Debasish Basu

Lithium prophylaxis of recurrent bipolar affective disorder: Long-term outcome and its psychosocial correlates

BACKGROUND Discrepancy between efficacy of prophylactic lithium and its effectiveness in ordinary clinical practice necessitates long-term follow-up data from specialised lithium clinics. Also, role of psychosocial factors in influencing the outcome is unclear. METHODS One hundred and eighteen patients of bipolar affective disorder attending a lithium clinic were followed-up for approximately 11 years (range 2-27 years). Demographic and clinical data, measures of social support and psychosocial stress were obtained at the intake in 1989-1990. Study design combined retrospective chart-review (till the time of intake) with prospective follow-up till July 1995. RESULTS On lithium, the patients had a mean of 0.43 relapses per year (manic, 0.26; depressive, 0.17) which was significantly less (p < 0.01) than the pre-lithium episode frequency. The figure for entirely relapse-free patients was 24%, and 62% had relapses up to one episode per year (median = 0.3 per year). Fifty-eight (49%) patients were good responders to lithium (relapses < or = 0.30 per year). In comparison to good responders, partial/poor responders had a significantly greater number of pre-lithium depressive episodes, poor lithium compliance, more psychosocial stress and lower social support at intake. These variables correlated well with relapses and explained 32% of the variance of the data. CONCLUSIONS Lithium had a definite prophylactic effect on long-term outcome. Social support and stressful life events are significant correlates of response to lithium. CLINICAL IMPLICATIONS Lithium prophylaxis of bipolar affective disorders seems justified though psychosocial factors appear to modulate its effectiveness. LIMITATIONS Other psychotropic medications were used during relapse and the assessment of psychosocial factors was cross-sectional.

Cannabis Psychosis and Acute Schizophrenia

Twenty cases of cannabis psychosis were compared with a control group of 20 patients with ‘acute schizophrenic episode’ on a number of demographic, clinical, illness-related and outcome variables in a case-control study design using a retrospective chart review. The two groups were comparable on demographic, past and family histories of mental illness, premorbid personality, psychomotor activity, Schneiderian first-rank symptoms and mild cognitive deficits. The cases, in contrast to the control group, had a psychosis of shorter duration characterized by reactive and congruent affect, relative absence of schizophrenic formal thought disorder and a predominantly polymorphic clinical picture. Relapse was always preceded by cannabis use. This study suggests that, in spite of certain overlaps, ‘cannabis psychosis’ may still be considered nosologically distinct from schizophrenia in India. The implication of the study is that the role of cannabis in any acute psychosis should be investigated carefully so as to prevent an overdiagnosis of schizophrenia.

The P300 event-related potential and its possible role as an endophenotype for studying substance use disorders: a review

The concept of endophenotypes has gained popularity in recent years. This is because of the potential that endophenotypes provide of measuring objective trait markers that are simpler to access and assess than complex behavioral disease phenotypes themselves. The simplicity, ease of measurement and the putative links to the etiology of the disease in the study of an endophenotype has the potential promise of unraveling the genetic basis of the disease in question. Of the various proposed endophenotypes, the P300 component of the event‐related potential has been used in studies on alcoholism, schizophrenia and externalizing disorders. The current state of knowledge regarding the concept of endophenotypes, P300 and the validity of P300 as an endophenotype with special reference to substance use disorders is discussed in this review. The implications of the above are discussed.

Testing the stress-vulnerability hypothesis in ICD-10-diagnosed acute and transient psychotic disorders.

Objective:  To examine if family‐history‐positive (FHP) vis‐à‐vis family‐history‐negative (FHN) probands with ICD‐10‐diagnosed acute and transient psychotic disorders (ATPD) differ significantly with respect to number of life events and cumulative stress score prior to the onset of ATPD.

Correlates of early- and late-onset alcohol dependence

The present study aimed at finding out demographic, clinical, personality, and behavioural correlates of age at onset of alcohol dependence. Fifty-one male patients of alcohol dependence (DSM-III-R, APA, 1987) attending the drug de-addiction clinic of a general teaching hospital in India comprised the sample. They were administered a composite socio-demographic and alcohol use proforma, modified Sensation-Seeking Scale (SSS), Multiphasic Personality Questionnaire (MPQ), and a checklist of behavioural tendencies when drinking. The early-onset alcoholics (age at onset of alcohol dependence 25 years or less) were younger. They had a larger proportion of first-degree relatives with both lifetime use and abuse/dependence of alcohol but not of other psychoactive substances. They had experienced a greater number of alcohol-related problems in the previous 1 year. They were also higher sensation seekers, higher on the Psychopathic deviate scale of MPQ, and tended to display aggression, violence, and general disinhibition when drinking. The late-onset alcoholics (age at onset of alcohol dependence more than 25 years) were anxiety-prone and guilt-ridden, and had less alcohol-related problems. The two groups were comparable on duration, frequently, and quantity of alcohol consumption. The findings are discussed in relation to some of the recently proposed typologies of alcoholism.

