Survey of autism spectrum disorder in Chandigarh, India.

Background & objectives: Prevalence of autism spectrum disorder (ASD) has been reportedly on the rise in western literature. However, accurate data from India are not available. The present study was planned to assess the community-based prevalence of ASD in Chandigarh, India. Methods: This study was a two-stage survey of representative child population of Chandigarh using stratified random sampling technique, covering 8820 children between the ages 1.5 and 10 yr. Proportionate population from urban (82.3%), rural (4.3%) and slum area (13.4%) were included in the study and screened using Chandigarh autism screening instrument (CASI). Thirty two children scored above cut-off, of whom two had shifted to other places before they could be assessed and 30 were assessed in detail. Detailed assessment was done using Autism Diagnostic Interview-Revised and Childhood Autism Rating Scale-2; diagnosis was made according to the Diagnostic and Statistical Manual-5. Nineteen were diagnosed with ASD. Results: Of the 8451 children screened between the age group of one and a half to 10 yr, 19 (10 boys and 9 girls) were diagnosed as ASD, thus the prevalence of ASD was found to be 2.25 per 1000 (0.69-5.19, 95% confidence interval) children in Chandigarh. No child below the cut-off on the screening instrument was diagnosed as ASD. Interpretation & conclusions: The results suggest that the prevalence of ASD in Chandigarh was in tandem with other reports from across India and was lower than western countries.

Development of a screening instrument for autism spectrum disorder: Chandigarh Autism Screening Instrument.

Background & objectives: There is a paucity of trained professionals for the diagnosis of autism spectrum disorder (ASD), and a large number of cases go undetected and are diagnosed only during adolescence. There is no screening instrument specifically developed for screening of Indian population for ASD. This study was undertaken to develop a screening instrument to screen ASD in north Indian Hindi speaking population by multipurpose health workers. Methods: A 37-item instrument in Hindi with dichotomous yes/no responses [Chandigarh Autism Screening Instrument (CASI)] was developed to be applied on children aged 1.5-10 yr. The instrument was pilot tested and then reliability and validity of this instrument were tested. The sample included children with intellectual disability (n=75), ASD (n=83), other developmental disorders (n=87) and typically developing children (n=160). Results: Reliability, construct and content validity testing of the instrument were performed, and a score of 10 as cut-off had sensitivity of 89.16 per cent, specificity of 89.13 per cent, positive predictive value of 67.89 per cent and negative predictive value of 96.96 per cent. A shorter four-item version (CASI Bref) has also been developed with good sensitivity (73.49%) and specificity (90.68%) at a cut-off score of 2. Interpretation & conclusions: CASI was found to be a valid instrument for screening general Hindi speaking population of north India with adequate sensitivity and specificity.

Prevalence of specific developmental disorder of scholastic skill in school students in Chandigarh, India.

BACKGROUND & OBJECTIVES: Several studies have been conducted in India to determine the prevalence of learning disabilities in school children which has been reported to be 3-10 per cent among students population. The present study was conducted to find out prevalence of specific developmental disorder of scholastic skills in students of classes VII to XII and to find out feasibility of screening tool in Chandigarh, India. METHODS: A cross-sectional study on school students was carried out in two phases. The students were drawn from classes VII to XII from 10 schools of Chandigarh, India. Details of academic performance of all the students was taken, subjectively from class teachers and objectively from the marks obtained in the last academic session. In phase I, 2402 students were assessed. In phase II, 108 students were randomly selected for evaluation for assessing sensitivity and specificity of screening proforma for teachers. A total of 124 students from phase I and all students in phase II were assessed in detail. Tests of intelligence (Malin's Intelligence Scale for Indian Children and Standard Progressive Matrices), and NIMHANS Index for specific learning disability (SLD) battery were administered. RESULTS: A total of 38 students were found to be having specific developmental disorder of scholastic skills in phase I, that gave a prevalence of 1.58 per cent. Majority had mixed type of errors on SLD battery. There were more boys diagnosed with specific learning disability. Teacher's screening instrument had high sensitivity (90.385) and specificity (94.68). INTERPRETATION & CONCLUSIONS: The findings of our study conducted in community, showed that specific learning disability was not identified even till later age. The screening instrument thus could be used by teachers to suspect students with specific learning disability.

