Anju Dhawan

Cardiac autonomic function in patients with diabetes improves with practice of comprehensive yogic breathing program

Background: The aim of this study was to observe the effect comprehensive yogic breathing (Sudarshan Kriya Yoga [SKY] and Pranayam) had on cardiac autonomic functions in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Cardiac autonomic functions were assessed in 64 diabetics. Patients were randomized into two groups, one group receiving standard therapy for diabetes and the other group receiving standard therapy for diabetes and comprehensive yogic breathing program. Standard therapy included dietary advice, brisk walking for 45 min daily, and administration of oral antidiabetic drugs. Comprehensive yogic breathing program was introduced to the participants through a course of 12 h spread over 3 days. It was an interactive session in which SKY, a rhythmic cyclical breathing, preceded by Pranayam is taught under the guidance of a certified teacher. Cardiac autonomic function tests were done before and after 6 months of intervention. Results: In the intervention group, after practicing the breathing techniques for 6 months, the improvement in sympathetic functions was statistically significant (P 0.04). The change in sympathetic functions in the standard therapy group was not significant (P 0.75). Parasympathetic functions did not show any significant change in either group. When both parasympathetic and sympathetic cardiac autonomic functions were considered, there was a trend toward improvement in patients following comprehensive yogic breathing program (P 0.06). In the standard therapy group, no change in cardiac autonomic functions was noted (P 0.99). Conclusion: Cardiac autonomic functions improved in patients with diabetes on standard treatment who followed the comprehensive yogic breathing program compared to patients who were on standard therapy alone.

Comprehensive yogic breathing program improves quality of life in patients with diabetes.

Objective: To assess the effect of a comprehensive yogic breathing program on glycemic control and quality of life (QOL) in patients with diabetes. Materials and Methods: This is a prospective randomized controlled intervention trial. Patients having HbA1c between 6 and 9% for at least 3 months with lifestyle modification and oral antidiabetic medication were included. They were followed-up and randomized at 6 months into two groups: one group receiving standard treatment of diabetes and the other group receiving standard treatment of diabetes and taught and told to regularly practice the comprehensive yogic breathing program (Sudarshan Kriya Yoga and Pranayam). Change in fasting and post-prandial blood sugars, glycated hemoglobin and QOL as assessed by the World Health Organization QOL WHOQOL BREF questionnaire were assessed. Results: There was a trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group following standard treatment alone, although this was not significant. There was significant improvement in physical, psychological and social domains and total QOL post-intervention in the group practicing the comprehensive yogic breathing program as compared with the group following standard treatment alone. Conclusion: There was significant improvement in the QOL and a non-significant trend toward improvement in glycemic control in the group practicing the comprehensive yogic breathing program compared with the group that was following standard treatment alone.

Diagnostic clinical features of pentazocine‐induced ulcers

Background  Pentazocine was introduced in 1967 as a “non‐narcotic, nonaddicting” analgesic. However, the abuse potential of this medication was soon recognized, and cutaneous and muscular complications of pentazocine abuse have been reported.

Inhalant abuse: An exploratory study

Background: Inhalants are being abused by large numbers of people throughout the world, particularly children and adolescents. It is also an often overlooked form of ubstance abuse in adolescents. Aims: The current study explored the inhalant abuse among adolescents seeking treatment from a tertiary care drug de-addiction clinic. Settings and Design: The study was conducted at a tertiary level multispecialty hospital. Materials and Methods: The current study was a chart review of the cases with inhalant abuse/dependence presenting to the clinic over a 1-year period. All the treatment records of the de-addiction clinic were reviewed, and information was gathered regarding patients with inhalant abuse/dependence. Statistical Analysis: Descriptive statistics with frequency distribution was carried out by using SPSS version 10.0. Results: The mean age of the subjects was 16.24 years (SD±1.9 years; range 12–18 years). Twenty-two percent of the subjects were illiterate. Forty percent of the adolescents had a family history of alcohol use problems and 48% that of tobacco use. The mean age of the initiation of inhalant use was 11.6 years (SD±2.17 years). It varied from 9 to 18 years. Forty percent of the adolescents had made a previous abstinence attempt. Conclusions: The findings provide important information on an underresearched area in psychiatry.

