Past History Of Substance Abuse Research Articles

IJCM_356A: Psychiatric evaluation of alleged sexual assault perpetrators in a tertiary care hospital in Southern Odisha: a cross-sectional study

Background: Sexual violence is defined as a range of behaviours, including nonconsensual sexual acts(e.g., rape), attempted non-consensual sexual acts or abusive sexual contact(e.g., unwanted touching),and noncontact sexual abuse(e.g.,threatened sexual violence or verbal sexual harassment). A psychiatric evaluation should not only be important in clinical but also in medicolegal field, for better understanding of psychological characteristics of an offender and making risk assessment of future offending behaviour. Objectives : 1. To study the socio-demographic profile of alleged sexual assault perpetrator presenting to FMT Department of MKCG, MCH Berhampur. 2. To evaluate their psychiatric co-morbidities and find any significant association. Methodology: A cross-sectional study has been conducted in the Department of FMT, MKCG, MCH, Berhampur, Odisha, within a period of 1 year. Using convenience sampling 169 perpetrators of sexual assault were selected. For data collection semi-structured questionnaire and Mini-5 scale was used. Results : Mean age was 45.3 ± 8.2years,78.9 % were unmarried,26.6 % were illiterate. Around 57.8% were unemployed,78.9 % had past history of substance abuse, antisocial personality disorder was seen in 71.05%. Psychotic disorder was seen in 65.7%, alcohol abuse and dependence was seen in 71.05%,substance dependence was seen in 52.6%. Significant association was seen with anti-social personality disorder, Psychotic disorder, alcohol abuse and substance abuse dependence in the perpetrators of sexual assault. Conclusion: From the present study, it was implicated that, mental health co-morbidities are one of the major contributing factors for the criminal behaviour of the perpetrators for sexual assault. Hence all the cases of sexual assaults have to be properly screened out and councelled by the mental health professionals to prevent criminality in the society.

30 A Study to Assess Functional and Psychological Outcome After 6 Months of Moderate and Severe Traumatic Brain Injury (TBI)

Objective:Assessment of clinical, functional and psychological outcome after 6 months of moderate and severe TBIParticipants and Methods:Sixty consecutive participants aged 18 and above with moderate to severe TBI (GCS score of 3-12 at admission) attending the Outpatient Department of Neurosurgery Specialty, Post Graduate Institute of Medical Education and Research, Chandigarh, India were recruited. The exclusion criteria were any pre-existing major psychiatric disorders, intellectual disability, current or past history of substance abuse, degenerative and/or progressive condition, terminal illness and past history of TBI. Ethical clearance was obtained from Institute Ethics Committee. Written informed consent was obtained from all participants prior to inclusion in the study. Socio-demographic details (age, sex, marital status, family type, place of residence, education and occupation) and clinical details (mode of injury, injury severity, treatment, status on discharge, any previous co morbidities) were obtained from participant and hospital records. Functional outcome was assessed by Glasgow Outcome Scale and Barthel’s Index of Activities of Daily Living. Mini Mental State Examination (MMSE) was used to assess cognitive status. Hospital Anxiety and Depression Scale was used to assess symptoms of anxiety and depression.Results:Out of 60 patients, 40 had moderate head injury and 20 patients had suffered from severe head injury. There were 53 male (88.3%) and 7 (11.7%) female and the mean age was 34 years (SD=14.5). The mean duration of TBI was 11 months (SD=6.5). Fifty percent participants were married and majority was living in joint/extended families. Majorities were residing in rural localities 36 (60%). With regard to education level 11.7% were illiterate, 33% were educated up to 10th standard and 21.7% up to 12th standard. With regard to occupation, 11.7% were unemployed, 6.7% were housewives, 11.7% were students, 8.3% were retired and rest (61.6%) was engaged in varied occupations.The most common mode of injury was road traffic accident (90%). Contusion was the most common CT abnormality noted (37 patients, 61.7%). Regarding treatment, 36 patients (60%) underwent surgical intervention and 24 (40%) were managed conservatively. With regard to surgical intervention, 28 (77.8 %) patients underwent decompressive hemicraniectomy and subsequent cranioplasty and rest 8 (22.2 %) underwent craniotomy and hematoma evacuation. As per Glasgow Outcome Scale, 50 (83%) had low disability and 10 (17%) had moderate to severe disability. The mean Barthel’s Index score was 19.6+1.07 (Range 15-20) which indicated that most of the patients had resumed independence in activities of daily living. Only 25% participants were observed to have cognitive impairment (MMSE). With regard to anxiety and depression 16.7% showed symptoms of anxiety whereas 30% showed symptoms of depression (HADS score >8).Conclusions:After 6 months of TBI, most participants had resumed independence in activities of daily living but cognitive impairment is persistent in 25% and symptoms of depression in 30% participants.

