Roshan Bhad

Predatory journals in psychiatry: A note of caution.

The birth of predatory publishers/journals in the past few years has become an important issue of concern in the scientific world. Predatory publishers/journals are defined as those publishers/ journals that unprofessionally abuse the author-pays publishing model for their own profit (Beall, 2013). Through the exploitation of open access model, predatory journals have raised doubts over the integrity of biomedical and scientific publishing and have raised questions over the transparency of the process of peer review and the validity of impact factor. Predatory journals, predatory publishing firms and fraudulent conferences are common phenomenon nowadays and cannot afford to be ignored by researchers (Bowman, 2014; Gutierrez et al, 2015). Good quality research studies form the foundation of evidence-based medicine, which are in turn the basis for new treatment guidelines, formulating policies and overall public health. The quality of published research will only be of a high standard if the peer review process is transparent and ethical/conflictual issues are addressed. However, predatory journals defeat this purpose, and the most important victims are newly developing scientific streams like psychiatry where research is still in nascent stages. Also, young researchers striving for employment, promotions and grants sham publications to enhance their resumes and to get a breakthrough in their career in an ever-increasing race for publications (Bartholomew, 2014). They are easy prey for predatory journals and a few stands to lose their creditability early in their career due to this. Predatory journals earn their revenue through hefty article processing charges from the authors. It is commonplace to receive emails inviting papers with assured publication in these journals. There will often be notifications like ‘‘call for paper’’ on their website. In most cases article processing charges are not revealed till the article is published or alternatively article processing charges are taken under the disguise of open access. Most importantly there is a faulty/nontransparent peer review process at the heart of the predatory journal where many papers with methodological flaws can get accepted. The famous example of the ‘‘spoof paper’’ on the ‘‘wonder’’ anticancer drug is quite obvious in this regard (Bohannon, 2013). In a developing branch like psychiatry where, there are still many unanswered questions, the new research is more important and anticipated. It is important from the perspective of patients as well as researchers to have access to genuine scientific research rather than fake, spurious, non-transparent publishing by the predatory journals (Beall, 2012). Young researchers, resident doctors, and auxiliary health workers in psychiatry are often the easy target of predatory

A Clinic-Based Study in Treatment-Seeking Adolescent Inhalant Users in India: Implications for Management

ABSTRACT An exploratory study was conducted on 23 consecutive treatment-seeking adolescent inhalant users at a tertiary drug dependence treatment center in India. Sociodemographic, clinical parameters and neuropsychological functioning were assessed using semi-structured interview, Composite International Diagnostic Interview (CIDI 3.0) for diagnosis, checklist for health damage and withdrawal symptoms, Malins Intelligence Scale for Indian Children (MISIC), Memory for Design test and Stroop test. Routine biochemical testing and urinary hippuric acid level for recent inhalant use, measured using Gas Liquid Chromatography with Nitrogen Phosphorous Detector (GLC-NPD) was conducted. All participants were urban males (mean age 16 [SD = 1.8] years), who used either ink eraser fluid (87%) or glue (13%). Most participants experienced inhalant withdrawal (80%) and revealed high prevalence of psychiatric co-morbidity (52%), behavioral problems (43.5%), and neuropsychological deficits. Biochemical analysis validated recent (1–3 days) toluene exposure in 69.6% of participants, consistent with self-report. Management plans should take these issues into consideration.

Kynurenine pathway (KP) inhibitors: Novel agents for the management of depression:

Depression is a highly prevalent and severely disabling condition globally. Despite being a major cause of disability worldwide, little progress has been made in the last three decades in developing rational and novel pharmacological treatment options for the management of depression. Recently there has been growing interest in the role of kynurenine pathway in pathophysiology of depression. In this paper, the potential role of kynurenine pathway inhibitors in the management of depression particularly in secondary and reactive depression and the development of novel antidepressant drugs targeting kynurenine pathway are discussed.

Why do young people sniff? An exploratory study of adolescent inhalant abuse from north India

Abstract Background: Inhalant abuse among adolescents is a growing problem worldwide including developing countries like India. It is important to understand the nature of adolescent inhalant abuse behaviour in order to counter the emerging problem.Aims: 1. To assess sociodemographic profile of treatment-seeking adolescents with inhalant abuse. 2. To explore inhalant abuse behaviour among treatment-seeking adolescents.Method: A 6-month long explorative study on 23 consecutive male adolescents seeking treatment for inhalant abuse (aged 13–18) in a tertiary de-addiction centre of India was conducted using a semi-structured questionnaire and a checklist to inquire about the perceived effect of inhalant abuse.Results: All adolescent males [mean age 16 (SD = 1.86) years] belonged to urban area and enjoyed adequate social support. “Sniffing” was the commonest route of inhalant abuse. Experimentation and peer pressure were the commonest reasons reported by adolescents for initiation (65.21%), whereas boldness (56%) was the commonest perceived effect of inhalant abuse.Conclusions: While experimentation and peer pressure contribute in initiation, perceived effects like boldness contribute in continuation of adolescent inhalant abuse in India. Increase in confidence and boldness is a much-desired effect in growing adolescents, and the abuse of inhalants reinforces the same.