Maternal serum median levels of alpha-foetoprotein, human chorionic gonadotropin & unconjugated estriol in second trimester in pregnant women from north-west India.

BACKGROUND & OBJECTIVES: Triple test as prenatal screening procedure does not form a part of routine health care of pregnant women in India. Hence, median values of triple test biomarkers are lacking for Indian population. This study was undertaken to establish population-specific medians for biomarkers viz. alpha-foetoprotien (AFP), human chorionic gonadotropin (hCGß), and unconjugated estriol (uE3) for detection of Down's syndrome, Edward's syndrome and neural tube defects (NTDs) in pregnant women in north-west India. METHODS: Serum biomarker values were derived from 5420 pregnant women between 15-20 wk of gestation who were enrolled for triple test investigations at Department of Gynecology and Obstetrics, Government Medical College and Hospital, Chandigarh, India, between January, 2007 to December, 2009. Median values were calculated for rounded weeks using database comprising pregnancies with normal outcomes only. Simple statistical analysis and log-linear regression were used for median estimation of the biomarker values. RESULTS: The levels of the three biomarkers were found to be ranging from 1.38 to 187.00 IU/ml for AFP, 1.06 to 315 ng/ml for hCGß, and 0.25 to 28.5 nmol/l for uE3. The age of women ranged from 18 to 47 yr and mean weight was 57.9 ± 9.8 kg. Data revealed that AFP, hCGß and uE3 medians in our study population were not significantly different from those reported from other countries or when compared ethnically. INTERPRETATION & CONCLUSION: The population-specific median values for the three biomarkers (AFP, hCGß, uE3) may be used as reference values during prenatal screening in Indian pregnant women.

Treatment gap for mental and behavioral disorders in Punjab.

Background and Aims: There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey. Settings and Design: Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016. Materials and Methods: Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders. Results: The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital. Conclusions: Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Maternal serum second trimester screening for chromosomal disorders and neural tube defects in a government hospital of North India.

OBJECTIVE: Down syndrome (DS) has major resource implications especially in developing countries being third most important cause of mental handicap. Maternal serum screening for chromosomal aneuploidies and neural tube defects (NTDs) is practiced worldwide in many countries and has been integrated into mainstream health care, while it is gradually gaining momentum in Asian countries. METHODS: This prospective cohort study was carried out in pregnant women undergoing triple screening test between January 2007 and December 2010 after informed consent. Biomarkers alpha-fetoprotein, human-chorionic-gonadotropin and unconjugated-estriol were tested, and risk of pregnancy being affected with DS, Edward's syndrome or NTDs were calculated. Screen-positive patients were referred for detailed ultrasonography and confirmatory amniocentesis. Follow-up record was maintained until delivery. RESULTS: Of 7400 pregnant women enrolled, 419(5.7%) were screen-positive, including 339 positive for DS, two for trisomy 18, and 62 for NTDs. Total eight cases of DS were eventually diagnosed in the population (prevalence of DS = 1 : 925), seven of which were detected in utero following diagnostic evaluation for positive serum screen (DR of DS screen = 87.5%). Total five cases of NTD were observed, yielding NTD prevalence of 0.67/1000. CONCLUSIONS: Triple screening in the second trimester is reasonably effective for the detection of major chromosomal defects and NTDs, and can be implemented successfully also in India.

The bispectral electroencephalogram during modified electroconvulsive therapy under propofol anesthesia: relation with seizure duration and awakening.