S3639 Two’s a Crowd: Case Report of Hepatitis C Genotype Mixed Pattern

Introduction: We present a clinical case of an unusual laboratory abnormality, mixed pattern Hepatitis C genotype. The incidence of “mixed genotype HCV infections has been assessed across numerous geographical regions with estimates between 1.2% and 25.3% reported” (McNaughton et al, 2017, p. 524). This case highlights the importance of accurate identification of HCV genotype, subtype,and resistance-associated substitutions. Case Description/Methods: A 30-year-old male presented with a chief complaint of postprandial nausea/vomiting occurring daily for 3 weeks as well as episodes of heartburn and unintentional weight loss. He had a past history of substance abuse: intranasal and IV drug use of both heroin and cocaine. He tested positive for hepatitis C. There was remote use of alcohol (Cessation of use > 1 year),as well as a history of bipolar/depression, suicidal ideations, and self-mutilation. On physical examination BMI was 30.6. There were multiple body piercings. The liver was not palpable. Laboratory: Hepatitis C genotype-1B/3(method used: RT-PCR and reverse hybridization of the 5' UTR and core region of the HCV genome performed by Quest Diagnostics).Viral load-199,000 , Alk. Phos-86, AST-75, ALT-186, Tbil-0.5, PLT-238,000. Negative for HIV. Urine toxicology-positive for benzodiazepine& cocaine. Ultrasound elastography revealed F1 fibrosis. He was lost to care due to incarceration. Discussion: This case report highlights the unusual existence of mixed HCV genotype and the importance of accurate determination of viral genotypes and subtypes for determination of treatment with DAA. In this situation there tends to be a major and a minor genotype presumably because one is more replicatively fit. This may make selection of the appropriate DAA difficult and may explain some treatment failures.

Tramadol Dependence in a Tunisian Patient with No Previous Substance Misuse History

Introduction Tramadol is an atypical, centrally acting, synthetic, analgesic. Its anti-nociceptive effects are mediated by a combination of μ-opioid agonist effects, and norepinephrine and serotonin reuptake inhibition. Initially, tramadol was said to have a low-abuse potential. However, its abuse liability and diversion were soon recognized, with several reports on physical dependence. Methods A case report and review of literature by a research on medline database. Key words: 'Tramadol”, 'opiate dependence”, 'tramadol withdrawal”, 'tramadol addiction” Case Report Mr. L.M. is a 24 year-old man without past history of substance abuse. In 2012, he underwent leg surgery after gunshot wounds. He was started on Tramadol treatment for his pain. He progressively increased Tramadol dosage and was taking 250mg to 750mg intravenous injections per day. He tried several times to stop taking Tramadol but each time his developed nausea, muscle aching, dysphoric mood and insomnia. His withdrawal symptoms had bad impact on his daily life and resulted in family life breakdown. Discussion Tramadol has long been considered to have a very low abuse potential. According to the US Food and Drug Administration, the rate of addiction was 1 in 100,000 during the last 18 months period of surveillance. Most of the cases had been in patients with a prior history of substance abuse. This case shows that Tramadol addiction may also occur in patients with no psychiatric or substance abuse history.

