A case of zolpidem dependence with extremely high daily doses.

The human population has been witnessing an increase in the number of diseases which are a consequence of progressively increasing physical and mental stress. Insomnia is one such condition whose prevalence is rising all over the world. Apart from the conventional behavioral interventions and use of benzodiazepines, the use of non-benzodiazepine drugs has seen a surge in recent times. The various adverse effects associated with benzodiazepines, dependence potential being one of them, led to an ever increasing use of non-benzodiazepine sedatives like zolpidem and zopiclone all over the world. But with their continuous and ever increasing use, it is seen that even these drugs carry dependence potential. Numerous cases of zolpidem abuse have been reported in literature until now. Here, we are presenting the case of a zolpidem-dependent patient who consumed it in quantities of 2400 mg/day, a quantity not reported anywhere in literature and around 240 times more than its usual prescribed daily dosage.

Prevalence of sleep disorders and severity of insomnia in psychiatric outpatients attending a tertiary level mental health care facility in Punjab, India.

BACKGROUND: Sleep disorders are frequently associated with psychiatric disorders and can be both cause and effect of the same. AIM: To study the prevalence of sleep disorders and the severity of insomnia in psychiatric outpatients. METHODS: 500 patients were randomly selected using purposive sampling from patients attending a tertiary level mental health care facility were evaluated for the presence of any sleep disorder along with their sleep quality. In patients having insomnia, severity of the same was determined. RESULTS: 83.4% of the population had some type of sleep disorder. Symptoms of insomnia were reported by 78.2% of the population and 29.2% had moderate to severe insomnia. 78.4% of the population had poor sleep quality. Significant difference was noted among the different psychiatric groups when insomnia severity index (ISI) was compared. In multinomial logistic regression, chance of severe insomnia is more if the diagnosis is depression, but less if mania or ocd, compared to psychosis. CONCLUSION: This study was the first in India to assess the prevalence of sleep disorders in psychiatric outpatients. Our study underscores the importance of careful evaluation of sleep problems for proper management of the patients.

Risperidone induced periorbital oedema.

Antipsychotic medications are associated with adverse cutaneous reactions (ACRs) in approximately 2-3% of patients. We present three cases of possible risperidone induced periorbital oedema in the absence of any other systemic or local cause responsible for the oedema. The development of periorbital oedema after the initiation of risperidone therapy, and disappearance after the discontinuation of this drug, suggests a possible causal relationship between periorbital oedema and risperidone. To our knowledge, there are very few reports of risperidone therapy and development of periorbital oedema. Risperidone is a valid and effective choice amongst antipsychotic medications, but these cases call for caution regarding ACRs at the time of prescribing.

Psychopathology, insight and compliance in schizophrenia.

Abstraact Objective: A four-week longitudinal study was conducted to assess the relationship between insight, psychopathology and treatment compliance in schizophrenia. METHOD: The study was conducted using Insight and Treatment Attitude Questionnaire (ITAQ), Positive and Negative Syndrome Scale (PANSS) and Medication Adherence Rating Scale (MARS). The sample comprised 50 patients with schizophrenia diagnosed according to research criteria of the International Classification of Diseases (ICD-10), with a mean duration of illness of 5.32 years. RESULTS: Substantial psychopathology was observed at intake and it improved significantly at the end of four weeks. Similar changes were observed in the score of insight and of compliance over four weeks. The insight and the compliance were positively correlated to each other at the beginning and at the end of four weeks. Both of these were negatively correlated with psychopathology scores on both occasions. CONCLUSION: Insight and psychopathology remain important determinants of treatment compliance in schizophrenia over short term and long term follow up.