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Guest Editorial
Training Issues in Psychiatry in Canada
Emmanuel Persad, John Leverette
(PDF)

In Review
The Implications of Core Competencies for Psychiatric Education and Practice in the US
Stephen C Scheiber, Thomas AM Kramer, Susan E Adamowski
(PDF)

Mastering CanMEDS Roles in Psychiatric Residency: A Resident’s Perspective
Isolda Tuhan
(PDF)

Residency Training: Challenges and Opportunities in Preparing Trainees for the 21st Century
Lawrence Martin, Karen Saperson, Barbara Maddigan
(PDF)

Original Research
Patient Characteristics Associated With Nonprescription Drug Use in Intentional Overdose Andre Lo, Stephen Shalansky, Marianna Leung, Yitzchak Hollander, Janet Raboud
(PDF)

The Canadian Psychiatric Association Practice Profile Survey: I. Methods and General Sample Characteristics
Elizabeth Lin, D Blake Woodside, Anne Rhodes
(PDF)

The Canadian Psychiatric Association Practice Profile Survey: II. General Description of Results
D Blake Woodside, Elizabeth Lin
(PDF)

Effect of Depression on Stroke Morbidity and Mortality
Rajamannar Ramasubbu, Scott B Patten
(PDF)

Switch to Mania Upon Discontinuation of Antidepressants in Patients With Mood Disorders: A Review of the Literature
Sherese Ali, Roumen Milev
(PDF)

Acute Neuroendocrine Response to Sexual Stimulation in Sexual Offenders
Philip Haake, Manfred Schedlowski, Michael S Exton, Christoph Giepen, Uwe Hartmann, Michael Osterheider, Martin Flesch, Onno E Janssen, Norbert Leygraf, Tillmann HC Krüger
(PDF)

Brief Communication
Weight Gain in First-Episode Psychosis
Jean Addington, Chrystal Mansley, Donald Addington
(PDF)

Influence of Season and Latitude in a Community Sample of Subjects With Bipolar Disorder
Ayal Schaffer, Anthony J Levitt, Michael Boyle
(PDF)

Book Reviews
(PDF)

Overcoming Resistance in Cognitive Therapy.
Reviewed by
Nancy L Kocovski, MA; Zindel V Segal, PhD, C Psych

Media Violence and Its Effect on Aggression: Assessing the Scientific Evidence.
Reviewed by
Jan Volavka, MD, PhD

Letters to the Editor
(PDF)

Biological Factors and Adolescent Alcohol Use

Minor Strokes Related to Paroxetine Discontinuation in an Elderly Subject: Emergent Adverse Events

Quetiapine Reduces Flashbacks in Chronic Posttraumatic Stress Disorder

Behaviour Therapy for Dizziness?

Involuntary Treatment of a Patient with Factitious Disorder: A Paradox?

Letters to the Editor

Biological Factors and Adolescent Alcohol Use

Dear Editor:

Several papers on the effect of psychosocial factors on adolescent alcohol use have been published over the past several years. Undoubtedly, psychosocial influences play an important part in alcohol use. However, biological factors and their interaction with environmental factors also play an important role in the development of alcohol use disorders in adolescents.

Alcohol misuse tends to run in families, and it is estimated that 40% to 60% of the variance of risk is explained by genetic influences (1,2). Numerous well- designed twin and adoption studies have demonstrated that genetic factors are important in determining vulnerability to alcoholism (3–5). Children of patients with alcohol dependence are 5 times more likely to develop alcohol-related problems than are children of nonalcohol- dependent individuals (6,7). There is a tendency for people who misuse alcohol to marry individuals who also abuse alcohol (assortative mating) (8). Thus, many adolescent alcohol misusers are from families with a high proportion of alcohol abuse or dependence. Some of these adolescents were exposed to alcohol in utero. Familial loading for alcohol dependence is a risk factor for developing psychiatric and neurological disorders in children and adolescents (9,10). A recent study suggests that offspring from families with a high proportion of alcoholism differ in both neuroanatomical and neuro- physiological characteristics. These differences could not be explained by a personal history of alcohol consumption or by specific childhood or adolescent psychopathology (10). Ethanol use during adolescence may disrupt maturational processes in certain brain regions (11). Dopamine projection regions, for example, are undergoing developmental change during adolescence (11). The importance of dopaminergic mechanisms in the biology of alcohol-induced award is well known (12–14). Withdrawal from alcohol is associated with decreased firing of dopaminergic neurons in the ventral tegmental area and decreased dopamine release in the nucleus accumbens (15).

