Affichage des articles dont le libellé est alcoolisme. Afficher tous les articles
Affichage des articles dont le libellé est alcoolisme. Afficher tous les articles

28 mai 2017

Les soins primaires centrés sur le patient pour les adultes à risque élevé pour les AUD: le choix d'options de consommation plus saine dans le cadre du test primaire CarE (CHOICE).

Aperçu: G.M.
La plupart des patients atteints de troubles liés à l'alcool (AUD) ne reçoivent jamais de traitement anti-alcool, et les experts ont recommandé la gestion des AUD dans les soins primaires. Le choix des options de consommation plus saine dans le cadre du test CarE primaire (CHOICE), était un essai randomisé d'efficacité contrôlée d'une nouvelle intervention pour les patients de soins primaires à haut risque pour les AUD. Ce rapport décrit le fondement conceptuel et scientifique du modèle de soins CHOICE, éléments critiques de la conception de l'essai CHOICE, conforme au modèle de description et de réplication d'intervention (TIDieR), aux résultats du recrutement et aux 
caractéristiques de base de l'échantillon inscrit.
Au total, 304 patients ont consenti à participer au procès CHOICE. Parmi les participants consentants, 90% étaient des hommes, l'âge moyen était de 51 (de 22 à 75 ans) et la plupart des critères de DSM-IV pour l'abus d'alcool (14%) ou la dépendance (59%). Beaucoup de participants ont également montré des résultats positifs pour l'usage du tabac (44%), la dépression (45%), les troubles anxieux (30-41%) et les troubles non-tabagiques (19%). 



Addict Sci Clin Pract. 2017 May 17;12(1):15. doi: 10.1186/s13722-017-0080-2.

Patient-centered primary care for adults at high risk for AUDs: the Choosing Healthier Drinking Options In primary CarE (CHOICE) trial

Author information

1
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, USA. Bradley.K@ghc.org
2
Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA. Bradley.K@ghc.org.
3
Department of Health Services, University of Washington, Seattle, WA, USA. Bradley.K@ghc.org.
4
Department of Medicine, University of Washington, Seattle, WA, USA. Bradley.K@ghc.org.
5
Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, USA.
6
Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA.
7
Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, Columbus, OH, USA.
8
Health Services Research and Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
9
General Medicine Service, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
10
Department of Medicine, University of Washington, Seattle, WA, USA.
11
Center of Excellence in Substance Abuse Treatment and Education (CESATE), Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA.
12
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
13
Department of Health Services, University of Washington, Seattle, WA, USA.

Abstract

BACKGROUND:

Most patients with alcohol use disorders (AUDs) never receive alcohol treatment, and experts have recommended management of AUDs in primary care. The Choosing Healthier Drinking Options In primary CarE (CHOICE) trial was a randomized controlled effectiveness trial of a novel intervention for primary care patients at high risk for AUDs. This report describes the conceptual and scientific foundation of the CHOICE model of care, critical elements of the CHOICE trial design consistent with the Template for Intervention Description and Replication (TIDieR), results of recruitment, and baseline characteristics of the enrolled sample.

METHODS:

The CHOICE intervention is a multi-contact, extended counseling intervention, based on the Chronic Care Model, shared decision-making, motivational interviewing, and evidence-based options for managing AUDs, designed to be practical in primary care. Outpatients who received care at 3 Veterans Affairs primary care sites in the Pacific Northwest and reported frequent heavy drinking (≥4 drinks/day for women; ≥5 for men) were recruited (2011-2014) into a trial in which half of the participants would be offered additional alcohol-related care from a nurse. CHOICE nurses offered 12 months of patient-centered care, including proactive outreach and engagement, repeated brief motivational interventions, monitoring with and without alcohol biomarkers, medications for AUDs, and/or specialty alcohol treatment as appropriate and per patient preference. A CHOICE nurse practitioner was available to prescribe medications for AUDs.

RESULTS:

A total of 304 patients consented to participate in the CHOICE trial. Among consenting participants, 90% were men, the mean age was 51 (range 22-75), and most met DSM-IV criteria for alcohol abuse (14%) or dependence (59%). Many participants also screened positive for tobacco use (44%), depression (45%), anxiety disorders (30-41%) and non-tobacco drug use disorders (19%). At baseline, participants had a median AUDIT score of 18 [Interquartile range (IQR) 14-24] and a median readiness to change drinking score of 5 (IQR 2.75-6.25) on a 1-10 Likert scale.

CONCLUSION:

The CHOICE trial tested a patient-centered intervention for AUDs and recruited primary care patients at high risk for AUDs, with a spectrum of severity, co-morbidity, and readiness to change drinking. Trial registration The trial is registered at clinicaltrial.gov (NCT01400581).

