Lekhansh Shukla

Correlates of baclofen effectiveness in alcohol dependence

Alcohol dependence is a global concern. Baclofen has shown promise as an anti-craving agent but its efficiency remains to be settled. We reviewed 549 male cases diagnosed with alcohol dependence who received Acamprosate (201) or Baclofen (348). ‘Time to first drink’ was compared between two groups and multiple regression analysis was done in baclofen group to identify correlates of effectiveness. There was a significant difference in outcome measure between Baclofen (M = 4.44, SD = 3.75) and Acamprosate group (M = 3.73, SD = 2.19); t (547) = 2.45, P = 0.01. Initial regression analysis with six predictor variables (average daily alcohol units, current age, age at onset of dependence, family history, duration of dependence and dose of baclofen in mg/day) showed significant correlation of outcome variable with only two predictor variables — dose of baclofen and average daily intake. Using the hierarchical method it was found that ‘dose of baclofen’ and ‘average alcohol intake’ explain a significant amount of variance in ‘time to first drink’. [F (1, 345) = 182.8, P < 0.001, R2 = 0.52, R2adjusted = 0.51]. This information can be used to select patients in long term longitudinal studies and may explain variable results seen in clinical trials of baclofen done earlier.

Benzodiazepine and “Z-Drug” Dependence: Data From a Tertiary Care Center

Objective To examine the clinical characteristics and course of benzodiazepine and �Z-drug� dependence in patients presenting to a tertiary deaddiction center in southern India. Methods Case files of 950 inpatients admitted between January 2007 and January 2014 who reported benzodiazepine or Z-drug use were reviewed. Patients (n = 170) with an ICD-10 diagnosis of mental and behavioral disorders due to the use of sedatives or hypnotics-dependence syndrome currently using substance (F13.24) were included in this study. Results Alprazolam (n = 86, 50.6%), nitrazepam (n = 40, 23.5%), and zolpidem (n = 19, 11.2%) were the most commonly reported drugs of abuse. Alcohol dependence was present in 37 subjects (21.8%) and opioid dependence in 41 subjects (24.1%). Comorbid psychiatric illness was diagnosed in 67 patients (39.0%). Only 28 patients (16.5%) had sedative dependence with no other substance use disorder. Conclusion High comorbidity occurs in this group of patients. Outcome varies significantly (P < .05) between sedative-dependent only and multiple-substance�dependent patients. High attrition should be addressed through follow-up and tracking mechanisms.

Facebook Role Play Addiction – A Comorbidity with Multiple Compulsive–Impulsive Spectrum Disorders

Background Problematic Internet use (PIU) is an emerging entity with varied contents. Behavioral addictions have high comorbidity of attention deficit hyperactivity disorder and obsessive–compulsive spectrum disorders. Social networking site (SNS) addiction and role playing game (RPG) addiction are traditionally studied as separate entities. We present a case with excessive Internet use, with a particular focus on phenomenology and psychiatric comorbidities. Case presentation Fifteen-year-old girl with childhood onset attention deficit disorder, obsessive–compulsive disorder, adolescent onset trichotillomania, and disturbed family environment presented with excessive Facebook use. Main online activity was creating profiles in names of mainstream fictional characters and assuming their identity (background, linguistic attributes, etc.). This was a group activity with significant socialization in the virtual world. Craving, salience, withdrawal, mood modification, and conflict were clearly elucidated and significant social and occupational dysfunction was evident. Discussion This case highlights various vulnerability and sociofamilial factors contributing to behavioral addiction. It also highlights the presence of untreated comorbidities in such cases. The difference from contemporary RPGs and uniqueness of role playing on SNS is discussed. SNS role playing as a separate genre of PIU and its potential to reach epidemic proportions are discussed. Conclusions Individuals with temperamental vulnerability are likely to develop behavioral addictions. Identification and management of comorbid conditions are important. The content of PIU continues to evolve and needs further study.

High-dose zolpidem dependence - Psychostimulant effects? A case report and literature review

Zolpidem, an imidazoline nonbenzodiazepine sedative drug, is used widely. Initial reports showed minimal abuse potential. However, multiple reports have appeared of dose escalation and abuse. Subjective effects of high-dose zolpidem are not known. In light of accumulating evidence of abuse potential, we hereby report a case of high-dose dependence and a review of relevant literature. A 33-year-old male presented with 5 years of daily use of 600–1700 mg of zolpidem tartrate. He reported subjective effects of euphoria, intense craving, and inability to stop use. Loss of receptor specificity, pharmacokinetic factors, and different receptor distributions can explain paradoxical stimulatory effects of high-dose zolpidem. Further studies are required to characterize subjective effects of high-dose zolpidem.

