Chronic alcohol use may have direct or indirect neurotoxic effects on the brain that can lead to cognitive impairment. However, the precise relationship between alcohol and dementia remains unclear. There are several epidemiological studies suggest that the protective effect of light-moderate alcohol drinking in dementia. But obviously the heavy alcohol drinking can lead to brain damage and increase the risk of various types of dementia. The clinicopathological issues and criteria regarding so-called 'alcoholic dementia' remain under debate. Alcohol-induced persisting amnestic disorder, alcohol-induced persisting dementia, and Wernicke-Korsakoff syndrome (thiamine deficiency) may constitute distinct disease entities, but they may also share some common features. Based on this theory, Oslin and colleagues proposed the broader diagnostic scheme and criteria for Alcohol Related Dementia (ARD), which may include cases of Wernicke-Korsakoff syndrome and also other cases of dementia that appear to be alcohol-related. In pathogenesis of the alcoholic dementia, the chronic exposure to ethanol results in the adaptive up-regulation of NMDA receptor sensitivity, which can result in an increased vulnerability to glutamate induced excitotoxicity. Despite the clinical importance of ARD, few medical treatments for ARD have been proposed and studied. Most of all, the gold standard of the treatment in alcoholic dementia is the maintaining abstinence. Some therapeutic trials with cholinesterase inhibitors (donepezil and rivastigmine) and memantine (NMDA receptor antagonist) have been conducted for the patients with Wernicke-Korsakoff syndrome and alcohol-related dementia, and these studies reported favorable outcomes. Especially memantine can be a more effective agent in the treatment of alcoholic dementia because of anti-craving effect reported in several studies.
Alcohol Amnestic Disorder ; Alcohol Drinking ; Alcoholics ; Brain ; Cholinesterase Inhibitors ; Cognition ; Dementia ; Ethanol ; Glutamic Acid ; Humans ; Korsakoff Syndrome ; Memantine ; N-Methylaspartate ; Up-Regulation

It was not above two or three decades from the changes began that regarding nicotine dependence as a kind of addictive disorder and a therapeutic target. Despite the short period of history, lots of medications were developed and showing significant clinical outcomes. In this review, we introduce the both of medications available at this time and in the status of developing for nicotine dependence. The clinical efficacies, practical ways of prescription, and common adverse events of the medications currently available are described through the survey of literatures. The novel medications in the process of developing are arranged by the proposed mechanism of action and summarized the phases of clinical trials at present. Among the diverse pharmacological tools now available, nicotine replacement and bupropion could be the first-line recommendation drugs and nortriptyline and clonidine could be the second-line recommendation drugs. Other medications like several antidepressants (e.g., moclobemide), buspirone, and naltrexone may be helpful in some specific population. Most of medications currently available have uncertainties in the aspects of their mechanisms of action except nicotine replacement materials; however, medications in developing have clearer neurobiological basis in their applications. Therefore, we can expect higher treatment outcomes by new products. Additionally, introduction of nicotine vaccines for high-risk group is drawing near. It could be possible for the individualizing for strategies of smoking cessation according to the patients' specific situation in a future.
Antidepressive Agents ; Bupropion ; Buspirone ; Clonidine ; Naltrexone ; Nicotine* ; Nortriptyline ; Prescriptions ; Smoking Cessation ; Tobacco Use Disorder* ; Vaccines

Alcohol-induced cognitive disorder is a very severe problem in problem alcohol drinker and alcohol itself seems to be one of the main causalities in the development of senile dementia. However, the spectrum of alcohol induced cognitive disorder is quite broad, for example, it covered from alcohol-induced persistent amnestic disorder to Wernicke-Korsakoff syndrome and alcohol-induced persistent dementia. By that reason, broad spectrum of cognitive impairment by excessive alcohol drinking is regarded as alcohol related dementia. The pharmacological treatment is not well established yet in alcohol related dementia, except Wernicke-Korsakoff syndrome which is definitely related to thiamine deficiency. Therefore we introduced that some reports about the clinical efficacies by rivastigmine or donepezil trial and recent outcomes of memantine trial by authors in this review.
Alcohol Drinking ; Alzheimer Disease ; Dementia ; Indans ; Korsakoff Syndrome ; Memantine ; Phenylcarbamates ; Piperidines ; Rivastigmine ; Thiamine ; Thiamine Deficiency

