A Cross Sectional study to assess psychopathology in children of male patients with alcohol dependence syndrome and their family functioning.

OBJECTIVES : To estimate the prevalence of psychopathology in children of male patients with alcohol dependence and assess the family functioning in their families. To assess and compare the sociodemographic, clinical, substance abuse related factors and family functioning with and without psychopathology in families of patients with alcohol dependence. METHODS : Patients with ICD-10 diagnosis for Alcohol Dependence Syndrome who have children between 6-18 years were scored on the Addiction Severity Index. Psychopathology in their children was assessed using Child Behaviour Checklist (CBCL). McMaster Family Assessment Device (MFAD) was used to measure family functioning in their families.Comparative analysis was done with the Total CBCL clinical and nonclinical groups with the socio-demographic variables of patient, mother, family and child, alcohol related variables and family functioning using chi- test for categorical variables and the student t-test or Mann-Whitney U test for continuous variables. Univariate logistic regression was done for variables found to be significant in the bivariate analysis. RESULTS : 72 patients and their families were recruited in the study. The mean age of the children was 11.69 (SD=3.56). The overall prevalence of psychopathology in the children as assessed by CBCL was 13.9%, with internalising and externalising disorders at 11.1% and 8.3% respectively. Significant family dysfunction was seen in 65%. Among sociodemographic and clinical factors associated with child psychopathology, the presence of psychiatric morbidity in the father and family size were found to be significant (p value <0.05). The interviewer rated scores of ASI showed significant association with child psychopathology in Family/social, Psychiatric and Alcoholdomains (p value <0.5). Problematic family functioning assessed by MFAD (score ≥2.00) was seen in all 10 cases with child psychopathology and was found to be statistically significant (χ 2=6.177, d.f=1, p=0.013).In the univariate logistic regression, mean ASI score for Psychiatric and Family/social domains continued to show significant association. with odds ratios of 1.35 (95%CI=1.07-1.70) and 1.64(95% CI=1.13-1.28) respectively. CONCLUSION : As a final point, it may be concluded that psychopathology is seen in children of alcoholic patients and it is significantly associated with specific socio-demographic and substance abuse related factors in families of patients with alcohol dependence. It can also be said that there is poorer family functioning in families of alcoholic patients. Subsequently, there is significant family dysfunction in the children with psychopathology in these families. There is lack of studies in this region on various factors associated with psychopathology and family functioning in children of alcoholics. Further longitudinal studies are required in this field

Sustained remission of rheumatoid arthritis with a specific serotonin reuptake inhibitor antidepressant: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>The mainstay of pharmacologic therapy for rheumatoid arthritis includes the use of disease-modifying agents like sulfasalazine and methothrexate, and more recently, anti-tumor necrosis factor-α agents. Depression remains a major co-morbidity in patients with rheumatoid arthritis and is thought to contribute to disability and mortality in these patients. Evidence now suggests that a biologic link exists between substrates responsible for inflammatory conditions and mood disorders. Most of this evidence comes from preclinical studies. Nevertheless, more research into this area is helping us to understand the possible mechanisms through which these conditions interact with each other.</p> <p>Case presentation</p> <p>We describe a 60-year-old Indian man with rheumatoid arthritis diagnosed 15 years ago who had minimal response to multiple therapies with disease-modifying agents and whose arthritis symptoms surprisingly remitted when he was started on a specific serotonin reuptake inhibitor antidepressant, three years ago, for co-morbid major depression. This remission has been maintained with this medication, and the patient is currently not taking any antirheumatoid medications.</p> <p>Conclusion</p> <p>Possible mechanisms linking substrates of mood disorders and inflammation are reviewed in this case report, particularly the serotonergic system. Evidence seems to suggest a significant interaction between the serotonergic systems and inflammation. This interaction seems to be bidirectional. An understanding of this relation is most important to gain insight not only into pathophysiological mechanisms underlying this condition, but also into how treatments for these conditions may complement each other and possibly provide greater therapeutic options in both of these disabling conditions.</p