A case of idiopathic edema after opioid abuse cessation: can failed aldosterone escape be implicated?

Edema is a recognized complication of ongoing heavy opioid use, regardless of the means of delivery or the specifics of the drug in question. The mechanism responsible remains incompletely understood. Hypotheses currently offered include increased Anti-Diuretic Hormone (ADH) secretion, histamine-mediated permeability changes, independent opioid-receptor mediated fluid retention and an exacerbation of pre-existing vascular compromise. Authors report a case of a 39yr old lady in whom edema emerged 7 months after cessation of opioid abuse. All secondary causes of edema were excluded by an exhaustive battery of investigations. The edema failed to recede with loop diuretics, and resolved only on institution of spironolactone, on which she maintained improvement. This case study reinforces hypotheses of ADH likely mediating opioid associated edema and suggests that aldosterone receptor antagonists are probably a superior class of drugs in opioid-associated edema. It also suggests that the physiological changes caused by opioid use that are responsible for edema are likely stable and persist well beyond the period of actual use. Reformed opioid abusers who never received OST are a huge population whose unique physiological status is likely to yield valuable insights into not just the pathology of opioid-abuse related edema, but the pathology of opioid use as a whole

Psychiatric comorbidity in multiple sclerosis

Aim: To study the prevalence of psychiatric comorbidities in patients of multiple sclerosisand their association to the degree of disability. Method: Psychiatric symptoms were assessed in 90 patients of multiple sclerosis using GHQ-12, MMSE, HADS, Beck Depression Inventory and AUDIT. Neurological disability wasassessed using Expanded Disability Status Scale. Correlations were determined between EDSS scores and psychiatric scale scores. Result: 61% of patients had significant psychological distress. Depression was most common (38.8%) which was followed by anxiety symptoms (27.8%). Cognitive functioning was relatively intact in patients with mild to moderate neurological disability. Alcohol abusewas mostly restricted to male gender. Conclusion: Psychiatric illness is highly prevalent in patients of multiple sclerosis leading to poor quality of life and significant distress. Psychiatric disability was higher in patients who had greater deterioration in neurological function. All cases of MS should be assessed for psychiatric morbidities as can be alleviated by appropriate intervention