Disorders related to use of psychoactive substances in DSM-5: changes and challenges

In the most recent edition of Diagnostic and Statistical Manual (DSM) that is DSM-5 many modifications have been made in substance use disorder section. These include changes in terminology; sections and categories; diagnostic criteria; threshold for diagnosis; severity; and specifier. Additionally, there have been certain additions and omissions from the earlier version. Critical evaluation of the changes made to the section on disorders related to use of psychoactive substances in India context has not been published so far. The current paper presents a critique of the changes made to the substance use disorder section in DSM-5. The rationale for these changes put forth by DSM-5 work group on substance related disorders have been discussed. Additionally, attempt has been made to highlight the possible future challenges consequent to the current nosological revision for substance use disorder category. Overall DSM-5 seems to be promising in fulfilling its goal of DSM-ICD harmonisation and movement towards an internationally compatible and practical diagnostic system for mental health disorders. It has increased the scope of addiction by inclusion of behavioural addiction. It has also tried to balance the categorical and dimensional approach to diagnosis. However, the real test of this newer edition of one of the most commonly used nosological systems will be during clinical care and research. This will help address the debatable issues regarding the changes that DSM-5 brings with it.

Utility of aripiprazole in co-occurring problem gambling and toluene dependence: A case report

ABSTRACT Inhalant use is a global problem but in spite of its large prevalence and significant physical and psychological complications, there is inadequate literature on the management of inhalant dependence. Inhalants are also considered a substance of adolescence with most users giving up use in adulthood. There is also limited literature on co-occurring behavioral and substance addictions and the linkage between them. We describe the case of 28-year-old man who had been using toluene in a dependent pattern for 14 years. He also had problem gambling in the past, abstaining from which led to an increase in the daily quantity of use of toluene. The patient was tried on Carbabmazepine but following an adverse event he was prescribed Aripiprazole. He improved over the course of 6 weeks and has been abstaining from inhalants since 3 months.

Behavioural Variant Frontotemporal Dementia with Bilateral Insular Hypometabolism: A Case Report

Fronto-Temporal Dementia (FTD) is a cluster of syndromes, characterized by progressive deterioration of cognition, language and/or behavioural changes associated with degeneration of the frontal and temporal lobes. A 53-year-old man was admitted with a history of gradually progressive behavioural disturbances, disinhibition, unprovoked anger outbursts, apathy, disorganised behaviour and impaired self-care. A clinical diagnosis of Fronto temporal Dementia (behavioural variant) was made. Extensive investigations found no abnormality except in FDG-PET scan of the brain which revealed hypo metabolism in bilateral anterior insular region. Insula is an important brain area implicated in emotional awareness and behaviour control. Hypo metabolism in insular region in the absence of any structural neuroimaging findings, in a case of behavioural variant of Fronto-temporal dementia suggest that, it might be one of the earliest neurobiological changes occurring in this disorder.

The drug ketamine: a double edged sword for mental health professionals

Abstract Ketamine was developed in the late 1950s as a potential general anesthetic agent. However, soon it became drug of abuse due to its property of giving “high”. Ever since there have been no systematic studies of ketamine abuse, dependence or withdrawal states in humans, barring some anecdotal case reports. Recently researchers have shown interest in ketamine as a novel agent for the treatment of depression. However, most research does not shed light on its addiction potential. In this paper, we present a case of ketamine dependence with interesting phenomenology, withdrawal symptoms which responded well to naltrexone. Implications of such cases for health professionals particularly psychiatrists and addiction specialists is discussed.

