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Alcohol use disorders (AUDs) are prevalent in intensive care units (ICUs). Alcohol abuse and/or dependence, leading to alcohol withdrawal syndrome (AWS), is as high as 10% or more. There seem to be wide variations in management strategies used to manage these patients, prompting an evaluation of the knowledge gap as well as finding the barriers. Noting lack of such literature in the Indian setting, a survey is undertaken to evaluate practice patterns surrounding the identification and management of alcohol dependence/abuse and AWS in the Indian critical care scenario. The main respondents of the survey are independent practitioners with anesthesia as their base specialty and overwhelmingly practice in multidisciplinary ICUs. They estimated AUD prevalence to be under 10%. The reason most expressed for lack of AUD documentation is fear of insurance rejection. Very few used risk assessment tool in evaluation of AUDs and AWS. Awareness of ICD 10/DSM-V components of AWS diagnosis was negligible. Chlordiazepoxide and lorazepam were used either in a fixed- or symptom-based therapy. Compared to available literature, haloperidol use is excessive, while barbiturates rarely. The wide variation is seen with the dose and frequency of thiamine in AWS without neurological complications. The impact on mortality and morbidity is poorly understood. In conclusion, the survey reported a lower prevalence compared to international literature. Insurance rejection is one of the main factors in limiting adequate history taking or documenting AUDs. Alcohol withdrawal syndrome risk assessment, monitoring, and management is variable and suboptimal. Variability in all aspects of AUDs is attributable to the knowledge gap. Further studies are needed to bridge the research gap. [ABSTRACT FROM AUTHOR]

Introduction: Catatonia, a poorly understood syndrome challenging the clinician's diagnostic and management skills, has scarce literatures regarding the clinical correlates and determining factors towards treatment response. Aim: To find the correlates of socio-demographic, clinical profile, catatonic features and identifying determining factors of treatment response to lorazepam and Modified Electroconvulsive Therapy (MECT) in catatonia. Materials and Methods: This cross-sectional study was conducted at the Department of Psychiatry, North Bengal Medical College, Siliguri, West Bengal, India from January 2020 to February 2021. The catatonia cases satisfying the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria were studied. A total of 66 patients were evaluated using the 23-item Bush Francis Catatonia Rating Scale (BFCRS) for severity and later grouped into lorazepam responder (Group I) and non responders (Group II) who received MECT. Background diagnoses using DSM-5 was made after symptom resolution. Statistical analyses like Chisquare and student's t-test to compare frequencies and means respectively, Pearson's and Spearman's correlation test for bivariate correlation and linear and logistic regression to predict factors for treatment outcome were employed using Statistical Package for the Social Sciences (SPSS) 16.0 with a p-value <0.05 considered significant. Results: Among 66 patients, group I had total 54 patients (mean age=25.25±7.03 years) and group II had 12 patients (mean age=23.25±4.30 years). Schizophrenia spectrum disorders were the major underlying psychiatric diagnosis. The MECT was needed in 58.33% of patients with positive family history of psychiatric disorders as compared to 14.81% who responded to lorazepam (p-value=0.001). Severity of catatonia measured by the total BFCRS Scores was higher in the Group II (p-value <0.001). Positive family history (Spearman's rho=-0.512, p-value <0.001) and longer hospital stay (Spearman's correlation coefficient=0.344; p-value=0.005) had significant correlation to catatonic severity. The BFCRS subscale bivariate correlational analysis showed high scores on immobility, mutism, staring, grimacing, rigidity, negativism, withdrawal and autonomic abnormality correlated significantly with MECT response. High scores on stereotypy, waxy flexibility and excitement correlated significantly with lorazepam response. Conclusion: Lorazepam was effective in most cases. Higher scores on BFCRS, positive family history of psychiatric illness, presence of mutism, rigidity, immobility, withdrawal and negativism correlated with lorazepam resistance and MECT response. Waxy flexibility, stereotypy and excitement correlated to lorazepam response. Severity of catatonic symptoms and positive family history were the determining factor for non response to Lorazepam. This could provide insight into the management strategies and treatment protocol in catatonia. [ABSTRACT FROM AUTHOR]

