Marcin Wojnar | Medical University of Warsaw (original) (raw)

Papers by Marcin Wojnar

Research paper thumbnail of Nawroty w uzale¿nieniu od alkoholu CzŒúÊ 2: Biologiczne predyktory Relapse in alcohol dependence. Part 2: Biological predictors

Alcohol dependence is a chronic disorder, and despite treatment efforts, most treated alcoholic p... more Alcohol dependence is a chronic disorder, and despite treatment efforts, most treated alcoholic patients achieve only short-term abstinence. The majority of treated alcoholics relapse. The importance of identifying predictors of relapse is essential in order to target them in the treatment process. This article addresses biological relapse predictors. Numerous biological markers for the predisposition to alcohol dependence have been identified so far but only few studies systematically have investigated biological predictors of relapse. These research have shown that some biological markers reflecting altered activity of central nervous system (CNS) are associated with an increased risk for relapse in alcoholic patients. Among them, central dopamine hypofunction as evidenced by reduced GH response to apomorphine and increased density of striatal D2 receptors in SPECT examination, specific D2 receptors genotype, were proposed as markers of relapse. Some studies have reported correlation between serotonergic activity dysfunction and susceptibility to relapse. Also decreased plasma beta-endorphin levels and decreased activity of hypothalamo-hypophyseal-adrenal system might be regarded as possible biological markers of relapse risk in alcoholism. Other studies have shown that polysomnography recorded sleep disturbances such as increased REM frequency (especially in early abstinence period) are significant predictors of poor treatment outcomes in alcoholic patients. Fast beta power or other EEG abnormalities, changes in event-related potentials indicating reduced frontal lobe activity have been considered as the other risk factors for failure in maintaining abstinence. The most recent studies have shown that genetic factors also may contribute to the predisposition to relapse in alcoholism. Susceptibility to dependence was found to be associated with polymorphisms of D2, D3 dopamine receptors genes, 5-HT1B gene, dopamine transporter gene, serotonin transporter gene and CB1 cannabinoid receptor gene. It is suggested that polymorphism of DRD2 gene in exon 8 is related to increased risk of relapse to drinking.

Research paper thumbnail of The association between partner and non-partner aggression and suicidal ideation in patients seeking substance use disorder treatment

Addictive Behaviors, 2009

Objective-The present study was designed to examine the relationship between prior partner and no... more Objective-The present study was designed to examine the relationship between prior partner and non-partner aggression and suicidal ideation in patients seeking drug and alcohol treatment.

Research paper thumbnail of Relationships of impulsiveness and depressive symptoms in alcohol dependence

Journal of Affective Disorders

Background: Depressive symptoms as well as high levels of impulsivity are subjects of special int... more Background: Depressive symptoms as well as high levels of impulsivity are subjects of special interest in alcohol dependence, as these factors are considered to influence the course of this disorder. However, until now mutual relationships between impulsivity and depression have not been investigated thoroughly in alcohol-dependent patients. Methods: By means of the Barratt Impulsiveness Scale (BIS-11) and stop-signal task, levels of impulsivity among 304 alcohol-dependent patients were measured. The stop-signal task was used as a manipulation-free method of estimating the level of behavioral impulsiveness, and the BIS-11 is a self report measure of global as well as cognitive impulsivity. Patients were also asked to complete the Beck Depression Inventory (BDI) and Hopelessness Scale (BHS). The results were analyzed in order to examine relationships between impulsiveness and depressive symptoms. Results: Statistical analyses revealed significant associations between impulsiveness and severity of depressive symptoms. Individuals with higher scores on the BDI were more impulsive on the BIS-11, whereas patients with higher scores on the BHS were more impulsive on both the stop-signal task and BIS-11. The strongest correlations were found with the attention impulsivity subscale of BIS-11. Adjusting for other variables, a linear regression analysis revealed that cognitive impulsivity was the strongest predictor of depression severity. Limitations: The main limitation of the study is a not fully representative sample, with exclusion of patients with active mood disorders Conclusions: The results indicate a strong association between depressive symptoms and impulsivity in alcohol-dependent patients, and suggest an important distinction between hopelessness and other depressive symptoms.

Research paper thumbnail of Sleep problems and suicidality in the National Comorbidity Survey Replication

Journal of Psychiatric Research, 2009

Objective-Links between sleep problems and suicidality have been frequently described in clinical... more Objective-Links between sleep problems and suicidality have been frequently described in clinical samples; however this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States.

Research paper thumbnail of Assessment and prevalence of depression in women 45–55 years of age visiting gynecological clinics in Poland

Archives of Womens Mental Health, 2003

¶The aims of the Polish survey were to assess efficacy of screening for depression in gynecologic... more ¶The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45–55, who were screened by 120 gynecologists throughout Poland. Patients completed the Beck’s Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.

