Alcohol Use Disorders and Diabetes Mellitus

Alcohol use disorder is a chronic relapsing brain disorder and is associated with high mortality and morbidity. Chronic alcohol use worsens diabetes and associated diabetes-related complication. Alcohol use, especially over the long-term, can impact the glycemic control in persons with diabetes mellitus. Heavy consumption of alcohol in people with diabetes can lead to worsening of diabetes-related complications like diabetic ketoacidosis, altered lipid metabolism, peripheral neuropathy, sexual dysfunction and cardiovascular disease. This review aims to describe the association between alcohol use and glucose tolerance, effects of alcohol on the pre-existing diabetes; association between alcohol use, diabetes mellitus and diabetes-related complications and interaction of medicines used to treat diabetes with alcohol.

Profile of female patients seeking in-patient treatment for prescription opioid abuse from a tertiary care drug dependence treatment centre from India.

Background & objectives: There has been a limited focus on prescription drug abuse among women in the country. Choice of psychoactive substance, reasons for initiation and co-occurring disorders have been found to be different among men and women. The current study was aimed at studying the profile of female patients seeking in-patient treatment for prescription drug use over a period of five years at a tertiary care drug dependence treatment centre in India. Methods: Case records of all female patients admitted with substance use disorder at a national level drug dependence treatment centre in north India across five years (between January 2008 and December 2012) were reviewed retrospectively to study their socio-demographic and clinical profile. The information was gathered using a semi-structured proforma and detailed case records. Abstinence, relapse and retention rates were calculated. Results: Over the five years, 31 female patients were admitted with prescription drug abuse. Of them, 12 (39%) used prescription opioids and 11 (36%) used prescription opioid along with benzodiazepines. Commonest prescription opioid was pentazocine used by 87 per cent of the women. Twenty two (71%) women were introduced to opioid by medical practitioners and commonest reason for introduction was pain (among 48%). Common co-occurring psychiatric diagnoses were depressive disorder (26%), cluster B traits/disorder (19%) and somatoform disorder (13%). Eight women did not complete treatment and left against medical advice. Thirteen women were advised maintenance treatment, and 70 per cent of them were retained for at least six months. Interpretation & conclusions: Our fi ndings revealed a link between mental illness, pain and non-medical use of prescription opioids among women. Majority of these women received opioids as a legitimate prescription form physician. Therefore, these legitimate prescribers should be trained for pain management to facilitate proper treatment of pain and to prevent the subsequent misuse of these medicines. Female patients with frequent pain complaints should be assessed for psychopathology while prescribing opioids.

A study exploring attributes and nature of the retracted literature on mental disorders.

This study was aimed at assessing the retracted medical literature on mental disorders. Another aim was to test the hypothesis that the weak research infrastructure in certain countries and the rising pressure to publish in Asia due to the progress of science in that continent may have contributed to the increase in the number of retractions. A bibliometric search was carried out using the PubMed database. The data were analysed using SPSS version 21. The retraction rate for articles on mental disorders (number of retracted articles per 100,000 published articles on mental disorders) varied from a low of 3.56 (for 2005) to a high of 49.25 (for 2012). Of the 38 articles for which the reasons for retraction could be accessed, 10 (26.31%) were retracted for fraud. Overall, 0.0138% of all articles on the biomedical sciences were retracted. Of the articles on mental disorders, 0.0095% were retracted. There was a disproportionately greater number of retractions in the case of articles originating from low- and middle-income countries than high-income countries. Similarly, there was a disproportionately greater number of retractions in the case of articles originating in Asian countries than non-Asian countries.

Anxiety and Depression amongst the urban females of Delhi in Ante-partum and Post-partum period.

