As respostas mnésicas do cérebro perante a presença do álcool

Abstract

O artigo de revisão visa a análise dos vários fenómenos mnésicos que podem ocorrer face à presença do álcool no sistema nervoso central.
A intoxicação pelo álcool perturba o decurso de codificação de novas memórias, contudo, não interfere com a recuperação mnésica do material previamente armazenado.
Os estudos mostram inclusivamente que a capacidade de reevocação do material mnésico pode melhorar quando accionado num estado similar ao do processo de codificação (memória dependente do contexto, neste caso, do estado de intoxicação pelo álcool); que o consumo do álcool pode favorecer o processo mnésico ao prejudicar preferencialmente a capacidade de produzir nova informação, e assim, interferir em menor grau na fase de pós-codificação; e que a população alcoólica demonstra determinadas propensões cognitivas ao nível da selectividade mnésica.
O consumo excessivo do álcool está associado frequentemente à ocorrência de períodos de perda de memória. Este episódio amnésico anterógrado induzido pelo consumo do álcool, definido como
blackout alcoólico, deve-se ao facto do álcool impossibilitar a capacidade de formar novas memórias durante o período do consumo excessivo de bebidas alcoólicas.

(Samuel Pombo; Acta Psiquiátrica Portuguesa; Vol.54, pp:1919-1926)

Denegação do alcoolismo nos subtipos I e II de Cloninger

Samuel Pombo, R Reizinho, F Ismail, J Cardoso

Análise Psicológica, Série XXVI, 2008.

Resumo
A denegação da alcoolização define a recusa dos bebedores dependentes em assumir o uso patológico do álcool, além de minimizar a relação entre os consumos do álcool e os seus problemas psicológicos, orgânicos e sociais associados. A escala de avaliação da denegação (Denial Rating Scale) confere ao terapeuta um instrumento de observação e quantificação da denegação do problema clínico do álcool.
O presente estudo tem como objectivo, traduzir e validar para a língua portuguesa a escala de avaliação da denegação (Denial Rating Scale) e avaliar o nível de denegação da doença alcoólica tendo em conta os sub-tipos I e II de Cloninger. No processo de confiabilidade inter-avaliadores e de validação da DRS obteve-se coeficientes estatísticos adequados, permitindo a utilização do instrumento num setting especializado para o tratamento da dependência alcoólica.
Os pacientes Tipo II de Cloninger apresentaram menores níveis de denegação do alcoolismo, quando comparados com os pacientes Tipo I.

www.scielo.oces.mctes.pt/pdf/aps/v26n1/v26n1a05.pdf

NEUROPSYCHOLOGICAL FUNCTION AND PLATELET MONOAMINE OXIDASE ACTIVITY

SAMUEL POMBO, P LEVY, M BICHO, F ISMAIL and J CARDOSO

Alcohol & Alcoholism; Vol. 43, No. 4, pp. 423–430.

Abstract — Aims: To explore neuropsychological function in two differentiated patterns of platelet monoamine oxidase B (MAOB) activity in alcoholic patients.Methods:Neuropsychological examination and platelet MAO B activity extracted from blood were collected from 42 alcohol-dependent patients recruited in the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital. Results: Alcoholics presented significantly low levels of platelet MAO B activity, when compared with control subjects; platelet MAO B activity in alcoholics classified as “under average subgroup” showed significant lower scores in the Raven Progressive Matrix and higher scores in hostility dimension, when compared with platelet MAO B activity in “above average subgroup.” Conclusions: Results suggested platelet MAO B as a trait marker also to type I alcohol-dependent patients and the two observed associations between platelet MAO B activity with neurocognitive measures of executive functions (nonverbal reasoning) and psychopathological dimension such as hostility may support the notion about the effect of platelet MAO B activity in the further development of an impulsive cognitive style.

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http://alcalc.oxfordjournals.org/cgi/content/abstract/43/4/423

“Alcoholic patients overlap among different typological classification schemes”

Oral presentation in the 11th Congress of the European Society for Biomedical Research on Alcoholism. ESBRA 2007, 25 September, 2007 / Berlin.

Samuel Pombo

Aims:This study aims to assess patients classification concordance among six different alcoholic typological models: Cloninger´s Type I/II Von Knorring, Sullivan and Gilligan operationalized criteria; Babor Type A/B; NETER Alcoholic Typology and Lesch Subtypes.
Methods:A sample of 318 alcohol-dependent patients recruited in the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital in Lisbon (Portugal) was eligible for study entry. All subjects were evaluated during the outpatient therapeutical programme for operacionalized criteria, reported by each alcoholism typology.
Results:Regarding concordance agreement (kappa values) for the three type I/II classifications, Von Knorring vs. Sullivan yielded the higher rate of agreement, followed by Von Knorring vs. Gilligan and Gilligan vs. Sullivan criteria. Chi-square comparisons showed a significant overlap between Babor type A and Cloninger type I of Von Knorring (72.7% concordance) and Sullivan (74.4%). Over-two type classifications showed the following significant positive relations: Lesch type I vs. NETER heredopathic subtype (.20); Lesch type II vs. NETER anxiopathic subtype (.40) and Babor type A (.26); Lesch type III vs. NETER tymopathic subtype (.58); Lesch type IV vs. Cloninger type II of Von Knorring (.18) and Sullivan (.20) criteria and NETER addictopathic subtype vs. Cloninger type II of Von Knorring (.18), Sullivan (.18) and Gilligan (.17) criteria.
Conclusions:Like in other studies it was verified a low level of agreement between the proposed methods for identifying Cloninger’s type I/II alcoholics. We also observed a significantly overlap between type I and type A patients and anxiety and depression classification criteria methods.

