Antipsychotic drugs and schizophrenia.
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Biomedical subjects
Publications and source records attributed to Debasish Basu.
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UNLABELLED: To assess the prevalence of substance use and other psychiatric disorders in first-degree relatives of males with opioid dependence compared to normal controls. DESIGN: Observational, case-control study using family history method. SETTING: A drug addiction treatment centre in northern India. PARTICIPANTS: First-degree relatives of 100 male probands with opioid dependence and no comorbidity (n=493) and those of 50 matched probands from normal population (n=254). Measurement Family interview of probands and family members, using the Family Interview for Genetic Studies. The main outcome measure was relative risk (expressed as odds ratio after controlling for confounding variables using logistic regression) of familial aggregation of psychiatric and substance use disorders. FINDINGS: First-degree relatives of opioid-dependent males were more likely to have a psychiatric disorder than those of normal controls [adjusted odds ratio (OR) 4.47; 95% confidence interval (CI) 1.97-10.11; P<0.001], especially for opioid use disorders in the brothers (adjusted OR 6.55; 95% CI 1.44-29.88; P=0.015) and for alcohol use disorders in the fathers of the probands (adjusted OR 5.64; 95% CI 2.39-13.24; P<0.001). Other disorders (major depression, chronic psychosis and obsessive compulsive disorder) did not have significant aggregation in the first-degree relatives of opioid-dependent subjects. CONCLUSIONS: This study provides further evidence for the higher rates of alcohol and opioid dependence in first-degree relatives of opioid-dependent patients. The exact pattern of this familial aggregation may be influenced by the gender of the relatives and their relation to the proband.
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OBJECTIVES: To compare the quality of life (QOL) of patients having dual diagnosis of bipolar affective disorder and substance dependence with those having either diagnosis alone and with healthy controls. METHODS: Cross-sectional assessment of the four groups of subjects was made. Euthymic bipolar patients and those substance dependent patients not in active withdrawal or intoxication were included. QOL assessment was made with the World Health Organization (WHO)-QOL--Bref Hindi version. RESULTS: Total QOL score and scores on all the four domains of WHO-QOL-Bref were significantly lower for the dual-diagnosis (DD) patients when compared with all the other groups. Significant negative correlations were found between (i) the number of days the drug was consumed and the score on the 'general well-being' items of WHO-QOL-Bref (r = -0.31, p < 0.05); and (ii) between severity of alcohol dependence and WHO-QOL total score (r = -0.44, p < 0.01) as well as its 'psychological' domain (r = -0.52, p < 0.05). CONCLUSIONS: The study indicates that bipolar DD patients experience a lower QOL when compared with the other groups studied. Their QOL is affected by the severity of alcohol dependence.
Epidemiology, definitions, concepts and various other relevant aspects including management of drug and alcohol abuse are reviewed. The role of general/primary care physicians has been highlited in the persepctive of substance-abuse disorders.
Data from a longitudinal cohort study were used to directly compare the concurrent and predictive validity of four univariate typologic approaches with a multivariate approach in subtyping drug dependence. The four univariate typologies were based upon: (a) age-of-onset of drug abuse/dependence, (b) presence of drug abuse in first-degree relatives, (c) presence of antisocial personality disorder, and (d) sex. The multivariate typologic approach was based on indices of vulnerability, chronicity, consequences, and psychopathology, yielding the Type A/B dichotomy first demonstrated in alcohol dependence. Subtypes generated from the univariate typologies were then each compared with the multivariate typology on measures of concurrent and predictive validity, and the strength of association was compared statistically. There was evidence of significantly greater concurrent validity of the Type A/B typology compared with the univariate typologies across all the domains of validation (risk, substance use, psychopathology, personality, and overall functioning). The multivariate typology also fared better than the univariate ones in all three domains on which predictive validity was evaluated: substance use, psychopathology, and overall functioning, as well as the degree of change in several composite scores (drug, medical, legal, and psychiatric) and the global psychiatric symptom index. This direct method of comparison seemed to demonstrate the superior validity of the multivariate cluster-analytic approach over the univariate approaches to classifying subjects with drug dependence.
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Inhalant abuse has been commonly reported especially in the young during the last decades globally. The reason for the relative paucity of literature from India may be attributed to a lack of knowledge about this growing problem among health professionals. A series of five cases of inhalant abuse is described in order to understand this growing public health concern. Most of the cases started inhalant abuse during adolescence. All patients except one abused typewriter erasing fluid and thinner which contains toluene. All the patients reported using inhalants as addictive substance because of their easy accessibility, cheap price, their faster onset of action and the regular 'high' that it provided. Whereas several features of inhalant dependence were fulfilled, no physical withdrawal signs were observed. The diagnosis of inhalant abuse can be difficult and relies almost entirely on clinical judgment. Treatment is generally supportive.
