Contemporary perspective on addictive behaviors: underpinning mechanisms, assessment, and treatment

This special issue gathered contributions from authors in the scientifc community working on addictive behaviors. In particular, authors were solicited to relate about underpinning mechanisms, assessment protocols, and intervention programs that are currently proposed for substance abuse, Internet addiction, and other forms of problematic conducts in pediatric populations, adolescence, and adulthood. Most of the papers used a biopsychosocial model for the onset and maintaining of addictive behaviors and their comorbidities with other psychopathologies. Although the intent was accept contributions focused on all forms of addictive behaviors, this special issue is composed of four papers concerning problematic use of the web and two articles focusing on substance use. Of note, all papers addressed the developmental phases of childhood and adolescence

COMPARING PRICES OF COMMONLY USED GASTRIC ACID SUPPRESSANTS AVAILABLE IN INDIA

ABSTRACTObjective: Drugs to reduce gastric acid secretion are one of the commonly prescribed drugs by doctors of varied branches. There are many numbersof brands of different drugs available in India. Hence, this study was designed to compare the prices of different gastric acid suppressants of variousbrands available in India.Methods: The Current Index of Medical Specialities October 2015-January 2016 was used to analyze the prices of various gastric acid suppressantsand their combinations. The cost of each molecule of different strengths was tabulated and cost range and % price variation were calculated.Results: A wide range of cost variations were seen among different categories of gastric acid suppressants available more so among proton pumpinhibitors. Furthermore, it was observed that wide variety of fixed drug combinations is available.Conclusion: Price control mechanism has an important role and is very much important to reduce the cost burden of treatment particularly in India.Keywords: Comparison, Gastric acid suppressants, India, Brands, Current Index of Medical Specialities

PICA WITH AN UNUSUAL FORM OF PRESENTATION: A CASE REPORT

ABSTRACTGeophagia is a condition involving the consumption of mud and is a form of eating disorder known as pica. Pica is an unusual craving for ingestion ofeither edible or inedible substances. Although, pica is not linked to solvent abuse, here we report a middle aged lady with mud eating that respondedto selective serotonin-reuptake inhibitors and cognitive behavior therapy.Keywords: Pica, Geophagia, Mud eating

Effect of psychotropics on bleeding and clotting factors

Introduction: Coagulopathies are rare side effects with psychotropics and are thus frequently overlooked while prescribing. Selective serotonin reuptake inhibitors are more commonly associated with deranged bleeding parameters, the most frequent being decreased platelet aggregability and activity, and the prolongation of bleeding time. Thrombocytopenia as a side effect of valproate administration often goes unnoticed, and olanzapine has been associated with a higher risk of venous thromboembolism. The aim of our study was to determine what percentage of patients on psychotropics develop changes in bleeding parameters, and whether these changes are significant enough to warrant routine monitoring of these parameters. Material and methods: This was a prospective observational, single-center study which included 100 patients newly started on psychotropics. Those on medications affecting bleeding parameters or having an acute illness like sepsis were excluded. Patients were only on a single psychotropic agent, and their bleeding parameters — prothrombin time, international normalized ratio (INR), bleeding time, clotting time (CT) and platelet count — were assessed at baseline and after 15 and 30 days. Results: Mean values of prothrombin time (PT), INR, bleeding time and CT increased over time while the mean value of platelet count showed a decreasing trend but no clinical manifestations were noted. Olanzapine was the only drug causing a reduction of PT, INR and CT and valproate was the only drug affecting platelet count. Paroxetine affected the bleeding parameters the most among the antidepressants. Sertraline, fluoxetine, amitriptyline and haloperidol were the other drugs affecting various bleeding parameters, though the effects were less compared to the other drugs in the study. Conclusions: Routine monitoring of bleeding parameters in patients receiving psychotropics is not warranted, but caution must be taken while prescribing these drugs, especially in groups such as patients with known blood dyscrasias or peri-operative patients

Transcranial direct current stimulation for auditory hallucinations in a 66-year-old male patient with schizophrenia

