Comorbidity of alcoholism and antisocial personality disorder

Transcription

1 Washington University School of Medicine Digital Presentations 2005: Alcoholism and Comorbidity 2005 Comorbidity of alcoholism and antisocial personality disorder R. O. Pihl McGill University Follow this and additional works at: Part of the Medicine and Health Sciences Commons Recommended Citation Pihl, R. O., "Comorbidity of alcoholism and antisocial personality disorder" (2005). Presentations. Paper 3 Samuel B. Guze Symposium on Alcoholism. This Presentation is brought to you for free and open access by the 2005: Alcoholism and Comorbidity at Digital Commons@Becker. It has been accepted for inclusion in Presentations by an authorized administrator of Digital Commons@Becker. For more information, please contact engeszer@wustl.edu.

2 Comorbidity of Alcoholism and Antisocial Personality Disorder R.O. Pihl McGill University

3 Alcoholism & ASPD Lets avoid the definitional quagmire. Lets agree there is a significant correlation between Alcoholism and ASPD. Lets agree that the nature of the relationship is well understood.

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7 The Role of Different Motivational Systems Motivational system responding to threat The Cognitive Control System Motivational system responding to reward

8 Behavior Aggression (Behaviorally-linked) Sensory information Threatening or punishing behavior Executive Cognitive Functions Facilitory: Cue for Reward Inhibitory: Cue for Punishment

9 Behavior Aggression Threatening or punishing behavior (Behaviorally-linked) Sensory information Inhibits Executive Cognitive Functions Facilitory: Cue for Reward Inhibitory: Cue for Punishment Acute Alcohol Intoxication

10 Behavior Aggression Threatening or punishing behavior (Behaviorally-linked) Sensory information Inhibits Executive Cognitive Functions Disorganizes Facilitory: Cue for Reward Inhibitory: Cue for Punishment Acute Alcohol Intoxication

11 Behavior Aggression Threatening or punishing behavior (Behaviorally-linked) Sensory information Inhibits Executive Cognitive Functions Disorganizes Facilitory: Cue for Reward Inhibitory: Cue for Punishment Potentiates Acute Alcohol Intoxication

12 The Role of Different Motivational Systems Environmental triggers 1. Threat, anxiety (novelty, cues of punishment, etc ) 2. Monotony (lack of immediate reinforcement) Genetically influenced susceptibility 1. Anxiety 2. Boredom Desired alcohol reinforcement 1. Anxiolysis (serotonin & GABA effects) 2. Stimulation (Dopaminergic effects)

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17 Family Pedigree

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19 Heart Rate Response to Alcohol Intoxication (Percent Change) Low-Aggressive High-Aggressive * Non-SOMA SOMA

20 No. of Alcoholic Beverages per year Low-Aggressive High-Aggressive * Non-SOMA SOMA

21 Alcohol-Induced HR Change from Baseline (BPM) NFH F (N = 49) NFH M (N = 99) UFH F (N = 17) UFH M (N = 30) MFH F (N = 20) MFH M (N = 92) ALC M (N = 12)

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23 Z scores on the SPSRQ SP SR Low HR responders High HR responders Dimensions of the SPSRQ

24 Z scores on the SURPS H/I AS IMP SS Dimensions of the SURPS Low HR responders High HR responders

25 Zscore (Number of "Risk Taking" Responses) Sober Intoxicated Low Heart Rate Responders High Heart Rate Responders

26 Subjects with a High Heart rate Response to Alcohol Challenge Self-rate more of a positive response Drink more Remember more words learned before drinking Release more dopamine in the Ventral Striatum

27 Positron Emission Tomography

28 Alcohol Promotes Dopamine Release in the Human Nucleus Accumbens and this release is associated to an increased HR response to alcohol

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30 Background Phenylalanine and tyrosine, two amino acids (AA)found in dietary protein, are the essential building blocks for the production of dopamine in the brain. Ingesting an AA mixture deficient in P&T reduces DA production by 1)causes protein synthesis diminishing the body s stores of these AA 2) increasing competition of other AAs for transport across the blood brain barrier. Peek effect of depletion occur 4-5 hours following the ingestion of the AA mixture

31 Drinks earned following APTD More Same Less 0 Relative number of drinks compared to balanced condition

32 Drinks Alcohol consumption High Low Balanced Depleted

33 APTD Change in Drinking and Ethanol Cardiac Response r=.-658, p=.006 percent change in earned drinks

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35 Figure 1 - Mean group differences (+ SE) between Low (n = 19) and High (n = 19) Heart Rate Responders in the average of age 10 to 17 delinquency scores

36 Zscore (Goldberg's Adjective Markers of the Big Five) Figure 2 - Mean group differences (+ SE) between Low (n = 18) and High (n = 20) Heart Rate Responders in Goldberg's Adjective Markers of the Big Five assessed at age Agreeableness Conscientiousness Emotional Stability Extraversion (Surgency) Intellect * * p < Low Heart Rate Responders to Alcohol Intoxication High Heart Rate Responders to Alcohol Intoxication

37 Zscore (Subjective High Assessment Scale) Figure 3 - Mean group differences (+ SE) between Low (n = 20) and High (n = 22) Heart Rate Responders in Subjective High Assessment Scale (SHAS) at age Subjective effects of alcohol "The worst that I have ever felt" "The best that I have ever felt" * * p = Low Heart Rate Responders to Alcohol Intoxication High Heart Rate Responders to Alcohol Intoxication

38 Apparatus: Taylor Aggression Paradigm (TAP)

39 Zscore (Mean Shock Selected) TAP - Mean Shock Level Selected Sober Intoxicated Low HR Responders High HR Responders

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44 Zscore Total Errors (SCALT & NSCALT &SOP) Non-SOMA & Non-Aggressive Non-SOMA & Aggressive SOMA & Non-Aggressive SOMA & Aggressive

45 Commonalities Alcoholism & ASPD Unusual high heart rate response to high dose of alcohol. High activation of the Cue for Reward System. A system that is dopamine mediated. Reduced ECF functioning.

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