The outcome of Mental Health Care Users admitted under Section 40 of the South African Mental Health Care Act (No 17 of 2002)

To determine the outcomes of mental health care users (MHCU's) admitted in terms of Section 40 of the South African Mental Health Care Act (No 17 of 2002) (MHCA) and the factors, if any, that are associated with these outcomes. The study was a retrospective record review of MHCU's, 18 years and older, referred by the South African Police Service (SAPS) to Chris Hani Baragwanath Hospital (CHBH). All mental health care users handed over to CHBH by SAPS with completed MHCA form 22's during the period July 2007 to December 2007 were included in the study. The outcomes, demographics and clinical characteristics of these referrals were obtained from hospital records. During the six-month study period, 718 MHCU's were referred by members of SAPS to the CHBH Emergency Department. Associations were found between discharged MHCU's and i) being male, ii) being less than 35 years of age, iii) being unemployed, iv) having a lower level of education, v) having a past history of substance abuse and/or vi) a past psychiatric illness. Females were twice as likely to be unemployed and admitted to hospital (either to a psychiatric or general medical ward). MHCU's diagnosed with delirium were more likely to be admitted into a medical ward as compared to a psychiatric ward. As has been the case in most countries where police services have been incorporated into mental health acts, South Africa's new Mental Health Care Act (No 17 of 2002) has resulted in a large number of referrals by the police to mental health services. However, many of these referrals may not be necessary as most MHCU's end up not being admitted. The characteristics of police referrals suggest that the receiving facility should have the capacity to identify factors that favour outpatient care (especially substance abuse problems) and divert MHCU's presenting with such factors to appropriate treatment facilities without admitting them to the hospital.

Psychological benefits 2 and 4 weeks after a single treatment with near infrared light to the forehead: a pilot study of 10 patients with major depression and anxiety

BackgroundMany studies have reported beneficial effects from the application of near-infrared (NIR) light photobiomodulation (PBM) to the body, and one group has reported beneficial effects applying it to the brain in stroke patients. We have reported that the measurement of a patient's left and right hemispheric emotional valence (HEV) may clarify data and guide lateralized treatments. We sought to test whether a NIR treatment could 1. improve the psychological status of patients, 2. show a relationship between immediate psychological improvements when HEV was taken into account, and 3. show an increase in frontal pole regional cerebral blood flow (rCBF), and 4. be applied without side effects.MethodsWe gave 10 patients, (5 M/5 F) with major depression, including 9 with anxiety, 7 with a past history of substance abuse (6 with an opiate abuse and 1 with an alcohol abuse history), and 3 with post traumatic stress disorder, a baseline standard diagnostic interview, a Hamilton Depression Rating Scale (HAM-D), a Hamilton Anxiety Rating Scale (HAM-A), and a Positive and Negative Affect Scale (PANAS). We then gave four 4-minute treatments in a random order: NIR to left forehead at F3, to right forehead at F4, and placebo treatments (light off) at the same sites. Immediately following each treatment we repeated the PANAS, and at 2-weeks and at 4-weeks post treatment we repeated all 3 rating scales. During all treatments we recorded total hemoglobin (cHb), as a measure of rCBF with a commercial NIR spectroscopy device over the left and the right frontal poles of the brain.ResultsAt 2-weeks post treatment 6 of 10 patients had a remission (a score ≤ 10) on the HAM-D and 7 of 10 achieved this on the HAM-A. Patients experienced highly significant reductions in both HAM-D and HAM-A scores following treatment, with the greatest reductions occurring at 2 weeks. Mean rCBF across hemispheres increased from 0.011 units in the off condition to 0.043 units in the on condition, for a difference of 0.032 (95% CI: -0.016, 0.080) units, though this result did not reach statistical significance. Immediately after treatment the PANAS improved to a significantly greater extent with NIR "on" relative to NIR "off" when a hemisphere with more positive HEV was treated than when one with more negative HEV was treated. We observed no side effects.ConclusionThis small feasibility study suggests that NIR-PBM may have utility for the treatment of depression and other psychiatric disorders and that double blind randomized placebo-controlled trials are indicated.Trial registrationClinicalTrials.gov Identifier: NCT00961454

A Case Report of Zolpidem-Induced Somnambulism.