Prevalence and clinical profile of delirium: a study from a tertiary-care hospital in north India

BACKGROUND There is scarcity of data from the Indian subcontinent in terms of rates of psychiatric referrals and prevalence of delirium in the medico-surgical setting. AIM The present research aimed to study the rates of psychiatric referrals, clinical profile and treatment of delirium in a tertiary-care hospital. METHODS The referral register in the department of psychiatry (which records all referrals to the Consultation-Liaison Psychiatry Team) was used to obtain data of all referred patients who had been diagnosed to have delirium while they were admitted in the Nehru Hospital, Postgraduate Institute of Medical Education and Research, Chandigarh, during the period 2000-2005. RESULTS Over 6 years, 3092 patients/referrals were received from different wards and included 1050 who were diagnosed as having delirium. The psychiatric referral rate ranged from 0.92% to 1.56% (mean=1.3%) per year; delirium formed the largest diagnostic category (30.77% to 38.95% of all referred cases). The prevalence of delirium in all inpatients ranged from 0.28% to 0.53% (mean=0.44%), with prevalence being higher in the elderly. In 80% of the cases, the referral was for abnormal behavior or patients noncooperation for treatment. Most of the cases improved with treatment. CONCLUSIONS Delirium forms the largest diagnostic category in psychiatry referrals and improves with treatment.

Inhalant Abuse: A Clinic-Based Study

Background: There are very few studies reporting inhalant abuse/dependence from India. Materials and Methods: Consecutive treatment seeking inhalant abuse cases (n = 21) were studied for the sociodemographic and clinical profile by using a semi-structured interview schedule. Results: A typical case profile was: unmarried male (100%), mean age 19 years, government school background (76%), unemployed (43%) or student (38%), urban nuclear family (86%), middle socioeconomic status (76%), and poor social support (62%); inhalant dependence (81%), inhalants being the only substance of abuse (33%) and of first or second preference (76%). Duration of inhalant use ranged 6-60 (mean 16) months. All subjects abused typewriter erasing fluid by sniffing (67%), huffing (19%) or bagging (14%). Initiation was out of curiosity (62%), under peer pressure (24%), or as a substitute (14%). Craving was more common (90%) than withdrawal (57%). Almost half of the cases (48%) had a family history for substance dependence. All cases were impaired, more so in family and educational/occupational domains. Conclusions: The results depict that easy availability, cheap price, faster onset of action, and a regular high makes inhalant a substance of abuse especially among the urban youth.

Management of anorexia and bulimia nervosa: An evidence-based review.

Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained.

Psychiatric Comorbidity in Patients With Substance Use Disorders Attending an Addiction Treatment Center in India Over 11 Years: Case for a Specialized “Dual Diagnosis Clinic”

Objective: Dual diagnosis of substance use disorders and psychiatric illness presents a distinct clinical challenge. These patients have been found to have more complications and poorer outcomes compared to patients with a single disorder only. Data from India are sparse. Methods: The study was a retrospective chart-based review of consecutive patients attending an addiction treatment center in a tertiary care hospital in north India from January 2000 until December 2010. Diagnoses were originally made clinically by face-to-face psychiatric interview and collateral information from family members and were confirmed by consultant psychiatrists following the detailed evaluation. Data on demographics, substance use disorder and psychiatric diagnoses, treatment, and short-term outcomes were extracted from the records. Results: Out of 5,283 patients registered over a span of 11 years, 5,116 (97%) records were available. Of these, 678 (13.2%) had a diagnosis of another non-substance psychiatric disorder. The comorbid psychiatric illnesses included mood disorders (n = 286, 42.2%), psychotic disorders (n = 186, 27.5%), anxiety disorders (n = 113, 16.7%), personality disorders (n = 68, 10.1%), organic disorders (n = 30, 4.5%), and others (n = 31, 4.6%). Alcohol use disorder was significantly more likely to be present with organic, mood, and anxiety disorders. Cannabis use disorder was significantly more likely in the dual diagnosis group as a whole and in particular with psychotic, mood, and personality disorders. Patient attrition from follow-up was substantive, but short-term outcomes among those few who did follow up were favorable. Conclusions: Though the proportion of dual diagnosis patients was relatively low among all patients attending the addiction treatment center, the cumulative number of patients in absolute figures over the years was appreciable. Given the high dropout rates but relatively favorable outcome for those retained in treatment, these patients need special and intensive focus with trained manpower and resources. There is indeed a case for a “dual diagnosis clinic.”

Substance-dependent women attending a de-addiction center in North India: Sociodemographic and clinical profile

BACKGROUND Treatment-seeking is limited in women substance abusers. Studying the sociodemographic and clinical profile of treatment-seeking substance-dependent women can help us to understand the problem better and respond appropriately in terms of primary and secondary prevention strategies. AIM To study the sociodemographic and clinical profile of women attending a de-addiction centre in North India. DESIGN AND METHODOLOGY Retrospective structured chart review of 35 women substance abusers. RESULTS The results indicated that a typical subject was urban (86%), married (63%), nuclear family (60%), based housewife (57%), educated up to school completion (54%), and having poor social support (57%). The common substances were opioids (60%), followed by alcohol (17%), and tobacco and benzodiazepines (11.5% each). The mean age at onset of substance use was 30.5 years, the mean duration of use was 9 years and mean duration to develop dependence was 5.5 years. The common reasons for initiating use were medical (63%) and curiosity (34%). Comorbidity profile was: physical illness (34%), psychiatric illness (23%) and dependence on another substance (14%). Only 20% had a family history of substance dependence. The social impairment ranged from 77% for social to 40% for financial and none for legal aspects. A typical subject had followed up 4.2 times in 8.4 months, while 54% were abstaining, 40% were continuing their substance dependence at the last follow up. CONCLUSIONS The results suggest that the development of substance dependence in women is a combination of genetic, personal, and social vulnerability factors, including the drug culture of the social milieu and the poor social support. Comorbidity and impairment are common features.