A rare association of schizophrenia and Mayer-Rokitansky-Küster-Hauser syndrome

Byline: Roshan. Bhad, Rakesh. Chadda, Nand. Kumar, Prashant. Goyal Sir, Schizophrenia is known to be associated with the various congenital disorders such as craniofacial anomalies, DiGeorge syndrome but its association with Mayer.Rokitansky.Kuster.Hauser. (MRKH) syndrome has rarely been reported.[sup][1],[2] MRKH syndrome is characterized by congenital aplasia of the uterus and the upper part. (2/3) of the vagina in women showing the normal development of secondary sexual characteristics and a normal 46, XX karyotype.[sup][3] To the best of our knowledge, till date, there has only been one published case report of the coexistence of these two disorders.[sup][4] We report another case of a 24-year-old unmarried woman Ms. A, with MRKH syndrome and schizophrenia for its interesting phenomenology and management. She presented with worries related to primary amenorrhea and infertility since adolescence, though detailed evaluation had not been done before. This was followed after 3-years by suspiciousness, the delusion of control and impulsive behavior. She believed that a certain unseen man staying abroad was controlling her mind and wants to marry her. She would hear voices of that man and converse with him. She would experience sensations in her vaginal area that she would attribute to sexual intercourse with that man, possible through some scientific technology devised by him. In addition, she would get distressed due to hearing voices of some other unknown persons, discussing about her and commanding her to do certain activities. Those unknown people would know her thoughts and control her actions through a transmitter device fitted in her ear. Ms. A would become irritable, aggressive, and violent toward family members whenever confronted regarding her beliefs. On psychiatric assessment, the psychopathology was confirmed. She had hallucinatory behavior, fearful affect, thought broadcast, the delusion of control, second and third person auditory hallucinations, a haptic hallucination of sexual content, impaired judgment with absent insight on mental status examination. She received a diagnosis of schizophrenia, paranoid type with MRKH syndrome. Diagnosis of MRKH was established by the presence of primary amenorrhea, normal development of secondary sexual characteristics, external genitalia, and ultrasonography finding of absence of the uterine structure between the bladder and rectum. The patient was started on oral olanzapine 10 mg/day, which was later, changed to oral quetiapine up to 600 mg/day with a satisfactory response. She was counseled for the vaginal atresia and vaginoplasty was recommended just before marriage after the consultation with the gynecologist. Future treatment options such as in vitro fertilization and embryo transfer was also discussed with the patient and family members. MRKH syndrome is associated with a number of neuropsychiatric manifestations such as distortions of body image, anxiety, depression, suicide, inter-personal sensitivity, and high psychological distress. …

Potential dual role of cephalosporins in management of alcohol use disorders.

Dear Sir, Apropos the paper by Alhaddad et al., titled “Effects of ceftriaxone on ethanol intake: a possible role for xCT and GLT-1 isoforms modulation of glutamate levels in P rats,” we would like to share our views on the other aspects of the potential role of cephalosporins in the treatment of alcohol use disorders. Traditionally, cephalosporins, a β-lactam antibiotic group, have been considered successful drugs to treat infection caused by Gram-positive bacteria (Page 2004). Overall, cephalosporins generally cause few side effects and mainly consist of hypersensitivity reactions like fever, arthralgia, and exanthema; hematological reactions like increase risk of bleeding, eosinophilia, and thrombocytosis; and renal reaction like decreased renal function (Norrby 1987). However, the adverse reaction that caught the attention of addiction specialists is disulfiram-like reaction in patients consuming alcohol following a cephalosporin dose. Cefamandole, cefoperazone, andmoxalactam have been repeatedly reported to produce this reaction (Uri and Parks 1983; Norrby 1987). Other cephalosporins, which can cause disulfiram-like reactions, are cefonicid, ceftriaxone, cefmenoxime, and cefuroxime (Kannangara et al. 1984; Marcon et al. 1990; Billstein and Sudol 1992; Dong et al. 2013). The reaction is commonly ascribed to the methyl-thiotetrazole (MTT) group, resembling part of the disulfiram molecule. Additionally, recent preclinical studies have successfully demonstrated a role of certain cephalosporins like ceftriaxone in reducing alcohol consumption. The possible mechanism for this effect is through regulation of glutamate transporter 1 (GLT1) and immunomodulation (Sari et al. 2011; Qrunfleh et al. 2013; Alhaddad et al. 2014). The unique properties of cephalosporins to cause both disulfiram-like reactions (deterrent) and reduction in alcohol consumption (anticraving agent) are the two most important strategies, which are used, in pharmacological management of alcohol use disorders. While the currently available anticraving agents like naltrexone and acamprosate reduce the amount of alcohol intake, disulfiram act as a deterrent agent causing unpleasant reaction when it is consumed along with alcohol. The US Food and Drug Administration (FDA) has approved these three drugs for treatment of alcohol dependence. Most importantly, combined pharmacotherapies (deterrent and anticraving agent combination) have superior efficacy compared to monotherapy in the management of alcohol use disorders (Besson et al. 1998; Jung and Namkoong 2006; Suh et al. 2006; Lee and Leggio 2014). Hence, a molecule with the benefit of both these properties will prove to be a boon to management of alcohol use disorders. To the best of our knowledge, cephalosporins are the only group of drugs that can potentially have dual action of deterrent and anticraving agents for alcohol use disorders. Further research on the exact molecular groups responsible for the deterrent and anticraving action can provide an impetus for development of newer drugs as well. A single drug for longterm treatment will improve compliance and minimize side effects with much benefit to patients and clinicians alike.