Sir: The physiology of sleep, memory, awareness, and arousal can be influenced by different drugs.1 Zolpidem tartrate is a nonbenzodiazepine hypnotic agent of the imid-azopyridine group with a rapid onset and short duration of action. Its side effect profile is milder than those of benzodiazepines and barbiturates used for treating insomnia.2 To our knowledge, there are 5 published articles3–7 related to zolpidem-induced somnambulism. Somnambulism, or sleepwalking, could be dangerous due to the possibility of accidental injury. Here, we present a case of somnambulism associated with zolpidem use. Case report. Mr. A, a 19-year-old white man, had a history of and current diagnoses of DSM-IV schizoaffective disorder and impulse-control disorder. The patient lived with his parents and a younger brother. He worked as a volunteer at a university hospital and had received a general equivalency diploma. Mr. A had no current or past history of substance abuse and did not smoke or drink alcohol. His medical history was unremarkable. The patient had a history of 2 psychiatric hospitalizations for worsening of his symptoms. He had no personal or family history of sleepwalking. In the past, olanzapine and paroxetine had been tried without successful results. Mr. A was stable on his medications, which included aripiprazole 15 mg once per day, venlafaxine extended release 150 mg once per day, and quetiapine 50 mg once per day. He received no other medications, including herbal supplements. During the course of his treatment, Mr. A began complaining of insomnia, for which brief zolpidem treatment was prescribed. He was started on treatment with zolpidem 10 mg orally at bedtime on an as-needed basis for insomnia. Within a few days of the initiation of zolpidem treatment, the patient's family noticed the patient waking up in the middle of night and walking into their room with a staring expression and some incoherent speech. The patient had no memory of this event in the morning. This sleepwalking episode was attributed to zolpidem, as no medication change was made besides initiating zolpidem and the patient had no history of such episodes in the past. Zolpidem treatment was stopped, and since then, no complaints of sleepwalking have been reported. Somnambulism, or sleepwalking, generally occurs during stages 3 and 4 of slow-wave sleep.8 During an episode of somnambulism, the normal arousal mechanism is altered, which results in partial arousal without full consciousness.9 Electroencephalographic changes associated with the use of zolpidem include suppression of REM sleep.10 It has been suggested that some drugs produce a physiologic state during slow-wave sleep that can present clinically as somnambulism.8 A definitive diagnosis of somnambulism usually requires all-night sleep recordings,8 which were not performed on our patient. We suggest that when seeking an etiology of somnambulism in a patient, a careful review of the patient's current medications should be performed.

Association of interferon-α-induced depression and improved treatment response in patients with hepatitis C

Thirty-nine patients with hepatitis C viral infection on interferon-α (IFN-α) therapy were monitored weekly using the Beck Depression Inventory (BDI). Thirteen of thirty-nine patients (33%) developed IFN-α-induced major depressive disorder (MDD). During the course of IFN-α therapy, patients who became depressed were treated with citalopram, a selective serotonin reuptake inhibitor (SSRI) antidepressant. Results indicated that: (1) IFN-α response rates were significantly higher in those patients who developed IFN-α-induced MDD than in those who did not (end-of-treatment response (ETR) rates: 61.5% versus 26.9% and sustained viral response (SVR) rates: 38.5% versus 11.5%), (2) male patients with ETR to IFN-α therapy were, on average, ∼33 pounds lighter in body weight than male patients who did not respond, and (3) gender, race, past history of MDD, and past history of substance abuse were not significantly associated with ETR. In conclusion, our findings suggest that IFN-α-induced MDD may be a predictor of a positive response to IFN-α therapy, or an indication of optimal dosing.