Background: Drug utilization evaluation is an important parameter for the safe, effective and rational use of medications in medical care. Alcoholism results in abundant cases of alcohol withdrawal which can prove to be life-threatening if untreated, lorazepam is a drug of choice for Alcohol Withdrawal Syndrome and requires close monitoring as its over-dosing or under-dosing is common in case of withdrawal. Objective: ensures the safe and rational use of Lorazepam in the management of Alcohol Withdrawal Syndrome. Materials and Method: This prospective, observational study was conducted among alcoholic patients admitted in the KC General Hospital, Karnataka, India. Baseline da ta for Clinical Institute Withdrawal Assessment for Alcohol revised scale (CIWA-Ar) was collected on the day of admission and the response to lorazepam treatment was recorded using the same with respect to the baseline data every 12th hourly after the initial administration until withdrawn. Results: Statistical analysis for 72 patients was done using ANOVA to calculate the overall progression of the syndrome with treatment. Among 72 patients 94.44% were male and 5.55% were female. The mean age of patients reported with AWS was found to be 44.90 years. A significant CIWA-Ar score reduction was observed with a p-value of <0.0001. Conclusion: Our study revealed a strong predominance of male patients with alcohol withdrawal syndrome, where maximum patients started consuming alcohol before the age of 20 years. After the administration of lorazepam, a significant CIWA-Ar score reduction was observed. [ABSTRACT FROM AUTHOR]

Aims: The study aimed at comparing the fixed tapering dose and the symptom-triggered regimens of lorazepam for alcohol detoxification. Methods: We carried out a prospective, randomized, double blind controlled trial involving 63 consecutive consenting male patients admitted with diagnosis of uncomplicated alcohol withdrawal. The patients were randomized into two groups based on the type of lorazepam dosage: symptom-triggered (n = 33) and fixed tapering dose regimens (n = 30). Alcohol withdrawal symptoms were rated on CIWA-Ar (Clinical Institute Withdrawal Assessment – Alcohol revised). The main outcome measures were the total amount and duration of lorazepam treatment and the incidence of adverse events or complications. Results: The mean lorazepam dose administered in the symptom-triggered group was significantly lower than in the fixed tapering dose group (9.5 versus 19.9 mg, P < 0.001) and for a significantly shorter duration of time (47.8 versus 146 h, P < 0.001) with more significant results for higher initial CIWA-Ar scores. There were no significant differences between both the groups in terms of the incidence of complications like seizures or delirium tremens. Conclusion: Symptom-triggered lorazepam treatment for alcohol withdrawal resulted in administration of lower total doses of medication for a shorter duration of treatment and was as safe as the fixed tapering dose. [ABSTRACT FROM PUBLISHER]

Background: Pheniramine is being used harmfully in combination with opiates and benzodiazepines through injecting route. However, the abuse liability of pheniramine has not been studied in humans. Aim: The present study is an attempt to analyze the abuse liability of pheniramine in human subjects. Materials and methodology: The study used a double-blind randomly allotted crossover design. The doses of the drugs used were placebo (normal saline) 2 mL, pheniramine maleate 45.5 mg and lorazepam 2 mg. The assessments were made at baseline and then at 15, 120 and 240 min. The subjects were assessed for the sociodemographic profile, drug-use history, physiological parameters (pulse rate, BP, respiratory rate), and Modified Single-Dose Questionnaire (MSDQ)//Morphine-Benzedrine Group Scale (MBG)//Pentobarbital-Chlorpromazine-Alcohol Group Scale (PCAG)//Visual Analog Scale (VAS)//Profile of Mood States (POMS) scale. Analysis: Analysis was carried out using SPSS version 10.0. In-between drug comparisons were done using one-way analysis of variance (ANOVA) (multiple comparisons). Results: MSDQ and PCAG showed comparable results between the two compounds. VAS and POMS scale had significant increase on the scale for both lorazepam and pheniramine. Conclusions: The findings suggest the possible abuse liability of pheniramine. These findings with the clinical observation of pheniramine abuse used in combination with injection buprenorphine and diazepam warrant the need of caution while prescribing the compound to individuals. [ABSTRACT FROM AUTHOR]

