Arpit Parmar

Natural opioid use in elderly in India: a case series

Abstract Introduction: Substance use among elderly is an emerging mental health problem and requires modification in management approaches. Systematic literature on natural opiates especially among elderly in India has been rather limited. Materials and methods: This retrospective chart review included 24 elderly subjects (aged 60 and above) seeking outpatient treatment at a tertiary care de-addiction center in North India. Information pertaining to socio-demographic profile, clinical characteristics, and treatment seeking was extracted from the records. Results: All the subjects were male with a mean age of 64.3 (±5.0) years. Most common substance used was doda (poppy husk) with a mean duration of dependence of 33.1 (±11.8) years. Six subjects (25.0%) had used other forms apart from natural forms of opiates. Most common reason for initiation of opiate use was to increase work efficiency (n = 9, 37.5%). Dependence on another substance (apart from opiate and tobacco) was present in seven subjects (29.2%). Majority of patients never sought any treatment previously despite using the substance for long duration. Conclusion: Natural opioid use among elderly has a distinct profile, especially in Indian setting where its use has sociocultural sanction. There is a need for research on management of elderly natural opioid users which may pose an important clinical challenge in the future.

Subacute sclerosing panencephalitis presenting with isolated positive psychotic and catatonic symptoms

Subacute sclerosing panencephalitis (SSPE) is a rare slowly progressing neurological illness. Although patients with SSPE initially present with symptoms such as myoclonic jerks, cognitive decline, and personality/behavioral changes usually, rarely pure psychiatric symptoms (e.g., mania, psychosis, and catatonia) have also been reported during the initial course of the illness. We report an unusual case of an adolescent with SSPE presenting with prominent positive psychotic and catatonic symptoms with the absence of classical symptoms of SSPE in initial course of illness and further discussed the relevant literature.

Profile of elderly women seeking treatment for substance use disorders at a tertiary care treatment center

Abstract Introduction: Elderly women comprise of a unique subpopulation of people who use drugs. However, literature on the profile of elderly women seeking treatment is scarce. Materials and methods: This retrospective chart review included 16 elderly (>60 years of age) women subjects seeking outpatient treatment at a tertiary care substance use treatment center located in North India. Information pertaining to their sociodemographics and substance use were extracted from available records. Results: The mean age of subjects was 63.63 ± 4.92 years (range 60–75 years). Most of the subjects were Hindu (14/16), married (13/16), illiterate (11/16), housewives (12/16), and coming from an urban background (11/16). Most common substances of abuse were tobacco (8/16) followed by opioids (05/16). Mean duration of opioid use was 3.20 ± 2.68. Only four patients reported comorbid psychiatric illness. None of the patients had sought treatment in the past. Conclusion: Elderly women substance users have a distinct profile. Interventions specifically targeted to them are required, especially in Indian settings.

Profile of women substance users seeking treatment at tertiary care treatment center in India: A retrospective chart review study

ABSTRACT Introduction: Among substance users, women represent a small, unique subpopulation. Studying their socio-demographic and substance-use profile helps us understand their concerns and formulate management strategies. Materials and Methods: In this retrospective chart review, all the available records of outpatient treatment seekers at National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), Ghaziabad, from 1 January 2011 to 31 December 2015 were screened. Data from the women substance users were entered into a specially designed MS Excel format and analyzed. Results: In these 5 years, 217 women (mean age 36.75 ± 11.84 years) sought treatment. Majority were married (75.6%), housewife (53.5%), educated (59.4%), from an urban background (70.0%). Most common primary substance used was opioid (61.3%), including heroin (30.0%) and pentazocine (16.1%). About 20.3% reported injectable opioid use. The mean duration of opioid use was 5.44 ± 4.68 years. History of prior treatment seeking was reported by 4.6% and no prior significant abstinence attempts by 77.4%. Discussion and Conclusion: Majority of female treatment seekers, are young, married urban women and seek treatment for opioid use, particularly heroin (as opposed to pentazocine, suggested by previous studies). Prior treatment seeking and abstinence rates are low. Data indicates the need of specialized services for this population.

Successful long-term management of a child with Kleine-Levin syndrome with low-dose lithium

Kleine-Levin syndrome (KLS) is a rare disorder characterized by episodic hypersomnia along with cognitive and behavioral disturbances (i.e., hyperphagia and hypersexuality). It is commonly seen in a young male. Not much is known about its long-term management; however, many reports suggest the usefulness of anticonvulsants and lithium for the same. We hereby report a case of childhood KLS from India who was successfully treated with low-dose lithium and discuss the relevant literature.

Reasons for rejection of manuscripts in psychiatry journals: A survey of editors

• Authors are likely to be benefitted by having a view of the reasons for rejection of manuscripts sent for possible publication to various psychiatry journals, as it may help them to better prepare their manuscripts.