Comorbidities and quality of life in patients with interferon-refractory chronic hepatitis C

OBJECTIVES: Patients with chronic hepatitis C (HCV) consistently report a reduction in multiple domains of health-related quality of life (HRQOL) that does not correlate with liver disease severity. This may in part be due to the use of insensitive HRQOL instruments or extrahepatic factors that independently influence HRQOL. We hypothesized that a past history of substance abuse or active medical and psychiatric comorbidities would correlate with HRQOL scores. METHODS: In 107 patients who had failed previous interferon therapy, HRQOL was measured by using the modified SF-36, a disease-specific instrument, and the Health Utilities Index (HUI) Mark III, a generic instrument. RESULTS: Multiple SF-36 subscale and summary scores as well as the HUI Mark III attributes of emotion and pain were significantly reduced in the study population compared with healthy controls ( p < 0.001). Serum alanine aminotransferase and HCV RNA levels, HCV genotype, liver histology, and HCV risk factors as well as demographic variables did not correlate with modified SF-36 and HUI scores. In addition, a history of alcohol abuse or dependency and intravenous drug use or dependency, identified in 52 and 51% of participants, respectively, did not correlate with HRQOL scores. However, the presence of one or more active medical comorbidities, defined as a chronic medical condition requiring treatment and monitoring, was significantly associated with both the modified SF-36 scores and HUI attribute deficits ( p < 0.001). In particular, painful medical comorbidities or depressed mood requiring treatment were significantly associated with modified SF-36 scores and with HUI attribute deficits and utility scores ( p < 0.001). CONCLUSIONS: Active medical and psychiatric comorbidities may account for some of the reduction and variability in HRQOL scores in patients with chronic HCV who have failed previous interferon therapy. Future studies that control for the presence of active comorbidities in large groups of treatment naı̈ve patients with varying severity of chronic HCV are needed to confirm these findings.

Menstrual Function in Human Immunodeficiency Virus-Infected Women Without Acquired Immunodeficiency Syndrome

To assess whether HIV infection is associated with menstrual abnormalities in HIV-infected women without AIDS, we evaluated 248 premenopausal HIV-infected women without AIDS and 82 HIV-negative women. Detailed medical, drug use, and menstrual histories (using menstrual calendars) were obtained. Complete physical and pelvic examinations and CD4 counts were performed. HIV-infected women were more likely to experience intervals > 6 weeks without menstrual bleeding [8 vs. 0%, odds ratio (OR) = 10.8, 95% confidence interval (CI) 1.8-1,000) and amenorrhea > 3 months (5 vs. 0%, OR = 7.1, 95% CI 1.1-1,000) (after adjustment for drug use, age, and race). Premenstrual breast swelling (p = 0.01), tenderness (p = 0.01), and dysmenorrhea (p = 0.04) were less common in HIV-infected women. There were no differences in intermenstrual bleeding or irregular menstrual cycles. Among HIV-infected women, only a past history of substance abuse was significantly associated with menstrual irregularities in a logistic regression model adjusting for age, current and past drug use, alcohol use, cigarette smoking, CD4 count, and category B conditions [1993 Centers for Disease Control (CDC) classification system]. The increase in amenorrhea (> 3 months) and in menstrual cycle intervals > 6 weeks and the lower rates of premenstrual breast symptoms in HIV-positive women suggest the possibility of disturbances in menstrual function that do not appear to be attributable to clinically apparent secondary complications of HIV. Changes in menstrual function were also significantly associated with a past history of, but not current, substance abuse, suggesting the possibility that socioeconomic factors rather than biologic effects of drugs may be responsible.

Social and physical health risk factors for first-onset major depressive disorder in a community sample.

