Efficacy of continuous theta burst stimulation - repetitive trancranial magnetic stimulation on the orbito frontal cortex as an adjunct to naltrexone in patients of opioid use disorder and its correlation with serum BDNF levels: a sham-controlled study.

Background: Opoid use disorder (OUD) is a global illness and reduction in craving by repeatative Transcranial Magnetic Stimulation (RTMS) is one of its management approaches. Orbito-frontal Cortex is implicated in the several behavioral aspects of substance use including craving. Brain derived neurotrophic factor (BDNF) has a critical role in addictive properties of drugs of use. Previous studies have shown significant improvement in craving with RTMS and demonstrated alterations of serum BDNF levels in various substance dependent individual associated with craving. Aim: To examine the efficacy of continuous Theta Burst Stimulation RTMS (CTBS-RTMS) over the right OFC as an adjunct to Naltrexone in patients of OUD and its correlation with serum BDNF levels. Methods: Forty patients with OUD were recruited with purposive sampling. At the end of detoxification CTBS -RTMS was applied by dividing them into two equal groups as active and sham group using alternate allocation. Obsessive compulsive drug use scale (OCDUS) was applied and serum BDNF level was measured overtime till the end of CTBS-RTMS session. Data was analyzed by SPSS version 25. Results: Both groups had shown significant reduction in craving (OCDUS score) and serum BDNF from the baseline to 14th session of the RTMS. But there was no significant difference when compared between the two groups. Significant correlation was observed between serum BDNF levels overtime with different clinical variables in active group. Conclusion: The study adds to the literature in building an understanding of how rTMS could be used in reducing cravings for opioids.

Absconding During Inpatient Care from a Tertiary Psychiatric Hospital: A Comparative Study.

BACKGROUND: Absconding from psychiatric hospitals is of great concern for patients and caregivers. Absconding affects not only the treatment and safety of these patients but also patient's caregivers and the community. Further investigation is needed to examine the pattern of this event and the characteristics of patients who abscond. Hence, our study was aimed to examine the sociodemographic and clinical profiles of inpatients who absconded from a psychiatric hospital in five years and to compare them with matched controls. METHODS: A retrospective chart review of inpatients who absconded and matched control inpatients during the specified period of five years from January 2014 to December 2018 was done at a psychiatric hospital. Each control was matched with a corresponding absconding case on the following order: (a) admission ward, (b) admission period, (c) diagnosis, and (d) age. Results: Among 20,052 adult admissions during the specified period, 38 patients absconded, with a rate of 1.8 per 1,000 admissions. Most of them were male, from a younger age group, diagnosed with schizophrenia or mood disorder, and having comorbid substance use disorder, irritable affect, impaired judgment, and absent insight. Most of the events occurred within the first two weeks of admission. About 11% of them had a history of prior absconding from the hospital. CONCLUSION: Knowledge about the associated sociodemographic and clinical profile would help clinicians and mental health care professionals to prevent absconding. Further risk assessment using a patient's profile would help to reduce absconding events from psychiatric hospitals in the future.

Inpatient Suicide in a Psychiatric Hospital: A Nested Case-control Study.

OBJECTIVE: Risk factors for inpatient suicide are different from those in the general population. We examined sociodemographic and clinical variables of patients who committed suicide as an inpatient in a psychiatric hospital in India. METHODS: Matched retrospective nested case-control design was adopted. Ten patients who died by suicide as inpatients between 2000 and 2013 were included, along with fifty controls, matched with respect to age, sex, diagnosis, and period of admission. RESULTS: Suicide completers were mostly unskilled in occupation (P = 0.03), had a history of past suicide attempts (P < 0.001), shorter duration of hospital stay (P = 0.001), poorer improvement on psychopathology (P = 0.02), and were having more suicidal ideation (P = 0.02). Significantly more completers were receiving antidepressants (P = 0.04). CONCLUSION: This study adds to the existing sparse literature on inpatient suicides from Asia. Strength of the study was close matching between case and controls and blindedness. Limitations were retrospective design, and variations in prescription behavior and treatment decisions.

Prevalence and Characteristics of Cavum Septum Pellucidum in Schizophrenia: A 16 Slice Computed Tomography Study.

