Chronic stress, sense of coherence and risk of type 2 diabetes mellitus.

AIMS: The study was conducted to ascertain whether chronic stress and sense of coherence are associated with risk of type 2 diabetes mellitus. METHODS: Stress questionnaires - Presumptive Stressful Life Events Scale (PSLES), Perceived Stress Scale (PSS) and Sense of Coherence (SOC) - were administered to 500 Newly Detected Diabetes Mellitus (NDDM) cases and 500 Normal Glucose Tolerance (NGT) controls recruited following 75 g OGTT. Assessment of stress was completed before the diagnosis of diabetes was revealed to them. RESULTS: PSLES and PSS scores were significantly higher and SOC score was significantly lower in NDDM subjects compared to those with NGT. PSLES and PSS correlated positively with anthropometric parameters (waist circumference, BMI), glycemic parameters (FPG, 2 hPG, A1C) and HOMA-IR and inversely with HOMA-ß whereas SOC correlated inversely with glycemic parameters (FPG, 2 hPG, A1C) and HOMA-IR and positively with HOMA-ß. In stepwise logistic regression analysis, SOC emerged as the strongest independent predictor of diabetes (OR: 0.774) after HOMA-IR (OR: 1.621) and BMI (OR: 1.288). Other significant predictors included PSS (OR:1.153), PSLES-LT (OR: 1.005) and HOMA-ß (OR: 0.894). CONCLUSION: Chronic stress and low sense of coherence are associated with a higher risk of type 2 diabetes mellitus.

Caregiver burden in Alzheimer-type dementia and psychosis: A comparative study from India.

BACKGROUND: Caregiver burden in dementia is an important area of research. Providing care for a relative can be a potent source of chronic stress and can have deleterious consequences for both the physical and emotional health of caregivers. This study aims to evaluate the burden of care in caregivers of patients with Alzheimer-type dementia and compare it with elderly psychosis; and to also study the factors that influence burden of care in Alzheimer's dementia. METHODS: Thirty-two caregiver-patient dyads of Alzheimer-type dementia were compared with thirty-two caregiver-patient dyads of psychosis. Cognitive assessment, abilities to perform activities of daily living and severity of dementia was assessed in the patients. Zarit Burden Interview was used to study the caregiver burden in both groups. RESULTS: The mean burden score in dementia caregivers was high at 47.7, whereas the mean burden score for elderly psychosis caregivers was lesser at 33.6, and this difference in mean burden scores was found to be statistically significant. Spouses had the highest mean burden scores of 53.48. Caregiver burden in dementia was positively correlated with cognitive impairment and inability to carry out ADLs. Presence of psychological distress in caregivers was also an indicator for greater caregiver burden in dementia. CONCLUSION: The study revealed that dementia carries a greater caregiver burden when compared with elderly patients with psychosis. Innovative interventions are needed to remove burden from caregiving, making it a meaningful practice integral to the Indian society.

Endocrine stress responses and risk of type 2 diabetes mellitus.

This study was carried to ascertain whether stress responses are associated with abnormalities in glucose tolerance, insulin sensitivity and pancreatic beta cell function and risk of type 2 Diabetes Mellitus. Salivary cortisol, a marker of hypothalamic-pituitary-adrenal (HPA) axis and salivary α-amylase, a marker of sympathetic nervous system (SNS) were compared in 125 subjects of newly detected diabetes mellitus (NDDM) and normal glucose tolerance (NGT) subjects who were diagnosed on the basis of oral glucose tolerance test (OGTT). Assessment of stress in them was done through stress scales - presumptive stressful life events scale (PSLES), perceived stress scale (PSS) and sense of coherence (SOC) and correlated with these and other stress response markers. Significantly higher 10 pm salivary cortisol and post dexamethasone salivary cortisol were found in NDDM subjects as compared to NGT. 10 pm salivary cortisol correlated significantly with fasting plasma glucose (FPG), 2 h plasma glucose (2h PG) and glycated hemoglobin (HbA1c) while post dex salivary cortisol correlated with 2h PG, HbA1c and salivary α-amylase with 2h PG. Stepwise logistic regression analysis showed that body mass index (OR: 1.840), SOC (OR: 0.688) and 10 pm salivary cortisol (OR: 1.427) were the strongest predictors of NDDM. The results of the present study indicate that NDDM subjects display significantly higher chronic stress and stress responses when compared to subjects with NGT. Chronic stress and endocrine stress responses are significantly associated with glucose intolerance, insulin resistance and diabetes mellitus.

