Prevalence of substance use disorders in Punjab: Findings from National Mental Health Survey

Background & objectives: Substance use disorders are a major public health concern in Punjab. However, reliable estimates of prevalence of substance use disorders are not available for the State. The present study reports estimates of prevalence of substance use disorders in Punjab, conducted as part of National Mental Health Survey, India. Methods: Using multistage stratified random cluster sampling, 2895 individuals from 719 households of 60 clusters (from 4 districts of Punjab) were interviewed. Mini International Neuropsychiatric Interview and Fagerstrom nicotine dependence scale were used to assess substance use disorders. Results: The sample comprised almost equal numbers of males and females. Nearly 80 per cent had less than or equal to high school education, and 70 per cent were married. The weighted prevalence of alcohol and other substance use disorders was 7.9 and 2.48 per cent, respectively. The prevalence of tobacco dependence was 5.5 per cent; 35 per cent households had one person with substance use disorder. The prevalence was highest in the productive age group (30-39 yr), urban metro and less educated persons. The prevalence of alcohol and other substance use disorders was much higher in Punjab as compared to other States where survey was done. Tobacco dependence was lowest in Punjab. Majority (87%) of the persons with substance use disorders did not suffer from any other mental disorder. Treatment gap was 80 per cent. Interpretation & conclusions: Punjab has a high burden of substance use disorders. The estimates will help clinicians and policymakers to plan the strategies against the menace of substance use disorders effectively.

Comparative Short term Efficacy and Tolerability of Methylphenidate and Atomoxetine in Attention Deficit Hyperactivity Disorder.

Objective: To compare the short term efficacy and tolerability of methylphenidate and atomoxetine in children with Attention deficit hyperactivity disorder (ADHD). Design: Open label randomized parallel group clinical trial. Setting: Child Guidance Clinic of a tertiary care hospital of Northern India from October 2010 to June 2012. Participants: 69 patients (age 6-14 y) with a diagnosis of ADHD receiving methylphenidate or atomoxetine. Intervention: Methylphenidate (0.2-1 mg/kg/d) or atomoxetine (0.5-1.2 mg/kg/d) for eight weeks. Main outcome measures: Treatment response (>25% change in baseline Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS); Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS); Clinical Global Impression Severity Scale (CGI-S) at eight weeks and adverse effects. Results: Treatment response was observed in 90.7% patients from methylphenidate group and 86.2% patients of atomoxetine group at an average dose of 0.45 mg/kg/d and 0.61 mg/kg/d, respectively. The patients showed comparable improvement on VADPRS (P=0.500), VADTRS (P=0.264) and CGI-S (P=0.997). Weight loss was significantly higher in methylphenidate group (-0.57±0.78 kg; P=0.001), and heart rate increase was observed at higher rate in atomoxetine group (7± 9 bpm; P=0.021). Conclusion: Methylphenidate and atomoxetine are efficacious in Indian children with ADHD at lesser doses than previously used. Their efficacy and tolerability are comparable.

Quality of life after electroconvulsive therapy in persons with treatment resistant schizophrenia.

Background & objectives: In recent years, health-related quality of life (QOL) has been regarded as the most important dimension of outcome in schizophrenia. Recent research has shown that atypical antipsychotics improve QOL in patients with schizophrenia. Importance of electroconvulsive therapy (ECT) has been demonstrated in restoring function and health related quality of life in depressed patients. However, there are no data on patients of schizophrenia. The objective of the present study was therefore, to assess the improvement in quality of life after ECT in treatment resistant schizophrenia. Methods: Thirty consecutive patients of treatment resistant schizophrenia were given ECT sessions twice a week and assessments were made with Positive and Negative Syndrome Scale of Schizophrenia (PANSS), WHO QOL Bref, Global Assessment of Functioning Scale and Clinical Global Impressions. Results: The group improved significantly on all the domains of quality of life scale except the domain named satisfaction with social relations. There was also significant change in the total score of PANSS after 6 ECT sessions (mean at baseline = 86.7, mean after 6 ECT = 65.5, P< 0.001) as well as on different subscales of PANSS. The score on the global assessment of functioning also changed significantly (mean 26.3 at baseline to 44.5 after 6 ECT sessions). Interpretation & conclusions: The present findings showed that ECT in addition to improvement in symptomatology led to improvement in QOL in patients of treatment resistant schizophrenia.

Impact of smoke-free law on tobacco consumption in Chandigarh: A community-based study.

Background and Objectives: Tobacco use is a major public health issue today and it is expected that 650 million smokers will die prematurely due to tobacco use. On 15 July 2007, Chandigarh became the first city to go smoke-free. However, there is no data on the impact of smoke-free law. The objective of the present study was therefore to study the pattern and prevalence of tobacco use and to examine the impact of smoke-free law in Chandigarh. Materials and Methods: Total sample comprised of 3000 subjects. Socio-demographic data sheet along with initial two questions from the General questionnaire were administered on each individual. In addition, all the tobacco users underwent administration of the Fagerstrom test for nicotine dependence or the Fagerstrom test for smokeless tobacco (smokeless tobacco users). Results: There were 43.9% tobacco users in the sample of 3000 subjects. Out of these tobacco users, 357 (11.9%) were pure smokers and 370 (12.3%) were using smokeless tobacco and 590 (19.6%) used both. The mean number of cigarettes/bidis smoked per day was 14 (+8.64) and the mean age of starting smoking was 19.41 (SD + 4.5 years).73.2% of population was aware about implementation of smoke-free law and all the participants (100%) reported smoking in public places. 43.4% smokers reported thoughts of quitting nicotine. Interpretation and Conclusion: Although the prevalence of tobacco use in Chandigarh is lower than the national average but the rates are still alarming and need attention. The findings of this study will help in designing tobacco control strategies and understanding the epidemiology of tobacco related health burden.

