Are the binary typology models of alcoholism valid in polydrug abusers? 

Samuel Pombo, Nuno Félix da Costa, Maria Luísa Figueira

Revista Brasileira de Psiquiatria. 2014;00:00–00

Objective: The study aims to evaluate the dichotomy type I/II and Type A/B alcoholism typologies in Opiate Dependent Patients with a co-morbid Alcohol Dependence Problem (ODP-AP).

Methods: The validity process comprised the information regarding the history of alcohol use (internal validity), cognitive-behavioural variables regarding substance use (external validity) and indicators of treatment in a 6-month follow-up (predictive validity).

Results: ODP-AP subjects classified as type II/B presented an early and much more severe drinking problem and a worse clinical prognosis when considering opiate treatment variables, when comparing with ODP-AP subjects defined as type I/A. Also, type II/B patients endorse more general positive beliefs and expectancies related to alcohol effect and tend to drink heavily across several intra-inter personal situations, when comparing with type I/A.

Conclusions: The study results confirmed two different forms of alcohol dependence, recognized as Low-Severity/Vulnerability Subgroup (LSVS) and High-Severity/Vulnerability Subgroup (HSVS), in an opiate dependent population with lifetime diagnosis of alcohol dependence.

http://www.scielo.br/pdf/rbp/2014nahead/1516-4446-rbp-1516-4446-2014-1384.pdf

Alexithymia and alcohol dependence: Do different subtypes manifest different emotion regulations?

• Addiction Research & Theory
• August 21, 2014
• • 
    

Authors: Samuel Pombo, et al.

Objective: Alcohol abusers are vulnerable to emotional disabilities. Studies have shown that alexithymia is significantly associated with alcohol dependence and many other phenotypic descriptors. Given the high phenotypic heterogeneity that characterises the alcohol dependence syndrome, the study aims to assess alexithymia features according to a multivariate classification scheme of alcoholism - the Lesch Alcoholism Typology (LAT).
Methods: A total of 274 alcohol dependence outpatients (DSM diagnosis) were recruited from the Alcoholism Unit of the Psychiatric Service of Santa Maria University Hospital. After a detailed clinical observation, subjects were evaluated with the alcoholism classification system (LAT) and self-rated alexithymia with the Toronto Alexithymic Scale - 20 items (TAS-20).
Results: Data showed that almost half of the alcohol dependent individuals were defined as alexithymic cases (48.5%). “Organic” alcohol dependent patients (type IV of Lesch classification) presented higher scores in TAS-20 when compared to other subtypes, even after controlling for potential confounding factors. Furthermore, the TAS-20 scores were related to educational level and family history of alcoholism.
Conclusions: Results indicate that the alexithymia construct is an important psychological dimension in the characterisation of alcohol dependence, especially the alcohol dependent phenotypes that are more likely to present co-existing organic complications.

https://www.researchgate.net/publication/264930134_Alexithymia_and_alcohol_dependence_Do_different_subtypes_manifest_different_emotion_regulations?ev=prf_pub

The role of 5-HTTLPR polymorphism in alcohol craving experience

• 
  
• Samuel Pombo^a, , , 
• Joana Ferreira^b, 
• José Maria Neves Cardoso^a, 
• Fátima Ismail^a, 
• Pilar Levy^b, 
• Manuel Bicho^b

The way in which genetic risk mediates the development of craving in alcohol dependence is still relatively unknown. The authors sought to clarify the extent to which alcohol craving could be predicted by a relevant polymorphism in the promoter region of the gene encoding the 5-HT transporter (5-HTTLPR). A sample of 101 alcohol-dependent patients admitted for alcohol treatment was recruited for the study. At admission, blood samples were taken for DNA extraction and alcohol craving information was collected with a composite measure. The 5-HTT polymorphism was genotyped. Alcohol dependent patients who were homozygous for the long allele (LL) self-reported higher scores of craving when compared to patients that were homozygous for the short allele (SS). However, the results were not statistically significant. Also, no significant associations were observed between the 5-HTTLPR genotype and other drinking variables. No 5-HTTLPR genotype effects were observed on alcohol craving experience in a sample of alcohol-dependent outpatients.