OBJECTIVE: Several significant midline abnormalities including cavum septum pellucidum (CSP) have been reported in schizophrenia. However, not all studies were able to replicate similar findings. Furthermore, very few of them were conducted with large samples. METHODS: CSP was identified and graded with 16 slice computed tomography (CT) machine in 138 patients of schizophrenia and 64 controls. RESULTS: We found 21.0% of patients in schizophrenia group had abnormal CSP compared to only 9.4% in control group (P = 0.047). Grade III was most frequent type (19.6%) in schizophrenia group. CONCLUSIONS: Our study adds to the existing literature suggesting abnormal CSP may reflect neurodevelopmental process in schizophrenia. The strength of our study was larger sample size. Limitations were use of CT, male predominance in schizophrenia group, the inclusion of nonpsychiatric patients in control group.

An Unusual Case of Delirium after Restarting Clozapine.

Clozapine is a gold standard medication and drug of choice in refractory schizophrenia. Among many of its fatal side effects, delirium is less reported and inconsistently recognized by clinicians. We here present a case of delirium which emerged during retreatment with clozapine in a patient of paranoid schizophrenia. A patient diagnosed with paranoid schizophrenia, was restarted on clozapine after he left medications and became symptomatic. He was delirious on 22nd day after clozapine was restarted. Clozapine was stopped and the patient was managed with standard treatment for delirium. After one week interval, clozapine was restarted. Delirium was not noted till 6 weeks of his hospital stay. Clozapine induced central anticholinergic toxicity or clozapine induced seizure might cause delirium in index case. Limited literature exist delirium with clozapine. Clinicians must have high index of suspicion to detect delirium during clozapine therapy. More researches should focus to explore the association between delirium and clozapine.

Reasons for Substance Use: A Comparative Study of Alcohol Use in Tribals and Non-tribals.

BACKGROUND: Consumption of alcohol has been attributed to different reasons by consumers. Attitude and knowledge about the substance and addiction can be influenced by the cultural background of the individual. The tribal population, where alcohol intake is culturally accepted, can have different beliefs and attributes causing one to take alcohol. This study attempts to examine the reasons for alcohol intake and the belief about addiction and their effect on the severity of addiction in people with a different ethnic background. MATERIALS AND METHODS: The study was conducted at a Psychiatric institute with a cross-sectional design. The study population included patients hailing from the Jharkhand state, twenty each, belonging to tribal and non-tribal communities. Patients fulfilling the ICD 10 diagnostic criteria of mental and behavioral disorders due to the alcohol dependence syndrome, with active dependence, were taken, excluding those having any comorbidity or complications. The subjects were assessed with specially designed Sociodemographic-Clinical Performa, modified version of Reasons for Substance Use scale, Addiction Belief scale, and the Alcohol Dependence scale. STATISTICAL ANALYSIS AND RESULTS: A significantly high number of tribals cited reasons associated with social enhancement and coping with distressing emotions rather than individual enhancement, as a reason for consuming alcohol. Addiction was severe in those consuming alcohol to cope with distressing emotions. Belief in the free-will model was noted to be stronger across the cultures, without any correlation with the reason for intake. This cross-sectional study design, which was based on patients, cannot be easily generalized to the community. CONCLUSION: [corrected] Societal acceptance and pressure as well as high emotional problems appears to be the major etiology leading to higher prevalce of substance depedence in tribals. Primary prevention should be planned to fit the needs of the ethnics.

Why do we Need to Control Alcohol Use Through Legislative Measures? A South East Asia Perspective?

BACKGROUND: Even though prevalence of alcohol use in the world is very high, it has not been brought under legal control in several countries, contrary to other controlled substances like opium, cocaine, cannabis, and so on. AIM: To demonstrate the similarities in both alcohol and opioid dependence by comparing and contrasting the course of clinical dependence for both substances. PATIENTS AND METHODS: Consecutively admitted patients during the period August 2005 to May 2006, in the Center for Addiction Psychiatry, Central Institute of Psychiatry, Ranchi, India, with ICD-10 (DCR) diagnosis of alcohol dependence syndrome or opioid dependence syndrome were recruited for the study and administered the alcohol or other drug (opioid) section of SSAGA-II, respectively, and the data was entered in the corresponding tally sheet. RESULTS: The total sample size was 150, of which 112 consented to participate. Eighty-one (72%) were alcohol-dependent and 31 (28%) were opioid-dependent. Mean ages of the patients of alcohol dependence for opioid dependence was 35.16 +/- 10.2 compared to 26.09 +/- 5.65. Mean age of onset of alcohol and opioid use were similar (18.72 +/- 6.84 and 20.73 +/- 3.93 years, respectively). Patterns of dependence were also similar for both substances, from the first criteria to dependence (0.49 years for alcohol versus 0.64 years for opioids), and from the appearance of the second criteria to dependence (0.24 years versus 0.28 years). CONCLUSION: This study recommends alcohol to be treated on par with opioids and calls for legislations for the control of alcohol, uniformly, across the world, as a public health policy, on the lines of the Framework Convention for Tobacco Control.

