Bichitra Nanda Patra

Adjustment disorder: current diagnostic status.

Adjustment disorder is a common diagnosis in psychiatric settings and carries a significant rate of morbidity. However, diagnostic criteria are vague and not much helpful in clinical practice. Also there has been relatively little research done on this disorder. In this article, we review the information that is available on the epidemiology, clinical features, validity, and current diagnostic status of adjustment disorder. In this article, the controversy surrounding the diagnosis is also highlighted. It also discusses the differential and comorbid diagnosis. The various recommendations for DSM-V and ICD-11 conclude the article.

A controlled study of serum lipid profiles in Indian patients with depressive episode

Background: Lower levels of circulating lipid fractions and cholesterol are risk factors for impulsivity and depressive disorder. A lower level of serum cholesterol is also associated with patients presenting with history of self-harm. Materials and Methods: A total of 30 depressive patients and 30 healthy matched control subjects were recruited from the department of Psychiatry of a tertiary care hospital. We measured serum total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein cholesterol and triglyceride levels of both patient and control group. Results: The serum TC and LDL-cholesterol levels were found to be significantly lower in study group than that of control group. Conclusion: Lower levels of serum cholesterol are associated with depressive disorder.

Complicated alcohol withdrawal presenting as self mutilation.

Self-mutilation has been defined as deliberate self injury to body tissue without the intent to die. There has been an association between substance abuse and self mutilation. Alcoholic hallucinosis is usually in auditory modality and regarded as harmless. But patients can indulge in self harm behavior when the hallucinosis is commanding type. We are presenting a case in which the patient inflicted multiple stab injury to his own abdomen in response to alcoholic hallucinosis. This has clinical implication to enquire about substance abuse in patients presenting to emergency setting.

Olanzapine induced neuroleptic malignant syndrome.

An 18 year old male diagnosed as a case of bipolar affective disorder (BPAD), developed neuroleptic malignant syndrome (NMS) following treatment with olanzapine (20 mg per day), an atypical antipsychotic drug. NMS is usually seen with typical antipsychotic drugs. The patient was diagnosed as a case of NMS, offending agent was immediately withdrawn and prompt treatment with bromocriptine and levodopa produced a good recovery. The various features of the case are discussed in view of the potential mortality of the syndrome.

Predictors of retention in treatment in a tertiary care de-addiction center

Context: Retention in treatment can improve the outcomes of patients with substance use disorders. Aims: This study aimed to assess the predictors of treatment retention in a set of patients admitted with substance use disorders. Setting and Design: This record-based study was conducted among consecutive patients discharged from the inpatient unit of a tertiary care de-addiction facility in Northern India. Materials and Methods: Patients were classified as being retained in treatment or drop-outs based on follow-up records. Statistical Analysis: Those who were retained and those who dropped out were compared using appropriate parametric and nonparametric tests. Logistic regression was used to find out the predictors of retention in treatment. Results: A total of 88 case records were evaluated. All subjects were males and majority of the sample was married, educated up to 10th grade, employed, belonged to the nuclear family and urban background. Opioid dependence syndrome (96.6%) was the most common substance use disorder identified. Guilt feelings, general weakness of body, and loss of social respect were the most common substance-related complications experienced. Of the total sample, 40 (45.4%) were classified as retained into treatment. Higher socioeconomic status and having a family member with substance use was associated with higher chances of treatment retention. Conclusion: Identification of patient characteristics predicting drop-outs can help in targeting those individuals at higher risk. This can help in more favorable patient outcomes.

Addiction Research in India

Use of, and addiction to, psychoactive substances has been known in India for many years. After important but sporadic reports in the earlier parts of the last century, research in various aspects of substance use and addiction has increased voluminously over the past 40 years. This chapter summarises the major trends in research in this area. This chapter is divided into two major sections. The first section deals with epidemiology. It is subdivided into studies in general population (national as well as regional or local), treatment-seeking populations and special populations (women, children, elderly, medical profession and other workers and the prison population). The second major section covers the research regarding individual categories of substances predominantly used in India (alcohol, opioids, tobacco, cannabis and inhalants) and emerging newer concerns (newer drugs such as ‘club drugs’ and non-substance (‘behavioural’) addictions. The substantial amount of published research related to each of these substances is discussed (depending upon the availability of published material) in the following fashion: harms related to substance use, comorbidity, other clinical issues (e.g. personality, subtyping and course), biological studies and treatment studies. The minor but emerging newer trends of substance and non-substance addictions are mentioned in the end. Overall, there is substantive amount of research in addictions in India, but with some notable exceptions, the research appears to be sporadic, uncoordinated and conducted from limited centres. Further, some of the major epidemiological and other data are already not up to date. Substance use and addictions, as well as their clinical features and management, are not static; they change patterns over the years and across places. There is an urgent need to conduct large-scale, multicentre collaborative projects in addiction research in India.

Substance use disorder and the family: An Indian perspective

The substance use disorder not only impacts the patient himself/herself, but also affects family members. This is more relevant in a country like India where the familial ties are stronger with family members playing a significant role in the treatment process. This narrative review takes an overview of the inter-relationship between substance use disorder and the family. The domestic violence and adverse familial circumstances, both often arise as a consequence of substance use. Although the spouses of substance users experience greater rates of psychopathology and distress, children of patients with substance user disorders demonstrate higher levels of behavioral disturbances. Codependence often develops in the familial relationship, which perpetuates the substance use disorder. Substance use places quite a burden on the family, both psychologically as well as in terms of resources. Nonetheless, family members provide motivation, emotional support, and practical help during the treatment of substance use disorders and hence need to be engaged in the therapeutic process. Finally, the changing family structure and family dynamics in India might influence the in the future both the effect of substance use disorder on the family, and the familial resource available for treatment.

Creativity and mental disorder

Kyaga et al found an intriguing association between creativity and severe mental disorder.[1][1] The study draws its strength from a large sample size. However, the retrospective data collection methodology brings with it certain inherent limitations, which the authors have acknowledged, and causal

A controlled study of plasma fatty acids in Indian patients with depressive episode

AIM To study the plasma omega 3 and omega 6 fatty acid levels in patients with depressive episode and in matched healthy controls. METHOD Thirty patients with first episode depression and thirty healthy matched control subjects were recruited from a tertiary care hospital setting. We measured plasma omega-3 and omega-6 fatty acid levels of the study and the control group. RESULT There were no significant differences in plasma omega 3 fatty acid levels between study group and control group. The plasma omega 6 fatty acid levels of study group were significantly less than that of control group. CONCLUSIONS The present study is an initial attempt to investigate the link between fatty acids and depression in a clinical setting in India. This comparative study with normal controls did not etiologically link these polyunsaturated fatty acids in this sample of depressive disorder.

Poor Scholastic Performance: Psychosocial Perspectives in Assessment and Management

Poor scholastic performance has immediate as well as lifelong adverse effects on a child and adolescent’s self-esteem and future growth. Psychosocial factors are one of the important causative factors for poor scholastic performance in the under privileged societies, and often remain unidentified. Poor scholastic performance is associated with poor concentration in studies and high dropout rate from schools, and thus has high social costs. A comprehensive assessment covering psychosocial and biological factors is needed to identify the exact cause and plan effective management at the earliest so as to avoid long-term complications. This chapter mainly focusses on psychosocial issues in assessment and management of poor scholastic performance.