http://www.sciencedirect.com/science/article/pii/S0165178114003230

PhD - Dissertação aprovada pelo Conselho Científico da Faculdade de Medicina de Lisboa em 2013

AS TIPOLOGIAS DO ALCOOLISMO: "da psicologia à neurobiologia dos fenótipos”

Samuel Pombo

Resumo

Perante a heterogeneidade imputada ao fenótipo clínico da dependência do álcool, tem-se assistido a várias tentativas de subtipificação de doentes alcoólicos em grupos mais homogéneos, no sentido de melhorar o conhecimento científico e adequar o doente a um protocolo terapêutico de maior efectividade. 

O estudo tem como objectivo a avaliação do processo de validação de cinco tipologias do alcoolismo, através de parâmetros psicológicos, clínicos e genéticos. Serão alvo de observação os modelos de Cloninger, Babor, Jellinek, Cardoso e Lesch. Foram recrutados da Consulta de Etilo-Risco do Serviço de Psiquiatria e Saúde Mental do Hospital de Santa Maria (HSM), 247 doentes dependentes do álcool (127 para o estudo dos polimorfismos genéticos).

Os resultados demonstram que os subgrupos de dependentes do álcool se diferenciam em termos de características sócio-demográficas (idade, sexo), clínicas (precocidade e gravidade do problema, consumo de outras drogas) e psicológicas (psicopatologia e personalidade). A avaliação prospectiva (3 meses), verificou, no geral, uma pior evolução clínica (adesão e recaída) nos subtipos delta de Jellinek, sociopático e adictopático de Cardoso, tipo II de Cloninger e tipo IV de Lesch. Quanto à análise dos polimorfismos genéticos, destaca-se a associação entre o alelo L do polimorfismo da COMT e do alelo S do polimorfismo 5-HTT_LPR com o subtipo II de Cloninger.

Concluí-se que a heterogeneidade da dependência do álcool não se expressa fenotipicamente de modo aleatório, pois os resultados enunciam que a sua disposição sintomatológica, configura-se em entidades sindromáticas clinicamente intuitivas, designadas por subtipos. Este paradigma das tipologias do alcoolismo visa a optimização do processo de diagnóstico, fornecendo um nível de compreensão e raciocínio clínicos indispensáveis à acção terapêutica futura.

Palavras-chave: dependência do álcool, tipologias do alcoolismo, evolução clínica, funcionamento psicológico, polimorfismos genéticos.

Abstract

Given the heterogeneity attributed to the clinical phenotype of alcohol dependence, several attempts have been made to subtype alcoholic patients in more homogeneous groups, in order to improve the scientific knowledge and matched patients to a therapeutical protocol of greater effectiveness.

The study aims to evaluate the process of validation of five alcoholism typologies, through psychological, clinical and genetic parameters. Will be target for observation the models of Cloninger, Babor, Jellinek, Cardoso and Lesch. A sample of 247 alcohol dependent patients was collected in the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria Universitary Hospital (127 for the study of genetic polymorphisms).

The results demonstrate that the subgroups of alcohol-dependent subjects differ in terms of socio-demographic characteristics (age, gender), clinical (age of onset and severity of the problem, use of other drugs) and psychological (personality and psychopathology). Prospective evaluation (3 months), found, in general, a worse clinical outcome (compliance and relapse) in delta subtypes of Jellinek, sociopathic and adictopatic of Cardoso, Cloninger type II and type IV of Lesch. As for the analysis of genetic polymorphisms, highlights the association between the L allele of the COMT polymorphism and the S allele polymorphism 5-HTT_LPR with subtype II Cloninger.

It could be concluded that the heterogeneity of alcohol dependence is not expressed phenotypically in a random basis, since the results state that its symptomatology is organized in clinically intuitive entities, called subtypes. This paradigm of alcoholism typologies aims the optimization of the diagnostic procedure, providing a level of understanding and clinical reasoning essential for future therapeutic action.