Background: Suicidal behaviour among youth is a major public health concern in Sri Lanka. Prevention of youth suicides using effective, feasible and culturally acceptable methods is invaluable in this regard, however research in this area is grossly lacking. Objective: This study aimed at determining the effectiveness of problem solving counselling as a therapeutic intervention in prevention of youth suicidal behaviour in Sri Lanka. Setting and design: This control trial study was based on hospital admissions with suicidal attempts in a sub-urban hospital in Sri Lanka. The study was carried out at Base Hospital Homagama. Materials and Methods: A sample of 124 was recruited using convenience sampling method and divided into two groups, experimental and control. Control group was offered routine care and experimental group received four sessions of problem solving counselling over one month. Outcome of both groups was measured, six months after the initial screening, using the visual analogue scale. Results: Individualized outcome measures on problem solving counselling showed that problem solving ability among the subjects in the experimental group had improved after four counselling sessions and suicidal behaviour has been reduced. The results are statistically significant. Conclusion: This Study confirms that problem solving counselling is an effective therapeutic tool in management of youth suicidal behaviour in hospital setting in a developing country. [ABSTRACT FROM AUTHOR]

The objective of this study is to evaluate the clinical and radiological characteristics and the outcome of status epilepticus (SE). 117 consecutive patients with SE were evaluated including their demographics, history of epilepsy, antiepileptic drug (AED) default, comorbidities, SE type and duration. The study included 22 children, 77 adults and 18 elderly patients with SE. Blood counts, serum chemistry, ECG, cranial MRI, cerebrospinal fluid and EEG were done. Patients were treated with IV phenytoin, valproate, lorazepam or diazepam as per a fixed protocol and responses to first and second drugs were noted. Death during hospital was recorded. The etiology of SE was infection in 53.8%, drug default in 7.9%, metabolic in 14.5%, stroke in 12.8% and miscellaneous in 11% of patients. 92.3% of patients had convulsive and 7.7% nonconvulsive SE. Cranial MRI was abnormal in 62%. Infection as an etiology was more common in children, drug default and metabolic causes in adults and stroke in adults and elderly. Following first AED, SE was controlled in 50%. 30% of patients remained refractory to second AED which was related to duration of SE and mortality. 29% patients died and death was higher in elderly (44%) compared to children (14%). Acute symptomatic SE is more common in developing countries. Refractory SE is associated with SE duration and mortality. [ABSTRACT FROM AUTHOR]

Purpose: We report the efficacy and safety of lorazepam (LOR), phenytoin (PHT), valproate (VPA) and levetiracetam (LEV) as first and second choice antiepileptic drug (AED) in status epilepticus (SE) and their combinations in preventing refractory SE., Materials and Methods: The results of our two earlier trials on SE were compared; one evaluated VPA versus PHT (group I) and the other LOR versus LEV (group II). In group I, additional patients were recruited in addition to published data. The primary outcome was cessation of SE after first and second AEDs and secondary outcome was mortality and side effects. The efficacy of these four drugs as first and second choice was compared. The frequency of refractory seizure in groups I and II and their contributing factors were analyzed., Results: One hundred and seventeen patients were in group I and 79 in group II. The baseline characteristics of the patients were similar in LOR, LEV, VPA and PHT groups. As a first choice, LOR controlled SE in 75.1%, LEV in 76.3%, VPA in 55.4% and PHT in 44.2% patients. As a second choice, LEV was effective in 88.9%, LOR in 70%, VPA in 74.1% and PHT in 25% patients. Refractory SE was more frequent in group I than group II (29.9% versus 10.5%), however, complications and mortality were higher in group II., Conclusion: LOR and LEV combination was superior in reducing refractory SE but at the cost of higher complications and death.