Research paper thumbnail of Prevalence of depressive disorders in perimenopausal women attending gynaecological clinics in Poland

European Neuropsychopharmacology, 2002

Research paper thumbnail of The Role of Somatic Disorders and Physical Injury in the Development and Course of Alcohol Withdrawal Delirium

Alcoholism-clinical and Experimental Research, 1999

In a retrospective study, we evaluated the role of somatic disease and physical injury in the dev... more In a retrospective study, we evaluated the role of somatic disease and physical injury in the development and course of alcohol withdrawal delirium. Medical records of 1179 patients treated for alcohol withdrawal in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Development, symptoms' severity, and the course of alcohol withdrawal delirium were assessed in possible relation to the somatic state of patients and other variables of alcohol dependence. Development of the first episode of delirium tremens (DT) was associated with the incidence of somatic disease or injury in 19% of cases. Somatic disorders directly preceded the second episode of DT in 73% and the third in 57% of cases. A positive correlation was found between the greater severity and/or longer duration of DT symptoms, and occurrence of pneumonia, coronary heart disease, alcohol liver disease, and anemia, as well as daily amount of alcohol consumed during the last drinking bout. There was no relationship of severity of DT with the duration of alcohol abuse. Early development and severe course of alcohol withdrawal delirium correlated with the late beginning of excessive drinking (over the age of 40) and concomitant abuse of benzodiazepines or barbiturates. We concluded that somatic disorders or physical injury might trigger delirium during alcohol withdrawal, and have essential influence on the symptoms' severity and duration of DT. A more severe course of DT is also correlated with the quantity of alcohol consumed and concomitant abuse of sedatives.

Research paper thumbnail of Prevalence of Past Year Assault Among Inner-City Emergency Department Patients

Annals of Emergency Medicine, 2009

Objectives: 1) To determine the rates of past year non-partner violent assault (NPV), both victim... more Objectives: 1) To determine the rates of past year non-partner violent assault (NPV), both victimization and aggression. 2) To assess variables associated with NPV, particularly with regards to substance use. Method: A cross sectional computerized standardized survey study was conducted to assess NPV, physical and mental health, and substance use among patients presenting to an inner-city ED over two years. Patients (age 19-60) with normal vital signs in an urban ED from 9am-11pm were eligible; pregnant patients and those with a chief complaint of psychiatric evaluation were excluded. Logistic regression analyses were conducted to predict any NPV .Results: 10,744 patients were enrolled (80 % response rate); 14% of the sample reported any past year NPV (9% perpetration; 11% victimization). Findings from regression analyses found participants with any past year NPV (victimization or aggression) were more likely than their counterparts to be younger (OR 1.1), male (2.2), single (1.5), unemployed (1.1), present to the ED for injury (1.9), report poor physical health (1.32) poor mental health (1.9). They were less likely to be African-American (0.8). Alcohol use (1.7), marijuana use (2.4), cocaine use (3.1), prescription drug use (1.4) and past treatment (1.7) were associated with experiencing past year NPV.

Research paper thumbnail of Differences in the Course of Alcohol Withdrawal in Women and Men: A Polish Sample

Alcoholism-clinical and Experimental Research, 1997

A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in w... more A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in women and men hospitalized in the Nowowiejski Hospital in Warsaw from 1973 to 1987. Medical records pertaining to 1179 patients were analyzed; 13.8% of these patients were women and 86.2% were men. The study showed that women began intensive alcohol drinking later than men ( p < O.OOOl ), but the period between the onset of alcohol abuse and the first occurrence of alcohol withdrawal was shorter in women than in men ( p < 0.OOOl ). In the period of heavy drinking before hospitalization, women consumed significantly less alcohol then men ( p < O. OOO1); moreover, women drank nonbeverage alcohol less frequently than men ( p c 0.05). Women were hospitalized substantially longer than men ( p < O.OOOl ), whereas the duration of alcohol withdrawal symptoms at the time of hospitalization was comparable in both groups. Withdrawal seizures were significantly more frequent among men than among women ( p < 0.001). Significant differences in the patients' somatic conditions were not noted between the groups, with the exception of anemia and decreased potassium concentration, which were more frequently observed in women (both p < O.OOOl ), and of increased concentration of ALT and hypoproteinemia, which were more frequent in men (respectively, p < 0.05 and p < 0.01).

Research paper thumbnail of Assessment of the Role of Kindling in the Pathogenesis of Alcohol Withdrawal Seizures and Delirium Tremens

Alcoholism-clinical and Experimental Research, 1999

The aim of this study was to evaluate the hypothetical role of kindling phenomenon in the develop... more The aim of this study was to evaluate the hypothetical role of kindling phenomenon in the development and course of alcohol withdrawal (AW) seizures and delirium tremens (DT). The 2186 medical records of 1179 patients hospitalized in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Investigating the role of kindling, a course of consecutive AW episodes of patients hospitalized several times was analyzed. The relationships of withdrawal seizures with the duration of alcohol abuse, the number of prior detoxification episodes, and other variables were also studied. Increasing severity of AW symptoms was observed during the course of consecutive episodes in 22.5% of patients. The first episode of DT was preceded by withdrawal seizures in 11 % of cases. First-ever withdrawal seizures occurred more frequently in patients with head injury in the past and with coexisting symptoms of alcohol liver disease. Occurrence of withdrawal seizures and DTs did not correlate with the number of previous withdrawal episodes or with the length of period of intensive drinking. We concluded that the kindling model could be applied only to some cases in the development of AW seizures and DTs. Kindling should be considered as one of the multiple mechanisms involved in the pathogenesis of AW delirium.

