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Brit. J Psychiat. (1971) 119, 605-6*************************************************** ABSTRACT

The Psychological Effects of Propranolol in the

Abstinence Phase of Chronic Alcoholics

By CARL CARLSSON and TAGE JOHANSSON

In a previous study hyperkinetic circulation was found in alcoholics in the abstinence phase. Normal conditions were restored by 40 mg. propranolol. Even tension symptoms decreased (Carlsson, 197l). MATERIAL AND METHOD The material consisted of 44 male chronic alcoholics (alcoholic addiction) admitted to a mental hospital and aged 29-54 years (mean 42). The dropout was 4 patients in each group. Initially all alcoholics with abstinence symptoms were treated with chlormethiazole (Hemineurint). The aim was to give the lowest possible dose. The patient generally had Severe symptoms of tension during the first few days, despite medication. Diazepam was also given sometimes, but owing to the risk of' habituation the aim here too was to give as little as possible. It would have been desirable to give only propranolol or placebo. However, the drop-out would then have been much greater, since the ward does not treat alcoholics behind closed doors or against their will. The treatment other than propranolol is given in Table I. The patients were examined twice by the psychologist (T.J.), the first time a few days after the patient had been admitted to the ward, and then after eight days on propranolol 40 mg (Inderal®) 4 times daily or placebo. The patients were given 56 questions at both times, from which were selected before the study 7 questions about tension, 8 about depression and 6 about dysphoria (irritability).

TABLE I Treatment other than propranolol or placebo during the 8 days of medication _______________________________________ Total dose for---------------- Total dose for The placebo group***** the propranolol group n = 18 ---***--------------n = 18 _______________________________________ Diazepam (Valium®) ***395 mg *******230 mg Chloralodol (Mecoral®) *75.2g *******102.4 g Phenytoin (Difhydan®) ***2.4 g**********2.1 g Chlormethiazole ********* 8.1 g ********20.7g (Hemineurin®) _______________________________________ RESULTS In the presentation of the results of the psychological examination, (Table II), all improvements are expressed in positive figures. Thus, the higher the figure the greater the improvement. There was a significant decrease in tension symptoms. In two cases bradycardia was noted (propranolol group). DISCUSSION The theory previously reached in an uncontrolled clinical study that propranolol has a selectively stress-relieving effect on the symptoms of alcoholics seems to have been confirmed, and the effect is often marked. There is no effect on dysphoric

TABLE II

Difference in points between questionnaires before and after 8 days of medication (calculated from total points for all patients)

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Tension _______________________ placebo **** propranolol 22 ********** 61 n = 18 ****** * n = 18 0,01 < P < 0,05

Depression ___________________ placebo ****** propranolol 11 ********* 70 n = 18 ****** * n = 18 0,05 < P < 0,10

Dysphoria ____________________ placebo ****** propranolol 33 ********** 27 n = 18 ****** * n = 18 No significance

Tension + Depression _____________________ placebo ****** propranolol 33 ***********131 n = 18 ****** * n = 18 0,01 < P < 0,05

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Kolmogorow - Smirnow two-sample test.

603

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606 PSYCHOLOGICAL EFFECTS OF PROPRANOLOL IN THE ABSTINENCE PHASE OF CHRONIC ALCOHOLICS

Symptoms. The doses of other preparations were fairly small (Table I), and it is improbable that the difference could be due to this. In a double-blind trial propranolol was found more effective than placebo in the treatment of anxiety (Granville-Grossman and Turner, 1966). Wheatley (1969) found propranolol as effective as chlordiazepoxide in the treatment of anxiety. High dosages of propranolol on laboratory animals have shown depressive effects on the central nervous system (Leszkovsky and Tardos, 1965). The mechanism of action of propranolol in the present study is of course partly peripheral, according to previous findings (Carlsson, 1971), but this can hardly be the whole explanation. Propranolol passes the blood-brain barrier and accumulates in various cerebral structures (Black et al., 1965). One can speculate whether the effect on the brain may be due to blockade of beta-adrenergic receptors. There are several studies indicating that betaadrcnergic receptors exist in the central nervous system (Connor et al., 1967).

There is no doubt that propranolol has a decreasing effect on tension symptoms, which clinically we have often found of great value. REFERENCES BLACK, J. W., DUNCAN, W. A. M., and SHANKS, R. G. (1965) . 'Comparison of some properties of pronethalol and propranolol.' Brit. 7. Pharmacol., 25, 577-91. CARLSSON, C. (1971). 'Haemodynamic studies in alcoholics in the withdrawal phase.' Int.-7. chin. Pharmacol. therapy and 7oxicol., Suppl., 3,61-3. CONNOR, J. D., ROSSI, G. V., and BAKER, NV. XV. (1967). 'Antagonism of intracaudate carbachol tremor by local injections of catecholamines.' 7. Pharmacol., 155,545 51. GRANVILLE-GROSSMAN, K. L., and TURNER, P. (1966). 'The effect of propranolol on anxiety.' She Lancet, i, 788-go. LESZKOVSKY, G., and TARDOS, L. ( 1965) . Some effects of propranolol on the central nervous system.' i. Pharm. Pharmacol., 17, 518 20. WHEATLEY, D. (1969). 'Comparative effects of propranolol and chloridiazepoxide in anxiety states.' Brit.v7. Psychiat., 115, 1411-12.

Carl Carlsson, M.D., Department II, Lillhagen Hospital, 422 o3 Hisings Backa 3, Sweden

TageJohansson, M.A., Department 11, Lillhagen Hospital, 422 o3 Hisings Backa 3, Sweden

(Received 25 November 1970)

To

Propranolol in the treatment of alcoholism: a review by C. CALSSON

Documents from Doctor Carl Carlsson / Documents du docteur Carl Carlsson

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