Decoding the link between substance dependence and attention deficit hyperactivity disorder in adults: A cross-sectional study from North India.

Background: Attention deficit hyperactivity disorder (ADHD) and Substance dependence are often thought to be linked as they are found to co-exist in many individuals. ADHD is estimated to be an essential indicator for the development of substance use disorder. Aim and Objective: To explore the relationship between different substance dependence and ADHD. Methods and Materials: This cross-sectional single-interview study was done at a tertiary care hospital in which a total of 153 Cases presenting to the Psychiatry OPD in a period of 03 months were selected serially based on inclusion and exclusion criteria. The diagnosis of substance dependence was made as per ICD-10 criteria. These subjects were then evaluated for the presence of ADHD and physical and psychological symptoms using the Adult ADHD self-rating scale and Maudsley's Addiction Profile. Results: The majority of our study subjects were aged between 24-29 years (45%) and were predominantly males (98.7%). Most of our subjects were dependent on smack (adulterated heroin) (38.5%) followed by cannabis (27.4%) and alcohol (18.3%). When evaluated for ADHD using the ADHD self-rating scale, we found that almost one-third of the study population had ADHD (33%). Prevalence of ADHD was maximum in the subjects with cannabis dependence (47.6%) followed by tobacco/smoking (38.8%), cocaine (33%), and alcohol (21.5%). This association was statistically significant for cannabis (p = 0.035). The standard mean of both the physical as well as psychological symptoms experienced by subjects was higher in the ADHD group compared to the non-ADHD group which was statistically significant (p < 0.05). Conclusion: While managing patients with substance dependence we need to target both underlying ADHD and any co-morbid physical and psychological illness if present for holistic recovery of the patient.

The devil molested me: A case series of incubus syndrome from North India.

Incubus syndrome is a disorder typically seen in females where she reports that a male demon lies upon her and engages in sexual activity with her. While the concept of incubus is typically based on Western folklore a limited number of case reports are present on this topic more from India. There is a diverse opinion among the authors related to this disorder where some link this to psychotic disorders while some to sleep disorders. Here we report a case series of females who were suffering from psychotic disorder and over time developed incubus syndrome. We also the role of cultural factors and superstition in the formation of these disorders and the role of antipsychotic medication and modified electroconvulsive therapy in its treatment.

Stigma in Bipolar Affective Disorder: A Systematic Quantitative Literature Review of Indian Studies.

BACKGROUND: Bipolar affective disorder (BPAD) is one of the most common severe mental illnesses that cause morbidity. Stigma can negatively influence the disease experience in patients with BPAD. Significant differences are observed in the attributes of stigma across the various sociocultural milieus. The current review was thus conducted to compile the evidence regarding the burden and correlates of various forms of stigma in BPAD in India. METHODS: An exhaustive literature review was conducted in PubMed, MedIND, and Google Scholar to identify Indian studies conducted on stigma in BPAD. The broad themes in various forms of stigma were identified (qualitative analysis). Quantitative analysis of measures of stigma was done, calculating the effect size in BPAD and comparator groups (schizophrenia and anxiety disorders) using standardized mean difference. RESULTS: Overall, 12 studies could be identified for qualitative analysis, and 5 were used for quantitative analysis. Overall, the current evidence points out that the stigma in BPAD is less than that in schizophrenia but more than that in anxiety disorders. Internalized stigma in BPAD is correlated with poor self-esteem, reduced community participation, and low quality of life. Caregivers of patients with BPAD also experience significant stigma. CONCLUSIONS: The review shows that stigma in BPAD is substantial. It also draws attention to the fact that the research regarding stigma in BPAD is lagging behind. This review also provides a platform to develop an intervention in the Indian scenario, where further research should be carried out.

Leptin levels in alcohol dependent patients and their relationship with withdrawal and craving.

OBJECTIVE: Association between leptin plasma levels and alcohol craving has been seen previously. This study aims to research this correlation in a different population while comparing this correlation with respect to hyper-excitable state of alcohol withdrawal. METHODS: 25 patients of alcohol dependence were assessed for withdrawal symptoms and craving for alcohol. Leptin levels were measured on 1st day, @ the end of 1st week, @ the end of 3rd week of stopping alcohol. Withdrawal was assessed using CIWA-A at day 1 and day 7, craving was assessed using PENN's scale of craving at week 1 and week 3. Control group consisted of 15 first degree relatives. RESULTS: Leptin levels [t (38) = 2.95, p = 0.005] was significantly higher in alcohol dependent patients. Levels had no significant correlation with alcohol withdrawal scores [Leptin/BMI and CIWA Ar: r = 0.18, p = 0.40 on day 1] but had positive correlation with craving scores [Leptin/BMI and PACS: r = 0.684, p = 0.001]. CONCLUSION: This study shows that leptin, known for balancing the energy homeostasis of body, also seem to play a role in pathways of drug dependence and craving. This relation is independent of stress hormone axis.