Impact of nurse-led medication adherence therapy on bipolar affective disorder: A randomized controlled trial.

PURPOSE: This study evaluated the impact of nurse-led medication adherence therapy (MAT) on medication adherence behavior and symptom severity of inpatients with bipolar disorder. METHOD: Two arms, single-blind, randomized controlled trial on individuals with bipolar disorder was conducted at inpatient department of mental healthcare setting, India. Eighty-five participants were randomly allocated to MAT group and Treatment as usual group. Standard measures were used to assess medication adherence and symptom severity of both groups at baseline and follow-up time points. CONCLUSION: MAT improved medication adherence behavior resulting in marked decrease in symptom severity of participants with bipolar disorders. IMPLICATIONS FOR NURSING PRACTICE: Psychiatric nurses can effectively implement MAT for bipolar inpatients, which improves better clinical outcomes, prevent relapse, and readmissions.

Effect of holistic relapse prevention intervention among individuals with alcohol dependence: a prospective study at a mental health care setting in India.

Present study examined effectiveness of Integrative Body Mind Spirit (I-BMS) intervention among individuals with alcohol dependence. A 2-group single blind RCT design was used, comparing I-BMS to treatment as usual (TAU) on drinking and psychological outcomes. One hundred participants diagnosed with alcohol dependent syndrome were randomly assigned to receive 7 sessions of I-BMS or TAU. Measurements done by a registered nurse who was blinded to the experimental design used standardized questionnaire on wellbeing, readiness to change, craving, quantity and frequency of drinking before and up to 6 months after the intervention. With respect to the within group effects, the I-BMS group demonstrated significant improvement in all outcome measures with large effect size. Compared to TAU, I-BMS participants showed lesser relapse rates and quantity of drinking at 3-month follow-up, reduction in craving and drinking days at 2-month follow-up. At 6 months follow-up, participants in I-BMS group reported significant improvement in wellbeing and motivation compared to TAU. Results of binary logistic regression showed that number of previous attempts and living in urban area positively predicted participant's relapse possibility at 6-month follow-up. Results suggest that I-BMS is worthy of further efficacy testing. In conclusion, it is feasible to implement I-BMS intervention for individuals with alcohol dependence.

Nurse-Led Body-Mind-Spirit Based Relapse Prevention Intervention for People With Diagnosis of Alcohol Use Disorder at a Mental Health Care Setting, India: A Pilot Study.

BACKGROUND: Alcohol dependence is associated with alcohol-related problems and persistent vulnerability to relapse. Despite newer medications, frequent relapses continue to occur. Hence, there is a need to look at holistic approaches to deal with this problem. OBJECTIVE: Evaluate the effectiveness of nurse-led body-mind-spirit (BMS)-based relapse prevention intervention on craving and quantity and frequency of alcohol consumption among alcohol-dependent individuals. METHODS: Randomized control trial was adopted, and the study was conducted at a mental health care setting in India. Sixty individuals with alcohol use disorder were randomly assigned to a BMS group (n = 30) and a treatment-as-usual (TAU) group (n = 30) between June 2017 and March 2018. Subjects of both groups were initially assessed for craving and quantity and frequency of alcohol consumption. BMS subjects received seven sessions of BMS intervention and routine treatment at de-addiction wards. The interventions comprise of body, mind, and spirit strategies that aid in handling triggers, accept responsibility for their own well-being and take charge of self health. TAU group subjects received only routine treatment. All the participants were followed up over 3 months postdischarge. RESULTS: Over 3 months of follow-up, BMS group subjects (vs. TAU group) reported significantly lesser quantity of alcohol consumption (F = 9.74, p < .001, η = .144), fewer drinking days (F = 14.04, p < .001, η = .195), lower relapse rates (14 vs. 28), and lesser craving (F = 14.01, p < .001, η = .195). Regression analysis showed that number of previous attempts (>1) and increased baseline drinking were associated with relapse. CONCLUSION: Findings provide evidence of BMS intervention in reducing craving and drinking outcomes among alcohol-dependent individuals in India.

Academic stress among Indian adolescent girls.

CONTEXT: Academic learning is the main source of stress among adolescents and is associated with mental health problems; finding its determinants helps to know the risk factors that influence stress. AIM: The main aim of the study was to assess the educational stress and their predictors among adolescent girls. SETTINGS AND DESIGN: A cross-sectional study was conducted in ten colleges involving adolescent girls pursuing preuniversity and university studies at Dharwad city, India. SUBJECTS AND METHODS: The study included 314 randomly selected adolescent girls aged between 16 and 19 years. The study was approved by the institutional ethics committee. Data were collected by employing random sampling technique. Self-administered questionnaires were administered which included sociodemographic data sheet, personality inventory, intelligence quotient (IQ) assessment, and educational stress scale for adolescents. RESULTS: Mean educational stress was 50.04 ± 10.82 (range 16-80). There was a significant association between educational stress and religion, father education, number of siblings, combination of subjects, type of personality, and IQ. Regression analysis revealed that number of siblings and extrovert neuroticism personality negatively predicted stress (beta = -0.115, P = 0.037; beta = -0.242, P = 0.001) and considered as protective factors. Introvert neuroticism, Hindu religion, illiterate father, and commerce combination of subjects positively predicted stress among adolescent girls (beta = 0.160, P = 0.026; beta = 0.119, P = 0.028; beta = 0.125, P = 0.017; and beta = 0.278, P < 0.001) and considered as risk factors. CONCLUSIONS: Findings help in better understanding of educational stress factors among adolescent girls and consider them while developing stress prevention programs.