In summary, genetic, developmental, and acquired biological factors affect adolescent alcohol use. Many adolescent drinkers have subtle or overt developmental deficits or psychiatric disorders that require appropriate treatments. Further studies of the role of biological factors in initiation and continuation of adolescent alcohol use are necessary.

References

1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Text revision. 4th ed. Washington (DC): American Psychiatric Press; 2000. p. 221–2.

2. Enoch M-A, Goldman D. Genetics of alcoholism. In: Pfaff DW, Berrettini WH, Joh TH, Maxson SC, editors. Genetic influences on neural and behavioral functions. Boca Raton: CRC Press; 2000. p 147–57.

3. Heath AC, Bucholz KK, Madden PAF, Dinwiddie SH, Slutske WS, Beirut DJ, and others. Genetic and environmental contributions to alcohol dependence risk in a national twin sample: consistency of findings in women and men. Psychol Med 1997;27:1381–96.

4. Kendler KS, Heath AC, Neale MC, Kessler RC, Eaves LJ. A population-based twin study of alcoholism in women. JAMA 1992;268:1877–82.

5. Pickens RW, Svikis DS, McGue M, Lykken DT, Heston LL, Clayton PJ. Heterogeneity in the inheritance of alcoholism. Arch Gen Psychiatry 1991;48:19–28.

6. Winokur G, Clayton PJ. Family history studies IV: comparison of mail and female alcoholics. Q J Stud Alcohol 1968;29:885–91.

7. Midanik L. Familial alcoholism and problem drinking in a national drinking survey. Addict Behav 1983;8:133–41.

8. Tambs K, Vaglum P. Alcohol consumption in parents and offspring: a study of the family correlation structure in a general population. Acta Psychiatr Scand 1990;82:145–51.

9. Hill SY, Lowers L, Locke-Wellman J, Shen SA. Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. J Stud Alcohol 2000;61:661–8.

10. Hill SY, De Bellis MD, Keshavan MS, Lowers L, Shen S, Hall J, Pitts T. Right amygdala volume in adolescent and young adult offspring from families at high risk for developing alcoholism. Biol Psychiatry 2001;49:894–905.

11. Spear LP. The adolescent brain and the college drinker: biological basis of propensity to use and misuse alcohol. J Stud Alcohol 2002;14:71–81.

12. Gianoulakis C. Implications of endogenous opioids and dopamine in alcoholism: human and basic science studies. Alcohol Alcohol 1996;31(Suppl 1):33–42.

13. Valenzuela CF, Harris RA. Alcohol: neurobiology. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG, editors. Substance abuse: a comprehensive textbook. 3rd ed. Baltimore: Williams and Wilkins; 1997. p 119–42.

14. Grace AA. The tonic/phasic model of dopamine system regulation and its implications for understanding alcohol and psychostimulant craving. Addiction 2000;95(Suppl 2):S119–S128.

15. Diana M, Pistis M, Carboni S, Gessa GL, Rossetti ZL. Profound decrement of mesolimbic dopaminergic neuronal activity during ethanol withdrawal syndrome in rats: electrophysiological and biochemical evidence. Proc Natl Acad Sci USA 1993;90:7966–9.

Leo Sher
MD New York, New York