KEYWORDS:

Alcohol use disorder; Brief interventions; Care management; Chronic Care Model; Intervention; Medical management; Patient-centered care; Primary care; Shared decision making; Veterans
PMID: 28514963
PMCID: PMC5436432
DOI: 10.1186/s13722-017-0080-2

22 mai 2017

Prévalence des troubles extériorisants et troubles du spectre de l'autisme chez les enfants avec un trouble du spectre de l'alcoolisation fœtale: examen systématique et méta-analyse

Aperçu: G.M.
En raison de leurs altérations du système nerveux central, les enfants souffrant de troubles du spectre de l'alcoolisation fœtale (ETCAF) présentent généralement des comportements extérieurs tels que l'hyperactivité, l'impulsivité et / ou la délinquance. Le but de la présente étude était d'estimer la prévalence des troubles du développement neurologique avec des comportements émergents éminents, à savoir le trouble de l'hyperactivité à déficit de l'attention (TDAH), le trouble de la conduite (CD), le trouble défiant l'opposition (ODD), ainsi que le trouble du spectre autistique (TSA) Parmi les enfants avec ETCAF. Une recherche systématique complète de la littérature a été réalisée, suivie de méta-analyses aux effets aléatoires spécifiques au trouble. Parmi les troubles étudiés, le TDAH était le trouble co-morbide le plus fréquent chez les enfants avec ETCA (52,9%), suivi de l'ODD (12,9%), du CD (7,0%) et du TSA (2,6%).
Par rapport à la population générale des États-Unis, ces taux sont nettement plus élevés: 15 fois plus élevé pour le TDAH, deux fois plus élevé pour les TSA, trois fois plus élevé pour le CD et cinq fois plus élevé pour les ODD.

Biochem Cell Biol. 2017 May 18. doi: 10.1139/bcb-2017-0014.

Prevalence of Externalizing Disorders and Autism Spectrum Disorder among Children with Fetal Alcohol Spectrum Disorder: Systematic Review and Meta-analysis

Lange S1,2, Rehm J1,3,4,5, Anagnostou E6,3,7, Popova S1,4,3,8.

Author information

1
Centre for Addiction and Mental Health, 7978, Institute for Mental Health Policy Research, Toronto, Ontario, Canada.
2
University of Toronto, 7938, Institute of Medical Science, Toronto, Ontario, Canada ; shannon.lange@camh.ca.
3
University of Toronto, 7938, Institute of Medical Science, Toronto, Ontario, Canada.
4
University of Toronto, 7938, Dalla Lana School of Public Health, Toronto, Ontario, Canada.
5
Technische Universitat Dresden, 9169, Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies, Dresden, Sachsen, Germany ; jtrehm@gmail.com.
6
Holland Bloorview Kids Rehabilitation Hospital, 37205, Toronto, Ontario, Canada.
7
University of Toronto, 7938, Department of Pediatrics, Toronto, Ontario, Canada ; eanagnostou@hollandbloorview.ca.
8
University of Toronto, 7938, Factor-Inwentash Faculty of Social Work, Toronto, Ontario, Canada ; lana.popova@camh.ca.

Abstract

Due to their central nervous system impairments, children with Fetal Alcohol Spectrum Disorder (FASD) commonly exhibit externalizing behaviours such as hyperactivity, impulsivity, and/or delinquency. The purpose of the current study was to estimate the prevalence of neurodevelopmental disorders with prominent externalizing behaviours, namely Attention-Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD), Oppositional Defiant Disorder (ODD), as well as Autism Spectrum Disorder (ASD) among children with FASD. A comprehensive systematic literature search was performed, followed by disorder-specific random-effects meta-analyses. Of the disorders investigated, ADHD was found to be the most common co-morbid disorder among children with FASD (52.9%), followed by ODD (12.9%), CD (7.0%), and ASD (2.6%). When compared to the general population of the United States, these rates are notably higher: 15-times higher for ADHD, two-times higher for ASD, three-times higher for CD, and five-times higher for ODD. The results call attention to the need for identifying a distinct neurodevelopmental profile to aid in the accurate identification of children with FASD and the discrimination of FASD from certain idiopathic neurodevelopmental disorders.
PMID: 28521112
DOI: 10.1139/bcb-2017-0014

21 septembre 2014

P-4three cases of alcoholism with autism spectrum disorder

Traduction: G.M.

Alcohol Alcohol. 2014 Sep;49 Suppl 1:i54. doi: 10.1093/alcalc/agu054.4.

3 cas d'alcoolisme avec un trouble du spectre autistique

Author information

  • Medical Office, Asahikawa Keisenkai Hospital, Japan.

Abstract

INTRODUCTION:

The relationship between alcoholism and autism spectrum disorder (ASD) has been the subject of much recent research. We report herein three patients with alcoholism and a history of ASD.
La relation entre le trouble du spectre autistique (TSA) et l'alcoolisme  a fait l'objet de beaucoup de recherches récentes. Nous rapportons ici le cas de trois patients souffrant d'alcoolisme et ayant un TSA. 

ETHICAL CONSIDERATIONS:

Consent was directly obtained from Patients 1 and 2. Care was taken to protect the identities of all three patients.