Impact of holistic stress management program on academic stress and well-being of Indian adolescent girls: A randomized controlled trial.

CONTEXT: Academic stress among adolescents is a significant contributor to a variety of mental and behavioral disorders. Holistic stress management interventions equip adolescents with good mental health and improve academic performance. AIM: The aim of the study is to evaluate the effectiveness of holistic group-based stress management program in reducing academic stress, depression, anxiety, and improving well-being among adolescent girls. SETTINGS AND DESIGN: Randomized control trial was adopted and the study was conducted at selected colleges of Dharwad city, Karnataka, India. MATERIALS AND METHODS: Two hundred and thirty adolescent girls were randomly selected and assigned to either experimental (n = 115) or control group (n = 115). Both group participants were initially assessed for academic stress, depression, anxiety, general stress, and well-being. The experimental group participants participated in eight sessions of holistic group-based stress management program over a period of 1 month. The intervention comprises of body-mind-spirit strategies focusing on techniques to handle stressful situations, accept responsibility for their own well-being, and take charge of self-health. Control group participants did not receive any intervention. Postintervention assessments were conducted for all the participants on monthly intervals for 6 months. RESULTS: Over 6 months follow-up compared to control group, the experimental group participants showed statistically significant decrease in academic stress (F = 131.60, P < 0.01, n2 G = 0.14), depression (F = 156.70, P < 0.01, n2 G = 0.13), anxiety (F = 190.50, P < 0.01, n2 G = 0.16), general stress (F = 166.10, P < 0.01, n2 G = 0.16), and improvement in well-being (F = 156.40, P < 0.01, n2 G = 0.13). CONCLUSIONS: These findings indicate that holistic stress management program has a positive effect on reducing stress, anxiety, depression, and improving well-being.

Relationship between serum lithium, salivary lithium, and urinary lithium in patients on lithium therapy.

Lithium carbonate is used in the treatment of both psychiatric and nonpsychiatric disorders. The aim of this study was to explore the relationship between serum lithium, salivary lithium, and urinary lithium. Blood, saliva, and urine samples were collected from 50 patients, and estimation of serum, salivary, and urine lithium was done using an atomic absorption spectrophotometer. Mean serum lithium was 0.75 ± 0.25 mEq/L, mean salivary lithium was 1.91 ± 0.80 mEq/L, and mean urine lithium was 7.16 ± 4.84 mEq/L. A significant direct correlation was found between serum lithium and salivary lithium (r = 0.695, p < 0.001). This correlation was higher in females (r = 0.770, p < 0.001) when compared to males (r = 0.665, p < 0.001). Even though a significant correlation was found between serum and salivary lithium levels, more studies are needed in this domain to establish salivary therapeutic monitoring as a feasible option for patients on lithium carbonate therapy.

Baclofen in the management of inhalant withdrawal: a case series.

INTRODUCTION: Abuse of inhalants and solvents is a significant public health problem. There is no specific treatment for inhalant withdrawal. OBJECTIVE: To study the effect of baclofen in treating craving and withdrawal symptoms in patients with inhalant dependence. CASE REPORTS: Case studies of 3 young male patients with DSM-IV diagnoses of inhalant dependence treated in an inpatient setting with baclofen are presented. All patients had nonspecific withdrawal symptoms in the form of irritability, insomnia, and craving. Baclofen was given in doses up to 50 mg/day and was continued throughout the period of hospitalization. DISCUSSION: All patients reported significant reduction in withdrawal symptoms within 48 hours of treatment and were free of symptoms for the duration of their hospital stay. One patient continued the medication as an outpatient and has remained abstinent to date. Baclofen was well tolerated by all patients. Our results suggest that baclofen may be an effective treatment modality in this patient population. These effects are possibly due to the agonistic action of baclofen at gamma-aminobutyric acid B receptors in the ventral tegmental area.

Fetal alcohol spectrum disorder.

BACKGROUND: Maternal alcohol use during pregnancy leads to fetal alcohol spectrum disorder (FASD) in their children. FASD is characterized by typical facial features, growth retardation, intellectual dysfunction and behavioral problems. JUSTIFICATION: Alcohol is neurotoxic to the brain during the developmental stage. Behavioral problems in children with FASD start at an early age and progress to adulthood. It is an important preventable cause of intellectual dysfunction and behavioral problems. This article reviews current prevalence, clinical features, pathogenesis and differential diagnosis of FASD. It also highlights the need for physicians to be aware of this condition. SEARCH STRATEGY: Articles were searched on the internet using fetal alcohol syndrome, fetal alcohol spectrum disorders, women and alcohol. Following links were used to locate journals; EBSCO, OVID, Science Direct, PubMed and NIAAA. MAIN CONCLUSIONS: Alcohol consumption during pregnancy can lead to a spectrum of deficits. Though physical features are essential to make the diagnosis of FAS, it is important to note that neurocognitive and behavioural deficits can be present in the absence of physical features (alcohol related neurodevelopmental disorder or ARND). Because there is no known safe amount of alcohol consumption during pregnancy, abstinence from alcohol for women who are pregnant or planning a pregnancy must be strongly advised.