Nicotine is the major substance that accounts for the addictive nature of smoking. Nicotine induces neurobiological and behavioral responses through diverse neurochemical mechanisms over the central nervous system. The brain reward system, particularly the dopaminergic pathway from the ventral tegmental area to nucleus accumbens, is central to understanding the behavioral reinforcement underlying substance addictions such as the addiction to nicotine. Nicotine acts as an agonist provoking activation or desensitization of nicotinic acetylcholine receptors in different brain areas including the brain reward system. Nicotine also indirectly influences the glutaminergic, GABAergic, noradrenergic, and serotonergic neurotransmission that lead ultimately to activation of the dopaminergic pathway in the brain reward system. Chronic exposure to nicotine activates neuroadaptation and associative learning with the nicotine-related stimulus through dopaminergic or cholinergic systems, which can lead to nicotine dependence or withdrawal. In sum, the neurobiological processes described above are deeply involved in the basis of nicotine dependence and underlie the frequent failure of attempts to quit smoking. In this review we discuss the neurobiological mechanisms of nicotine addiction focusing on the roles of the nicotinic acetylcholine receptor.
Brain ; Central Nervous System ; Dopamine ; Learning ; Nicotine ; Nucleus Accumbens ; Receptors, Nicotinic ; Reinforcement (Psychology) ; Reward ; Smoke ; Smoking ; Synaptic Transmission ; Tobacco Use Disorder ; Ventral Tegmental Area

Nicotine is the major substance that accounts for the addictive nature of smoking. Nicotine induces neurobiological and behavioral responses through diverse neurochemical mechanisms over the central nervous system. The brain reward system, particularly the dopaminergic pathway from the ventral tegmental area to nucleus accumbens, is central to understanding the behavioral reinforcement underlying substance addictions such as the addiction to nicotine. Nicotine acts as an agonist provoking activation or desensitization of nicotinic acetylcholine receptors in different brain areas including the brain reward system. Nicotine also indirectly influences the glutaminergic, GABAergic, noradrenergic, and serotonergic neurotransmission that lead ultimately to activation of the dopaminergic pathway in the brain reward system. Chronic exposure to nicotine activates neuroadaptation and associative learning with the nicotine-related stimulus through dopaminergic or cholinergic systems, which can lead to nicotine dependence or withdrawal. In sum, the neurobiological processes described above are deeply involved in the basis of nicotine dependence and underlie the frequent failure of attempts to quit smoking. In this review we discuss the neurobiological mechanisms of nicotine addiction focusing on the roles of the nicotinic acetylcholine receptor.
Brain ; Central Nervous System ; Dopamine ; Learning ; Nicotine ; Nucleus Accumbens ; Receptors, Nicotinic ; Reinforcement (Psychology) ; Reward ; Smoke ; Smoking ; Synaptic Transmission ; Tobacco Use Disorder ; Ventral Tegmental Area

Alcohol and nicotine dependencies are known to be severe disorders on their own and particularly they get worse if they coexist. However, few optimal therapeutic approaches are available for comorbid nicotine and alcohol dependencies, although studies have suggested that more than 95% of alcoholics had comorbid nicotine dependence. Nonetheless patients, caregivers, and even health professionals gave a failure to notice of the health problems caused by nicotine dependence. In addition, some clinicians believe that concomitant intervention of nicotine dependence may have the risks increased during treatments of alcohol dependence, possibly by aggravating symptoms of alcohol dependence or provoking relapse. However, we need to give more attention onto the fact that harmful effects of alcohol and nicotine would be amplified when they coexist. In fact currently available data showed that medical morbidity may be dramatically increased when the two psychiatric conditions coexist. Furthermore, alcoholics have an increased tendency of smoking during a recovery phase from alcohol dependence and even may suffer more complications from smoking. Hence we will review the health risks posed by concurrent alcohol and nicotine dependencies as well as explore the effects of additional smoking cessation therapy on the quitting rate, the alteration of drinking behavior and relapse rate of alcohol dependence, in comorbid alcohol and nicotine patients. Finally proper smoking cessation therapy should be also provided for motivated patients to quit smoking at proper treatment phase and routine clinical advices should be appropriately provided for patients who are not motivated to quit smoking as well in clinical practice.
Alcoholics ; Alcoholism ; Caregivers ; Comorbidity ; Drinking Behavior ; Health Occupations ; Humans ; Nicotine ; Recurrence ; Smoke ; Smoking ; Smoking Cessation ; Tobacco Use Disorder

Alcohol use disorder is a kind of chronic illness that is difficult to treat. The disorder often recurs easily and patients visit the outpatient clinic while intoxicated. Therefore, is often too difficult to treat all people of concern, i.e., the caregiver, patient, and doctor, due to the frequent helpless and hopeless relapse. If the patient has severe withdrawal symptoms or poor physical condition, it is very difficult to maintain treatment at an outpatient clinic. On the other hand, many patients abstain or reduce drinking and go on to live a sober life by outpatient-based management. In addition, psychosocial treatment techniques and efficient medications are available at the level of a psychiatric outpatient clinic. Under the scope and limitations of outpatient-based approaches, patients with alcohol use disorder can develop a new life called ‘recovery’ with the help of psychiatrists, by the way of motivating changes, correcting cognitive errors, establishing effective coping skills, utilizing external resources actively, and facilitating healthy roles with their families.
Adaptation, Psychological ; Alcoholism ; Ambulatory Care Facilities ; Caregivers ; Chronic Disease ; Drinking ; Drug Therapy ; Hand ; Humans ; Outpatients ; Psychiatry ; Psychotherapy ; Recurrence ; Substance Withdrawal Syndrome