Research paper thumbnail of Correlates of Intimate Partner Violence Among Men and Women in an Inner City Emergency Department

Journal of Addictive Diseases, 2009

The present study surveyed medical and/or injured patients (men and women) in an inner city ED to... more The present study surveyed medical and/or injured patients (men and women) in an inner city ED to examine the rates and correlates of IPV, including substance use patterns. Over a two-year period, participants (n=10,744) self-administered a computerized health survey during their ED visit that included screening items regarding past year history of IPV (including victimization and aggression). Overall, rates of any involvement in past year IPV were 8.7% (7.3% victimization and 4.4% aggression); however, women were more likely than men to report IPV. When examining participants' substance use patterns, participants who reported using both alcohol and cocaine were most likely to report IPV. Predictors of partner aggression and victimization were remarkably similar. This paper provides unique data regarding correlates of past year IPV history among a comprehensive sample of male and female ED patients presenting for medical complaints and/or injury.

Research paper thumbnail of Clinical and Genetic Risk Factors for Suicide under the Influence of Alcohol in a Polish Sample

Alcohol and Alcoholism, 2009

Aims: Despite the large number of suicides that occur with intoxication, little is known about th... more Aims: Despite the large number of suicides that occur with intoxication, little is known about the unique predictors of suicide after alcohol consumption. The goal of this study was to examine clinical and genetic risk factors for alcohol-related suicide. Methods: Data on 162 suicide victims were obtained from post-mortem examinations, police and prosecution inquiries, autopsy protocols and available medical records. Four single nucleotide polymorphisms in the central serotonin system and the renin-angiotensin system related genes previously found to be associated with suicide, alcohol dependence or depression were genotyped. Results: The strongest predictor of suicide under the influence of alcohol was alcohol dependence (OR = 4.63). Those who did not drink alcohol before suicide were more likely to have a diagnosis of major depressive disorder in their medical record and more often had the TT genotype of the tryptophan hydroxylase 2 gene. Conclusions: Suicide under the influence of alcohol is strongly connected with alcohol dependence. The TPH2 gene may play an important role in suicide vulnerability especially in individuals who did not drink alcohol before suicide.

Research paper thumbnail of The CC genotype in HTR2A T102C polymorphism is associated with behavioral impulsivity in alcohol-dependent patients

Journal of Psychiatric Research

High levels of impulsivity can increase the vulnerability for development of alcohol dependence. ... more High levels of impulsivity can increase the vulnerability for development of alcohol dependence. Moreover, impulsivity is considered to be a predictor of poor treatment outcomes. Few studies, however, have directly examined the genetics of impulsivity in alcohol-dependent patients. We analyzed the relationships between a well-recognized genetic marker of serotonin activity and levels of impulsivity as measured by both the Barratt Impulsiveness Scale (BIS-11) and the stopsignal task among 304 alcohol-dependent patients. The stop-signal task was used as an independent, objective method of estimating the level of behavioral impulsivity, and the BIS-11 as a self-report measure of global impulsivity. Blood was collected and analyzed for the T102C (rs6313) polymorphism in the serotonin type 2A receptor gene (HTR2A). Our results indicate a significant association between high levels of behavioral impulsivity and the C/C genotype of rs6313 in alcohol-dependent patients. The CC genotype has been previously found to be associated with a reduction in 5HT2A receptors in the central nervous system. These results support the hypothesis that genetic factors are important determinants of behavioral impulsivity in alcohol-dependent patients, and that the serotonin system plays an important role in establishing its level.

Research paper thumbnail of Impulsive and non-impulsive suicide attempts in patients treated for alcohol dependence

Journal of Affective Disorders, 2009

Background: Suicidal behavior has been recognized as an increasing problem among alcohol-dependen... more Background: Suicidal behavior has been recognized as an increasing problem among alcohol-dependent subjects. The aim of the study was to identify correlates of impulsive and non-impulsive suicide attempts among a treated population of alcohol-dependent patients.

Research paper thumbnail of Association of polymorphisms in HTR2A, HTR1A and TPH2 genes with suicide attempts in alcohol dependence: A preliminary report

Psychiatry Research

We investigated a relationship between selected polymorphisms: rs6313 in HTR2A, rs6295 in HTR1A a... more We investigated a relationship between selected polymorphisms: rs6313 in HTR2A, rs6295 in HTR1A and rs1386494 in TPH2, and suicidal behaviour in 150 alcohol-dependent patients. There was a significant association between more frequent C102C genotype in HTR2A and suicide attempts in alcoholic females. No differences in genotype distribution in HTR1A and TPH2 SNPs were found between patients with and without suicide attempts.

Research paper thumbnail of Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Drug and Alcohol Dependence, 2008

Background: The present study was designed to examine the influence of suicidality on relapse in ... more Background: The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined. Methods: A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months. Results: Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chi-square = 2.37, d.f. = 1, p = 0.124). However, impulsive suicide attempts strongly predicted relapse (OR = 2.81, 95% CI = 1.13-6.95, p = 0.026) and time to relapse (OR = 2.10, 95% CI = 1.18-3.74, p = 0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity.