Tipologias da dependência do álcool e o seu significado para a terapêutica médica

Serviço de Psiquiatria do Hospital de Santa Maria e Clínica Psiquiátrica de Viena

Dvorak A, Pombo S, Ismail F, Barbosa A, Cardoso JM, Figueira ML, Walter H, Lesch OM (2006)

Acta Psiquiátrica Portuguesa. Vol.52; Num. 2, pp:1693-1705.

Abstract

Considerando a heterogeneidade dos comportamentos alcoólicos, a necessidade de definir subgrupos de dependentes do álcool torna-se indispensável ao nível da investigação básica (pré-clínica) e da intervenção terapêutica (clínica). A influência dos factores de personalidade, o tipo de comorbilidade e a dimensão dos problemas ligados ao álcool, têm que se encontrar reflectidos na planificação terapêutica. Embora não haja uma tipologia da dependência do álcool universalmente aceite, com razoável
exactidão e validade prognóstica, existem algumas tipologias que alcançaram preponderância no campo da investigação básica e terapêutica. Destacam-se as tipologias de Jellinek,
Cloninger et al., Babor et al., Schuckit et al., Lesch et al., e a NAT de Cardoso et al.
Os autores avaliaram a bibliografia disponível no que respeita à qualidade metodológica dos estudos e coligiram os resultados dos métodos terapêuticos aplicados à dependência do álcool.
Tais achados e o tipo de reacção às várias terapias demonstram que, para a terapia medicamentosa de dependentes do álcool torna-se indispensável a definição de subgrupos específicos.

NETER Alcoholic 5 Subtypes: Validity with Lesch 4 Evolutionary Subtypes

Samuel Pombo, R Reizinho, F Ismail, A Barbosa, M Figueira, Cardoso, OM Lesch

Psychiatric Service of Santa Maria University Hospital

(International Journal of Psychiatry in Clinical Practice, 2007, 1-10).

Objective।validate NETER’s Alcoholic Typology (NAT), taking into account the differentiated distribution of the measures used as external criteria in the alcohol dependent sub-groups and its relationship with Lesch’s Alcoholic Typology (LAT). Method. A sample of 133 alcohol-dependent patients integrated in the alcoholism unit (NETER) of the Psychiatric Service of Santa Maria University Hospital were included in the study. Results and Conclusions. Convergent validity was assured by the agreement between the subtypes of the two typologies (NETER and Lesch), considering the same underlying model of alcoholism development: Anxiopathic subtype of NETER and Type II (Model of anxiety, alcohol as conflict solution) of Lesch and the Tymopathic subtype of NETER and type III (Model of Depression, alcohol as antidepressant) of Lesch. Discriminant analysis (external criteria) showed significant differences between the subtypes in the following variables: gender; tobacco; beer and whisky consumption; daily average of drinks; clinical conditions as Delirium Tremens, alcoholic blackouts and seizures; alcohol related problems severity; psychological dimensions as psychological maturity and extroversion; and suicidal ideation during the alcohol consumption period. A more exhaustive description of alcoholic sub-groups may improve alcoholism genetic studies and adequate the alcoholic patient to a specific therapeutical protocol.

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http://www.informaworld.com/smpp/1664274099-44622359/content~content=a782123246~db=all~tab=content~order=pubdate

NETER ALCOHOLIC TYPOLOGY (NAT)*

CARDOSO, A BARBOSA, F ISMAIL and SAMUEL POMBO

* Alcohol and Alcoholism, November 28, 2005

Aims: To establish an alcohol-dependent drinker's clinical typology, based on patients attending the Alcoholism Unit of Santa Maria's General Hospital in Lisbon, Portugal। Methods: A multivariate statistical analysis was used to extract the typology solution. Results: We obtained five factors: Anxiopathic, typifies anxious functioning; Heredopathic, congregates familiar and genetic influences on alcoholism; Thimopathic, typified by affective symptomatology; Sociopathic, characterized by disruptive behaviours under alcohol influence; and Adictopathic, isolates younger individuals who consume alcohol and other types of psychoactive substances. Conclusions: There are increasingly alcoholic polymorphic subtypes derived from the interactive complexity between genetic/family and psychosocial factors.