Completion report: Effect of Comprehensive Yogic Breathing program on type 2 diabetes: A randomized control trial.

Background: Yoga has been shown to be beneficial in diabetes in many studies, though randomized control trials are few. The aim of this randomized control trial was to see the effect of Sudarshan Kriya and related practices (comprehensive yogic breathing program) on quality of life, glycemic control, and cardiac autonomic functions in diabetes. Diabetes mellitus is a risk factor for sudden cardiac death. Cardiac autonomic neuropathy has been implicated in the causation of sudden cardiac death. Therefore, a maneuver to prevent progression of cardiac autonomic neuropathy holds significance. Materials and Methods: A total of 120 patients of diabetes on oral medication and diet and exercise advice were randomized into two groups: (1) Continued to receive standard treatment for diabetes. (2) Patients administered comprehensive yogic breathing program and monitored to regularly practice yoga in addition to standard treatment of diabetes. At 6 months, quality of life and postprandial plasma glucose significantly improved in the group practicing yoga compared to baseline, but there was no significant improvement in the fasting plasma glucose and glycated hemoglobin. Results: On per protocol analysis, sympathetic cardiac autonomic functions significantly improved from baseline in the group practicing comprehensive yogic breathing. Conclusion: This randomized control trial points towards the beneficial effect of yogic breathing program in preventing progression of cardiac neuropathy. This has important implications as cardiac autonomic neuropathy has been considered as one of the factors for sudden cardiac deaths.

(De-) criminalization of attempted suicide in India: A review

Attempted suicide is a serious problem requiring mental health interventions, but it continues to be treated as a criminal offence under the section 309 of Indian Penal Code. The article reviews the international legal perspective across various regions of the world, discusses the unintended consequences of section 309 IPC and highlights the need for decriminalization of attempted suicide in India. The Mental Health Care Bill, 2013, still under consideration in the Rajya Sabha (upper house), has proposed that attempted suicide should not be criminally prosecuted. Decriminalization of suicidal attempt will serve to cut down the undue stigma and avoid punishment in the aftermath of incident, and lead to a more accurate collection of suicide-related statistics. From a policy perspective, it will further emphasize the urgent need to develop a framework to deliver mental health services to all those who attempt suicide.

A 24‐week outcome following buprenorphine maintenance among opiate users in India

Aims: To evaluate the outcome at 24 weeks following a community‐based treatment programme using buprenorphine maintenance among male opiate users in Dimapur, Nagaland ( India). Design: Quasi‐experimental prospective follow‐up study. Participants: Fifty‐four male current opiate users were recruited following fulfilment of inclusion criteria from a community. All users seeking treatment met the DSM III‐R criteria for opioid dependence. Methods: All subjects received buprenorphine (1.2–1.8 mg sublingually per day) from a community clinic and attended psychosocial sessions. Measurements included an assessment of demographic and clinical variables, Addiction Severity Index (ASI), retention in treatment, drug use at baseline and follow‐up at 24 weeks. Findings: The mean age of sample was 26.3±4.1 years, with a mean duration of opioid use of 4.0±3.8 years. The retention rate was 81.5% at 24 weeks. Scores on the Addiction Severity Index decreased and injecting use reduced. No adverse events were reported. Conclusion: Buprenorphine was found to be effective with greater retention rates and less opioid use. Results support the theory that community‐based setting to provide maintenance treatment with very low staff investment from a community clinic can be initiated and replicated safely and effectively in India. However, future work on evaluation of higher doses is recommended.

