Psychosocial factors associated with relapse in men with alcohol or opioid dependence.

Background & objectives: Relapse is a common and distressing aspect of substance dependence mediated by several biological and psychosocial factors. This study examined the association between demographic variables, clinical parameters and certain psychosocial factors and relapse among patients with either alcohol or opioid dependence. Methods: Structured assessments of clinical/demographic parameters, relapse precipitants, coping strategies, self-efficacy, stressful life events and perceived social support were carried out among patients with alcohol/opoid dependence (n=30) who had relapsed and compared with those (n=30) who had managed to remain abstinent. Similar comparisons were also carried out between relapsed and abstinent patients in the individual subgroups of alcohol and opioid dependence. Results: Patients who had relapsed were significantly more likely (i) to have a positive family history of substance use and higher number of previous relapses; (ii) to be using maladaptive coping strategies; (iii) to have been exposed to a higher total number of ‘high risk’ situations; and (iv) have experienced a higher number of undesirable life events. Those who had remained abstinent tended to use significantly more number of coping strategies, principally adaptive ones and scored significantly higher on all measures of self-efficacy. Factors influencing relapse appeared to be largely similar among patients with alcohol and opioid dependence. Interpretation & conclusions: This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It extended these results to substances other than alcohol and provides the basis for investigating correlates of relapse in a wide range of behavioural and substance use problems.

Metabolic syndrome & psychiatric disorders.

The metabolic syndrome, a constellation of symptoms associated with obesity, dyslipidaemia, insulin insensitivity, deranged glucose metabolism and hypertension has been gaining widespread interest due to its immense clinical relevance. We review the metabolic syndrome in terms of its diagnostic criteria and its relationship with severe mental illnesses and psychotropic medications, and the guidelines to manage it.

Substance-dependent women attending a de-addiction center in North India: sociodemographic and clinical profile.

BACKGROUND: Treatment-seeking is limited in women substance abusers. Studying the sociodemographic and clinical profile of treatment-seeking substance-dependent women can help us to understand the problem better and respond appropriately in terms of primary and secondary prevention strategies. AIM: To study the sociodemographic and clinical profile of women attending a de-addiction centre in North India. DESIGN AND METHODOLOGY: Retrospective structured chart review of 35 women substance abusers. RESULTS: The results indicated that a typical subject was urban (86%), married (63%), nuclear family (60%), based housewife (57%), educated up to school completion (54%), and having poor social support (57%). The common substances were opioids (60%), followed by alcohol (17%), and tobacco and benzodiazepines (11.5% each). The mean age at onset of substance use was 30.5 years, the mean duration of use was 9 years and mean duration to develop dependence was 5.5 years. The common reasons for initiating use were medical (63%) and curiosity (34%). Comorbidity profile was: physical illness (34%), psychiatric illness (23%) and dependence on another substance (14%). Only 20% had a family history of substance dependence. The social impairment ranged from 77% for social to 40% for financial and none for legal aspects. A typical subject had followed up 4.2 times in 8.4 months, while 54% were abstaining, 40% were continuing their substance dependence at the last follow up. CONCLUSIONS: The results suggest that the development of substance dependence in women is a combination of genetic, personal, and social vulnerability factors, including the drug culture of the social milieu and the poor social support. Comorbidity and impairment are common features.

Courses of substance use and schizophrenia in the dual-diagnosis patients: is there a relationship?

BACKGROUND: Interrelationship of schizophrenia and substance use is complex and multifactorial. Examining the influence of various psychoactive substances on course of patients with pure dual-diagnosis schizophrenia may help to solve this riddle. AIM: To examine the relationship of the courses of substance use and schizophrenic symptomatology in substance abusing "dual-diagnosis" patients with schizophrenia. SETTINGS AND DESIGN: Outpatient Deaddiction and Treatment Center of a tertiary care hospital with a retrospective design. METHODS and MATERIAL: Twenty-two substance abusing dual-diagnosis patients with schizophrenia were investigated regarding the course of substance use (abuse/dependence, use, non-use) and that of schizophrenia (psychotic, non-psychotic, in remission). A graphical representation of course of schizophrenia and substance abuse was made and their relationship studied by superimposition of respective graphs. STATISTICS: The Friedman two-way analysis of variance of ranks was applied to see the relationship between time spent by patients while on and off various substances. RESULTS: In five cases, the onset of schizophrenia preceded the onset of substance use. In seven out of 22 subjects, the schizophrenic exacerbation was clearly preceded by increase in substance abuse in the preceding two-twelve months. In none of the subjects decrease in substance use led to a decrease or increase in schizophrenic symptoms. CONCLUSIONS: Although substance use disorder preceded the onset of schizophrenic illness in the majority, and increase in substance abuse preceded schizophrenic exacerbation in one-third of dual-diagnosis patients, overall there was no evidence that the course of substance use was associated with that of schizophrenia after both disorders were diagnosed.

Akathisia--diagnostic dilemma and behavioral treatment.

Akathisia, an involuntary movement disorder resulting from exposure to antipsychotics, is characterized by subjective restlessness and a strong desire to move about. The diagnosis is often complicated by the overlapping symptoms of pseudoakathisia, chronic akathisia and tardive dyskinesia. This report deals with a patient with schizophrenia who developed akathisia after exposure to antipsychotics. Later, she developed movements that were more like pseudoakathisia and tardive dyskinesia rather than acute akathisia. On failure of anti-akathisia medication, she was treated with a behavioral regime to which her akathisia responded. This behavioral regime used the technique of distraction as a primary tool. This case report highlights the diagnostic difficulties in akathisia and the application of behavioral treatment for akathisia that is non-responsive to anti-akathisia medication.

Subtypes of codeine cough syrup abusers.

This paper highlights the abuse potential of the codeine containing cough syrups, which may take two forms. One, experimental abuse in school or college students which later persists in a dependent pattern. Two, pre-existing opioid abusers, as a substitute which starts after the school or college years. The short term treatment outcome is better in the former group in that they are able to maintain abstinence for a relatively longer period.

Huntington's disease and alcohol abuse.

The dopamine, glutamate and GABA systems are known to mediate the effects of alcohol on the movement disorders, though their exact roles are not clear. Thus, use of alcohol has implications for pathogenesis as well as management of the movement disorders. These implications are discussed citing a patient who had a strong family history of Huntington's disease and in whom movement disorder and behavioral problems were manifest under alcohol use and withdrawal, but not while being abstinent.

HIV screening & risk behaviour in psychoactive substance users.

Patients admitted to the Drug De-addiction and Treatment Centre, Postgraduate Institute of Medical Education & Research, Chandigarh, were screened for HIV antibodies. Out of 116 patients, 45 (39%) were injecting drug users (IDUs), 29 (25%) were other drug users and 42 (36%) were primary users of alcohol. One IDU was HIV seropositive (2.2% of the IDUs). Analysis of HIV-related risk behaviour showed that the IDUs were at high risk, because of needle sharing as also because of having multiple sex partners. The potential for HIV infection in these persons practising high-risk behaviour calls for timely preventive measures.