46, p<0.001; F = 503.04, p<0.001). Cronbach alpha values were above 0.7 during the first 3 measurement days. The withdrawal and severity scores recorded the same day showed positively significant correlations (>0.45). Conclusion: Our findings demonstrate that the Clinical Institute Withdrawal Assessment of Alcohol, Revised is a reliable and valid psychometric tool for the detailed analysis of withdrawal symptoms in Hungarian general hospital settings. Orv Hetil. 2019; 160(30): 1184–1192

The personality profile of chronic alcohol dependent patients with comorbid gambling disorder symptoms

BACKGROUND AND AIMS: The importance of personality characteristics in the diagnosis and treatment of gambling disorder (GD) and alcohol use disorder (AUD) is often highlighted in scientific literature. This study aimed to test predictions about the associations of temperament and character in chronic AUD patients with comorbid GD symptoms and without them. METHODS: Chronic AUD patients enrolled from an inpatient clinic were divided in two groups based on cluster analysis, AUD patients with (AUD + GD group: n = 30) and without (AUD group: n = 68) GD symptoms. Severity of GD symptoms and personality dimensions (Cloninger\u27s Temperament and Character Inventory Revised, TCI-R) were assessed. Associations of tested variables were analysed with analysis of covariance, one-sample and independent sample t-tests. RESULTS: GD symptoms proved to be a clustering factor in terms of personality, where AUD + GD group expressed a more maladaptive personality profile. Compared to Hungarian normative TCI-R scores, both patient groups showed elevated levels of Harm Avoidance and Novelty Seeking with lower scores of Self-directedness, while the AUD + GD group scored lower on Persistence and Cooperation as well. The AUD + GD group reported significantly higher levels of Harm Avoidance, with lower scores of Reward Dependence compared to the AUD group. DISCUSSION: Comorbid GD symptom severity is an important factor in chronic AUD, where AUD patients with comorbid GD symptoms exhibited a more maladaptive personality constellation than singular AUD patients. These emphasize the need of special attention for comorbid GD symptoms in AUD, since treatment recommendations and prognosis for them may also differ