Research paper thumbnail of P01-56 - Relationship between impulsiveness and depressive symptoms in alcohol-dependent patients

European Psychiatry, 2011

Research paper thumbnail of Association Between Val66Met Brain-Derived Neurotrophic Factor (BDNF) Gene Polymorphism and Post-Treatment Relapse in Alcohol Dependence

Alcoholism-clinical and Experimental Research, 2009

Background: The purpose of this study was to examine relationships between genetic markers of ce... more Background: The purpose of this study was to examine relationships between genetic markers of central serotonin (5-HT) and dopamine function, and risk for post-treatment relapse, in a sample of alcohol-dependent patients.Methods: The study included 154 patients from addiction treatment programs in Poland, who met DSM-IV criteria for alcohol dependence. After assessing demographics, severity of alcohol use, suicidality, impulsivity, depression, hopelessness, and severity of alcohol use at baseline, patients were followed for approximately 1 year to evaluate treatment outcomes. Genetic polymorphisms in several genes (TPH2, SLC6A4, HTR1A, HTR2A, COMT, and BDNF) were tested as predictors of relapse (defined as any drinking during follow-up) while controlling for baseline measures.Results: Of 154 eligible patients, 123 (80%) completed follow-up and 48% (n = 59) of these individuals relapsed. Patients with the Val allele in the Val66Met BDNF polymorphism and the Met allele in the Val158Met COMT polymorphism were more likely to relapse. Only the BDNF Val/Val genotype predicted post-treatment relapse [odds ratio (OR) = 2.62; p = 0.019], and time to relapse (OR = 2.57; p = 0.002), after adjusting for baseline measures and other significant genetic markers. When the analysis was restricted to patients with a family history of alcohol dependence (n = 73), the associations between the BDNF Val/Val genotype and relapse (OR = 5.76, p = 0.0045) and time to relapse (hazard ratio = 4.93, p = 0.001) were even stronger.Conclusions: The Val66Met BDNF gene polymorphism was associated with a higher risk and earlier occurrence of relapse among patients treated for alcohol dependence. The study suggests a relationship between genetic markers and treatment outcomes in alcohol dependence. Because a large number of statistical tests were conducted for this study and the literature on genetics and relapse is so novel, the results should be considered as hypothesis generating and need to be replicated in independent studies.

Research paper thumbnail of The association between insomnia and suicidal thoughts in adults treated for alcohol dependence in Poland

Fuel and Energy Abstracts

Suicidal ideation is elevated for individuals with alcohol use disorders. Sleep problems are asso... more Suicidal ideation is elevated for individuals with alcohol use disorders. Sleep problems are associated with suicide risk and alcohol use, and sleep problems may be associated with suicide risk in those with alcohol use disorders. For the present study, we hypothesized that self-reported sleep problems are associated with suicidal thoughts in a sample of adults seeking treatment for alcohol dependence in Poland. The sample included 304 patients in addiction treatment programs in Warsaw, Poland who met criteria for alcohol dependence. Measures included demographic characteristics, frequency of alcohol use, psychiatric symptoms, suicidal ideation and two measures of insomnia, which differed by time frame: the Athens Insomnia Scale (AIS, past 1 month) and the Sleep Disorders Questionnaire (SDQ-7, past 6 months). Multivariable logistic regression models tested the association between insomnia and suicidal thoughts. In models that controlled for age, gender, and days of recent drinking, both measures of sleep problems were associated with suicidal ideation: AOR=2.01 (95% CI: 1.50-2.70) [AIS] and 1.73 (95% CI: 1.29-2.31) [SDQ-7]. The association of sleep problems, as measured by the AIS, with suicide remained significant after adjusting for psychiatric symptoms, although the estimated effect size was smaller (AOR=1.47; 95% CI: 1.05-2.06). Among Polish adults with alcohol dependence, insomnia severity was associated with suicidal ideation. This finding highlights the need to assess for sleep problems, in addition to suicidal thoughts, in alcohol treatment settings and to further examine the potential consequences of poor sleep in this population.

Research paper thumbnail of Sleep and body mass index in depressed children and healthy controls

Sleep Medicine, 2010

Higher body mass index (BMI) has been associated with more sleep disturbance and depressive sympt... more Higher body mass index (BMI) has been associated with more sleep disturbance and depressive symptoms, but the combined effects of depression and BMI on sleep have not been studied in children. This study evaluated the relationship between BMI and polysomnography in children with major depressive disorder (MDD), compared to healthy controls (HCs).The sample of 104 subjects included 72 children, 8–17 years old, with MDD and 32 similarly aged HCs with no personal or family history of psychopathology. BMI was adjusted using the CDC formula for percentiles by age. Subjects were categorized as (1) normal weight (5–84th percentile) or (2) high weight, which included at risk of overweight and overweight (⩾85th percentile). All analyses were adjusted for sex and Tanner maturational stage scores.In the MDD group only, higher BMI was significantly correlated with decreased sleep efficiency, decreased percentage of rapid eye movement sleep (REM%), and higher percentage of time spent awake and moving (TSPAM). In the HC group only, higher BMI correlated with higher total sleep time. Multivariate analyses revealed significant interactions between the BMI and diagnostic groups for several REM sleep parameters, such that high-weight children from the HC and MDD groups had increases and decreases in REM sleep, respectively. TSPAM increased in the high-weight MDD group, but decreased in the high-weight HC group.Although limited by small sample size, these findings suggest that children and adolescents with MDD and a high BMI have more fragmented sleep than other children. The increased REM sleep patterns observed with MDD in this and other studies normalized in high-weight children with MDD. Prevention and treatment strategies should target both sleep and weight as factors that can potentially influence the development and course of MDD.

