Halime DAL, Ercan DURMAZ, Nabi ZORLU, Rüstem AŞKIN, İbrahim TAYMUR, Buket Belkız GÜNGÖR, Buket Belkız GÜNGÖR

Erken ve geç başlangıçlı alkol bağımlılığında dürtüsellik ve karar vermenin değerlendirilmesi

Amaç: Bu çalışmada erken ve geç başlangıçlı alkol bağımlılarında dürtüsellik ve karar vermenin (KV) karşılaştırılması ve dürtüsellik ile KV arasında ilişki olup olmadığının araştırılması amaçlanmıştır. Yöntem: Çalışmamızda 27'si erken başlangıçlı 28'i geç başlangıçlı olmak üzere toplam 55 erkek alkol bağımlısı hastada Barratt Dürtüsellik Ölçeği (BIS-11) ile dürtüsellik, Iowa Kumar Testi (IKT) ile de KV değerlendirildi. Erken ve geç başlangıçlı gruplar ayrıca Obsesif Kompulsif İçme Ölçeği (OKİÖ), günlük kullanılan alkol miktarı ve ailedeki alkolizm öyküsünün varlığı açısından da karşılaştırıldı. Bulgular: Erken başlangıçlı grupta hastaların yalnızca %33.3'ü evli iken, geç başlangıçlı grupta hastaların %71.4'ü evliydi. Erken başlangıçlı grubun %66.6'sının, geç başlangıçlı grubun %39.3'ünün ailesinde alkol bağımlılığı öyküsü vardı. Erken başlangıçlı grupta dikkat ve motor dürtüsellik geç başlangıçlı gruba göre anlamlı düzeyde yüksek bulundu. Erken başlangıçlı grupta OKIÖ puanı geç başlangıçlı gruba göre anlamlı düzeyde fazlaydı. IKT'nin ilk aşamasından son aşamasına kadar IKT puanı ile değerlendirilen KV'nin iki grup arasında farklı olmadığı saptandı. Eğitim düzeyi ile dikkat dürtüsellik arasında negatif korelasyon saptandı. Alkolü düzenli kullanım yaşı ile günlük kullanılan alkol miktarı, dikkat dürtüsellik, OKİÖ puanı arasında anlamlı düzeyde negatif korelasyon saptandı. Günlük kullanılan alkol miktarı ile dikkat, motor, plan yapmama dürtüsellik ve OKİÖ puanı arasında anlamlı pozitif korelasyon saptandı. Regresyon analizinde dikkat dürtüsellikteki artışa günlük kullanılan alkol miktarının ve OKİÖ puanının fazla olmasının etkili olduğu saptandı. Motor dürtüsellikteki artışa günlük kullanılan alkol miktarının fazla olmasının etkili olduğu saptandı.Sonuç: Erken başlangıçlı alkol bağımlılarında dürtüsellik geç başlangıçlı gruba göre anlamlı düzeyde fazla bulunurken, iki grup arasında KV'nin farklı olmadığı saptandı.

Evaluation of Impulsivity and Decision Making in Early and Late-Onset Alcohol Addiction

Evaluation of impulsivity and decision making in early and late-onset alcohol addiction Objective: In this study we aimed to compare impulsivity and decision-making (DM) in early and late-onset alcohol addicts and investigate the relation between impulsivity and DM. Method: In our study, impulsivity and DM were evaluated respectively with Barratt Impulsivity Scale (BIS-11) and Iowa Gambling Test (IGT) in total 55 alcohol addicted male patients, 27 of them were early onset and 28 were late onset. Early and late onset groups were compared in terms of Obsessive Compulsive Drinking Scale (OCDS), alcohol amount that was consumed per day and the family history of alcoholism.Results: While only 33.3% of patients in early onset group were married, the patients in late onset group who were married were found to be 71.4%. There was a history of alcohol addiction respectively in the family of 66.6% of early onset group and of 39.3% of late onset group. In early onset group, attention and motor impulsivity were at more significant level than late onset group. In early onset group; OCDS score were at significant level more than late onset group. It was determined that there is no difference in terms of DM which was evaluated from the early stage to the last stage of IGT. Negative correlation was found between education period and attention impulsivity. Negative correlation was determined at significant level between age of regular alcohol usage, alcohol amount that was consumed per day, attention impulsivity and OCDS. Positive correlation was determined at significant level between alcohol amount which is used per day, attention, motor, non-planning impulsivity and OCDS. Increased amount of alcohol that was consumed per day and high OCDS score are effect attention impulsivity in regression analysis. Increased amount of alcohol that was consumed per day is effects motor impulsivity.Conclusion: While impulsivity in early-onset alcohol addicts is at more significant level than late-onset group, it was determined that there is no difference of DM between two groups.

