Lorazepam-Assisted Interview in a Resistant Case of Functional Dysphonia.

BACKGROUND: Functional neurological symptom disorder presents with varied neurological signs often as a result of stress. It is usually treated with supportive psychotherapy and occasionally antidepressants. Literature regarding treatment for resistant cases is scarce. We describe on such presentation. CASE PRESENTATION: A 40-year-old man who presented with a history of sudden onset dysphonia for 5 days. There were no immediate stressors. Physical examination revealed that he was unable to make movements of the tongue while speaking although power and range of movement were normal. Magnetic resonance imaging and computed tomography of brain and endoscopic examination of oral cavity and larynx did not reveal any organic cause. Functional magnetic resonance imaging imaging was conducted under a language protocol to determine neurophysiological circuits involved in this unique presentation. The patient failed conventional pharmacotherapy and supportive psychotherapy. Thereafter, he underwent lorazepam-assisted interviews where he would be asked to made purposive movements of the tongue and attempt to pronounce basic phonemes. He would converse normally during the lorazepam interviews and made gradual improvements after each session. The patient was able speak clearly after 12 such sessions and continues to maintain well since. CONCLUSIONS: We describe a resistant case of functional dysphonia. The patient presented without any stressor and failed conventional treatments. The case demonstrates that Lorazepam can be used effectively in drug-assisted interviews for functional dysphonia. It also provides information regarding functional activity of the brain during a dissociative state.

Transdermal buprenorphine patch: Potential for role in management of opioid dependence.

Despite proven clinical utility, use of sublinugual buprenorphine is fraught with issues of potential diversion among patients with opioid dependence. Transdermal buprenorphine patches provide an alternative delivery model that can be utilized to reduce such diversion. This narrative review discusses the transdermal buprenorphine formulations, and its pharmacology, drug interaction and tolerability profile. The studies utilizing buprenorphine transdermal patches in the treatment of opioid dependence are examined, while the potential of using such patches for maintenance treatment of opioid dependence is examined.

Chlorpromazine as Prophylaxis for Bipolar Disorder with Treatment- and Electroconvulsive Therapy-Refractory Mania: Old Horse, New Trick.

A 22-year-old male diagnosed with bipolar affective disorder presented to us with a 3rd episode mania resistant to both olanzapine and haloperidol as well as electroconvulsive therapy. He, however, responded to chlorpromazine (CPZ) which was also effective as a mood stabilizer. The patient had a relapse of his illness when CPZ was stopped and responded again when it was started. The case demonstrates that CPZ may have a role in as both an anti-manic agent and for the maintenance for bipolar disorders. The possible underlying mechanism for this role is also discussed.

A Cross-sectional Study to Assess Disability and Its Correlates among Treatment Seeking Individuals with Alcohol Use Disorders.

BACKGROUND AND OBJECTIVES: Alcohol use is a major risk factor for global disease burden, and excessive use leads to disability in the individual. This study aimed to assess the disability and its correlates among individuals with alcohol use disorders (AUDs). In addition, it assessed the quality of life measures in this population group. METHODOLOGY: A cross-sectional study on a sample (N = 62) from among treatment seekers for alcohol dependence. Diagnostic and Statistical Manual, Fifth Edition (DSM-5) criteria were used to assess disorder severity. The WHO Disability Assessment Schedule (WHODAS) 2.0 and World Health Organization Quality of Life-BREF were used to assess disability and quality of life, respectively. Descriptive statistics, correlation analysis, and linear regression analysis were used for comparative assessments. The level of statistical significance was kept at P < 0.05 for all the tests. RESULTS: DSM-5 diagnosis of the individuals suggested a high severity of substance use disorder as an average of 8.8 (±1.8) criteria were fulfilled. WHODAS 2.0 revealed maximum disability in the domains of "participation in the society," "household and work-related activities" and "cognitive functioning." The quality of life measures indicate poor physical health, reduced work capacity, and cognitive dysfunction. A negative correlation was seen between the social dimensions of disability (getting along) and quality of life measures of psychological health (P = 0.026) and social relationships (P = 0.046), work domain of disability schedule and physical health score on quality of life evaluation (P = 0.001). Older age had greater impairment in the work domain (P = 0.040), and unemployment was associated with higher disability (P = 0.001). Unemployment and duration of alcohol use were the independent predictors of greater disability. CONCLUSIONS: Disability assessment using WHODAS 2.0 shows significant impairment in individuals with AUDs that is negatively correlated with quality of life measures.

Effects of citral, a naturally occurring antiadipogenic molecule, on an energy-intense diet model of obesity.

OBJECTIVES: Retinaldehyde inhibits adipogenesis, increases metabolic rate, reduces weight gain, and improves tolerance to a glucose load. We assessed the effects of citral - an inhibitor of retinaldehyde dehydrogenase (the primary enzyme metabolizing retinaldehyde), on body weight, glucose tolerance, fasting plasma glucose and insulin levels, metabolic rate, adipocyte size, and morphology in a diet-induced model of obesity. MATERIALS AND METHODS: Out of the 5 groups of 6-week-old male Sprague-Dawley rats, 4 were maintained on an energy-intense, palatable, diet for a period of - 42 days, while 1 served as the control. After obesity had been induced, 3 groups were treated with daily doses of citral (10, 15, and 20 mg/kg body weight) for a period of 28 days. They were then subjected to metabolic experiments. Body weight, fasting plasma glucose, glucose tolerance to an intraperitoneal glucose load, metabolic rate, and adipocyte size were assessed. RESULTS: Citral-treated groups showed a dose-dependent reduction in body weight gain. They significantly had lower fasting glucose levels, improved glucose tolerance, lower fasting plasma glucose, higher metabolic rate, and smaller adipocytes after drug administration. CONCLUSION: The findings suggest that citral increased energy dissipation (and also reduced lipid accumulation) consequently preventing and ameliorating diet-induced obesity. In addition it improved insulin sensitivity and glucose tolerance. In the current scenario of increasing prevalence of obesity and diabetes, citral may prove as novel agent in its management.

Diagnosis of bacterial vaginosis in cases of abnormal vaginal discharge: comparison of clinical and microbiological criteria.

INTRODUCTION: Bacterial vaginosis is a polymicrobial syndrome involving replacement of normal vaginal hydrogen peroxide producing lactobacilli by a variety of mycoplasmas and Gram-negative rods. Bacterial vaginosis has been conventionally diagnosed using Amsel criteria (a clinical method) or Nugent's score (a laboratory method with higher reproducibility). This study was undertaken to compare the diagnostic ability of the Amsel criteria with that of Nugent's score among patients presenting with abnormal vaginal discharge. METHODOLOGY: The study was conducted at the Medical College in Kolkata, India to determine the prevalence of patients with bacterial vaginosis and their demographic profile. Subjects attending the outpatient department presenting with abnormal vaginal discharge were evaluated for the presence of bacterial vaginosis by Amsel criteria and Nugent's score. RESULTS: Prevalence of bacterial vaginosis was 24% by Nugent's score. In comparison, Amsel criteria had sensitivity of 66.67%, specificity of 94.74%, positive predictive value of 80% and negative predictive value of 90%. There was no perfect inter-rater agreement between the Amsel criteria and Nugent's score (Kappa = 0.58). Presence of clue cells correlated best with a positive diagnosis by Nugent's score while the amine test (whiff test) had the lowest correlation. CONCLUSION: Although the Amsel criteria method is a convenient and inexpensive means of diagnosing bacterial vaginosis, it is not always reliable.  Alternative reliable and inexpensive diagnostic methods that unify clinical and microbiological parameters, thus increasing sensitivity while retaining specificity, are needed.