Research paper thumbnail of Nawroty w uzale¿nieniu od alkoholu CzŒúÊ 2: Biologiczne predyktory Relapse in alcohol dependence. Part 2: Biological predictors

Alcohol dependence is a chronic disorder, and despite treatment efforts, most treated alcoholic p... more Alcohol dependence is a chronic disorder, and despite treatment efforts, most treated alcoholic patients achieve only short-term abstinence. The majority of treated alcoholics relapse. The importance of identifying predictors of relapse is essential in order to target them in the treatment process. This article addresses biological relapse predictors. Numerous biological markers for the predisposition to alcohol dependence have been identified so far but only few studies systematically have investigated biological predictors of relapse. These research have shown that some biological markers reflecting altered activity of central nervous system (CNS) are associated with an increased risk for relapse in alcoholic patients. Among them, central dopamine hypofunction as evidenced by reduced GH response to apomorphine and increased density of striatal D2 receptors in SPECT examination, specific D2 receptors genotype, were proposed as markers of relapse. Some studies have reported correlation between serotonergic activity dysfunction and susceptibility to relapse. Also decreased plasma beta-endorphin levels and decreased activity of hypothalamo-hypophyseal-adrenal system might be regarded as possible biological markers of relapse risk in alcoholism. Other studies have shown that polysomnography recorded sleep disturbances such as increased REM frequency (especially in early abstinence period) are significant predictors of poor treatment outcomes in alcoholic patients. Fast beta power or other EEG abnormalities, changes in event-related potentials indicating reduced frontal lobe activity have been considered as the other risk factors for failure in maintaining abstinence. The most recent studies have shown that genetic factors also may contribute to the predisposition to relapse in alcoholism. Susceptibility to dependence was found to be associated with polymorphisms of D2, D3 dopamine receptors genes, 5-HT1B gene, dopamine transporter gene, serotonin transporter gene and CB1 cannabinoid receptor gene. It is suggested that polymorphism of DRD2 gene in exon 8 is related to increased risk of relapse to drinking.

Research paper thumbnail of The association between partner and non-partner aggression and suicidal ideation in patients seeking substance use disorder treatment

Addictive Behaviors, 2009

Objective-The present study was designed to examine the relationship between prior partner and no... more Objective-The present study was designed to examine the relationship between prior partner and non-partner aggression and suicidal ideation in patients seeking drug and alcohol treatment.

Research paper thumbnail of Relationships of impulsiveness and depressive symptoms in alcohol dependence

Journal of Affective Disorders

Background: Depressive symptoms as well as high levels of impulsivity are subjects of special int... more Background: Depressive symptoms as well as high levels of impulsivity are subjects of special interest in alcohol dependence, as these factors are considered to influence the course of this disorder. However, until now mutual relationships between impulsivity and depression have not been investigated thoroughly in alcohol-dependent patients. Methods: By means of the Barratt Impulsiveness Scale (BIS-11) and stop-signal task, levels of impulsivity among 304 alcohol-dependent patients were measured. The stop-signal task was used as a manipulation-free method of estimating the level of behavioral impulsiveness, and the BIS-11 is a self report measure of global as well as cognitive impulsivity. Patients were also asked to complete the Beck Depression Inventory (BDI) and Hopelessness Scale (BHS). The results were analyzed in order to examine relationships between impulsiveness and depressive symptoms. Results: Statistical analyses revealed significant associations between impulsiveness and severity of depressive symptoms. Individuals with higher scores on the BDI were more impulsive on the BIS-11, whereas patients with higher scores on the BHS were more impulsive on both the stop-signal task and BIS-11. The strongest correlations were found with the attention impulsivity subscale of BIS-11. Adjusting for other variables, a linear regression analysis revealed that cognitive impulsivity was the strongest predictor of depression severity. Limitations: The main limitation of the study is a not fully representative sample, with exclusion of patients with active mood disorders Conclusions: The results indicate a strong association between depressive symptoms and impulsivity in alcohol-dependent patients, and suggest an important distinction between hopelessness and other depressive symptoms.

Research paper thumbnail of Sleep problems and suicidality in the National Comorbidity Survey Replication

Journal of Psychiatric Research, 2009

Objective-Links between sleep problems and suicidality have been frequently described in clinical... more Objective-Links between sleep problems and suicidality have been frequently described in clinical samples; however this issue has not been well-studied in the general population. Using data from a nationally representative survey, we examined the association between self-reported sleep difficulties and suicidality in the United States.

Research paper thumbnail of Assessment and prevalence of depression in women 45–55 years of age visiting gynecological clinics in Poland

Archives of Womens Mental Health, 2003

¶The aims of the Polish survey were to assess efficacy of screening for depression in gynecologic... more ¶The aims of the Polish survey were to assess efficacy of screening for depression in gynecological practice and to estimate prevalence of depressive disorders in midlife women visiting gynecologists. The study included 2262 female outpatients aged 45–55, who were screened by 120 gynecologists throughout Poland. Patients completed the Beck’s Depression Inventory (BDI) and were assessed by gynecologists to verify the presence of symptoms of a current Depressive Episode according to ICD-10 diagnostic criteria. Patients who obtained a score of 12 points or more on the BDI were referred for psychiatric evaluation, including the modified version of Mini International Neuropsychiatric Interview (MINI). The study showed that gynecologists in Poland are able to perform screenings for depression effectively in outpatient settings. Results also suggested that about 19% of women aged 45 to 55 years visiting gynecologists may suffer from depressive disorders.