Patients with schizophrenia may sometimes have refractory symptoms that do not respond to medical treatments. One such symptom commonly seen in schizophrenia is refractory and distressing auditory hallucinations that do not respond to medication and psychotherapy. Transcranial direct current stimulation (tDCS) has been used successfully in adult patients in the management of refractory auditory hallucinations in schizophrenia. We report here a case of severe distressing refractory auditory hallucinations in a 66-year-old male with schizophrenia that responded to once daily tDCS which was then continued over a 3-month period. More than 80% improvement was reported in a month of treatment which was then continued over 3 months to yield 95% improvement. The patient had a better quality of life and relief from a distressing symptom. No side effects were noted due to the tDCS treatment. This case report supports the view that tDCS is an effective treatment for resistant and refractory auditory hallucinations in geriatric patients with schizophrenia

Probable respiratory dyskinesia in an elderly patient after sudden stoppage of antipsychotics

Antipsychotic drugs are widely used in the management of schizophrenia in the elderly. Extrapyramidal reactions to these drugs and tardive dyskinesia are a dreaded side effect of these drugs that may be seen in the elderly. We present herewith, a case of probable respiratory dyskinesia, a rare but important variant of tardive dyskinesia seen in an elderly patient with schizophrenia after the sudden stoppage of antipsychotic medication

Isolated Sleep Paralysis And Generalized Anxiety Disorder: A Case Report And Review

Objective: This case report highlights a case of isolated sleep paralysis, a transient, generalized inability to move or speak that usually seen during the patient's transitions between sleeping and wakefulness. Method: We report the case of a 44-year-old man with long standing recurrent isolated sleep paralysis and generalized anxiety disorder who sought help almost 20 years after the first onset of symptoms. The presenting manifestations of this disorder and its management are also discussed. Results: Isolated sleep paralysis is reported to occur with co-morbid anxiety disorders especially panic disorder. Its presentation may confuse the psychiatrist with other psychiatric disorders. Conclusion: It is important for psychiatrists to be aware of the presentation of a patient with isolated sleep paralysis and simultaneously understand the cultural undertones in such cases. ASEAN Journal of Psychiatry, Vol. 14 (1), January - June 2013: XX XX

Electroconvulsive in a 75-year-old patient with severe agitated behavior and dementia

Various drugs have been used in the management of behavioral and psychotic symptoms including aggression and agitation in dementia. However, the risk of side effects and sedation limits the use of higher doses of many agents. Electroconvulsive therapy (ECT) has been used in the management of behavioral symptoms related to dementia although sparingly and rare. We report the case of a 75.year.old male patient with moderate Alzheimer's dementia and severe agitated behavior and aggression which failed to respond to pharmacological treatment and whom we treated using seven ECT sessions with success. Significant clinical improvement was noted and no cognitive decline or worsening of the dementia in any form was reported. The patient was followed up 6 months post the ECT sessions. This case report demonstrates the safety and efficacy ECT use patients with Alzheimer's dementia when behavioral problems and aggression or agitation fail to respond to medications

The use of cerebroprotein hydrolysate in dementia: A case series of 25 cases seen in a tertiary general hospital

Background: Cerebroprotein hydrolysate (Cerebrolysin) is a pharmacological and neurotrophic agent that has been used widely in the management of various forms of dementia. Purpose: The present paper presents a retrospective chart review of 25 patients with dementia visiting a tertiary general hospital psychiatry unit who received cerebroprotein hydrolysate as an add on treatment for dementia. Materials and Methods: Twenty-five patients were administered 20 doses of cerebroprotein hydrolysate intravenously at a dose of 60 mg in 250 ml normal saline over 1-2 h after a test dose on 20 consecutive days. The cognitive assessment was done before the first injection and after the last dose using the Adenbrook′s Cognitive Examination-Revised (ACER) and the Mini Mental Status Examination (MMSE). Results: There was significant improvement in scores on the ACER and MMSE, although the final scores remained in the dementia range. None of the patients experienced any major side effects. Conclusions: Cerebroprotein thus is a useful pharmacological option in the management of dementia and warrants further study and exploration