Siddharth Sarkar

Sexual dysfunction in clinically stable patients with bipolar disorder receiving lithium.

Abstract There is limited data on the prevalence of sexual dysfunction in patients with bipolar disorder receiving lithium. This study aimed to evaluate the prevalence of sexual dysfunction in patients with bipolar disorder receiving lithium and to study the correlates of sexual dysfunction. One hundred clinically stable patients with bipolar disorder (Global Assessment for Functioning score of >70, Hamilton Depression Rating Scale score of ⩽7 and Young Mania Rating Scale score of ⩽7, and no change in medications at least in the last 3 months) receiving lithium were evaluated on Arizona Sexual Experience Scale and Brief Adherence Rating Scale. The mean age of study sample was 44.3 years. The mean Hamilton Depression Rating Scale score was 1.06 (SD, 1.7) and the mean Young Mania Rating Scale score was 0.1 (SD, 0.5) and the mean Global Assessment for Functioning scale score was 84 (SD, 6.0). The mean duration of lithium use was approximately 119.62 (SD, 99.6) months, and the mean dose of lithium was 799.5 (SD, 251.4) mg/d. Of the 100 patients, approximately one third of the patients (n = 37) were found to have sexual dysfunction as per Arizona Sexual Experience Scale. Compared with those without sexual dysfunction, those with sexual dysfunction were older (t value = 3; P = 0.003). Those with sexual dysfunction had lower level of functioning (Global level of functioning score of 81.7 vs 85.5; t value = 3.2; P = 0.002), higher number of other adverse effects with lithium (total number of other adverse effects, 2.9 vs 1.4; t value = 4.2; P < 0.001), and poor medication compliance. To conclude, the present study suggests that approximately one third of the patients receiving lithium experience sexual dysfunction, and it is associated with poor medication adherence.

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.”

Liver transplant-psychiatric and psychosocial aspects.

Liver transplantation is a life saving surgical procedure that is associated with improved longevity and enhanced quality of life. The number of successful liver transplants is growing worldwide. The procedure requires a dedicated and trained team of experts. A psychiatrist plays an important role in such a team. Psychiatric and psychosocial assessment is considered imperative to evaluate the candidates suitability as a transplant recipient. Many psychiatric disorders may lead to the need for liver transplant, and if kept unchecked can adversely affect outcomes. Psychiatric problems arising in the post-transplant period may also require intervention of the psychiatrist. The donor too needs to be evaluated adequately to assess for psychological fitness for the procedure. This article provides broad overview of the various psychiatric and psychosocial issues pertaining to liver transplantation.

Demographic and clinical profile of substance abusing women seeking treatment at a de-addiction center in north India.

Background: In the recent decades increasing number of women have been seeking deaddiction services. Despite that the report data is very limited from India. Objectives: The present research aimed to study the demographic and clinical profile of women seeking deaddiction treatment at a tertiary care center in North India. Materials and Methods: Retrospective structured chart review of 100 women substance abusers seeking treatment at a deaddiction center between September 1978 and December 2011. Results: A typical case was of 36.3 years age, married (65%), urban (61%), nuclear family (59%) based housewife (56%), with good to fair social support (69%). The commonest substance of abuse was tobacco (60%), followed by opioids (27%), alcohol (15%), and benzodiazepines (13%). The common reasons for initiation of substance use were to alleviate frustration or stress (49%) and curiosity (37%). Family history of drug dependence (43%), comorbidity (25%), and impairments in health (74%), family (57%), and social domains (56%) were common. Only a third of the sample paid one or more follow visit, and of those 58% were abstinent at the last follow-up. Significant predictors identified were being non-Hindu and higher educational years for abstinent status at follow-up. Conclusion: The common substances of abuse were tobacco, opioids, and alcohol and benzodiazepines; and family history of drug abuse and comorbidity were common. The follow-up and outcome were generally poor. This profile gives us some clues to address a hidden health problem of the community.

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.

Tramadol dependence: A case series from India

Tramadol is an atypical, centrally acting, synthetic analgesic, acting through opioid and non-opioid systems. We present a series of seven cases, all men, who sought treatment at our centre for tramadol-dependence. The majority were using other opioids at some point in their lives. Their tramadol use had begun with a prescription of tramadol for opioid detoxification, for headache and body pains, and as an alternative to injectable opioids. The doses of tramadol used varied from 50 to 1500 mg per day. All subjects reported an experience of euphoria with tramadol use. Four patients were put on naltrexone, but had poor compliance. This case series underscores the need for caution, while using tramadol in substance-dependent patients.

Anxiety and depression in patients with myocardial infarction: findings from a centre in India

OBJECTIVES The study was conducted to assess the occurrence of anxiety and depression in patients with recent myocardial infarction (MI) and also to assess the relationship of these symptoms with other relevant factors and clinical outcome. METHODS A total of 103 patients with recent MI attending the cardiology outpatient department (OPD) of a tertiary care centre in India were included. The patients were evaluated using Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D) and Mini International Neuropsychiatric Interview (MINI), and pertinent demographic and clinical parameters were recorded. The patients were followed up at 12 weeks telephonically to ascertain outcome. RESULTS Significant anxiety and depressive symptoms were present in 48.5% and 25.2% of the sample. Anxiety or depressive disorder diagnosis was present in 25.2% of the sample. Aspirin use predicted lower anxiety and depressive symptom scores. A multivariate linear regression showed that female sex, history of angina and use of aspirin independently predicted scores on HAM-A. Diagnosis of psychiatric disorder, use of aspirin and increased body mass index also independently predicted scores on HAM-D. CONCLUSIONS There is a need to screen for anxiety and depressive symptoms in patients with MI, so that appropriate intervention can be incorporated in the management plan.