Experiences from a Community Based Substance Use Treatment Centre in an Urban Resettlement Colony in India

Background. There are limited community based treatment services for drug dependence in India. Rural areas and urban resettlement colonies are in particular deficient in such services. Aims. The current study aimed at preliminary assessment of substance use disorder management services at a community based substance use treatment clinic in an urban resettlement colony. Methods. The study was carried out at community based substance use treatment centre in a resettlement colony in India. The records of the centre were chart reviewed. Results. A total of 754 patients were registered at the clinic during the study period. Heroin was the primary drug of abuse for 63% of the patients. The mean duration of follow-up for the patients with opioid and alcohol dependence was 13.47 (SD ± 10.37; range 0-39) months. A total of 220 patients of opioid dependence were prescribed substation or abstinence directed therapy. Buprenorphine (87), slow release oral morphine (SROM) (16), and dextropropoxyphene (98) were used for opioid substitution. Conclusion. It is possible to deliver substance use disorder treatment services in community setting. There is a need to develop area specific community based treatment services for substance abuse in socially disadvantaged populations such as urban resettlement colonies.

Occupational Rehabilitation of Opiate Users on Maintenance Treatment in India: A Microcredit-Based Approach

Occupational functioning is an important parameter of substance use treatment outcome. The rehabilitation needs of the patients undergoing recovery are unique and require a tailor‐ made approach. This article introduces an innovative approach to addressing the occupational rehabilitation needs of patients undergoing maintenance treatment in India, a country where there are no social security provisions for the underprivileged, and where there is a lack of employment opportunities for individuals with special needs, such as drug users in recovery. This article describes the implementation of a microcredit-based, low‐ cost vocational rehabilitation model for 55 male patients receiving agonist (buprenorphine) maintenance treatment. The results have been encouraging, with a promise of replicability.

Opioid maintenance therapy with slow release oral morphine: Experience from India

It is well known that opiate dependence is a chronic relapsing disorder and pharmacological treatment often has to be continued beyond the phase of detoxification to maintain abstinence. The focus of this maintenance treatment phase is to reduce/eliminate drug use, restore socio-occupational functioning and reduce risk-taking behaviour. Substitution on an agonist agent is a well accepted treatment strategy for the maintenance phase of treatment. Over decades, it has been proved that methadone is an effective agonist agent to treat opioid dependent patients and improve their functioning (Ward, Mattick, & Hall, 1994). The alternative agent for agonist maintenance is buprenorphine, a partial m agonist (Johnson et al., 2000). In India, methadone is not available and buprenorphine has been used as a maintenance drug in a few treatment centres. It is thought that if an economical alternative is available, it may be possible to have agonist maintenance available on a wider scale. Thus, the need for an agonist which is cheaper with a wide range of acceptability and long duration of action has been felt. Slow release oral morphine (SROM), a natural derivative of opium and a m receptor agonist, is relatively cheap with long duration of action. The pharmacokinetics of SROM shows that it can be conveniently administered as a once a day preparation (Maccarone, West, Broomhead, & Hodsman, 1994). It is being used as a pain-relieving agent in cases of patients suffering from cancer (Gourlay et al., 1997). SROM has been used as a maintenance agent in methadone intolerant individuals dependent on opioid with favourable results in countries such as the UK, Austria and Australia (Brewer, 1995; Eder et al., 2002; Fischer et al., 1999; Kraigher, Ortner, Eder, Schindler, & Fischer, 2002; Sherman, 1996). However, these studies were conducted in few countries and need replication across various centres. We hereby report our experience with sustained release morphine as an agonist maintenance drug in a community treatment centre in Delhi, India. Patients who fulfilled the criteria for opioid dependence syndrome and were willing to visit the centre daily were administered SROM after obtaining informed consent. Thus, a total of 74 patients were started on SROM. Out of these 74 patients, 33 patients (45%) regularly followed up in the clinic for 4 weeks and more. These 33 patients were interviewed by the third author to record their experience with SROM. A semi-structured Performa was used to collect the information. The details of drug use before the start of maintenance treatment as well as the details of the dose and duration of SROM were collected from the record files of the patients. The mean age of the 33 patients was 39 years with an age range of 22–55 years. Most (51.0%, n 5 17) were in the age range of 31–40 years. All the patients were males. About 54.5% (n 5 18) of the patients were married and 60.0% (n 5 20) had received formal education. The majority of the patients were unskilled workers (63.6%, n 5 21). Journal of Substance Use, October 2005; 10(5): 259–261