How is substance use linked to psychosis? A study of the course and patterns of substance dependence in psychosis.

Substance use in mentally ill patients is now a major problem that influences the course and outcome of psychosis. With prevalence ranging up to 60%, several theories were postulated to explain the link. It would be interesting to know if substances have different effects in persons with psychosis than in those without. This study aimed to explore patterns of symptomatology of dependence and comorbid psychiatric illness by comparing and contrasting it with a group suffering from pure substance dependence. Consecutively admitted patients who were matched for age, sex, and tobacco use were divided into 3 groups. These were substance dependence without any comorbid psychiatric disorder (SD; n = 32), schizophrenia with substance dependence (SC; n = 31), and bipolar disorder with substance dependence (BD; n = 31). Patients were administered the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and Mini International Neuropsychiatric Inventory (MINI) to evaluate the chronology of criterion of International Classification of Diseases (ICD)-10 dependence. Results showed that cannabis was the most common substance used by both the SC (100%) and BD (80%) groups. This was followed by alcohol as the most common substance used, with prevalence of 87% in SC and 77% in BD groups. There was a significant difference in the pattern of use of cannabis in patients with psychosis, who developed tolerance much faster (P = .018) and had longer durations of cannabis use (P = .001) than the SD group. The presence of "loss of control" over drug use criterion seems to be a specific marker predicting development of dependence and psychosis. Cannabis use is more strongly associated with development of psychosis than any other substance.

Prevalence of tobacco use among young adult males in India: a community-based epidemiological study.

BACKGROUND: Prevalence of tobacco use in India is reaching alarming proportions, despite efforts by both World Health Organization (WHO) and Government of India (GOI) in controlling it. Part of the problem has been lack of available data on tobacco use in various groups. Although Global Youth Tobacco Survey (GYTS) and National Family Health Survey (NFHS) III have focused on adolescents and adults, respectively, data on use among young adults is lacking. Another limitation has been the use of the questionnaire method to determine tobacco use which may not reveal exact prevalence. This study aimed to explore the prevalence of tobacco use among young adult males in Ranchi, as confirmed by serum cotinine levels. METHODS: Five-hundred male students were selected through systematic randomized process to represent 5 universities in Ranchi. After informed consent, the students were administered Tobacco and Other Substance Use questionnaire and then subjected to urine Rapid Nicotine Test to improve sensitivity and biologically confirm prevalence. All tobacco users then were administered Fagerstrom's Scale for Severity of Nicotine Dependence. RESULTS AND CONCLUSION: Biologically confirmed prevalence of tobacco use among male students was 55.6%, revealing high degree of prevalence in this age group. Predominant form of tobacco use was cigarettes (78%) followed by khaini (20%) and gutkha (2%), showing that most young adults use cigarettes possibly due to the 'cool image' associated with it. Seventy-seven percent of all tobacco users want to quit, thereby giving a strong opportunity to carry out cessation services in this group. There was higher mean Fagerstrom's Scale for Severity of Nicotine Dependence (FTND) score in smokers (6.7 +/- 2.2) compared to chewers (4.6 +/- 2.5), revealing higher severity of dependence among smokers than chewers.

The conceptualization of terms: 'Mood' and 'affect' in academic trainees of mental health.

BACKGROUND: The management of psychiatric disorders should ideally be carried out by a multidisciplinary team that consists of mental health professionals from different disciplines. All mental health professionals are expected to learn similar basic clinical skills during their training, despite the difference in their graduation. OBJECTIVE: To compare the conceptualization of the terms 'mood' and 'affect' in all academic trainees of mental health in the Central Institute of Psychiatry (CIP), Ranchi, India. MATERIALS AND METHODS: The 'modified mood and affect questionnaire' administered to all mental health trainees of CIP, Ranchi, India, in this study. The participants were requested to mark one response (either 'true', 'false' or 'not sure') for each item. The completed questionnaire was collected on the spot. RESULTS: The statistical analysis was done for the data from psychiatric residents and trainees of clinical psychology. The statistical differences were observed between these two groups in response to the items-'Mood is the moment to moment emotional tone' and items of 'sign/symptom dimension'. CONCLUSIONS: The observed statistical difference in items could be the reflection of the differences in the description of 'mood' and 'affect' in textbooks of psychopathology, as well as, the difference in their graduation. The trainees of clinical psychology may be benefitted with more exposure in medical knowledge during their training.