IMPLICATION STATEMENT: : Use of the bispectral electroencephalogram during modified electroconvulsive therapy (MECT) under propofol anesthesia was found to be an accurate predictor of seizure duration and awakening. This may have potential clinical implications on therapeutic success and elimination of the undesirable effects associated with this treatment modality. BACKGROUND AND OBJECTIVES: : Propofol anesthesia when compared with barbiturates may induce relatively shorter duration seizures during MECT. This study was designed with the intent to test the hypothesis that the bispectral index (BIS) electroencephalogram (EEG) could predict MECT-induced seizure duration and awakening under propofol anesthesia. METHODS: : Twenty-five patients, between 16 and 60 years of age (American Society of Anesthesiologists physical status I or II), underwent a total of 100 MECT sessions (4 sessions each) under propofol anesthesia (1.0 mg/kg) in a prospective, observational study. The BIS was monitored continuously, and average BIS values of each of the 4 sessions of MECT that each patient received were analyzed. Bispectral index values were recorded at T0 (baseline), T1 (before induction), T2 (after propofol), T3 (preictal), T4 (postictal), T5 (awakening), and T6 (1 minute after awakening). Motor seizure duration was measured by isolated forearm technique and electrical seizure duration by BIS EEG. RESULTS: : The mean preictal BIS was 50 (SD, 14), which was found to have a significant positive correlation (P < 0.01) with motor (r = 0.707) as well as electrical seizure duration (r = 0.736). A significant negative correlation was also found between the preictal BIS value and the time to eye opening (3.53 [SD, 1.8] minutes) (r = -0.397; P < 0.05). Awakening occurred at mean BIS value of 52 (SD, 17) (range, 20-97) during this procedure. CONCLUSIONS: : The mean pre-ECT BIS values correlate significantly with the durations of both the motor and electrical seizure activity and awakening time under propofol anesthesia. Before extrapolation to daily clinical practice, further large controlled clinical trials need to be done to establish the role of BIS monitoring in predicting seizure duration and awakening time during MECT.

Pain threshold and pain tolerance as a predictor of deliberate self-harm among adolescents and young adults.

BACKGROUND: Recently, the assessment of pain has been used as a parameter to differentiate adolescents who indulge in deliberate self-harm from healthy individuals. AIMS AND OBJECTIVES: The present study was conducted to compare pain sensitivity between three groups, i.e., nonsuicidal self-injury/nonsuicidal self-harm (NSSI), suicide attempters (SA), and matched healthy control (NSSI, SA, and healthy controls). MATERIALS AND METHODS: Ninety participants (30-NSSI, 30-SA, and 30 matched control) between the age of 10 and 25 years were inducted from the individuals who came for help at the outdoor and emergency services for recent self-harm. Pain sensitivity was assessed by cold pain stimulation test through a cold pressor task. RESULTS: Pain threshold, pain tolerance, total pain index as well as pain experience intensity were significantly different in the three groups. CONCLUSION: Participants who indulge in NSSI and SA have significantly higher pain threshold, pain tolerance, total pain index, and pain experience intensity as compared to healthy control. Although all the pain parameters were higher in the NSSI group as compared to SA group, the difference did not reach to significant level.

Coping With Craving and Withdrawal Due to Substance Use Disorders During the COVID-19 Lockdown.

OBJECTIVE: Substance use disorder (SUD) is a chronic remitting and relapsing disorder, and abrupt discontinuation of the substance due to nonavailability in the absence of treatment precipitates withdrawals and craving. The objective of this study was to assess the craving and withdrawal coping mechanisms used by patients with SUDs as a result of disruption in availability of substances and medications due to sudden lockdown in response to coronavirus disease 2019. METHODS: A survey was administered via telephone from June 25, 2020, to July 15, 2020, to patients who had previously attended the substance use clinic of a tertiary care teaching hospital in North India from January 1, 2020, to March 21, 2020 (up to the time of lockdown). Sociodemographic and clinical details were obtained from case record files. A 16-item questionnaire was developed to collect information on coping with craving and withdrawal symptoms. A total of 215 patients were registered in the substance use clinic during this period for the treatment of SUDs, and of those, 43 could not be contacted due to various reasons such as wrong contact numbers, patient expired (not related to substance withdrawal), or not willing to talk. The mean age of the subjects was 37.05 (SD = 13.22) years, and men outnumbered women. The remaining 172 patients were contacted via telephone, and responses were gathered regarding withdrawal symptoms and coping with craving. RESULTS: More than two-thirds of the patients were still maintaining abstinence from their primary substance of abuse during lockdown. A large number of patients (n = 41, 43.2%) reported difficulty in obtaining prescribed medication for detoxification without renewal of their prescription. More than 66% of patients reported that they were able to control their craving, and many kept themselves busy with household activities. CONCLUSIONS: The majority of patients who had completed the acute phase of withdrawals were able to maintain abstinence in the absence of renewal of prescribed medication and substance of abuse due to sudden disruption in supply. The patients were able to use certain strategies to control their craving.