Objectives: To assess and compare the prevalence of anxiety and depression during and after pregnancy. Methodology: This cross sectional study was done in an inpatient setting in Department of Gynecology and Obstetrics in a tertiary level multi-specialty hospital in Delhi, India over a period of nine months.Two groups of women were studied. Group 1 sample included all pregnant women in last trimester awaiting delivery and Group 2 included the women in postpartum period (4-12 weeks after childbirth). Hospital Anxiety & Depression scale (HADS) was used to assess anxiety & depressive symptoms. Results: Of the 100 women included, 59% were awaiting delivery and 41% were in postpartum. The mean age was 23.87 years (SD 3.19), and both the groups were comparable on socio-demographic parameters. Of currently pregnant women 27% & 17% scored above cut-off on anxiety and depression scale respectively while amongst postpartum females 17% scored above cut-off on anxiety and depression scales. Both groups differed significantly (p<0.05) on the total HADS score and Anxiety subscale scores of HADS. There was no significant difference amongst the groups on Depression subscale scores. Conclusions: Prevalence of anxiety and depression is high amongst women during antepartum and postpartum periods. Pregnant women experience more anxiety during ante partum period as compared to post partum period and most of them are not being monitored during this time.

A pilot comparative study of attitude of trainee nurses, nursing staff and trainee doctors towards the mentally ill patients.

Context : The issue of stigma in mental illness has great practical and research implications. Health professionals including the nursing staff are important stakeholders in this issue. The issue of health professionals’ attitude towards people with mental illness has been controversial. Aims : The current study aims at comparison of the attitudes of the nursing students, nursing staff and trainee doctors towards mentally ill. Settings and design : The study was conducted at a tertiary level medical teaching and training institution with an attached hospital. Methods and Materials : The survey was conducted among trainee nurses, nursing staff and trainee doctors in the institution. A total of seven trainee nurses, eighteen nursing staff (including four Psychiatric nursing staff) and forty nine trainee doctors were included in the study. The participants were asked to complete a self-rated Attribution Questionnaire-27 (AQ 27). Statistical Analysis : Analysis was carried out using SPSS ver 16.0. ANOVA with post-hoc analysis was carried out to find in-between group differences on the nine domains of AQ 27. Results : The four groups differed significantly on the different domains of AQ 27. Conclusion : The negative attributes towards the mentally ill persons tend to be high among the nursing trainee, nursing staff and trainee doctors. There is a need to address these issues in the training curricula of these professionals in order to improve the health care delivery to the mentally ill.

Anxiety and Depression among the Caregivers of patients with Neurological illness.

Caregivers of the patients have shown to demonstrate high levels of psychological distress and depression; increased rates of physiological illness and personal, financial, family, and social problems. It is important to assess the mental health status and attend to the needs of care givers. The study was carried out in the Neurology in-patient setting in a tertiary care hospital. Thirty consecutive patients receiving in-patient care were included in the study. The anxiety and depression levels of these individuals were assessed using the Hospital Anxiety and Depression Scale (HADS). Male and female caregivers differed significantly on the total HADS score as well as the Anxiety and Depression subscale scores of HADS. The female care givers had significantly higher scores on HADS-Total, HADS-Anxiety and HADS-Depression sub scales. Additionally there was a significant correlation between the number of family members with chronic illness and HADS-Anxiety sub scale scores. It is crucial to screen the care givers, especially female care giver, of the patients with neurological illness for presence of anxiety and depression. This approach will help timely identification and proper management of these individuals.

Undergraduate Psychiatric Training: Insights from Emergency Room.

Context: Undergraduate medical training involves a number of subjects for the trainee to go through and develop the skills necessary to mange the cases. Subjects such as psychiatry are underrepresented during this training. Aims: This study aims to assess the quality of undergraduate psychiatric training through the management of psychiatry cases by MBBS graduated in the emergency department. Settings and Design: The study was carried out in the emergency department and OPD set up. The study used the consecutive sample inclusion. Methods and Materials: The study included the consecutive initial 40 consultation from the emergency department. The analysis included the management done by the emergency department, the reasons for referral and the differences in diagnosis/ management of emergency department staff and resident doctor of psychiatry. Statistical Analysis used: The data was analysed using SPSS ver 10. Results: The diagnosis in 15 cases was revised by the psychiatry resident doctor from that made by the emergency department staff. There were certain unusual reasons for referrals to a psychiatrist. There were differences in the line of management of some of the cases as per the emergency department staff and the psychiatry resident. Conclusion: There is a need to relook into the training curriculum of the undergraduate psychiatric training programme.

Impact of alcohol and substance abuse on adolescent brain: A preclinical perspective.

