Autonomic cardiac abnormalities in alcohol-dependent patients admitted to a psychiatric department

Abstract

Standardized heart rate analyses were performed in 60 drug-free patients with alcohol dependence, who were admitted consecutively to a psychiatric department, and in 60 healthy normal matched subjects. The procedure included time and frequency derived measurements of heart rate variability (HRV). The investigations were carried out 3 weeks after admission and treatment on a closed ward to avoid autonomic hyperexcitability during withdrawal or relapse. The patients showed a significantly increased heart rate (p < 0.05), a significant reduction in the coefficient of variation while resting (p < 0.01) and a significant decrease of the high frequency power of spectral analysis (p < 0.01) compared with the normal subjects. Cardiovascular autonomic dysfunction was found in 12 of the patients, but in only one of the normal subjects (p < 0.01). The results indicated moderate parasympathetic (vagal) alteration in alcohol-dependent patients treated in a psychiatric department. This may have implications for psychotherapeutic or psychopharmacological treatment strategies and prognosis in such patients with alcohol dependence.

Enhanced Negative Emotion and Alcohol Craving, and Altered Physiological Responses Following Stress and Cue Exposure in Alcohol Dependent Individuals

“…Furthermore, unlike in the SD group, where higher HRs were associated with cue-induced alcohol craving as previously reported in the literature (Carter and Tiffany, 1999), the AD group showed increased HR in the cue condition but no association between increased HR and craving levels. Elevated cardiac output, increased HR, and decreased HR variability have been reported during acute alcohol withdrawal and during alcohol abstinence up to 4 weeks (Rechlin et al, 1996;Ingjaldsson et al, 2003;Bar et al, 2006;Thayer et al, 2006;Kahkonen and Bondarenko, 2000). Consistent with these human data, recent preclinical findings in nonhuman primates also indicate that chronic use of moderate levels of alcohol significantly increased HR, decreased HR variability, and altered HR responses to stress of a novel environment (Shively et al, 2007).…”

Modeling Relapse Situations in the Human Laboratory

“…Dramatic adaptations of the HPA axis akin to tolerance has also been demonstrated with regular and chronic alcohol abuse in animals (Zhou et al 2000;Richardson et al 2008) and in humans (Adinoff et al 1998(Adinoff et al , 2005Wand and Dobs 1991). Similarly, chronic alcohol-related changes in autonomic responses, particularly in parasympathetic vagal tone has also been documented in non-human primates (Shively et al 2007) and in humans (Ingjaldsson et al 2003;Rechlin et al 1996;Thayer et al 2006). These data are consistent with changes in peripheral stress pathways which parallel other basic science findings of alcohol-related adaptations in the extrahypothalamic corticotrophin releasing factor (CRF) systems and the noradrenergic pathways that are consistent with an upregulated central CRF and noradrenergic pathways (Rasmussen et al 2006;Cleck and Blendy 2008;Koob and Kreek 2007;Koob 2009; also see Heilig et al 2010 for review).…”

The role of stress in addiction relapse

“…Research has shown that both acute and protracted withdrawal from psychoactive substances are associated with overactivity of the corticotropin-releasing factor (CRF) systems as documented in preclinical studies [8] and in clinical studies showing CRF-HPA disturbances in alcoholics, opiate addicts, and cocaine-addicted individuals [2•,7,17,18]. Autonomic and noradrenergic abnormalities also have been well documented, with overactivity of these systems during acute and protracted withdrawal from opiates, alcohol, and cocaine [2•, [19][20][21][22][23]. These findings indicate that the CRF and the autonomic/noradrenergic systems are dysregulated during acute withdrawal.…”