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Wednesday, Jan 21, 2015

Dr. Shehla Alavi Leading psychiatrist in Pakistan. Counselor Karachi Pakistan. Top psychiatrist in Karachi

Relationship between alcohol and tobacco use and cognitive performance
Sunday, Jan 18, 2015

This is an extract of Dr. Shehla Alvi’s paper on Alcoholism. Dr. Shehla Alvi is a expert psychiatrist and one of the leading counselors of Karachi, Pakistan.

Alcohol and nicotine are associated with different dimension of impulsivity. This causes multiple socio-behavioural problems, which are usually evident in the social circumstances. It is also postulated that alcohol combined with alcohol can damage brain areas which exacerbates the problem of impulsivity. This study is trying to find the association of chronic alcohol and tobacco use on the increment of impulsivity. Methods: 60 university students’ ages of 18-26 participated in the study who either smoke or drink (heavily or light) or non-smoker and non drinkers were selected to participate. Impulsivity was assessed by using self report questionnaires and behavioural tasks on the computer. Data was analyzed using SPSS16.0 and ANOVA was applied to find the association. Pearson’s correlation was also applied to get predictive correlation. Results: no significant association of alcohol with smoking together and neither separately on ANOVA’S were found, in augmentation in any of measures of impulsivity. The Pearson’s co-relational analysis came with significant relations with BISII total and its subscales with alcohol and tobacco use. Whereas, there were not very significant correlation with behavioural tasks except BART with alcohol use neither with smoking. Inferring that behavioural tasks measuring a specific dimension of impulsivity may be not affected with alcohol or tobacco usage. Conclusion: this study does not support the hypothesis and did not show any conclusive or significant deterioration of impulsive traits with chronic use of alcohol and smoking together.

Trait impulsivity, alcohol intake and alcohol-related aggression
Tuesday, Jan 13, 2015

This is an extract of Dr. Shehla Alvi’s paper on Alcoholism. Dr. Shehla Alvi is a expert psychiatrist and one of the leading counselors of Karachi, Pakistan.

Impulsivity is a multidimensional concept that has been defined variously as an inability to wait, or to inhibit inappropriate behaviors, a tendency to act without forethought, insensitivity to consequences. Impulsivity can also be defined as preference for a small immediate reward over a larger delayed reward4. Aspects of impulsivity can be captured by either self-report measures of personality or behavioural task that measure over behaviour related to specific dimensions of impulsivity. In the domain of personality, impulsivity is considered as a trait dimension and is usually measured by self-report personality questionnaires such as Barratt Impulsiveness Scale-11 (BIS-11). Pattonet et al who developed BIS-11, argued that three specific dimensions constitute impulsivity: cognitive (not focusing on the task at hand), motor (acting on the spur of the moment) and non-planning (not planning and thinking carefully. Reward focus and lack of reflectivity is thought to produce impulsive behavior, and this pathway is probably moderated by coexisting constitutional and environmental influences resulting in other specific behavioral expressions of disinhibition such as aggression or hyperactivity. Disinhibition has been characterized by several sub dimensions, including impulsivity, aggression, high activity level, and sensation seeking. Though the broad dimension of disinhibition as well as its sub-dimensions has been associated with adolescent alcohol and drug use, suggesting impulsivity is proximal to the core features of disinhibition, and therefore impulsivity may be a good indicator of disinhibitory processes. According to Neal’s study, the student population is mostly at risk due to the effects of poor impulse controls and the associated impact whereas, male gender is more impulsive and misuses illicit drugs. There has been an association of low serotonergic concentration in CSF and frontal lobe which, is the centre of executive functioning (ECF) and impulsivity. Furthermore any kind of change in the frontal lobe whether due to the structural damage or change in the neurotransmitter complex has the direct effect on the impulsivity and aggression resulting in, misjudgment, disinhibition and lack of planning or foresightedness leading to unprovoked aggression. Dolan also in his study tried to prove that an inverse relationship has been observed between indices of central serotonin function and aggression in humans and nonhuman primates12. Trait variation in serotonin function may explain individual differences in the aggression-promoting effect of alcohol. Giancula found that nearly 65% of male murderers displayed signs of frontal dysfunction on neurological examination determining that a prefrontal lesion was the best predictor of violent behaviour in a sample of 45 neuropsychiatric patients. One aspect of impulsivity is its inability to inhibit behaviour. This aspect of impulsivity is the factor that predicts alcohol use and alcohol problems. The association between impulsivity and alcohol has been suggested to underlie in common neurobiological factor. Giancola et al suggested that individuals prone to alcoholism are characterized by frontal lobe impairment and especially deficits in executive cognitive functioning18. Executive cognitive functioning (ECF) includes response inhibition, attention, working memory, strategy and assessment of behaviour consequences. Moreover, alcohol use has been suggested to play a role in frontal lobe atrophy. Also, alcohol has been suggested to reduce attention, limiting abstract thinking and problem solving. Thus, it can be argued that impulsive individuals are more prone to alcohol use and alcohol problems due to their inability to control their behaviour which results from dysfunction in ECF. However, impulsive people tend to drink more and because alcohol further impairs ECF there is a possibility that there would be an increase in problems related to alcohol consumption among impulsive individuals.