The National Mental Health Survey of India (2016): Prevalence, socio-demographic correlates and treatment gap of mental morbidity.

BACKGROUND: Recognizing the need for good quality, scientific and reliable information for strengthening mental health policies and programmes, the National Mental Health Survey (NMHS) of India was implemented by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, in the year 2015-2016. AIM: To estimate the prevalence, socio-demographic correlates and treatment gap of mental morbidity in a representative population of India. METHODS: NMHS was conducted across 12 Indian states where trained field investigators completed 34,802 interviews using tablet-assisted personal interviews. Eligible study subjects (18+ years) in households were selected by a multi-stage, stratified, random cluster sampling technique. Mental morbidity was assessed using MINI 6. Three-tier data monitoring system was adopted for quality assurance. Weighted and specific prevalence estimates were derived (current and lifetime) for different mental disorders. Mental morbidity was defined as those disorders as per the International Statistical Classification of Diseases, Tenth Revision Diagnostic Criteria for Research (ICD-10 DCR). Multivariate logistic regression was conducted to examine risk for mental morbidity by different socio-demographic factors. Survey was approved by central and state-level institutional ethical committees. RESULTS: The weighted lifetime prevalence of 'any mental morbidity' was estimated at 13.67% (95% confidence interval (CI) = 13.61, 13.73) and current prevalence was 10.56% (95% CI = 10.51, 10.61). Mental and behavioural problems due to psychoactive substance use (F10-F19; 22.44%), mood disorders (F30-F39; 5.61%) and neurotic and stress-related disorders (F40-F48; 3.70%) were the most commonly prevalent mental morbidity in India. The overall prevalence was estimated to be higher among males, middle-aged individuals, in urban-metros, among less educated and in households with lower income. Treatment gap for overall mental morbidity was 84.5%. CONCLUSION: NMHS is the largest reported survey of mental morbidity in India. Survey estimated that nearly 150 million individuals suffer from one or the other mental morbidity in India. This information is to be used for planning, delivery and evaluating mental health programming in the country.

A population-based analysis of suicidality and its correlates: findings from the National Mental Health Survey of India, 2015-16.

