Suchergebnisse

Background Recently, there has been a revived interest in the validity of the Penrose hypothesis, which was originally postulated over 75 years ago. It suggests an inverse relationship between the numbers of psychiatric hospital beds and the sizes of prison population. This study aims to investigate the association between psychiatric hospital beds and prison populations in a large sample of 26 European countries between 1993 and 2011. Methods The association between prison population sizes and numbers of psychiatric hospital beds was assessed by means of Spearman correlations and modeled by a mixed random coefficient regression model. Socioeconomic variables were considered as covariates. Data were retrieved from Eurostat, the statistical office of the European Union. Outcomes Mean Spearman correlation coefficients between psychiatric beds and prison population showed a significant negative association (-0.35; p = <0.01). However, in the mixed regression model including socioeconomic covariates there were no significant fixed parameter estimates. Meanwhile, the covariance estimates for the random coefficients psychiatric beds (σ2 = 0.75, p = <0.01) and year (σ2 = 0.0007, p = 0.03) yielded significant results. Interpretation These findings do not support the general validity of the Penrose hypothesis. Notably, the results of the mixed-model show a significant variation in the magnitude and direction of the association of psychiatric hospital bed numbers and the prison population sizes between countries. In this sense, our results challenge the prevalent opinion that a reduction of psychiatric beds subsequently leads to increasing incarcerations. These findings also work against the potential stigmatization of individuals suffering from mental disorders as criminals, which could be an unintentional byproduct of the Penrose hypothesis.

<b><i>Aims:</i></b> Patients with alcohol use disorder (AUD) frequently suffer from cognitive deficits ranging from mild symptoms to most severe forms. Wernicke encephalopathy (WE), caused by thiamine deficiency, is a potentially fatal syndrome characterized by the clinical triad of ophthalmoplegia, ataxia, and confusion. WE frequently presents in patients with AUD and, if left untreated, can progress to Wernicke-Korsakoff syndrome, which constitutes severe anterograde amnesia, confabulation, and behavioral abnormalities. Due to oftentimes indistinct clinical presentation, WE remains undiagnosed in up to 80% of cases. We conducted a review of current treatment guidelines for AUD in order to identify recommendations for the use of thiamine. <b><i>Methods:</i></b> Three different keyword combinations ("alcohol treatment guideline," "alcohol withdrawal guideline," and "alcohol treatment recommendation") were entered in PubMed and Scopus, additional guidelines were searched screening the online sites of the respective agencies or societies. In total, 14 guidelines were included. <b><i>Results:</i></b> Thiamine was mentioned in all but one of the reviewed publications. Specifications on application modalities and indications varied considerably. While the majority of reviewed guidelines recommended parenteral thiamine only for patients at high risk for WE, some gave no information regarding the application form or dosage. <b><i>Conclusion:</i></b> Substitution of parenteral thiamine in individuals with suspected WE is a well-established treatment regimen. However, suggestions according to guidelines vary widely. Furthermore, hardly any evidence-based recommendations exist on a more general use of thiamine as a preventative intervention in individuals with AUD. Further research is of utmost importance to raise awareness for this potentially undervalued problem.

Abstract

Aims
While clinical consequences of thiamine deficiency in alcohol use disorder (AUD) are severe, evidence-based recommendations on dosage, type of administration and duration of thiamine substitution (TS), and its' target levels remain sparse. This study aimed to compare the effect of two best practice TS regimens on thiamine blood levels (i.e. thiamine pyrophosphate, TPP) and cognitive function.


Methods
In 50 patients undergoing in-patient alcohol-withdrawal treatment, TPP levels were determined at baseline and end of weeks 1, 2 and 8 following administration of oral TS (3 × 100 mg/day for 7 days followed by 1 × 100 mg/day thereafter) either with or without preceding intravenous TS (3 × 100 mg/day for 5 days). An extensive psychiatric assessment was conducted at baseline, including an evaluation of AUD severity and depressive symptoms. Additionally, cognitive function and depressive symptoms were repeatedly evaluated.


Results
Relevant increases (mean increase by 100.2 nmol/l [CI 76.5–123.8], P &lt; 0.001) in peripheral blood TPP levels were observed in all patients at the end of weeks 1 and 2. Furthermore, no relevant difference between the intravenous and the oral group was found (average difference between increases: 2.3 nmol/l, P = 0.912). Importantly, an association between the 'extent of the response' to TS and the performance in a memory task was revealed in secondary analyses.


Conclusion
TS was associated with improving cognitive function in patients with AUD, independently of the substitution regime. Thus, in clinical practice, oral TS might be a sufficient but obligatory medication to prevent cognitive decline in AUD in the absence of Wernicke–Korsakoff Syndrome.

Abstract

Aims
Alcohol is an important risk factor for morbidity and mortality, especially within the European region. Differences in per capita consumption and drinking patterns are possible reasons for regional differences and diverging trends in alcohol-related health outcomes.


Methods
Twenty-nine countries within the World Health Organization (WHO) European region were evaluated for trends and predictions in alcohol-related deaths within the last four decades using data available from the WHO Health for All database.


Results
Between 1979 and 2015, age-standardised death rates due to selected alcohol-related causes decreased significantly for both sexes in all assessed countries of the WHO European region, but regional differences are still pronounced. Assuming a similar trend in the future, the model predicted a further decrease until the year 2030.


Conclusion
Even though alcohol-related mortality may have decreased within the last decades, the detrimental effects of alcohol consumption and alcohol dependence remain a considerable burden of disease within Europe.