Brief Interventions for Cannabis Use Disorders: A Review

Background:Cannabis use and abuse is an important health hazard which has several harmful consequences on person’s physical and psychological well-being. Although cannabis use disorder is a common problem across various countries, the effective medications for treatment are still limited. Because of this, the major focus of interventions for cannabis use disorder has been on psychological modalities. One such intervention is a brief intervention, which targets mainly those persons with less severe cannabis use problems. The current narrative review aims at providing an overview of the role and relevance of brief intervention in cannabis use disorders and discusses the relevant methodological issues. Subjects and Methods:We reviewed multiple scientific search engines including Google Scholar, PubMed, and PubMed Central. Search terms used includes but are not limited to, “brief intervention,” “cannabis use disorders treatment,” “cannabis abuse treatment,” “brief interventions for cannabis,” etc. Studies assessing efficacy/effectiveness of brief intervention in cannabis use disorders were included in this review. Results:The majority of studies points toward the effectiveness of brief intervention in reducing the cannabis use and/or associated consequences in cannabis use disorders. However, the studies should be interpreted cautiously given the variation in the type, theoretical construct, duration, and outcome measures for brief intervention and the therapist attributes. Conclusions:Brief interventions might be useful for mild to moderate cannabis users for reducing cannabis use and/or associated consequences. Future studies, especially in developing countries are required to look for applicability of such interventions in different populations.

An Observational Study of Treatment Seeking Users of Natural Opiates from India

ABSTRACT Background: The type of opioid used influences the severity and complications experienced. Natural opiates (opium and poppy husk) use is a socio-culturally accepted phenomenon reported in India. However, studies on their profile, quality of life, and addiction severity are limited. Objectives: The objective of this cross-sectional, observational study was to assess the socio-demographic profile, clinical profile, addiction severity, and quality of life of treatment-seeking natural opiate users. Method: Hundred subjects aged 18–65 years using opium or poppy husk seeking outpatient treatment at a tertiary addiction treatment center in India were interviewed to collect information on their socio-demography, natural opiate, and other substance use. Additionally, their addiction severity and quality of life were assessed using Addiction Severity Index-Lite and WHO Quality of Life-Bref instrument, respectively. Results: All subjects were male with a mean age of 44.6 (±11.0) years. Majority (97%) used poppy husk daily orally. Curiosity/experimentation (63%) was the most common reason for starting opiate use. The past month rates of tobacco, alcohol, cannabis, and sedative-hypnotics use was 58%, 33%, 3%, and 12%, respectively. Only 4% injected any opioid. Inability to afford opiates (72%) was the most common reason for seeking treatment. Rates of medical, familial, social, psychological, and legal complications were low, while the WHOQOL-BREF scores fell between 40 and 50 across various domains. Conclusions/Importance: Natural opiate users may constitute distinct subgroup of opioid users with fewer/no complications despite long duration of uninterrupted use. These findings would be important in planning management strategies for people dependent on natural opiates.

A study of pathological gambling and its correlates among patients seeking treatment for substance use disorders in North India

ABSTRACT Background: Gambling, although being a common leisure activity in India, and it has been studied scarcely. There is a dearth of research regarding the rates of problem gambling among substance users in India. Methods: This cross-sectional observational study was conducted at a tertiary care de-addiction center in India. Male patients aged 18–65 years were included. Diagnosis of gambling disorder or pathological gambling were made using Diagnostic and Statistical Manual–Fifth edition (DSM-5) and International Classification of Disorders–10th Edition Diagnostic Criteria for Research (ICD-10 DCR) respectively. Pattern of gambling as well as the prevalence of probable pathological gambling was assessed using South Oaks Gambling Screen (SOGS). Results: A total of 114 substance users were recruited in the study. The occurrence rate of pathological gambling according to ICD-10 DCR was 6.1%, gambling disorder according to DSM-5 was 11.4%, and probable pathological gambling according to SOGS was 12.3%. Playing cards for money was the most common type of gambling. Pathological gamblers had higher rates of injection drug use and high-risk sexual behaviors as compared to non-problem gamblers. Conclusion: Our study suggests pathological gambling to be a common comorbidity among substance use disorder patients. There is a need to study the impact and course of pathological gambling among the Indian patients with substance use disorders.

High proportion of pentazocine dependence among treatment-seeking female injecting drug users (FIDUs) in India: A distinct population?

ABSTRACT Background. Adverse consequences of injecting are greater among female injecting drug users (FIDUs), yet treatment-seeking is low because of stigma, poor social support, and unavailability of gender-specific services. FIDUs, despite being a distinct subpopulation of women substance users, are sparsely studied. Aims. We aimed to study the sociodemographic and clinical profile of treatment-seeking FIDUs at a tertiary drug treatment center in North India. Methods. In this retrospective study, we reviewed medical records of all the FIDUs who sought outpatient treatment from January 1, 2011, to December 31, 2015. Results. Out of a total of 217 records of female patients, 44 were current IDUs (20.27%), with mean age 35.48 ± 10.13 years. Majority were Hindu (84.1%), married (81.8%), homemakers (52.3%) educated up to 12 years (65.9%). Primary drug of dependence was injection pentazocine for 33 patients (75.0%) and injection smack (street heroin) for 8 (18.2%). Commonest reason for initiation of drug use was iatrogenic (n = 25; 56.8%). Major physical complications were reported by 29 (65.9%), while 12 (22.8%) reported psychiatric comorbidity. Conclusion. A typical treatment-seeking FIDU is middle-aged, educated, homemaker using injecting pentazocine. High rate of injecting with iatrogenic onset highlights the need for women-specific services as well as awareness-building among physicians.