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PURPOSE: To study the audiovestibular function in patients of long-term alcohol dependence and compare these changes with social users of alcohol and complete abstainers. MATERIAL AND METHODS: This was a prospective study of 20 randomly selected patients of long-term alcohol dependence fulfilling International Statistical Classification of Diseases, 10th Revision criteria of alcohol dependence. Audiovestibular function in this group was compared with social user of alcohol and complete abstainers. RESULTS: Statistically significant elevations of thresholds were found at higher frequencies (4000 and 8000 Hz ) in the alcohol-dependent group (P < .001). Alcohol-dependent patients had elevated thresholds at 4 and 8 kHz. Brainstem-evoked response audiometry showed prolongation of latencies of waves I, III, and V alone with interpeak latencies of I-III and III-V. One third of alcohol-dependent patients had abnormal electronystagmographic (ENG) findings. Abnormal ENG findings were only seen in alcohol-dependent patients with vertigo. There was no significant correlation between duration of alcohol dependence and abnormal ENG. CONCLUSIONS: Elevated thresholds at higher frequencies can be the only abnormality in alcohol-dependent patients. Presence of vertigo in alcohol-dependent patient may be associated with abnormal ENG findings. There is no correlation of duration of dependence and ENG abnormalities.
In spite of having been formulated nearly two decades back, there is as yet no consensus on the validity of the clinically popular self-medication hypothesis (SMH) of substance use disorders in patients with dual diagnosis. SMH broadly proposes that patients use substances in a non-random fashion so that the psychopharmacologic characteristics of particular substances are used to alleviate a variety of psychiatric symptoms and emotional distress. In order to test the SMH empirically, it was broken down to five sub-hypotheses, which were tested in a group of dual-diagnosis schizophrenia (DDS) patients vis-à-vis a group of only-schizophrenia (S) patients (n = 22 each). The DDS group scored lower than the S group regarding general and some specific psychopathology. The DDS patients ascribed reasons for substance use more often for hedonistic pursuit but also for reduction in symptoms and distress. There was a trend for alcohol to be used more for self-medication purposes compared to opioids and cannabis. The perceived effects of these three substances were significantly different on several symptom/distress dimensions. Finally, there was some degree of "match" between symptom-oriented reasons for use of substances and the effect that was perceived. All of this evidence provides a consistent but modest support for the SMH for "some patients, some substances, and some symptoms." The implications are discussed.
There are several queries on the effectiveness of acamprosate in pharmacoprophylaxis of alcohol dependence despite studies conducted over the last decade regarding its efficacy. In this retrospective chart review, 62 patients with ICD-10-diagnosed alcohol dependence who received treatment from an addiction center in India were studied to compare those on acamprosate or naltrexone versus those on no prophylactic drugs with regard to their demographic and clinical background and short-term outcome after treatment. Compared to those on naltrexone or no drugs, significantly more patients on acamprosate came from higher socioeconomic strata and had fewer family/marital complications and less comorbid use of opioids and other drugs; however, they also had more liver function impairment and alcoholic liver disease and a higher average duration of relapse in the past (p < 0.05 or less in each case). The group on no drugs had significantly less family/social support (p = 0.006) and poorer motivation rating (p < 0.001) than the other two groups on drugs. Intent-to-treat analysis showed that there was a non-significant trend of a higher proportion of acamprosate patients remaining abstinent (77%) than those on naltrexone (36%) or no drug (50%). At follow-up, acamprosate patients had significantly better functioning in several areas. However, because many of the baseline patient characteristics might themselves have influenced the outcome, no conclusion should be drawn from this data regarding the efficacy of the drug. Logistic regression analysis showed that both family/social support and acamprosate appeared to contribute modestly toward explaining the variance in short-term outcome.
This study attempted to apply age at onset typology in ICD-10-diagnosed opioid dependence. The sample is comprised of eighty men seeking treatment at an addiction clinic in India. The measures included a sociodemographic and clinical profile, Severity of Opioid Dependence Questionnaire, Sensation Seeking Scale, Multiphasic Personality Questionnaire (MPQ), and Family History Assessment Module. Application of k-means cluster analysis led to the emergence of two cluster types: early onset (mean age at onset 21 years) and late onset (mean age at onset 27 years). The early onset group was characterized by a significantly younger current age, more urban and unemployed subjects, younger ages at the onset of opioid use and dependence, a higher severity of opioid use, a higher lifetime use of sedatives and tobacco, younger ages at the onset of dependence on alcohol and cannabis, higher sensation seeking, and higher global psychopathology in terms of MPQ. Other less differentiating features were higher family history of psychiatric illness (including substance abuse), longer duration of opioid use and dependence, and higher lifetime use of cannabis. These results show the age at onset typology in opioid dependence to be feasible and to have some similarities to age at onset typology in alcoholism.