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1. Ince A, Dogruer Z, Turkcapar MK. Comparision of sociodemographic, clinic and psychopathologic features of the early and late onset alcohol dependent males. Clinical Psychiatry 2002; 5:82-91. (Turkish)
2. Nigg J, Glass J, Wong M, Poon E, Jester J, Fitzgerald H, Puttler L, Adams K, Zucker R. Neuropsychological executive functioning in children at elevated risk for alcoholism: findings in early adolescence. J Abnorm Psychol 2004; 113:302-314.
3. Wicks S, Hammar J, Heilig M, Wisen O. Factors affecting the short-term prognosis of alcohol dependent patients undergoing inpatients detoxification. Subst Abus 2001; 22:235-245.
4. Demir B, Ulug B. Neuropsychological functions in early and late onset alcoholism. Turk Psikiyatri Derg 2002; 13:15-21. (Turkish)
5. Joos L, Schmaal L, Goudriaan AE, Fransen E, Van den Brink W, Sabbe BG, Dom G. Age of onset and neuropsychological functioning in alcohol dependent inpatients. Alcohol Clin Exp Res 2013; 37:407-416.
6. Crews FJ, Boettiger CA. Impulsivity, frontal lobes and risk for addiction. Pharmacol Biochem Behav 2009; 93:237-247.
7. Moeller FG, Barratt ES, Doughery DM. Psychiatric aspects of impulsivity. Am J Psychiatry 2001; 158:1783-1793.
8. Vitaro F, Ferland F, Jacques C, Ladouceur R. Gambling, substance use and impulsivity during adolescence. Psychol Addict Behav 1998; 12:185-194.
9. Bjork JM, Hommer DW, Grant SJ, Danube C. Impulsivity in abstinent alcohol-dependent patients: relation to control subjects and type 1- type 2 like traits. Alcohol 2004; 34:133-150.
10. Dom G, D'haene P, Hulstjin W, Sabbe B. Impulsivity in abstinent early- and late- onset alcoholics: differences in selfreport measures and a discounting task. Addiction 2006; 101:50- 59.
11. Bechara A. Decision making, impulse control and loss of will power to resist drugs: a neurocognitive perspective. Nat Neurosci 2005; 8:1458-1463.
12. Yazici K, Yazici AE. Neuroanatomical and neurochemical basis of impulsivity. Current Approaches in Psychiatry 2010; 2:254-280.
(Turkish)13. Bechara A, Tranel D, Damasio H. Characterization of the decision making deficit of patients with ventromedial prefrontal cortex lesions. Brain 2000; 123:2189-2202.
14. Bechara A, Damasio AR, Damasio H, Anderson SW. Intensity to future consequences following damage to human prefrontal cortex. Cognition 1994; 50:7-15.
15. Bechara A, Dolan S, Denburg N, Hindesa A, Anderson SW, Nathan PE. Decision-making deficits, linked to a dysfuntional ventromedial prefrontal cortex, revealed in alcohol and stimulant abusers. Neuropsychologia 2001; 39:376-389.
16. Petry NM. Delay discounting of money and alcohol in actively using alcoholics, currently abstinent alcoholics and controls. Psychopharmacology (Berl) 2001; 154:243-250.
17. Graham Jr, Strenger VE. MMPI characteristics of alcoholics: a review. J Consult Clin Psychol 1988; 56:197-205.
18. Winstanley CA, Eagle DM, Robbins TW. Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies. Clin Psychol Rev 2006; 26:379-395.
19. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of Impulsivity. Am J Psychiatry 2001; 158:1783-1793.
20. W Hall, C Sannibale. Are the two types of alcoholism? Lancet 1996; 348:1258.
21. Oner H, Tamam L, Levent BA, Oner S. Assessment of axis I and axis II comorbidities in hospitalized patients with alcohol dependence. Bulletin of Clinical Psychopharmacology 2002; 12:14-22. (Turkish)
