酒精使用障碍的药物治疗课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,*,酒精使用障碍的药物治疗进展,Medication for Alcohol Use Disorders,酒精使用障碍的药物治疗进展Medication for Al,交流提纲,交流提纲,概述,酒精使用障碍（alcohol use disorder，AUD）,酒精依赖,酒精戒断反应,酒精所致精神病,酒精所致人格改变,酒精所致智能障碍,概述酒精使用障碍（alcohol use disorder，,The association between alcohol use and psychosis was documented,as early as 1847 by Marcel.,He was credited for differentiating the disorder from delirium tremens,(Johansson 1961).,The association between alcoho,Kraepelin(1913)and other authors also reported a distinct psychotic syndrome associated with alcoholism that differed from delirium tremens(alcohol withdrawal with delirium),Wernickes encephalopathy,Korsakoffs psychosis and alcohol-induced dementia(Glass 1989a).,Kraepelin(1913)and other aut,Psychotic manifestations may also occur in other general medical or neurological disorders associated with alcohol dependence(Greenberg and Lee 2001).,Psychotic manifestations may a,Early descriptions of a distinct psychotic syndrome associated with excessive alcohol use were based on case-studies,and clinical observation.,Bleuler(1916)termed the condition,alcoholic hallucinosis.,Early descriptions of a distin,Follow-up studies on patient groupsappeared from around the 1950s and described the features of what is currently known as:,Alcohol-induced Psychotic Disorder(AIPD)(APA,DSM-IV-TR 2000;DSM-5,2013),or Psychotic Disorder due to the use of Alcohol(WHO ICD-10 1993).,Follow-up studies on patient g,Essentially the DSM criteria require:,(A)the presence of prominent hallucinations or delusions,(B)evidence from the history,physical examination or laboratory findings that the symptoms developed within or during a month of alcohol intoxication or withdrawal.,The symptoms are(C)not better accounted for,by a psychotic disorder that is not substance-induced(e.g.symptoms precede substance use)and(D)do not exclusively occur during the course of a delirium.,Essentially the DSM criteria r,DSM 5 stipulates that,the period of onset should be“during or soon”after intoxication,or withdrawal of alcohol and that the disturbance should,cause clinical significant distress or impairment.,DSM 5 stipulates that,Initial studies on groups of patients did not compare patients with other diagnostic groups(Benedetti 1952;Burton-,Bradley 1958;Victor and Hope 1958).,Conclusions were based on clinical observations and follow-up studies over,variable periods of time.,From the 1960s studies adopted a more systematic research approach(Glass 1989a).,Initial studies on groups of p,Epidemiology,Whereas the lifetime risk for alcohol dependence is 1015%,(males)and 35%(females)(Schuckit 2005),only 23%of,such patients had psychotic symptoms(Victor and Adams,1953).,EpidemiologyWhereas the lifeti,However,these figures did not exclude patients,experiencing psychotic symptoms associated with alcoholwithdrawal,delirium.It is estimated that AIPD patients represent,a minority(33.1%)of the group of patients experiencing,psychotic symptoms associated with alcohol dependence(the,rest being mostly associated with alcohol withdrawal delirium),(Soyka et al.1988).,However,these figures did not,The prevalence of AIPD in alcohol,dependent patients varied between 0.4%and 0.7%(inpatients,Germany)(Soyka 2008a),4%(inpatients,lifetime,Finland)(Perl et al.2010)and 12.36%(Nepal)(Sedain,2013).A lifetime prevalence of 0.41%was reported in the,general population(Perl et al.2010).,The prevalence of AIPD in alco,The German study,excluded patients with other substance abuse,whilst the,Finnish study included comorbid lifetime substance use,(20%)and other psychiatric disorders(76%).,The German study,Alcohol-withdrawal delirium was included in the alcohol-induced,psychotic syndrome(AIPS)group and 13%of AIPD patients,developed a primary psychosis.,Alcohol-withdrawal delirium wa,Overestimation of AIPD,prevalence may therefore be possible in the Finnish study,as,these comorbid disorders may also be associated with psychotic,features.,Overestimation of AIPD,Underreporting of AIPD is however also,possible because some patients may receive other diagnoses,eg.“dual diagnosis”,alcohol-withdrawal delirium etc.or may,not seek treatment because of favourable outcome(Soyka,2008a;Perl et al.2010;Kumar and Bankole 2010).,Underreporting of AIPD is howe,AIPS was associated with a high mortality rate(37%over 8 years),(Perl et al.2010),and“AIPD”(including patients with delirium tremens)was also identified as a risk factor for premature death(Mattisson et al.2011).,AIPS was associated with a hig,No significant demographic differences(age,education,marital status and employment)were found between male,alcoholic patients with and without a history of psychosis,(Tsuang et al.1994).,No significant demographic dif,The age of onset of alcoholism reported,in AIPD varied between 21.4(Jordaan et al.2009),and,29.1 years(Tsuang et al.1994)with the latter study showing,a significantly younger age of onset of alcoholism for AIPD,patients than their non-psychotic male counterp