BACKGROUND: India accounts for 18% of the global population and 26·6% of global suicide deaths. However, robust population-based, nationally representative data on suicidality are not readily available to plan and implement suicide prevention programmes in India. We aimed to investigate the prevalence and sociodemographic differentials of suicidality using data from the National Mental Health Survey (NMHS) of India, 2015-16. METHODS: Trained field data collectors from the NMHS obtained information on suicidality (during the past month) from a community sample of adults aged 18 years and older using the suicidality module of the Mini-International Neuropsychiatric Interview (version 6.0). Suicidality was categorised as low, moderate, high, and overall (representing any suicidality), and examined for sociodemographic differentials using normalised sampling weights. For each of the 12 surveyed states, we calculated the age-standardised suicidality prevalence for men and women, men-to-women ratio of weighted suicidality prevalence, ratio of suicidality to suicide deaths, and ratio of suicide attempts to suicide deaths. We used logistic regression analysis to examine the association between sociodemographic factors and overall suicidality and severity. FINDINGS: Among 34 748 participants with complete interviews, 5·1% (95% CI 4·7-5·6) had some level of suicidality, and 0·3% (0·2-0·4) had at least one suicide attempt in the past month. The prevalence of overall suicidality was higher in women (6·0% [5·4-6·6]) than in men (4·1% [3·7-4·6]). The prevalence of overall suicidality was highest in those aged 40-49 years among women and in those aged 60 years or older among men. Compared with their counterparts, individuals with lower educational attainment, individuals residing in urban metropolitan cities, individuals who were widowed, separated, or divorced, and unemployed individuals had a higher prevalence of overall suicidality. The men-to-women ratio of overall suicidality prevalence for India was 0·68 (range 0·55-0·85). For every death by suicide in India, there were more than 200 people with suicidality and more than 15 suicide attempts. We found variations for various severities of suicidality. We found an increased risk for overall suicidality in women versus men (odds ratio [OR] 1·54 [95% CI 1·31-1·81]; p<0·0001) and in individuals residing in urban metropolitan cities versus those residing in rural areas (1·75 [1·30-2·35]; p=0·0002). Individuals belonging to the lowest income quintile (reference group with OR <1·00 and p<0·05 for other income quintiles), those with depressive disorders (28·78 [20·04-41·33]; p<0.0001) and those with alcohol use disorders (6·52 [3·83-11·10]; p<0.0001) had an increased risk for high suicidality, compared with their corresponding counterparts. INTERPRETATION: A national suicide prevention strategy that is comprehensive, using multisectoral approaches, is required to address the prevailing sociodemographic and other risk factors for reducing suicidality and suicide deaths in India. This study also has implications for other low-income and middle-income countries in south Asia, where sociodemographic factors play a crucial role for suicide prevention. FUNDING: Ministry of Health and Family Welfare, Government of India.

Prevalence of disability in Chandigarh: Findings of large household screening.

BACKGROUND: The robust and sound national statistics on disability is the cornerstone for empowering the disabled population to have a barrier-free and right-based society for this population. The disability rates in India have marked discrepancies across various surveys. Taking into account the lack of data on disability in Chandigarh in terms of the proportion of disabled not included or counted owing to nonavailability of disability certificate or just lack of awareness as well as lack of data on the degree of utilization of various disability benefits, the present survey was planned. METHODOLOGY: The present study aimed at screening all the households of Chandigarh for different forms of disability using a 12-item screening tool. The survey included 254, 436 households with 925,380 population. A total of 8577 persons were screened positive for disability. The prevalence rates for the whole population were extrapolated by further confirming disability in a random sample chosen from screen-positive cases. RESULTS: The estimated prevalence for disability in Chandigarh ranged between 0.83 and 0.86 after generating the confidence intervals. CONCLUSION: The prevalence rate of disability in Chandigarh is less than the national census data.

Comparative efficacy of baclofen and lorazepam in the treatment of alcohol withdrawal syndrome.

BACKGROUND: Benzodiazepines (BDZs) have been the treatment of choice for alcohol withdrawal syndrome (AWS); however, they are associated with several side effects and also have abuse potential. In some studies, the use of baclofen has been effective in reducing symptoms of alcohol withdrawal symptoms. AIM: The objective of this study was to compare the efficacy of baclofen and benzodiazepine (lorazepam) in reducing symptoms of AWS. MATERIALS AND METHODS: It was a single-center, randomized, open-label study. Patients with alcohol dependence syndrome were enrolled in the study and randomized into two groups using computer-generated random table number. Baclofen (experimental group, 10 mg three times a day) and BZDs (control group, lorazepam, 8-12 mg/day in divided doses) were orally administered for reducing symptoms of alcohol withdrawal. Both groups received Vitamin B1 (100 mg/day through intramuscular route) and psychotherapeutic interventions. The severity of alcohol dependence was assessed by using the Severity of Alcohol Dependence Questionnaire, and alcohol withdrawal was assessed with the Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar). RESULTS: Sixty-six patients were randomized (baclofen n = 34, benzodiazepine (BZD) group n = 32). Two patients (one patient in each group) had complicated withdrawal symptoms and were dropped from the final analysis. There was a significant reduction in alcohol withdrawal symptoms in both groups. There were no significant differences in CIWA-Ar scores between the two groups. Both the drugs were well-tolerated. CONCLUSION: Baclofen and lorazepam are comparable in efficacy and tolerability in reducing symptoms of AWS.