22. Corapcioglu A, Aydemir O, Yildiz M, Esen A, Koroglu E. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Clinical Version. Hekimler Yayin Birligi, Ankara, 1999. (Turkish)
23. Gulec H, Tamam L, Gulec MY, Turhan M, Karakus G, Zengin M, Stanford MS. Psychometric properties of the Turkish version of the Barratt impulsiveness scale-11. Bulletin of Clinical Psychopharmacology 2008; 18:251-258. (Turkish)
24. Gulec H, Gulec MY, Kucukali CI. Psychometric properties of the Turkish version of the Iowa Gambling Task in male prisoners diagnosed with adults attention deficit hyperactivity disorder. Psychiatry in Turkey 2007; 9:91-97. (Turkish)
25. Anton RF, Moak DH, Latham PK. The Obsessive compulsive drinking scale: a new method of asseising outcome in alcoholism treatment studies. Arch Gen Psychiatry 1996; 53:225-231.
26. Evren C, Celik S, Evren B, Aksoy R. Validation study of the Turkish version of the obsessive-compulsive drinking scale in male alcohol dependent inpatients. Düşünen Adam: The Journal of Psychiatry and Neurological Sciences 2011; 24:1-12. (Turkish)
27. Matzger H, Delucchi K, Weisner C, Ammon L. Does marital status predict long term dirinking? Five-year observations of dependent and problem drinkers. J Stud Alcohol 2004; 65:255-265.
28. Evren C, Dalbudak E, Cakmak D. Personality dimensions in male patients with early-onset alcohol dependence who seek treatment. Isr J Psychiatry Relat Sci 2009; 46:204-206.
29. Reimer S, Maylor EA, Neil S, Neil C. Associations between a one-shot delay discounting measure and age, income, education and real-world impulsive behavior. Pers Individ Dif 2009; 47:973-978.
30. Evren C, Dalbudak E. Relationship of personality trait impulsivity with clinical variables in male alcohol-dependent inpatients. Bulletin of Clinical Psychopharmacology 2009; 19:15-23. (Turkish)
31. Hingson R. Advances in measurement and intervention for excessive drinking. Am J Prev Med 2004; 27:261-263.
32. King KM, Chassin L. A prospective study of the effect of initiation of alcohol and drug use on young adult substance dependence. J Stud Alcohol Drugs 2007; 68:256-265.
33. Tatsuzawa Y, Yoshimasu H, Moriyama Y, Furusawa T, Yoshino A. Validation study of the Japanese version of the ObsessiveCompulsive Drinking Scale. Psychiatry Clin Neurosci 2002; 56:91-95.
34. McCown WG. Multi impulsive personality disorder and multiple substance abuse: evidence from members of self help groups. Br J Addict 1988; 83:431-432.
35. Joos L, Goudriaan AE, Schmaal L, De Witte NA, Van den Brink W, Sabbe BG, Dom G. The relationship between impulsivity and craving in alcohol dependent patients. Psychopharmacology (Berl) 2013; 226:273-283.
36. Cloninger CR, Sigvardsson S, Bohman M. Childhood personality predicts alcohol abuse in young adults. Alcohol Clin Exp Res 1988; 12:494-504.
37. Fein G, Mc Gilivray S, Finn P. Normal performance on a simulated gambling task in treatment naive alcohol dependent individuals. Alcohol Clin Exp Res 2006; 30:959-966.
38. Mazas CA, Finn PR, Steinmetz JE. Decision-making biases, antisocial personality, and early-onset alcoholism. Alcohol Clin Exp Res 2000; 24:1036-1040.
39. Toor D, Roozen HG, Evans BE, Rombout L, Wetering BJM, Vingerhoets JJM. The effects of psychiatric distress, inhibition and impulsivity on decision making in patients with substance use disorders: a matched control study. J Clin Exp Neuropsychol 2011; 33:161-168.
40. Bechara A. Risky business: emotion, decision making and addiction. J Gambl Stud 2003; 19:23-51.