As impulsivity, aggression is a multidimensional construct that has been variously defined. Traditionally, it has been defined as an ‘intention to harm another living being, and not simply the delivery of harm, aimed at the injury of a target’. This intention seems clear in some kinds of aggression, but in other kinds of aggression the perpetrators of the harm, might be able to deny any intent to cause harm; according to behaviorist approach ‘aggression is to deliver noxious stimuli to another organism’ or, it is ‘the delivery of any form of definite and observable harm-giving behavior towards any target’, without mentioning the eventual intention of the actor. Aggression can be categorized as direct- indirect harm, physical, verbal (verbal means words to inflict harm) and active- passive aggression (extent to which the aggressor actively engages or passively engages by not doing any thing. According to Buss, the indirect aggression is the response which results in pain stimulus by rejecting or excluding victim. The impulsive aggression is without any forethought as compared to the planned aggression. According to Geen, major premise is that the elicitation of aggression is dependent on the interaction of two general factors. The first involves background variables such as genetics, physiology, temperament, personality, social-cultural expectations, and exposure to violence which predisposes individual and the second factor is provoking or frustrating stimuli in the environment that produce stress, arousal, and anger. These stimuli can take many forms, such as a verbal or physical attack, family conflict, hot temperatures, and physical pain. Pernanen hypothesized that psychological coping mechanisms that rely on conceptual or abstract reasoning are being affected by the excessive alcohol consumption which further increases the probability of an aggressive reaction. According to Pihl et al, posited a biosocial model of intoxicated aggression in which cognitive functioning is, but a single aspect of a multidimensional mechanism24. According to these theorists, acute alcohol consumption disrupts the functioning of the prefrontal cortex (the primary neural substrate believed to sub serve executive functioning) and its sub cortical connections, especially the hippocampus, which, may be the cause of recognition of threat. Thus, by disrupting these neural regions and circuits, alcohol eliminates signals of punishment through its anxiolytic effects (i.e., reduces fear reactions) thus resulting in decreased inhibitory control over behaviour.

Alcohol intoxication is often associated with violent crimes, suicide, and the spread of sexually-transmitted diseases, injuries and automobile accidents. Empirical studies of alcohol-induced impulsivity have generally been limited to motor impulsivity even though cognitive impulsivity may better represent the behavioural processes associated with intoxication (e.g. drinking and driving, unprotected sex, aggression, etc.) and long-term drug use (e.g. choice of immediate, short-term effects of intoxication over delayed, long-term effects of abstinence). A concept closely related to cognitive impulsivity is behavioural choice theory. According to behavioural choice theory drug use is influenced, not only by availability of the abused substance, but also by access to non-drug alternative activities. An extensive body of research indicates that alcohol consumption is strongly linked to a variety of aggressive behaviors, including verbal aggression, aggressive threats, family violence, marital aggression, violence-related emergency room visits, child abuse, firearm use, sexual aggression, homicide and suicide.

Multiple studies have been done to prove the association between impulsivity and aggression or alcohol and aggression or impulsivity. In our study we are trying to find the association of trait impulsivity to alcohol related aggression if alcohol is being used as the mediator of impulsivity and aggression.

The hypothesis is that, impulsivity predicts aggression when mediated by the use of alcohol. As, alcohol inhibits the control of acting out behaviour and the non-aggressive impulses in an individual.