Stressful life events, hopelessness, and coping strategies among impulsive suicide attempters

Background: Suicides are among the most important causes of death in the economically productive population. Characteristics of impulsive and nonimpulsive suicide attempters may differ which would have a bearing on planning preventive measures. Aims: This study aimed to characterize the clinical and psychological profile of impulsive and nonimpulsive suicide attempters. Settings and Design: This retrospective comprehensive chart-based study was conducted at a tertiary care hospital in South India. Methods: The study utilized records of patients over a period of 3 years. An attempt was considered impulsive if the time between suicidal idea and the attempt was <30 min. Stressful life events were assessed using presumptive stressful life events scale; hopelessness was evaluated using Beck Hopelessness Scale (BHS) and coping was measured using Coping Strategies Inventory Short Form. Statistical Analysis Used: Impulsive and nonimpulsive suicide attempters were compared using appropriate inferential statistical tests. Results: Of 316 patients, 151 were classified as having an impulsive suicidal attempt (47.8% of the sample). The impulsive and nonimpulsive suicide attempters did not differ on demographic characteristics. Use of natural plant products was more common in impulsive attempters (27.2% vs. 12.7%), while physical methods like hanging was less common (0.7% vs. 7.3%). Those with an impulsive attempt were more likely to have a recent contact with a health professional (24.5% vs. 4.5%). Impulsive suicide attempters had higher scores on BHS (Mann–Whitney U = 7680.5, P < 0.001), and had recollected greater number of stressors. Conclusion: Impulsive suicide attempters differ from nonimpulsive suicide attempters in clinical features like methods of attempt, presence of hopelessness, and stressors.

Psychotherapeutic applications of mobile phone-based technologies: A systematic review of current research and trends

There is a growing interest in using mobile phone technology to offer real-time psychological interventions and support. However, questions remain on the clinical effectiveness and feasibility of such approaches in psychiatric populations. Our aim was to systematically review the published literature on mobile phone apps and other mobile phone-based technology for psychotherapy in mental health disorders. To achieve this, electronic searches of PubMed, ScienceDirect, and Google Scholar were carried out in January 2016. Generated abstracts were systematically screened for eligibility to be included in the review. Studies employing psychotherapy in any form, being delivered through mobile-based technology and reporting core mental health outcomes in mental illness were included in the study. We also included trials in progress with published protocols reporting at least some outcome measures of such interventions. From a total of 1563 search results, 24 eligible articles were identified and reviewed. These included trials in anxiety disorders (8), substance use disorders (5), depression (4), bipolar disorders (3), schizophrenia and psychotic disorders (3), and attempted suicide (1). Of these, eight studies involved the use of smartphone apps and others involved personalized text messages, automated programs, or delivered empirically supported treatments. Trial lengths varied from 6 weeks to 1 year. Good overall retention rates indicated that the treatments were feasible and largely acceptable. Benefits were reported on core outcomes in mental health illness indicating efficacy of such approaches though sample sizes were small. To conclude, mobile phone-based psychotherapies are a feasible and acceptable treatment option for patients with mental disorders. However, there remains a paucity of data on their effectiveness in real-world settings, especially from low- and middle-income countries.

Relationship between matrix metalloproteinase-9 and oxidative stress in drug-free male schizophrenia: a case control study.

Abstract Background: Deregulation of synaptic plasticity and oxidative stress are reported to play a crucial role in the pathogenesis of schizophrenia. Matrix metalloproteinase-9 (MMP-9) is an extracellular protease involved in regulation of synaptic plasticity. Malondialdehyde (MDA) is a marker of lipid peroxidation which is elevated in schizophrenia. Earlier studies have reported polymorphism of MMP-9 and its association with schizophrenia. The present study was designed to assess the serum levels of MMP-9, MDA and total antioxidant status (TAS) and their association in schizophrenia. Methods: A total of 40 cases and 40 controls were included in the study. Serum MMP-9, MDA and TAS were estimated in all the subjects. Disease severity was assessed using Positive and Negative Syndrome Scale (PANSS). Results: MMP-9 and MDA were significantly increased and TAS were significantly reduced in schizophrenia cases compared to controls. MMP-9 was positively correlated with MDA (r=0.353, p=0.025) and negatively correlated with TAS (r=−0.461, p=0.003). TAS was significantly correlated with total (r=0.322, p=0.043) and negative symptom scores (r=0.336, p=0.034). Higher MMP-9 levels were associated with previous exposure to antipsychotics (p=0.032). Conclusions: MMP-9 and oxidative stress were increased and correlate well with each other in schizophrenia cases. Though total oxidant status showed positive association with disease severity, MMP-9 and MDA were not associated with the severity of the disease.