Research paper thumbnail of Prevalence of depressive disorders in perimenopausal women attending gynaecological clinics in Poland

European Neuropsychopharmacology, 2002

Research paper thumbnail of The Role of Somatic Disorders and Physical Injury in the Development and Course of Alcohol Withdrawal Delirium

Alcoholism-clinical and Experimental Research, 1999

In a retrospective study, we evaluated the role of somatic disease and physical injury in the dev... more In a retrospective study, we evaluated the role of somatic disease and physical injury in the development and course of alcohol withdrawal delirium. Medical records of 1179 patients treated for alcohol withdrawal in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Development, symptoms' severity, and the course of alcohol withdrawal delirium were assessed in possible relation to the somatic state of patients and other variables of alcohol dependence. Development of the first episode of delirium tremens (DT) was associated with the incidence of somatic disease or injury in 19% of cases. Somatic disorders directly preceded the second episode of DT in 73% and the third in 57% of cases. A positive correlation was found between the greater severity and/or longer duration of DT symptoms, and occurrence of pneumonia, coronary heart disease, alcohol liver disease, and anemia, as well as daily amount of alcohol consumed during the last drinking bout. There was no relationship of severity of DT with the duration of alcohol abuse. Early development and severe course of alcohol withdrawal delirium correlated with the late beginning of excessive drinking (over the age of 40) and concomitant abuse of benzodiazepines or barbiturates. We concluded that somatic disorders or physical injury might trigger delirium during alcohol withdrawal, and have essential influence on the symptoms' severity and duration of DT. A more severe course of DT is also correlated with the quantity of alcohol consumed and concomitant abuse of sedatives.

Research paper thumbnail of Prevalence of Past Year Assault Among Inner-City Emergency Department Patients

Annals of Emergency Medicine, 2009

Objectives: 1) To determine the rates of past year non-partner violent assault (NPV), both victim... more Objectives: 1) To determine the rates of past year non-partner violent assault (NPV), both victimization and aggression. 2) To assess variables associated with NPV, particularly with regards to substance use. Method: A cross sectional computerized standardized survey study was conducted to assess NPV, physical and mental health, and substance use among patients presenting to an inner-city ED over two years. Patients (age 19-60) with normal vital signs in an urban ED from 9am-11pm were eligible; pregnant patients and those with a chief complaint of psychiatric evaluation were excluded. Logistic regression analyses were conducted to predict any NPV .Results: 10,744 patients were enrolled (80 % response rate); 14% of the sample reported any past year NPV (9% perpetration; 11% victimization). Findings from regression analyses found participants with any past year NPV (victimization or aggression) were more likely than their counterparts to be younger (OR 1.1), male (2.2), single (1.5), unemployed (1.1), present to the ED for injury (1.9), report poor physical health (1.32) poor mental health (1.9). They were less likely to be African-American (0.8). Alcohol use (1.7), marijuana use (2.4), cocaine use (3.1), prescription drug use (1.4) and past treatment (1.7) were associated with experiencing past year NPV.

Research paper thumbnail of Differences in the Course of Alcohol Withdrawal in Women and Men: A Polish Sample

Alcoholism-clinical and Experimental Research, 1997

A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in w... more A retrospective study compared the course of alcohol withdrawal, including delirium tremens, in women and men hospitalized in the Nowowiejski Hospital in Warsaw from 1973 to 1987. Medical records pertaining to 1179 patients were analyzed; 13.8% of these patients were women and 86.2% were men. The study showed that women began intensive alcohol drinking later than men ( p < O.OOOl ), but the period between the onset of alcohol abuse and the first occurrence of alcohol withdrawal was shorter in women than in men ( p < 0.OOOl ). In the period of heavy drinking before hospitalization, women consumed significantly less alcohol then men ( p < O. OOO1); moreover, women drank nonbeverage alcohol less frequently than men ( p c 0.05). Women were hospitalized substantially longer than men ( p < O.OOOl ), whereas the duration of alcohol withdrawal symptoms at the time of hospitalization was comparable in both groups. Withdrawal seizures were significantly more frequent among men than among women ( p < 0.001). Significant differences in the patients' somatic conditions were not noted between the groups, with the exception of anemia and decreased potassium concentration, which were more frequently observed in women (both p < O.OOOl ), and of increased concentration of ALT and hypoproteinemia, which were more frequent in men (respectively, p < 0.05 and p < 0.01).

Research paper thumbnail of Assessment of the Role of Kindling in the Pathogenesis of Alcohol Withdrawal Seizures and Delirium Tremens

Alcoholism-clinical and Experimental Research, 1999

The aim of this study was to evaluate the hypothetical role of kindling phenomenon in the develop... more The aim of this study was to evaluate the hypothetical role of kindling phenomenon in the development and course of alcohol withdrawal (AW) seizures and delirium tremens (DT). The 2186 medical records of 1179 patients hospitalized in Nowowiejski Hospital in Warsaw from 1973 to 1987 were reviewed using a structured questionnaire. Investigating the role of kindling, a course of consecutive AW episodes of patients hospitalized several times was analyzed. The relationships of withdrawal seizures with the duration of alcohol abuse, the number of prior detoxification episodes, and other variables were also studied. Increasing severity of AW symptoms was observed during the course of consecutive episodes in 22.5% of patients. The first episode of DT was preceded by withdrawal seizures in 11 % of cases. First-ever withdrawal seizures occurred more frequently in patients with head injury in the past and with coexisting symptoms of alcohol liver disease. Occurrence of withdrawal seizures and DTs did not correlate with the number of previous withdrawal episodes or with the length of period of intensive drinking. We concluded that the kindling model could be applied only to some cases in the development of AW seizures and DTs. Kindling should be considered as one of the multiple mechanisms involved in the pathogenesis of AW delirium.

