Time Trend For Substance Use Disorder And Psychiatric Disorders Among Patients Seeking Treatment From A Dual Diagnosis Clinic Of A Tertiary Care Substance Use Disorder Treatment Centre In India

Objective: The study is aimed at assessment of time trend for substance use disorder and psychiatric disorders among patients seeking treatment from a dual diagnosis clinic of a tertiary care substance use disorder treatment centre in India. Methods: The study is based on chart review of the patients seeking treatment from the Dual Diagnosis Clinic of a tertiary care substance use disorder treatment centre. The records of the patients seeking treatment over a six-year period (2009-2014) were reviewed. Information was collected on sociodemographic variables, substance use disorder and co-occurring psychiatric disorder. Results: A total of 289 patients sought treatment from the dual diagnosis clinic of the centre. Majority were male (97.2%). Primary drugs of abuse were nicotine (74.4%), alcohol (49.5%), cannabis (38.4%), and opioids (28.7%). Most common co-occurring psychiatric disorders were psychiatric disorders, including schizophrenia (45.0%), Major depressive disorder (24.9%), Bipolar disorder (18.3%), anxiety disorder (4.5%) and OCD (2.4%). Most patients with psychotic disorders and depressive disorders had co-occurring alcohol dependence. Most patients with bipolar disorder had co-occurring cannabis dependence. There was a marginally significant increase in proportion of subjects with cannabis dependence (PTrend= .07). There was no significant time trend for various co-occurring psychiatric disorders. Conclusions: The findings of the current study suggest that there has been a marginally significant increase in proportion of subjects with cannabis dependence over the six study years. However, the proportion of co-occurring psychiatric disorders was stable across these years. The findings of the current study suggest that the centre should be prepared to cater to an increasing proportion of patients with cannabis dependence and possibly co-occurring psychotic disorders in the coming years. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

Efficacy of combination of fluoxetine and cognitive behavioral therapy and fluoxetine alone for the treatment of obsessive compulsive disorder

A number of pharmacological approaches as well as psychological interventions are effective in the treatment of obsessive-compulsive disorder [OCD]. The present study was conducted to see the relative efficacy of treatment approaches. 30 diagnosed cases of OCD were taken and divided into two groups. Each group consisted of 15 patients. Group A [N=15] received Capsule Fluoxetine and Group B [N=15] received Capsule Fluoxetine and CBT [13 weekly sessions]. Twenty six participants completed the study [13 in each group]. Dhaka University Obsessive-compulsive Scale [DUOCS] was used to measure the symptom severity. Symptom scores were measured at weeks 1, 5, 9 and 13. After 13 weeks, analysis of the data was done and the means of initial DUOCS score and 13th week score were compared. In both the groups the mean score changes were highly significant [p=0.000]. Intra group analysis revealed that both the treatment approaches were highly efficacious. Inter-group analysis revealed that the response in combination group was significantly higher starting from 9th week, continuing up to 13th week. Mean symptom reduction and mean percentage reduction of symptoms were also higher in the case of combination group

Clinical and autonomic functions: a study of childhood anxiety disorders

Childhood and adolescent anxiety is generally associated with a varied somatic symptom pattern thought to reflect autonomic system activity. Few studies have examined the autonomic characteristics of generalized anxiety disorder [GAD]. This omission is at odds with contemporary models of autonomic cardiovascular control. The current study aimed to find differences in autonomic functions between children with a diagnosis of childhood anxiety disorder and a control group using a case-control design. A cross sectional experimental study conducted in the years 2004-2005 in the psycho-physiology lab of a tertiary care multi-speciality teaching hospital. Assessments were carried out using a semistructured interview, K-SADS [Schedule for Affective Disorders and Schizophrenia for Children and Adolescents]; STAIC [State and Trait Anxiety Inventory for Children]; CDRS [Childhood Depression Rating Scales]; SCARED [Self-Report for Childhood Anxiety-Related Disorders]. Autonomic reactivity was tested using the standard battery of tests. There were differences between 34 children and adolescents [age range, 8-18 years] with a diagnosis of childhood anxiety disorder and a control group of 30 age- and sex-matched subjects from a nearby school in autonomic activity and reactivity between individuals with anxiety disorder and non-anxious control subjects. Our finding is suggestive of autonomic rigidity or diminished physiologic flexibility in children with anxiety disorder. The study is probably the first of its kind to look into the issue in detail using a detailed battery of the autonomic function tests, and the results are of help in better understanding the condition. The result of the present experiment supports differences in autonomic activity and reactivity between individuals with anxiety disorder and non-anxious control subjects

Profile difference between male and female psychiatric patients seeking certificate of disability

Neuropsychiatric disorders are one of the major contributors to the global burden of disease and disability. Issue of disability in psychiatric disorders has been studied across multiple studies in India. However, there are no reports on the profile and nature of disability among those seeking disability certificates. The current study aims at understanding the socio-clinical profile of patients seeking disability certificate in a tertiary care hospital in India. The study was carried out in the Department of Psychiatry of a tertiary care multispecialty teaching hospital. A chart review of the records of the patients referred for disability evaluation over a one year period was conducted. The disability was assessed using IDEAS. In between group comparisons were carried out for male and female subjects for different sociodemographic variables, IDEAS total score and individuals item score using independent sample t test [parametric test] and Mann Whitney-U test [non parametric test]. Additionally, Spearman's rank order correlation was calculated to establish the level of correlation between total IDEAS score and score on individual items of the scale. The subjects were diagnosed to have been suffering from mental retardation 107 [61.8%], schizophrenia 54 [31.2%], dementia 5 [2.9%], bipolar affective disorder 4 [2.3%] and obsessive compulsive disorder 3 [1.7%] as per ICD-10. Male and female subjects differed significantly on the global IDEAS score. The total score was significantly higher for male subjects compared to female subjects. The difference was statistically significant for "self care" and interpersonal activities items of the scale with male subjects having higher disability scores. The current study provides some important insights into profile of disability certificate seeking individuals in India

The Role of NMDA Receptor Antagonists in Nicotine Tolerance, Sensitization, and Physical Dependence: A Preclinical Review

Nicotine, the primary psychoactive component of tobacco products, produces diverse neurophysiological, motivational, and behavioral effects through several brain regions and neurochemical pathways. Various neurotransmitter systems have been explored to understand the mechanisms behind nicotine tolerance, dependence, and withdrawal. Recent evidence suggests that glutamate neurotransmission has an important role in this phenomenon. The aim of the present review is to discuss preclinical findings concerning the role of N-methyl-D-aspartate (NMDA) receptor neurotransmission in mediating the behavioral effects of nicotine, tolerance, sensitization, dependence, and withdrawal. Based on preclinical findings, it is hypothesized that NMDA receptors mediate the common adaptive processes that are involved in the development, maintenance, and expression of nicotine addiction. Modulation of glutamatergic neurotransmission with NMDA receptor antagonists may prove to be useful in alleviating the symptoms of nicotine abstinence and facilitate tobacco-smoking cessation.