OBJECTIVES: This study was carried out to explore the relationship between the impulsiveness and aggressiveness in adolescent prisoners and a polymorphism of the promoter region of the 5-HTT gene (5HTTLPR). METHODS: 198 adolescent prisoner volunleers and 68 male medical students as a normal control group were included in this study. The characteristics of adolescent prisoners and control subjects were assessed by using Barratt Impulsiveness Scale and Achenbach's Child Behavior Checklist (CBCL). Genotypes of 5-HTTLPR were analysed with the primers flanking the regulatory region from genomic DNA. RESULTS: Adolescent prisoners were significantly more aggressive (t=4.780, df=248, p<0.001), impulsive (t=5.220, df=248, p<0.001), and delinquent (t=12.299, df=173.554, p<0.001) than control group. There were no statistically significant differences in genotype frequencies of 5-HTT between adolescent prisoners and control group (chi2=2.378, df=6, p=0.882). There were no statistically significant differences in allelic frequencies of 5-HTT between adolescent prisoners and control group (chi2=2.027, df=4, p=0.731). CONCLUSION: In view of the negative results in the association of the promoter region polymorphism of serotonin transporter and the characteristics of adolescent prisoner, the promoter region polymorphism dose not appear to be a candidate gene for the characteristics of adolescent prisoner group. Further systematic researches including varying variables of phenotype would be required.
Adolescent* ; Checklist ; Child ; Child Behavior ; DNA ; Genotype ; Humans ; Male ; Phenotype ; Prisoners* ; Prisons* ; Promoter Regions, Genetic* ; Regulatory Sequences, Nucleic Acid ; Serotonin Plasma Membrane Transport Proteins* ; Serotonin* ; Students, Medical

Objectives : A diverse range of adverse effects has been linked to the application of antidepressants for the treatment of depressive disorder. Recently, evidence has been emerging of the adverse metabolic effects of antidepressants. This study investigated the effects of antidepressants on plasma glucose and other factors in the fat and muscle tissue relating to metabolism. METHODS : Long-Evans-Tokushima-Ostuka (LETO) rats were used to evaluate the effects of different antidepressants. Amitriptyline, fluoxetine, and mirtazapine were administered to each of three subgroups for 4 weeks, between 11 and 15 weeks old, while a fourth subgroup was administered no antidepressant during the same period. Changes of weight and daily intake were monitored. Tissues and blood were collected at 15 weeks. RESULTS : The fluoxetine subgroup showed lower weight gain and lower food efficacy ratio than did the other subgroups. Blood glucose and other circulating factors showed no significant differences among groups, except for the leptin levels of the fluoxetine subgroup. However, the amitriptyline and mirtazapine subgroups showed similar patterns in the response of mRNA expression of peroxisome proliferator-activated receptors gamma cofactor-1 and uncoupling protein-1, 2, 3. CONCLUSION : These results could indicate possible differences in metabolic response based on the kind of antidepressant used.
Amitriptyline ; Animals ; Antidepressive Agents ; Blood Glucose ; Depressive Disorder ; Energy Metabolism ; Fluoxetine ; Glucose ; Leptin ; Mianserin ; Muscles ; Peroxisome Proliferator-Activated Receptors ; Plasma ; Rats ; RNA, Messenger ; Weight Gain

OBJECTIVES: The aim of this study was to explore trends associated with the amendment of The Mental Health Welfare Act by comparing involuntary admission processes in Asian countries. METHODS: We obtained copies of the Mental Health Acts for four East Asian countries ??Korea, Japan, Singapore, and Taiwan (China). We then analyzed the contents of the acts including their definitions of mentally ill patients, the types of hospitalization, and the procedures for involuntary admission. RESULTS: The Japanese provision for involuntary admission was the prototype used for the Korean system prior to the total revision of the Korean system in 2016. Regardless, Korea and Japan still regard family members as pivotal in deciding on involuntary admission. Taiwan and Singapore acts are characterized by the involvement of government or government-designated medical practitioners, not caregivers, in the hospitalization process. In Taiwan, involuntary admission is decided by a judgment of a review committee and is a task of the government. In Singapore, the opinions of experts are considered when making the initial decision on involuntary hospitalization, whereas a judicial decision is essential for extension of that hospitalization. CONCLUSION Despite cultural and historical similarities, the systems of involuntary admission were considerably different across the countries. We observed a reduction in the role of family guardians and an increase in the use of more objective screening processes. All four countries were in the process of applying those recommendations from international organizations that were in accordance with their society/culture. There may be a need to partially amend The Mental Health Welfare Act in Korea in order to protect the human rights of psychiatric patients while maintaining a stable therapeutic environment.