Research paper thumbnail of Correlates of Intimate Partner Violence Among Men and Women in an Inner City Emergency Department

Journal of Addictive Diseases, 2009

The present study surveyed medical and/or injured patients (men and women) in an inner city ED to... more The present study surveyed medical and/or injured patients (men and women) in an inner city ED to examine the rates and correlates of IPV, including substance use patterns. Over a two-year period, participants (n=10,744) self-administered a computerized health survey during their ED visit that included screening items regarding past year history of IPV (including victimization and aggression). Overall, rates of any involvement in past year IPV were 8.7% (7.3% victimization and 4.4% aggression); however, women were more likely than men to report IPV. When examining participants' substance use patterns, participants who reported using both alcohol and cocaine were most likely to report IPV. Predictors of partner aggression and victimization were remarkably similar. This paper provides unique data regarding correlates of past year IPV history among a comprehensive sample of male and female ED patients presenting for medical complaints and/or injury.

Research paper thumbnail of Clinical and Genetic Risk Factors for Suicide under the Influence of Alcohol in a Polish Sample

Alcohol and Alcoholism, 2009

Aims: Despite the large number of suicides that occur with intoxication, little is known about th... more Aims: Despite the large number of suicides that occur with intoxication, little is known about the unique predictors of suicide after alcohol consumption. The goal of this study was to examine clinical and genetic risk factors for alcohol-related suicide. Methods: Data on 162 suicide victims were obtained from post-mortem examinations, police and prosecution inquiries, autopsy protocols and available medical records. Four single nucleotide polymorphisms in the central serotonin system and the renin-angiotensin system related genes previously found to be associated with suicide, alcohol dependence or depression were genotyped. Results: The strongest predictor of suicide under the influence of alcohol was alcohol dependence (OR = 4.63). Those who did not drink alcohol before suicide were more likely to have a diagnosis of major depressive disorder in their medical record and more often had the TT genotype of the tryptophan hydroxylase 2 gene. Conclusions: Suicide under the influence of alcohol is strongly connected with alcohol dependence. The TPH2 gene may play an important role in suicide vulnerability especially in individuals who did not drink alcohol before suicide.

Research paper thumbnail of The CC genotype in HTR2A T102C polymorphism is associated with behavioral impulsivity in alcohol-dependent patients

Journal of Psychiatric Research

High levels of impulsivity can increase the vulnerability for development of alcohol dependence. ... more High levels of impulsivity can increase the vulnerability for development of alcohol dependence. Moreover, impulsivity is considered to be a predictor of poor treatment outcomes. Few studies, however, have directly examined the genetics of impulsivity in alcohol-dependent patients. We analyzed the relationships between a well-recognized genetic marker of serotonin activity and levels of impulsivity as measured by both the Barratt Impulsiveness Scale (BIS-11) and the stopsignal task among 304 alcohol-dependent patients. The stop-signal task was used as an independent, objective method of estimating the level of behavioral impulsivity, and the BIS-11 as a self-report measure of global impulsivity. Blood was collected and analyzed for the T102C (rs6313) polymorphism in the serotonin type 2A receptor gene (HTR2A). Our results indicate a significant association between high levels of behavioral impulsivity and the C/C genotype of rs6313 in alcohol-dependent patients. The CC genotype has been previously found to be associated with a reduction in 5HT2A receptors in the central nervous system. These results support the hypothesis that genetic factors are important determinants of behavioral impulsivity in alcohol-dependent patients, and that the serotonin system plays an important role in establishing its level.

Research paper thumbnail of Impulsive and non-impulsive suicide attempts in patients treated for alcohol dependence

Journal of Affective Disorders, 2009

Background: Suicidal behavior has been recognized as an increasing problem among alcohol-dependen... more Background: Suicidal behavior has been recognized as an increasing problem among alcohol-dependent subjects. The aim of the study was to identify correlates of impulsive and non-impulsive suicide attempts among a treated population of alcohol-dependent patients.

Research paper thumbnail of Association of polymorphisms in HTR2A, HTR1A and TPH2 genes with suicide attempts in alcohol dependence: A preliminary report

Psychiatry Research

We investigated a relationship between selected polymorphisms: rs6313 in HTR2A, rs6295 in HTR1A a... more We investigated a relationship between selected polymorphisms: rs6313 in HTR2A, rs6295 in HTR1A and rs1386494 in TPH2, and suicidal behaviour in 150 alcohol-dependent patients. There was a significant association between more frequent C102C genotype in HTR2A and suicide attempts in alcoholic females. No differences in genotype distribution in HTR1A and TPH2 SNPs were found between patients with and without suicide attempts.

Research paper thumbnail of Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Drug and Alcohol Dependence, 2008

Background: The present study was designed to examine the influence of suicidality on relapse in ... more Background: The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined. Methods: A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months. Results: Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chi-square = 2.37, d.f. = 1, p = 0.124). However, impulsive suicide attempts strongly predicted relapse (OR = 2.81, 95% CI = 1.13-6.95, p = 0.026) and time to relapse (OR = 2.10, 95% CI = 1.18-3.74, p = 0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity.

