A model for competency-based training of undergraduate medical students to perform screening and brief intervention in alcohol use disorder-Findings from a study in a medical college in Delhi.

Background: Alcohol use disorder (AUD) is a major cause of prolonged disability and an economic burden on communities across the world. The undergraduate (UG) curriculum in medical school in India does not allow adequate time to a structured learning about alcohol use disorder, its treatment, and prevention. The screening and brief intervention module (SBI) developed by the World Health Organisation (WHO) is an effective way to reduce drinking among risky drinkers. Training of undergraduates in SBI may go a long way in early intervention among problem drinkers. Hence, there is a felt need to incorporated the module in the clinical training schedule to enhance SBI skills among UGs to provide appropriate intervention at the primary healthcare level. Methodology: 50 final year UG students of a medical college in Delhi were exposed to a competency-based training in alcohol SBI comprised of lectures, focused group discussions (FGD), and role-play during their 2-week clinical posting in psychiatry along with a hands-on training under supervision of faculty. Subsequently, they were assessed for knowledge and skills gained through objective-structured clinical examination (OSCE) and feedback taken from students about changes in their knowledge and attitudes towards alcohol use disorder SBI. Results: Pre- and post-self-reported outcome variables revealed significant positive impact (p < 0.001) of SBI module on competency of students in implementing SBI on patients. Assessment of knowledge on OSCE revealed mean scores of 9.48 ± 1.20 on 10 MCQs (of 01 mark each) with 47 students scoring 80% or above. On integrated OSCE assessment of competencies, 94% students made satisfactory demonstration at a desired level. Attendance in lectures and supervised SBI, attitudes pre- and post-intervention and confidence level post-intervention were found to be predictors of a high MCQ score. All faculty agreed about the feasibility of implementing competency-based SBI in existing clinical posting schedule. Conclusion: The study has demonstrated the feasibility of teaching competency-based alcohol SBI to undergraduate medical students in existing clinical posting curriculum in psychiatry and its efficacy in having a positive impact on the perception and approach of the students towards patients with alcohol use disorder.

Influence of early adversity on cortisol reactivity, SLC6A4 methylation and externalizing behavior in children of alcoholics.

BACKGROUND: Children of parents with alcoholism face considerable stress, and often have externalizing behaviors. Early adversity is known to affect DNA methylation and the functioning of the HPA axis. We investigated the association of early adversity with cortisol reactivity, 5HTTLPR genotype, site specific DNA methylation in the SLC6A4 gene and externalizing behavior in children of alcoholics (COA), and a matched sample of control children. METHODS: We examined children of alcoholics (N = 50) and age matched control children (N = 50) for exposure to early adversity (both prenatal and postnatal), assessed their salivary cortisol reactivity and evaluated their levels of emotional and behavioral difficulty in terms of externalizing and internalizing behavior. Site-specific DNA methylation at a previously characterized SLC6A4 region was determined in salivary DNA using pyrosequencing. The 5HTTLPR region of the SLC6A4 gene was also genotyped. RESULTS: COA had significantly higher experience of early adversity than control children. Cortisol reactivity was reduced in COA, and negatively correlated with early adversity. Both early adversity and cortisol reactivity correlated with externalizing behavior. SLC6A4 methylation was higher in COA, and correlated with early adversity. SLC6A4 genotype did not show association with any of the variables. CONCLUSION: Our study provides further evidence that early adversity is associated with blunted cortisol reactivity, increased site-specific CpG DNA methylation at the SLC6A4 gene, and high externalizing behavior.

Association of educational stress with depression, anxiety, and substance use among medical and engineering undergraduates in India.

BACKGROUND: Students pursuing higher education are subject to high stress levels which could be associated with dysfunctional coping. Maladaptive coping is known to be operative in manifesting as psychopathology as depression, anxiety, suicidal ideation, and substance abuse. This study aimed to elaborate the psychological morbidity among professional undergraduates in general and medical students in particular, its evolution over the years and its psychosocial correlates. METHODOLOGY: The study examined medical students (n = 202) and age-matched engineering students (n = 145) belonging to the first and final year for psychological stress and coping, educational stress, domestic and professional concerns, depression, anxiety, and substance abuse. Psychometric scales along with demographic questionnaire were used to assess and quantify stress and psychological morbidity. RESULTS: Medical students had higher levels of stress (psychological and education related) and higher psychological morbidity (depression and anxiety). Stress scores correlated positively with depression and anxiety scores and negatively with substance use score. Psychological stress other than educational stress was noted to be predictors of alcohol use in the sample. CONCLUSION: Our study elucidates that medical students face higher levels of psychological and education-related stressors and have higher levels of psychological morbidity than students from engineering colleges. Psychoactive substances are used as a form of self-medication to alleviate stress.