Use of alcohol and addictive substances by human juveniles and adolescents is common. Animal models offer researchers unique insight into the effects of alcohol and drugs on adolescents. Recent work in rat indicates that periadolescent substance use may disrupt normal pubertal development and may induce stronger effects on system subserving plasticity and cognition than in adults. Several processes may influence the adolescent risk of neurocognitive damage. The brain goes through various dynamic changes during adolescence and can seriously affect the short term growth process. The features of the adolescent brain may in fact predispose a youngster to behave in ways that place him or her at particular risk of experimenting with alcohol or other drugs. In addition to behavioral and neurochemical changes, a number of important physiological alterations occur during adolescence, including changes in brain regions implicated in the reinforcing properties of alcohol and other drugs of abuse. Damage during early stages can cause long term damage which is irreversible. The present review discusses the neurobehavioral, neurochemical and neuroendocrinal effects of alcohol and other drugs of abuse on the adolescent brain in rats.

References - Far from Unirformity: A Preliminary Study.

Context – Reference section of the articles being published in various medical journals have got a wide range of variations in the format they follow. The current paper tries to venture into this area and to consider the need and possibly of having a uniform referencing system. Objective – The study aims at identifying the variations in the referencing style followed by various journals. Design – The study included the observation of differences in referencing pattern of journals. Outcome measures – the differences in the pattern of referencing. Results – Inspite of the existing guidelines on writing the references, the journals are far from uniform in this regard.

Tobacco Use Among Drug Dependent Patients in Treatment Setting.

Tobacco use is widely prevalent in substance using patients in treatment settings. Nearly three times as many individuals with alcohol and drug problems smoke cigarettes compared to the general population. In addition to addressing the primary drug of abuse, it is important to systematically assess characteristics and patterns of tobacco use and treat tobacco dependence in these patients as they are at high risk of mortality from tobacco related illnesses..Consecutive patients presenting to the Tobacco Cessation Clinic of a national level deaddiction centre were assessed in detail using a semi-structured proforma. Most were males(97.3%) and majority (61.8%) of patients belonged to the 21-40 yrs age group. Most were self employed and primary drug of abuse was heroin in 47 (42.3%) and alcohol in 44 (39.6%) subjects. 53 (47.7%)used smoking tobacco only, 16 (14.7%) used only smokeless tobacco and 40 (36%) used a combination of both. Majority of smokable tobacco use was in the form of bidi (69.4%). Majority of the subjects (56.7%) were in the contemplation stage of change whereas 36 (32.7%) of subjects had taken steps towards quitting the use of tobacco products and qualified for the action stage as per RTCQ. The majority of patients qualified for moderate [56 (50.9%) dependence] to high dependence [37 (33.3%)] as per FTND score. This has obvious treatment implications.

Neurobiology of cannabis addiction.

Cannabis has emerged as a common substance of abuse and dependence and the peculiarities associated with this widely available and used substance has triggered substantial research in this field. The earlier held concept of rather benign nature of this compound as a substance of abuse and dependence has changed as a result of the ongoing clinical and research findings. Cannabis has been found to have multiple physical and mental effects in human beings. But still a lot remains to be answered regarding the basis for the development of dependence on cannabis. However, the discovery of various cannabis receptors and their endogenous and synthetic ligands have added fuel to the ever growing interest in this substance. Various hypotheses have been postulated in this regard based on the findings of both the animal and human studies which serve as potential explanations to the observations. These findings have helped in the better understanding of the issue and have provided substrate for the clinical application.

Chronic mania: An unexpectidly long episode?

Mood disorders (unipolar and bipolar disorders) are one of the most distressing and disabling disorders known to man kind. Mood disorders may present as either a depressive phase or manic phase. Chronic mania by definition means presence of manic symptoms in excess of 2 yrs without remission. Chronic mania differs in its psychopathological presentation from the acute mania. Chronic mania also poses a diagnostic and management challenge. Along with the poor response to the treatment these patients are also likely to suffer from severe impairment in the social, familial, interpersonal and occupational functioning. These disturbances may add to the chronicity of the condition. This case underlines the significance of keeping possibility of chronic mania which has been overlooked in the recent literature.