Key-words: alcohol dependence, alcoholism typologies, clinical outcome, psychological functioning, genetic polymorphisms.

full@ http://repositorio.ul.pt/bitstream/10451/8632/1/ulsd65677_td_Samuel_Pombo.pdf#!

"The burden of cyclothymia on alcohol dependence" 

in Journal of Affective Disorders

Samuel Pombo^a, M Luísa Figueira^a, Nuno Félix da Costa^a, Fátima Ismail^a, Guang Yang^b, Kareen Akiskal^c, Hagop Akiskal^b,c

Background The relationship between cyclothymic temperament and alcoholism remains insufficiently explored.

Methods A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal & Akiskal (2005) temperament scale.

Results Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems.

Limitations Correlational study

Conclusions CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.

full paper@   http://dx.doi.org/10.1016/j.jad.2013.09.002

A comunicação motivacional com o doente dependente 

de substâncias: para uma intervenção psicológica que 

se pretende terapêutica

2012 / News nº 29 | Setembro/Outubro 2012 / Espaço Ciência

Samuel Pombo

Resumo

Este trabalho visa analisar alguns dos mecanismos psicológicos inerentes às dependências e à intervenção psicológica e relacional com o doente dependente de substâncias. São abordados o papel dos consumos na regulação dos afectos e a perspectiva da motivação para a mudança no contexto das defesas cognitivas que preservam os consumos e que contribuem para a manutenção do equilíbrio mental. Posteriormente, são focados os fundamentos da construção da relação terapêutica e os modelos mais directivos cognitivocomportamentais, que suportam a abordagem motivacional direccionada para a mudança.

Conclui-se que a intervenção psicológica com o dependente de substâncias deve obedecer a guidelines científicos de intervenção psicológica, para que o encontro clínico possa alcançar efeito terapêutico.

Palavras-chave: intervenção psicológica; entrevista motivacional; dependências

Ver artigo completo:

http://news.fm.ul.pt/Backoffice/UserFiles/File/News29/Comunicacao%20Motivacional.pdf

Para um novo paradigma de intervenção clínica na dependência do álcool: a tipologia alcoólica de Lesch (TAL)

Samuel Pombo, Otto Lesch

REVISTA TOXICODEPENDÊNCIAS EDIÇÃO IDT VOLUME 17 NÚMERO 3  2011 pp. 65-81


RESUMO

Há muito que não só a prática clínica como a investigação científica observam que os alcoólicos não são todos iguais. Aliás, bem pelo contrário, apresentam uma elevada heterogeneidade, por exemplo, no padrão de consumo do álcool, na estrutura de personalidade, no tipo de co-morbilidade e vulnerabilidade neurobiológica. Esta diversidade produz manifestações fenotípicas distintas no perfil clínico do doente alcoólico (subtipos), podendo repercutir-se na eficácia dos modelos de tratamento disponíveis se não se encontrar reflectida na planificação terapêutica. A Tipologia Alcoólica de Lesch (TAL) define 4 subtipos de dependentes do álcool, validados cientificamente, desenvolvidos a partir de preditores clínicos a longo prazo: tipo I traduz um subgrupo fisiológico (“Modelo de alcoolismo enquanto doença física”); tipo II define um subtipo Ansioso (“Modelo de alcoolismo para lidar com ansiedade e resolução de problemas”); tipo III caracteriza um subtipo Depressivo (“Modelo do álcool como anti-depressivo”) e tipo IV representa um Subtipo Orgânico (“Modelo de alcoolismo secundário a problemas do desenvolvimento infantil e de alterações cerebrais pré-alcoólicas”). Este trabalho visa a introdução ao paradigma das tipologias do alcoolismo, com foco particular na investigação científica e clínica da TAL e suas propostas terapêuticas.Conclui-se a disponibilidade de um corpo teórico e evidência científica que justifica a intervenção na dependência do álcool racionalmente fundamentada pela TAL.

full paper @: http://www.idt.pt/PT/RevistaToxicodependencias/Artigos%20Ficheiros/2011/3/artigo6_Toxico3_2011.pdf