Using prospective data on 3,170 respondents aged 18 years and over who were at risk for a first-onset major depression from the New Haven site of the Epidemiologic Catchment Area (ECA) study, these analyses assessed the effects of social status, physical health status, and social isolation on first-onset depression in a 1-year period, controlling for demographic characteristics and baseline psychiatric factors. Among the assessed potential risk factors, poverty status [odds ratio (OR = 2.034, P < 0.05)] and confinement to a bed or chair (OR = 4.015, P < 0.05) were independently associated with an increased risk for a first-onset depressive episode when controlling for gender, age, past history of substance abuse, and subclinical depressive symptoms. The effects of poverty, and to a lesser degree homebound status, were substantially reduced when controlling for degree of isolation from friends and family, suggesting that social isolation mediates some of the relationships between social and physical statuses and major depression.

What happens to Special Hospital patients admitted to medium security?

Abstract Most studies of discharged Special Hospital patients have examined the outcome of patients discharged directly into the community. Some have included patients transferred to NHS hospitals, but there have been no reports of the progress of Special Hospital patients transferred to regional secure units (RSUs). This article describes the outcome of all the Special Hospital patients who were admitted to and discharged from medium secure units in the West Midlands region over 10 years. There were 51 patients included in the study and the follow-up ranged from 10 years to 6 months with a mean of 5.3 years The main findings were similar to other Special Hospital studies, in that patients with a legal classification of psychopathic disorder had a poorer prognosis dian mentally ill patients. No other factors could predict success or failure, such as sociodemographic variables, nature of offence, previous criminal and psychiatric histories, or past history of substance abuse. In the study failure was defin...

Structural brain abnormalities in first-episode mania

Using magnetic resonance imaging (MRI), we studied brain morphometric differences between patients with first-episode mania ( n = 17) and normal control subjects ( n = 16). Patients were admitted for their first psychiatric hospitalization and met DSM-III-R criteria for bipolar disorder, manic or mixed. Diagnoses were made using the Structured Clinical Interview for DSM-III-R. Patients and control subjects were matched for age, gender, height, past history of substance abuse, and handedness, although control subjects had attained higher levels of education. MRI inversion recovery coronal scans were used for measurements. Volumetric measurements were obtained for cerebral hemispheres, lateral and third ventricles, caudate, thalamus, and cingulate gyrus. Patients with first-episode mania demonstrated significantly larger third-ventricular volumes, possibly increased lateral ventricular volumes, and differences in gray/white matter distribution compared with normal control subjects. The possible pathophysiologicical meaning of these findings is discussed.

The impact of prior substance abuse on treatment outcome for bulimia nervosa

The present investigation examined the significance of a past history of substance abuse on treatment outcome for bulimia nervosa. Seventy-five women with bulimia nervosa participated in a 6-week double-blind outpatient trial of desipramine; 19 patients had a history of substance abuse and 56 did not. Although patients with a history of substance abuse reported higher levels of anxiety and depression at presentation for treatment than patients without such histories, the two groups reported a similar age of onset of their bulimia nervosa and similar severity of eating pathology with regards to binge and vomit frequencies and measures of concern about body shape and weight. On all outcome measures, the improvement of the substance abuse group was equal to or greater than that in the group without a history of substance abuse. Results suggest that a past history of substance abuse has no implication regarding response to pharmacological treatment for bulimia nervosa.

Prescribing psychotropic agents in opiate dependency: the need for caution.

The value of prescribing psychotropes to narcotic-dependent persons depends upon the indications for such prescriptions. This paper reviews the prevalence of psychological disorders in opiate dependency, effectiveness of existing psychotropic agents in treating these disorders and risks of prescribing these agents in a less than controlled, conservative manner. The existing data suggest that although psychotropic drugs are effective in specific narcotic-dependent persons, the potential for misuse, abuse and dependency is quite real. Such drugs should be prescribed only after careful consideration, with close monitoring for compliance. The most effective management of narcotic dependency in those without severe psychiatric symptoms may be psychotherapy combined with regular clinic services. If such therapy is effective, it is preferred to prescription of a mood-altering drug to an individual with a past history of substance abuse.