Stress and suicidal ideas in adolescent students in Chandigarh.

Background and Objectives: School students in India have a high stress level and high rate of deliberate self-harm. The present study was conducted to find out stress, psychological health, and presence of suicidal ideas in school students and to find out any correlation between these variables. Setting and Design: Cross-sectional study conducted on school students in urban area of Chandigarh city. Materials and Methods: Data was collected on 2402 students from classes VII to XII on socio-demographic scale, 12-item general health questionnaire, Mooney problem checklist, and suicide risk eleven -a visual analogue scale. Statistical analysis used was chi square and Spearman's correlation. Results: Out of 2402 students, 1078 (45.8%) had psychological problems, half (1201 students) perceived problems in their role as students, 930 (45%) reported academic decline, 180 (8.82%) students reported that life was a burden, 122 (6%) reported suicidal ideas and 8 (0.39%) students reported suicidal attempt. There was significant correlation between student's perception of life as a burden and class they were studying, mother's working status, psychological problems and problems students experienced in relation to study, peers, future planning and with parents. Conclusions: Students with academic problems and unsupportive environment at home perceived life as a burden and had higher rates of suicidal ideations.

Electroconvulsive Therapy for Migraine.

Till date, there have been no reports on the use of electroconvulsive therapy in treatment of migraine. We report a 43-year-old man who was given a course of modified ECTs for severe depression. The patient developed this depression secondarily to his long-standing, medication refractory migraine. After the course of ECT, successful migraine relief was achieved. The patient has since been headache free for a reasonably long period of time. ECT can show promise as a powerful new method of migraine treatment.

Attitude towards Acquired Immune Deficiency Syndrome and its determining factors: A community survey in rural and slum areas in India.

This survey was conducted to find out attitude of persons living in villages and slum areas of Chandigarh towards Acquired Immune Deficiency Syndrome and evaluate its determining factors. Methods - Households were selected from 5 villages and 5 slum areas by stratified random sampling. Trained field workers studied 2992 persons. A specially designed performa was administered to assess awareness, knowledge, and attitude about Acquired Immune Deficiency Syndrome. Result - Only 26.6% of study population had heard of Acquired Immune Deficiency Syndrome. Positive attitude towards Acquired Immune Deficiency Syndrome patients’ movement in community, work, school and continuing friendship was found. Majority knew about four major routes of transmission and basic preventive measures. A negative correlation was found between knowledge & attitude scores. On stepwise regression analysis, sex, education and marital status contributed to the variance with attitude as dependent variable. Conclusion – Majority of subjects held positive attitudes towards Acquired Immune Deficiency Syndrome. Education and marital status determined attitudes.

Alcohol Dependence Syndrome: One year outcome study.

The major challenge in the treatment of patients with substance use disorders is not only to maintain the follow up but also to prevent relapse. The current study was planned to see the abstinence and relapse rate in patients with Alcohol Dependence Syndrome over a period of one year. A total of 49 patients of alcohol dependence syndrome fulfilling ICD-10 criteria were included in the study. The mean age was 43 years, majority were above 30 years, males (97.9%), employed (81.6%), and from urban (81.6%) background. the mean duration of dependence was 4.3 years, 12.2% had a family history of dependence, 20.4% had a co-morbid affective disorder and 4.0% had a co-morbid non-affective disorder. In total 71.4% received pharmacologist treatment for relapse prevention. At 6 months, abstinence rates were 100% (n = 10/ 10) for disulfiram, 60% (n=6/10) for anticraving agents (Naltrexone and Acamprosate), 30% (n=3/10) for SSRI group. At 12 months, abstinence rates were 66.67% (n=2/3) for disulfiram, 42.9% (n=3/7) for anticraving agents, 0% (n=2) for SSRI group.

Early intervention in developmental delay.

OBJECTIVES: To establish the socio-demographic and clinical profile of children attending Early Intervention Program (EIP). METHODS: Retrospective analysis of case records of 100 consecutive children examined from July 2002 to June 2004. Data regarding socio-demographic variables, clinical profile, locomotor, speech and audiology functions were recorded. Data is described in terms of frequency and mean (with SD). RESULTS: Mean age of these children was 4.0 +/- 1.4 years. 70% were male and a similar percentage hailed from urban areas. 88% were mentally retarded with mean IQ of 50 +/- 24.3. Cerebral Palsy was seen in 50% of the children, learning disorder in 24%, Attention Deficit Hyperactivity Disorder (ADHD) in 12% and autism in 4%. 25% of children suffered from epilepsy and 66% were unable to communicate verbally. 21% of children had strong evidence of genetic disorders. An etiological diagnosis could not be made in 31% of children. CONCLUSIONS: Awareness of developmental delay as well as of possible interventions is low in India. Speech delay is the only delay which is considered important by parents. Active involvement and early referrals from pediatricians, obstetricians and other specialists is suggested.

Loading dose diazepam therapy for alcohol withdrawal state.

Two dose regimens of diazepam, conventional dose and loading dose, were randomly given for the treatment of alcohol withdrawal state in 21 and 20 male subjects, respectively. Total dose of diazepam in conventional and loading dose groups were 200 mg and 67 +/- 9.3 mg, respectively. Clinical response was comparable in both the groups. None of the subjects developed diazepam related side effects.