Endocrine stress responses and risk of type 2 diabetes mellitus.

This study was carried to ascertain whether stress responses are associated with abnormalities in glucose tolerance, insulin sensitivity and pancreatic beta cell function and risk of type 2 Diabetes Mellitus. Salivary cortisol, a marker of hypothalamic-pituitary-adrenal (HPA) axis and salivary α-amylase, a marker of sympathetic nervous system (SNS) were compared in 125 subjects of newly detected diabetes mellitus (NDDM) and normal glucose tolerance (NGT) subjects who were diagnosed on the basis of oral glucose tolerance test (OGTT). Assessment of stress in them was done through stress scales - presumptive stressful life events scale (PSLES), perceived stress scale (PSS) and sense of coherence (SOC) and correlated with these and other stress response markers. Significantly higher 10 pm salivary cortisol and post dexamethasone salivary cortisol were found in NDDM subjects as compared to NGT. 10 pm salivary cortisol correlated significantly with fasting plasma glucose (FPG), 2 h plasma glucose (2h PG) and glycated hemoglobin (HbA1c) while post dex salivary cortisol correlated with 2h PG, HbA1c and salivary α-amylase with 2h PG. Stepwise logistic regression analysis showed that body mass index (OR: 1.840), SOC (OR: 0.688) and 10 pm salivary cortisol (OR: 1.427) were the strongest predictors of NDDM. The results of the present study indicate that NDDM subjects display significantly higher chronic stress and stress responses when compared to subjects with NGT. Chronic stress and endocrine stress responses are significantly associated with glucose intolerance, insulin resistance and diabetes mellitus.

Validity of self-report of recent opiate use in treatment setting.

Self-report validity of recent drug use among heroin abusers depends on many factors including the population being studied and the setting in which the study is carried out. This study was conducted by the treating physicians to assess the self-report validity of recent heroin use by heroin dependent patients in the outdoor setting using 'thin layer chromatography' (TLC) and two highly sensitive methods of urinalysis viz. 'gas liquid chromatography' (GLC) and 'high performance liquid chromatography' (HPLC). Out of seventy-six heroin dependent patients who entered the study, 64 provided urine sample on the same day. Patients' self-report about recent opiate use was found to have a moderate agreement with urinalysis report. However, it is important to validate it with urinalysis during the treatment process because a substantial proportion of patients fails to report recent opiate use. It is recommended that all drug dependence treatment centres should be equipped with a sensitive urinalysis facility. Otherwise, the outcome of the treatment process should be considered with caution.

Cognitive function in younger type II diabetes.

