Valproate Treatment of Acute Alcohol Hallucinosis: A Double-Blind, Placebo-Controlled Study

Aliyev, Zafar N.; Aliyev, Nadir A.

doi:10.1093/alcalc/agn043

Cited by 20 publications

(10 citation statements)

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“…Valproate efficacy to reduce excessive alcohol consumption in bipolar patients 14 was confirmed 16 and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics 17 and to improve alcohol hallucinosis. 42 Several compounds deserve to be investigated for their efficacy to reduce alcohol use disorders in bipolar patients:…”

Section: Discussionmentioning

confidence: 99%

“…In 2008, Aliyev and Aliyev 42 reported the results of a 10-day randomized, double-blind, placebo-controlled study of valproate in 40 patients with acute alcohol hallucinosis. Patients were randomized to valproate 3000 mg/day (n = 20) or placebo (n = 20).…”

Section: Alcohol Hallucinosismentioning

confidence: 99%

“…The therapeutic benefit of topiramate in alcohol-dependence may be due to its anticonvulsant properties since other controlled studies revealed that valproate is of therapeutic benefit in acute alcohol withdrawal, 40 that it prevents relapse in newly abstinent alcoholics 17 and improves alcohol hallucinosis. 42 Moreover, carbamazepine seems also effective to reduce alcohol withdrawal symptoms and prevent relapse.…”

Section: Alcohol Hallucinosismentioning

confidence: 99%

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Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism

Azorin

Bowden²,

Garay

et al. 2010

NDT

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About half of all bipolar patients have an alcohol abuse problem at some point of their lifetime. However, only one randomized, controlled trial of pharmacotherapy (valproate) in this patient population was published as of 2006. Therefore, we reviewed clinical trials in this indication of the last four years (using mood stabilizers, atypical antipsychotics, and other drugs). Priority was given to randomized trials, comparing drugs with placebo or active comparator. Published studies were found through systematic database search (PubMed, Scirus, EMBASE, Cochrane Library, Science Direct). In these last four years, the only randomized, clinically relevant study in bipolar patients with comorbid alcoholism is that of Brown and colleagues (2008) showing that quetiapine therapy decreased depressive symptoms in the early weeks of use, without modifying alcohol use. Several other open-label trials have been generally positive and support the efficacy and tolerability of agents from different classes in this patient population. Valproate efficacy to reduce excessive alcohol consumption in bipolar patients was confirmed and new controlled studies revealed its therapeutic benefit to prevent relapse in newly abstinent alcoholics and to improve alcohol hallucinosis. Topiramate deserves to be investigated in bipolar patients with comorbid alcoholism since this compound effectively improves physical health and quality of life of alcohol-dependent individuals. In conclusion, randomized, controlled research is still needed to provide guidelines for possible use of valproate and other agents in patients with a dual diagnosis of bipolar disorder and substance abuse or dependence.

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Section: Discussionmentioning

confidence: 99%

Section: Alcohol Hallucinosismentioning

confidence: 99%

Section: Alcohol Hallucinosismentioning

confidence: 99%

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Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism

Azorin

Bowden²,

Garay

et al. 2010

NDT

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confidence: 99%

“…3. Outcome: Aliyev and Aliyev (2008) reported rating for verbal hallucinations of the PANSS scale as outcome. It is unclear from the paper how many patients were actually symptom free at the end of treatment.…”

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confidence: 99%

Pharmacological Treatment of Alcohol Hallucinosis

Soyka¹

2008

Alcalc

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We read with interest and sympathy the recent paper of Aliyev and Aliyev (2008) reporting results of a double-blind placebocontrolled study in 40 patients with acute alcohol hallucinosis indicating valproate to be effective in reducing verbal hallucinations. This is the first placebo-controlled study in this rare disorder, a widely neglected subject of research. The pathophysiology of alcohol hallucinosis is not clear (Soyka, 1995;Soyka et al., 2000a). There is no evidence for a common genetic basis for alcohol psychosis and schizophrenia (Glass, 1989a). An impaired dopaminergic neurotransmission and hyperdopaminergic state has not been shown in alcohol hallucinosis (Soyka et al. 2000b). Recent PET findings indicate a hypofunction of the thalamus in patients with alcohol psychosis that may resolve on clinical improvement (Soyka et al., 2000(Soyka et al., , 2005Kitabayashi et al., 2007).With respect to pharmacological treatment, no standard therapy has been established yet . To date there are only a few predominant case series and reports, mostly uncited in the Aliyev paper, which may indicate a rather good prognosis in patients treated with neuroleptics (Soyka et al., 1992(Soyka et al., , 1997(Soyka et al., , 2007de Millas and Haasen, 2007). Therefore, it is surprising to read the results of this study. A few specific questions on this study raise some concern:1. Epidemiology: There is broad consensus that alcohol hallucinosis is a rare disorder (Tsuang et al., 1994). In the Psychiatric Hospital of the University of Munich (200 inpatients) over a 10-year episode we only saw 13 cases (Soyka et al., 2007). Recent data from official German hospital statistics indicate a prevalence of 0.6-0.7% in alcoholics (Soyka, 2008). We therefore wonder how a single centre is able to include 40 patients in an unreported period of time. This may either be explained by a much higher rate of alcohol hallucinosis in this area, as we understand a predominantly Islamic state compared to elsewhere, or schizophrenic patients with secondary alcoholism were included, a frequent diagnostic dilemma (Surawicz, 1980). Psychopathology is only briefly described in the Aliyev paper, but we wonder how these patients were excluded. 2. Methodology: There also is broad consensus that alcohol hallucinosis is a very acute disorder that deserves treatment. We wonder about the 2-week washout phasefrom what drugs? In our experience, most alcoholics with acute hallucinosis are admitted as emergency patients, free of medication and require acute treatment. In addition, none of the 40 patients recovered spontaneously within the 2 weeks although the prognosis is usually good (Glass, 1989b). This may again raise the question whether some patients with schizophrenia might have been included. 3. Outcome: Aliyev and Aliyev (2008) reported rating for verbal hallucinations of the PANSS scale as outcome. It is unclear from the paper how many patients were actually symptom free at the end of treatment. In the larger case series with neuroleptics, >90% were no l...

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Anticonvulsants for alcohol withdrawal

Amato

Vecchi

Davoli

2010

Cochrane Database of Systematic Reviews

102

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Valproate Treatment of Acute Alcohol Hallucinosis: A Double-Blind, Placebo-Controlled Study

Abstract: Valproate is effective in the treatment of acute hallucinosis and is generally well tolerated.

Cited by 20 publications

References 18 publications

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism

Possible new ways in the pharmacological treatment of bipolar disorder and comorbid alcoholism

Pharmacological Treatment of Alcohol Hallucinosis

Anticonvulsants for alcohol withdrawal

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