CASE REPORTS:

Patient 1 was a 34-year-old man. From adolescence onwards,he had few friends and tended to isolate himself. At 21 years old, he began drinking alcohol due to the stress of interpersonal communication. At 29 years old, he was admitted with alcohol withdrawal symptoms. Post-discharge, no relapse has occurred. ASD was confirmed on psychological testing. Patient 2 was a 38-year-old man with a long-term history of anthropophobia. He entered employment at the age 19, but quit employment at age 30 due to the stress of interpersonal communication. After turning to alcohol in order to reduce anxiety, he became an alcoholic. He was admitted at 36 years old. Post-discharge, no relapse has occurred. ASD was confirmed on psychological testing. Patient 3 was a 28-year-old woman with a long-term history of stranger anxiety. She began drinking excessively in order to reduce the stress of interpersonal communication. At 26 years old, she was admitted for alcohol epilepsy. Post-discharge, no relapse has occurred. ASD was confirmed on psychological testing.

DISCUSSION:

The following characteristics were common to all three patients: ASD; interpersonal communication disorder from a young age; development of alcoholism at a young age; and no difficulty maintaining abstinence after successfully quitting. In connection with alcohol consumption, ASD traits, including strong preferences, obsessive-compulsive behaviors, and stereotypies, reportedly result in early addiction, but also work favorably to enable maintained abstinence. These characteristics are consistent with the present patients. The identification of a history of ASD is important for the successful management of alcoholism.
Les caractéristiques suivantes sont communes aux trois patients: TSA; trouble de la communication interpersonnelle à partir d'un jeune âge; le développement de l'alcoolisme à un jeune âge; et pas de difficulté à maintenir l'abstinence avec succès après avoir arrêté.
Dans le cadre de la consommation d'alcool, les traits TSA, incluant de fortes préférences, des troubles obsessionnels-compulsifs et des stéréotypies, rapportés résultent en une addiction précoce, mais aussi concourent favorablement à la capacité de rester abstinent.
Ces caractéristiques sont compatibles avec les présents patients.  
L'identification d'un TSA est importante pour la bonne gestion de l'alcoolisme. 


© The Author 2014. Medical Council on Alcohol and Oxford University Press. All rights reserved.
PMID: 25221235

25 août 2014

Autism and attention-deficit/hyperactivity disorder among individuals with a family history of alcohol use disorders

Traduction: G.M.

Elife. 2014 Aug 19;3:e02917. doi: 10.7554/eLife.02917.

Trouble de l'autisme et de déficit d'attention / hyperactivité chez les personnes ayant des antécédents familiaux de consommation d'alcool des troubles

Author information

  • 1Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, United States jan.sundquist@med.lu.se
  • 2Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, United States.
  • 3Center for Primary Health Care Research, Lund University, Malmö, Sweden jianguang.ji@med.lu.se

Abstract

Recent studies suggest de novo mutations may involve the pathogenesis of autism and attention-deficit/hyperactivity disorder (ADHD). Based on the evidence that excessive alcohol consumption may be associated with an increased rate of de novo mutations in germ cells (sperms or eggs), we examine here whether the risks of autism and ADHD are increased among individuals with a family history of alcohol use disorders (AUDs). The standardized incidence ratios (SIRs) of autism and ADHD among individuals with a biological parental history of AUDs were 1.39 (95% CI 1.34-1.44) and 2.19 (95% CI 2.15-2.23), respectively, compared to individuals without an affected parent. Among offspring whose parents were diagnosed with AUDs before their birth, the corresponding risks were 1.46 (95% CI 1.36-1.58) and 2.70 (95% CI 2.59-2.81), respectively. Our study calls for extra surveillance for children with a family history of AUDs, and further studies examining the underlying mechanisms are needed.

Résumé

Des études récentes suggèrent que des mutations de novo peuvent impliquer la pathogénie de l'autisme et du trouble de déficit d'attention/hyperactivité (TDAH).  
Sur la base de la preuve que la consommation excessive d'alcool peut être associée à une augmentation du taux de mutations de novo dans les cellules germinales (spermatozoïdes ou ovules), nous examinons ici si les risques d'autisme et de TDAH sont augmentés chez les personnes ayant des antécédents familiaux des troubles de consommation d'alcool (AUDs). 
Les ratios d'incidence standardisés (SIR) de l'autisme et du TDAH chez les personnes ayant des antécédents de AUDs chez les parents biologiques  étaient de 1,39 (IC à 95% 1,34 à 1,44) et de 2,19 (IC 95% 2.15 à 2.23), respectivement, par rapport aux personnes sans parent affecté .  
Parmi les enfants dont les parents ont été diagnostiqués avec AUDs avant leur naissance, les risques correspondants étaient de 1,46 (IC à 95% 1,36 à 1,58) et de 2,70 (IC à 95% 2,59 à 2,81), respectivement. 
Notre étude appelle à une surveillance accrue des enfants ayant des antécédents familiaux de AUDs, et d'autres études portant sur les mécanismes sous-jacents sont nécessaires.
 
DOI: http://dx.doi.org/10.7554/eLife.02917.001. 
Copyright © 2014, Sundquist et al.

PMID: 25139954