OBJECTIVE: To examine central nervous system involvement as a possible complication of diabetes by performing a comprehensive neuropsychological evaluation of relatively young (age < 55 years) NIDDM patients and a group of control subjects. RESEARCH DESIGN AND METHODS: A cross-sectional comparative study of 28 patients, with duration of diabetes 5-18 years (mean +/- SD +/- 3.2 years), screened for acceptable glycemic control and absence of hypoglycemia on the day of examination, compared with 28 demographically similar, nondiabetic control subjects. Neuropsychometric tests performed were Mini-Mental Status Examination (MMSE), Neurobehavioral Cognitive Status Examination (NCSE), and P300 latencies (endogenous evoked potentials). RESULTS: Seven (25.0%) patients reported history suggestive of cognitive impairment during day-to-day activities, and 17 (60.7%) had distal symmetrical polyneuropathy. Average P300 latencies were significantly delayed among the diabetic patients compared with the control subjects (349.5 +/- 28.2 vs. 312.9 +/- 19.3 ms; t = 5.68, P < 0.001). Although there was no significant difference in MMSE scores, compared with control subjects significantly more patients had impairment in NCSE tests of attention (chi 2 = 7.38, P < 0.01), repetition (chi 2 = 4.073, P < 0.05), and memory (chi 2 = 5.83, P < 0.05), while there was no significant difference in tests of comprehension, naming, construction, and calculation. Duration of diabetes, HbA1c levels, and the presence of distal symmetrical polyneuropathy among patients each did not correlate with any of the parameters of cognitive function evaluated. Higher blood glucose levels during the electrophysiological testing were associated with less delay in P300 latencies among the patients. CONCLUSIONS: Central nervous system impairment, manifesting as mild impairments in certain cognitive skills, should be recognized as a possible complication of long-standing NIDDM, even in relatively younger individuals.

Injection drug use: harbinger of HIV / AIDS.

PIP: The spread of HIV infections in southeastern Asia is expected to be significant. In this area, as in other parts of the world, the habits of intravenous drug users (IDUs) who share needles and supplies and engage in high-risk sexual behavior will contribute to the spread of the disease in the general population. Because drug treatment programs that promote abstinence are only successful among the limited number of drug abusers who are motivated to stop taking drugs, a harm-reduction approach to this problem makes the best sense. Reducing HIV risk requires giving priority to HIV prevention rather than to control of drug use. Interventions to prevent HIV transmission among IDUs include counseling for in-treatment drug users, needle and syringe exchange programs, and preventive intervention programs that attempt to change high-risk behavior. In India, drug abuse has a long history, and the northeastern states have experienced a rapid increase in heroin use accompanied by the spread of HIV infection. In other areas, injection of Buprenorphine is increasing. It is important to recognize IDUs as a group at high risk of transmitting HIV infection and to design strategies, such as those that have been successful in New York City, to stabilize sera-prevalence in this rapidly increasing group.^ieng

Lipid profile in alcohol dependence.

Fifty three patients of alcohol dependence were studied for lipid profile at Drug Dependence Treatment Centre, A.I.I.M.S. Statistically significant differences were observed on most of lipid profile indicators when compared to control group. Ratio of Apo A-I & Apo B appeared to be better indicator than Apo A1 or Apo B. The findings of the study are discussed in context of other studies from India and other countries.

Brain metabolite changes in alcoholism: an in vivo proton magnetic resonance spectroscopy (MRS) study.

Image-guided, single voxel, localized proton magnetic resonance (MR) spectroscopy was performed to assess the brain metabolite changes in 10 (n = 10) alcoholic patients in the frontal lobe, cerebellum, and thalamus regions. The spectra obtained were characterized by a reduced N-acetyl-aspartate (NAA) to choline (Cho) (p < .01) and NAA to total creatine (Cr + PCr) (p < .01) ratios relative to age-matched (n = 27) controls. These decreased ratios correspond to depleted concentration of the metabolite levels such as NAA and Cho. Reduction of NAA is consistent with the neuronal loss while reduction in Cho suggests significant changes in the membrane lipids of alcoholics.

Profile of liver dysfunction in alchohol dependence.

Ninety two patients of alcohol dependence were studied for liver function at a specialised drug dependence treatment centre. Biochemical laboratory evidence of liver dysfunction was found in a very large number of patients, including the patients who had no clinical signs or symptoms. The findings from this retrospective study are discussed in the context of the earlier studies from other settings in India.

Anti-nuclear antibody positivity in multi-transfused thalassemia major.