Stress and suicidal ideation among adolescents having academic difficulty.

BACKGROUND AND OBJECTIVES: Academically typically achieving adolescents were compared with students having academic difficulty on stress and suicidal ideas. MATERIALS AND METHODS: In a cross-sectional study, 75 academically typically achieving adolescents were compared with 105 students with academic difficulty and 52 students with specific learning disability (SLD). Academic functioning was assessed using teacher's screening instrument, intelligence quotient, and National Institute of Mental Health and Neurosciences index for SLD. Stress and suicidal ideas were assessed using general health questionnaire, suicide risk-11, and Mooney Problem Checklist (MPC). Appropriate statistical methods were applied. RESULTS: Three groups were comparable on age, gender, mother's working status, being only child, nuclear family, self-reported academic decline, and type of school. About half of adolescents reported psychological problems on General Health Questionnaire (mean score >3 in all the groups). Academically typically achieving adolescents showed higher stressors in peer relationships, planning for future and suicidal ideation compared to adolescents with academic difficulty. Adolescents face stress regarding worry about examinations, family not understanding what child has to do in school, unfair tests, too much work in some subjects, afraid of failure in school work, not spending enough time in studies, parental expectations, wanting to be more popular, worried about a family member, planning for the future, and fear of the future. Significant positive correlation was seen between General Health Questionnaire scores and all four subscales of MPC. Suicidal ideas showed a negative correlation with MPC. INTERPRETATIONS AND CONCLUSIONS: Adolescents experience considerable stress in multiple areas irrespective of their academic ability and performance. Hence, assessment and management of stress among adolescents must extend beyond academic difficulties.

Identification of genetic correlates of response to Risperidone: Findings of a multicentric schizophrenia study from India.

Risperidone is most commonly used as an antipsychotic in India for treatment of schizophrenia. However, the response to treatment with risperidone is affected by many factors, genetic factors being one of them. So, we attempted to evaluate the association between dopamine D2 (DRD2) receptor, serotonergic (5HT2A) receptor and CYP2D6 gene polymorphisms and response to treatment with risperidone in persons with schizophrenia from North India. It was a multicentric 12-weeks prospective study, undertaken in patients diagnosed with schizophrenia according to International Classification of Diseases 10th revision, Diagnostic Criteria for Research module (ICD-10 DCR). Patients were treated with incremental dosages of risperidone. Nine gene polymorphisms from three genes viz. DRD2, 5-HT2A and CYP2D6 along with socio-demographical and clinical variables were analyzed to ascertain the association in response to risperidone treatment. The change in the Positive and Negative Syndrome Scale (PANSS) was used to measure the outcome. Significant differences in the frequencies of single nucleotide proteins (SNPs) rs180498 (Taq1D) and rs 6305 (C516T) polymorphisms were found amongst the groups defined according to percent decline in PANSS. The CYP2D6*4 polymorphism differed significantly when drop outs were excluded from analysis. Presence of DRD2 Taq 1 D2D2 and 5-HT2A C516T CT genotypes in patients were more likely to be associated with non-response to risperidone. Ser311Cys (rs1801028) mutation was absent in the North Indian patients suffering from schizophrenia.

Clinical profile of patients seeking services at urban community psychiatric services in Chandigarh.

