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Acetaldehyde, the first metabolite of ethanol, has been implicated in the pathogenesis of alcoholic liver disease. In order to investigate a possible immunologic mechanism whereby acetaldehyde might exert its toxic effect acetaldehyde protein conjuates were prepared and characterized. This study demonstrates that acetaldehyde conjugated albumin can be an immunogen, can form a more negatively charged, more acidic, heterogeneous conjugate than albumin and can elicitate a specific rabbit antibody. ELISA can be used to assay antibodies produced in response to acetaldehyde albumin conjugates suggesting that chronic alcohol ingestion can lead the generation of antibodies against acetaldehyde conjugated human serum albumin. The significance of this study is that it possibly can provide a method to investigate the mechanism responsible for the sequelae of alcoholism.

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Screening is the first step in identifying and treating alcohol-related problems among the senior population. This study was designed with two purposes. The first was to cross-validate the Senior Alcohol Misuse Indicator (SAMI) with two commonly used screening tools - the CAGE and the Shortened Michigan Alcoholism Screening Test – Geriatric version (SMAST-G). The second purpose was to examine the feasibility of using these tools within a front-line health care worker’s clinical protocol. The effectiveness of each screening tool was assessed by calculating the sensitivity, specificity, and the area under the receiver operating characteristic (AUROC) for each screening tool with a sample of seniors recruited from clinical and community sources (N=87). Participants were classified into different types of drinker with a structured clinical interview (i.e., the Structured Clinical Interview for the DSM-IV and a medical history, including medication list). Seven problem drinkers, 36 at-risk drinkers, 25 non-problem drinkers, and 19 non-drinkers were identified. Among the three screening tools, the SAMI had the highest sensitivity (83.72%) in identifying at-risk drinkers and problems drinkers and best overall performance with the greatest AUROC (0.710), whereas the SMAST-G had the highest specificity (95.45%) in ruling out an alcohol-related problem among participants classified as non-problem drinkers and non-drinkers. Six outreach mental health care workers tested each screening tool at least three times with their senior clientele and rated each tool on a number of characteristics. An ANOVA and post-hoc analyses using the Least Significant Difference (LSD) compared these ratings among the three screening tools. The SMAST-G and CAGE were cited as the easiest to score (p=0.002), while the SMAST-G was cited as the screening tool providing the most clinical information (p=0.047) and the most comprehensive (p=0.019) of the three tools. These results point to the overall effectiveness of the SAMI and the user-friendliness of the SMAST-G as appropriate screening tools for identifying alcohol-related problems among the senior population. Future studies may further examine these two screening tools among as-yet-untested clinical populations (i.e., geriatric mental health outreach patients, cognitively impaired, collateral informants) and how to improve screening tool usage among health care providers. / Thesis (Ph.D, Psychology) -- Queen's University, 2013-08-23 15:11:13.165

This thesis investigates the ways in which hereditary degeneration was discussed by Scottish psychiatrists in the late nineteenth and early twentieth centuries with particular reference to the anti-alcohol debate. I examine the theoretical writings of both clinical and forensic psychiatry to show how the theory of degeneration functioned as part of a new understanding of legal medicine and that psychiatric knowledge was always implicitly related to a broader conception of criminal capacity and the role of the modern state. While the argument is situated in the wider literature covering psychiatry and degeneration in Europe and America during the late nineteenth and early twentieth centuries, I trace a rather singular story rooted in the institutional peculiarities of Scotland, showing how psychiatrists attempted to use the problem of alcoholic degeneration to mould their science into a branch of public health, propelling them into their preferred role as guardians of the race. This public health campaign facilitated the creation of new categories of psychiatric knowledge consisting of mental abnormalities that did not amount to absolute insanity, but that none the less had a bearing on how people thought about the mind, conduct, and criminal capacity. All the leading figures of Scottish psychiatry had a significant interest in alcohol as a cause of degeneration, and in their descriptions of the condition, the legal applications of the doctrine were never from view. One reason for this was undoubtedly the autonomous nature of the Scottish legal system which, when combined with the relatively small professional population of Scotland, greatly increased the rate of intellectual exchange between psychiatrists and lawyers while intensifying the political implications of associating with certain doctrines. Thus, a large part of my thesis will also be devoted to the legal interpretation of psychiatric claims, and in later part of the thesis I examine in depth the extent to which psychiatric knowledge claims were able to modify the laws of Scotland. Three substantive themes protrude from the documents consulted: Heredity, degeneration and alcohol, and medico-legal interaction. In analysing these themes, I engage with specific aspects of the social and institutional life of Scottish psychiatrists in the late-nineteenth and early-twentieth centuries.

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