The frequency of anti-nuclear antibodies (ANA) was evaluated in multi-transfused patients of thalassemia major. Twelve out of 83 patients (14.5%) had positive ANA at titres of 1:80 or above. The results were compared with age and sex matched healthy controls who showed positive results in only 1 of 52 cases (1.9%; p less than 0.05). Antibody against double stranded DNA was absent. ANA positivity was found to correlate with higher age (p less than 0.01), more amount of blood transfused (p less than 0.01), splenectomy status (p less than 0.01), higher levels of serum ferritin (p less than 0.01) and presence of hepatitis B surface antigen (p less than 0.01) and antihepatitis C antibody (p less than 0.01).

A rapid survey on substance abuse disorders in the urban slums of New Delhi.

The results are presented of a rapid survey screening method of general population for identifying dependent and non dependent drug abusers, especially in vulnerable groups such as slum dwellers. The results showed that with the help of instrument with modified DSM III and interviewing only the heads of the households it was possible to get reliable estimates of dependence disorder in the community. This method can be of assistance to health planners for a quick assessment of the magnitude of the problem leading to better allocation of funds and developing services for the affected population. The method is an improvement on key informant technique and a full fledged survey.

Pituitary - adrenal functioning in male alcoholics.

Serum adrenocorticotrophic hormone (ACTH) and Cortisol were assayed in 38 males alcoholics and 24 male control subjects using radioimmunoassay (RIA) techniques. Biochemical parameters of hepatic function, depressive symptoms and severity of withdrawal were also assessed. Thirteen percent and eleven percent of the patients and elevated serum ACTH and Cortisol levels respectively. Evidence of advance liver disease was scant and significant symptoms of depression was observed in only 14% of the patients. By and large withdrawal symptoms were mild. Two patients have clinical features suggestive ofpseudo Cushing's syndrome without hypercortisolaemia.

Pituitary gonadal functioning in male alcoholics in an Indian psychiatric hospital.

Serum levels of luteinizing hormone (LH), testosterone and hepatic functions were measured in 38 male alcoholics and in 24 male control subjects. Significant elevation of serum LH and a trend of low serum testosterone were noted with scant evidence of advanced liver disease. None of the alcoholics had clinical stigmata of hypogonadism and feminization.

Alcoholism--assessment and diagnosis.

Ninety-two patients with alcoholism were interviewed on various aspects of alcohol use. Factor analysis of the data revealed five factors: withdrawal symptoms; help seeking behaviour; pathological drinking; legal difficulties; family problems. The analysis suggested the possibility of heterogenity in this clinical sampling with alcoholism.

Outcome of family therapy--two year follow-up.

The authors report the findings of an evaluation exercise to assess the efficacy of brief, integrative, inpatient family therapy with a follow-up period of two years. The index patients and their families were assessed for improvement in symptoms and satisfaction in family life. The assessment was possible for 55% of the families, either in person or by post. Nearly 43% of the families reported good improvement, 8% reported no improvement at all and the remaining families reported varying degrees of improvement. Regularity of follow up visits and degree of improvement did not seem to be related. One fifth of the families had not reported for any follow up visits, but when assessed after two years reported good improvement and satisfaction with the treatment.

Male alcoholism-biochemical diagnosis and effect of abstinence.

Eighty three patients with alcoholism were evaluated on several biochemical parameters against seventy five healthy controls. Linear discriminant analysis of three laboratory tests (GGT, GOT and GPT) yielded accurate diagnosis among 63% of the total sample. Sensitivity of these tests was 47% and specificity 80%. Repeat analysis of these three test among 50 alcoholics following thirty days of abstinence showed significant decline of values. Preliminary observation suggests improvement of liver function following cessation of drinking habit.

Potentiation of lithium with carbamazepine in acute mania.

In a 6 month prospective randomized open trial addition of 400 mgs. of carbamazepine per day to lithium carbonate was assessed. Although statistically non-significant, the trends suggest that use of carbamazepine hastens recovery and leads to less frequent use of emergency sedation without any increase in side effects.