CONTEXT: About two-third of patients with mental, neurological, and substance use disorder in India do not get adequate treatment due to insufficient clinical facilities. In a country with diverse population such as India, no single model can be effective and each region needs to develop local system of service delivery unique to population needs. Community outreach clinics (COCs) being run by the department of psychiatry provide mental health services in the primary health-care setting. The study reports on the pattern of service utilization across different COCs in Chandigarh. AIMS: The aim of this study was to describe the sociodemographic and clinical profile of patients seeking mental health-care services from COCs and to compare this with patients seeking care at tertiary care center. SETTINGS AND DESIGN: This was a cross-sectional case record review. SUBJECTS AND METHODS: Community services are provided in the areas adjoining Chandigarh, through four COCs: Civil Dispensary, Dhanas; Khuda Ali Sher; Rural Health Training Center, Palsaura; and Police Dispensary Sector 26 by Department of Psychiatry, Government Medical College and Hospital, Chandigarh. The current study reports on sociodemographic and clinical profile of 728 patients seen in these clinics from July 2010 to June 2011. STATISTICAL ANALYSIS USED: Descriptive statistics were performed using SPSS version 16.0. Chi-square test was used to compare two groups, ANOVA for comparing more than two groups. RESULTS: Out of the 728 patients, majority were males in productive age group with diagnosis of substance use disorder. Majority were reaching the clinics on their own and only a few were referred by various community referral agencies. Only twelve patients needed referral to the Department of Psychiatry in the above mentioned period. CONCLUSIONS: Patients of substance use disorder prefer to be seen in the outreach clinics and it is possible to manage them in these clinics with very little need to refer them to tertiary care hospitals.

Clinical experience of baclofen in alcohol dependence: A chart review.

INTRODUCTION: Craving is recognized as a formidable barrier in the management of patients with alcohol dependence. Among pharmacological agents that have been used in experimental studies for reduction in craving, baclofen appears to have a significant advantage over other agents. METHODOLOGY: The study is retrospective chart review of patients (n = 113) who have been treated with baclofen for alcohol dependence in a tertiary hospital of North India. Baseline assessments included sociodemography, motivation, quantity-frequency of alcohol use, and other alcohol-related clinical parameters. Weekly assessments, for a period of 4 weeks, were extracted from records which included dose of baclofen, craving intensity, and alcohol consumption. RESULTS: The study sample was predominantly male, mean age of 41.49 (±9.75) years, most having a family history of substance use (70.97%), and many reporting binge use pattern in last year (49.46%). Baseline assessment revealed 48.7% of the sample was in precontemplation phase for alcohol use and 70% reported severe and persistent craving. This persistent craving was reported by only 15% of the sample by the end of 4 weeks treatment with baclofen (20-40 mg/day). Thirty-four percent of patients reported continued problematic use of alcohol by the end of 4 weeks. CONCLUSION: Our clinical experience suggests that baclofen reduces craving and alcohol consumption including in those with poor motivation. The drug causes few side effects and does not add to the intoxication effect of alcohol. Considering that baclofen is safe in those with liver cirrhosis and reduces withdrawal symptoms due to alcohol, a controlled trial comparing it with standard treatment is required.

Current and future perspective of newborn screening: an Indian scenario.

BACKGROUND: Newborn screening comprises a paramount public health program seeking timely detection, diagnosis, and intervention for genetic disorders that may otherwise produce serious clinical consequences. Today newborn screening is part of the health care system of developed countries, whereas in India, newborn screening is still in the toddler stage. METHOD: We searched PubMed with the keywords newborn screening for metabolic disorders, newborn screening in India, and congenital disorder in neonates, and selected publications that seem appropriate. RESULTS: In India, in spite of the high birth rate and high frequency of metabolic disorders, newborn screening programs are not part of the health care system. At Union Territory, Chandigarh in 2007, newborn screening was initiated and is currently ongoing for three disorders, that is, congenital hypothyroidism, congenital adrenal hyperplasia, and glucose-6-phosphate dehydrogenase (G6PD) deficiency. Prevalence of these disorders is found to be 1:1400 for congenital hypothyroidism, 1:6334 for congenital adrenal hyperplasia, and 1:80 for G6PD deficiency. CONCLUSION: Mandatory newborn screening for congenital hypothyroidism should be implemented in India, and other disorders can be added in the screening panel on the basis of region-wise prevalence. The objective of this review is to provide insight toward present scenario of newborn screening in India along with recommendations to combat the hurdles in the pathway of mandatory newborn screening.