Baclofen in the short-term maintenance treatment of benzodiazepine dependence

Benzodiazepine (BZD) dependence is a significant public health problem. Apart from the long-term tapering doses of BZD, no others drugs are available for the maintenance treatment of BZD dependence. Baclofen has been used in alcohol and other drug dependence as long-term anti-craving agent. Since alcohol and BZD act through the GABA receptor, we attempted to study the effect of Baclofen as maintenance treatment in a series of five cases with BZD dependence.

Election Bans and Alcohol Banes: the impact of elections on treatment referrals at a tertiary addiction treatment facility in India

Pattern of alcohol use and its related complications is determined by multiple factors. We studied the effects of sudden ban of alcohol during elections in a state of India. We found that unexpected election bans could lead to severe complications in alcohol dependent individuals. Impact of sudden policy changes needs to be thought prior to implementation.

Cushing's syndrome and treatment-resistant depression

First, although, the title suggests that patient had “Cushing’s syndrome,” the report does not mention any clinical or biochemical abnormalities suggestive of Cushing’s syndrome except depression. Nonpsychiatric symptoms of Cushing’s syndrome include central obesity, facial plethora, round face, purple striae, easy bruising of the skin, and muscle weakness. These symptoms are accompanied by clinical and biochemical signs of treatment‐resistant hypertension, hyperglycemia, osteoporosis, hypokalemia, and nephrolithiasis.[2] Thus, the diagnosis of Cushing’s syndrome, in this case, rests solely on laboratory evidence of hypercortisolemia. Authors have reported raised plasma cortisol (722.7 nmol/L, laboratory reference: 193–634 nmol/L).[1] Plasma cortisol has a well‐defined circadian rhythm. Thus, it is important to mention the time at which sample was collected. Further, cortisol secretion increases during periods of stress like hospitalization and electro‐convulsive therapy. For this reason, it is suggested that 24‐h urinary free cortisol or midnight plasma cortisol should be used as a screening test for Cushing’s syndrome.[2] Authors also report dexamethasone nonsuppression, which is a frequently used test to diagnose Cushing’s syndrome. The case report does not mention the protocol of dexamethasone suppression test used in this case. Importantly, nonsuppression of cortisol levels with low‐dose dexamethasone (1 mg) is expected in patients suffering from severe depression.[3] In such cases, a slightly cumbersome test which involves administration of 0.5 mg of dexamethasone at intervals of 6 h for 2 days and collection of two plasma samples is more appropriate.[2] Keeping in mind, that this patient also had an adrenal mass suggestive of adrenal adenoma, it falls in a difficult to diagnose category called subclinical Cushing’s syndrome with an “Incidentaloma.”[4]

A case of carbamazepine-induced severe cholestatic hepatitis: Case report and review of literature

Carbamazepine (CBZ) is one of the widely prescribed drugs in the field of neuropsychiatry. We report a case of a 27-year-old female patient presenting with severe cholestatic hepatitis presenting after the initiation of CBZ. We establish the probability of drug-induced liver injury using Council for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method causality assessment scale, and the patient had high probability with a score of 9. We briefly review the literature in this field discussing the scope of the problem, etiopathogenesis, clinical manifestation, course, and management.

Value of ethyl glucuronide and ethyl sulfate in serum as biomarkers of alcohol consumption

Background: Urinary Ethyl glucuronide (EtG) and Ethyl sulfate (EtS) are established markers of alcohol conumption. Measurement of these markers in serum offers certain advantages. This outpatient department based study evaluated performance of serum Ethyl glucuronide (EtG) and Ethyl sulphate (EtS) as biomarkers of recent alcohol consumption in alcohol dependent subjects. It also evaluated effect of alcohol dose and time since consumption on serum EtG and EtS concentration. Methods: Information regarding alcohol intake was collected using Time line follow back calendar method from 152 subjects. Blood samples were collected to determine serum EtG and EtS concentration. Results: The results revealed that serum EtG (at a threshold of 45 ng/mL) could detect recent moderate to heavy alcohol consumption with 85 percent sensitivity and 89 percent specificity. The results also show that simultaneous measurement of EtS does not increase test accuracy. We found that dose of alcohol and time since alcohol consumption explain 68 and 62 percent variance in serum EtG and EtS levels. Conclusion: EtG testing in blood was found useful as a way to detect recent drinking. This sensitive and specific short-term biomarker provides valuable information about recent alcohol consumption.