Donders Institute for Brain, Cognition and Behaviour
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Thesis defense Serge Walvoort (Donders series 236)

4 November 2016

Promotors: prof. dr. J.Egger, prof. dr. R. Kessels, Copromotor: dr. P. van der Heijden

The neuropsychologyof alcohol use disorder: A multimethod evaluation of
cognition and illness insight

Chronic alcohol use as well as acute alcohol withdrawal may bias self-evaluation and the outcome of self-report questionnaires in two ways. First, withdrawal effects of alcohol during abstinence may cause emotional and somatic discomfort that should be distinguished from other forms of (comorbid) psychopathology. Second, chronic alcohol use may lead to cognitive dysfunction and impaired illness insight affecting self-evaluations with questionnaires. In the present thesis, a multimethod evaluation of cognition and illness insight is employed in patients with Alcohol Use Disorders (AUD) by means of the following methods: classification (DSM), plain and corrected self-report methods, performance tasks and rating scales (self and others), as well as a systematic clinician based evaluation. Furthermore, empirical evidence was presented on the required period for abstinence before a reliable neuropsychological assessment of AUD patients can be carried out.

The use of this ‎multimethod evaluation of psychopathology, cognitive complaints, cognitive functioning, and illness insight in patients with AUD, leads to the conclusion that (1) while DSM-5 classification necessitates the identification of cognitive deficits, additional neuropsychological assessment is obligatory to information about the neuropsychological domains of functioning; (2) it is preferred to apply an abstinence period of at least six weeks before neuropsychological testing and self-report questionnaires can be reliably administered; (3) knowledge of the obscuring effects of alcohol withdrawal, alcohol-related cognitive dysfunctions, and lack of illness insight on self-report questionnaires and cognitive functioning, will contribute to better understanding of AUD patients. All this results in a more reliable and comprehensive profile of an individual’s strengths and weaknesses, in order to achieve a better treatment indication.