Research paper thumbnail of P01-56 - Relationship between impulsiveness and depressive symptoms in alcohol-dependent patients

European Psychiatry, 2011

Research paper thumbnail of Association Between Val66Met Brain-Derived Neurotrophic Factor (BDNF) Gene Polymorphism and Post-Treatment Relapse in Alcohol Dependence

Alcoholism-clinical and Experimental Research, 2009

Background: The purpose of this study was to examine relationships between genetic markers of ce... more Background: The purpose of this study was to examine relationships between genetic markers of central serotonin (5-HT) and dopamine function, and risk for post-treatment relapse, in a sample of alcohol-dependent patients.Methods: The study included 154 patients from addiction treatment programs in Poland, who met DSM-IV criteria for alcohol dependence. After assessing demographics, severity of alcohol use, suicidality, impulsivity, depression, hopelessness, and severity of alcohol use at baseline, patients were followed for approximately 1 year to evaluate treatment outcomes. Genetic polymorphisms in several genes (TPH2, SLC6A4, HTR1A, HTR2A, COMT, and BDNF) were tested as predictors of relapse (defined as any drinking during follow-up) while controlling for baseline measures.Results: Of 154 eligible patients, 123 (80%) completed follow-up and 48% (n = 59) of these individuals relapsed. Patients with the Val allele in the Val66Met BDNF polymorphism and the Met allele in the Val158Met COMT polymorphism were more likely to relapse. Only the BDNF Val/Val genotype predicted post-treatment relapse [odds ratio (OR) = 2.62; p = 0.019], and time to relapse (OR = 2.57; p = 0.002), after adjusting for baseline measures and other significant genetic markers. When the analysis was restricted to patients with a family history of alcohol dependence (n = 73), the associations between the BDNF Val/Val genotype and relapse (OR = 5.76, p = 0.0045) and time to relapse (hazard ratio = 4.93, p = 0.001) were even stronger.Conclusions: The Val66Met BDNF gene polymorphism was associated with a higher risk and earlier occurrence of relapse among patients treated for alcohol dependence. The study suggests a relationship between genetic markers and treatment outcomes in alcohol dependence. Because a large number of statistical tests were conducted for this study and the literature on genetics and relapse is so novel, the results should be considered as hypothesis generating and need to be replicated in independent studies.

Research paper thumbnail of The association between insomnia and suicidal thoughts in adults treated for alcohol dependence in Poland

Fuel and Energy Abstracts

Suicidal ideation is elevated for individuals with alcohol use disorders. Sleep problems are asso... more Suicidal ideation is elevated for individuals with alcohol use disorders. Sleep problems are associated with suicide risk and alcohol use, and sleep problems may be associated with suicide risk in those with alcohol use disorders. For the present study, we hypothesized that self-reported sleep problems are associated with suicidal thoughts in a sample of adults seeking treatment for alcohol dependence in Poland. The sample included 304 patients in addiction treatment programs in Warsaw, Poland who met criteria for alcohol dependence. Measures included demographic characteristics, frequency of alcohol use, psychiatric symptoms, suicidal ideation and two measures of insomnia, which differed by time frame: the Athens Insomnia Scale (AIS, past 1 month) and the Sleep Disorders Questionnaire (SDQ-7, past 6 months). Multivariable logistic regression models tested the association between insomnia and suicidal thoughts. In models that controlled for age, gender, and days of recent drinking, both measures of sleep problems were associated with suicidal ideation: AOR=2.01 (95% CI: 1.50-2.70) [AIS] and 1.73 (95% CI: 1.29-2.31) [SDQ-7]. The association of sleep problems, as measured by the AIS, with suicide remained significant after adjusting for psychiatric symptoms, although the estimated effect size was smaller (AOR=1.47; 95% CI: 1.05-2.06). Among Polish adults with alcohol dependence, insomnia severity was associated with suicidal ideation. This finding highlights the need to assess for sleep problems, in addition to suicidal thoughts, in alcohol treatment settings and to further examine the potential consequences of poor sleep in this population.

Research paper thumbnail of Sleep and body mass index in depressed children and healthy controls

Sleep Medicine, 2010

Higher body mass index (BMI) has been associated with more sleep disturbance and depressive sympt... more Higher body mass index (BMI) has been associated with more sleep disturbance and depressive symptoms, but the combined effects of depression and BMI on sleep have not been studied in children. This study evaluated the relationship between BMI and polysomnography in children with major depressive disorder (MDD), compared to healthy controls (HCs).The sample of 104 subjects included 72 children, 8–17 years old, with MDD and 32 similarly aged HCs with no personal or family history of psychopathology. BMI was adjusted using the CDC formula for percentiles by age. Subjects were categorized as (1) normal weight (5–84th percentile) or (2) high weight, which included at risk of overweight and overweight (⩾85th percentile). All analyses were adjusted for sex and Tanner maturational stage scores.In the MDD group only, higher BMI was significantly correlated with decreased sleep efficiency, decreased percentage of rapid eye movement sleep (REM%), and higher percentage of time spent awake and moving (TSPAM). In the HC group only, higher BMI correlated with higher total sleep time. Multivariate analyses revealed significant interactions between the BMI and diagnostic groups for several REM sleep parameters, such that high-weight children from the HC and MDD groups had increases and decreases in REM sleep, respectively. TSPAM increased in the high-weight MDD group, but decreased in the high-weight HC group.Although limited by small sample size, these findings suggest that children and adolescents with MDD and a high BMI have more fragmented sleep than other children. The increased REM sleep patterns observed with MDD in this and other studies normalized in high-weight children with MDD. Prevention and treatment strategies should target both sleep and weight as factors that can potentially influence the development and course of MDD.