Dual Diagnosis In India

Dual diagnosis is the co-occurrence of substance use disorder and other psychiatric disorder.

Dual diagnosis is the co-occurrence of substance use disorder and other psychiatric disorder when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from [a single] disorder. ~Center for Substance Abuse Treatment (2005)

The study conducted by Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Drug De-addiction and Treatment Centre, Chandigarh, was aimed to study the profile of patients with dual diagnosis form an integrated Dual Diagnosis Clinic(DDC). 

“Till date the existence of integrated dual diagnosis clinic (DDC) in India is not known. The Drug De-addiction and treatment center of our hospital has initiated one of the first such clinics in India in October, 2009. This clinic was started after an 11 year retrospective data from our centre which showed that the prevalence of dual diagnosis is 13.2% and there has been a very high attrition rate and favorable outcome in those who were retained in the treatment”, Basu D, Sarkar S, Mattoo SK (2013)  Journal of Dual diagnosis 9: 23-29. Dual diagnosis counseling and active surveillance by the psychiatric social workers are the forms psycho-social interventions considered in the clinic.

Out of 1929 patients registered over a span of 28 months, 1907 (98.8%) records were traceable. Amongst these, 287 (15%) had a comorbid non-substance psychiatric disorder.  The figure was much less than those found in other studies from India (50-75%) and the US (50-60%).

When the pattern of psychiatric disorders in the clinically confirmed dual diagnosis cases was analyzed, mood disorders were the commonest (141, 49.1%) amongst all dual diagnoses. Psychotic disorders (65, 22.6%) were the second most prevalent diagnosis followed by anxiety and stress related disorders (58, 20.2%), organic disorders (6, 2%) and other mental disorders (22, 7.7%). This trend is comparable with the existing literature from our centre, other studies in India and the US [58]. Alcohol was the primary substance of use in both psychotic (30.8%) and non-psychotic (47.3%) co-occurring disorder. This perhaps reflects the treatment seeking pattern in the de-addiction centres of India [9]. However, cannabis use is relatively more prevalent (23%) in the psychosis group. This finding is also in line with the literature across the world [1012]. Opioid (nonpsychotic- 26% and psychotic-28%). and nicotine (non-psychotic-16% and psychotic-15.6%) use was equally prevalent in both the groups. Mean duration of outpatient follow up was 2.6 months. There has been a high attrition rate (24%) following detailed evaluation (after the first 2 visits). Those who remained in the treatment net, significant proportion (45.7%) of patients were improved. High dropout rate has also been observed in the studies from the US and the rate of dropout after first contact is as high as 42%. Half of the subjects were failed to be engaged in the treatment because of their short follow up duration.

A PGIMER spokesperson disclosed, “A recent study published in a peer reviewed journal from our centre showed that one in every third person visiting our centre is a case of Dual Diagnosis.” She pointed that the PGIMER has been running a weekly Dual Diagnosis Clinic since 2011and more than 660 patients had been registered in this clinic.

The study was carried out on 179 patients that came as outpatients to the Drug De-addiction and Treatment Centre at the PGIMER between April 10, 2013 and June 28, 2013 from across the region.

“The prevalence of Dual Diagnosis was 58 (32.4%). Duration of use and dependence (in months) of alcohol, opioids and nicotine was was shorter and of cannabis and benzodiazepines was longer in Dual Diagnosis group. This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The prevalence reported in our study is lower than reported in some western hospital based and community based studies,” says the abstract of the study.

It needs to be pointed out that PGIMER is seen as the second most important health medical facility in the country after AIIMS in Delhi.

The study further points out that in the group that showed Dual Diagnosis alcohol was the predominant substance (50 %) followed by opioid (41.4%). The next was cannabis (6.9%) and nicotine (1.7 %). The most common opioid used by this group was heroin (31.9%). This was followed by synthetic opioids.

The PGIMER recently held a special continuing medical education programme on the “Dual Diagnosis: Facing the Reality and the Challenges” aiming at capacity building for enhancing the diagnostic and management skills of psychiatry trainees and young psychiatrists. More than 150 delegates from different parts of India attended the programme where experts comprising guest faculty addressed queries of the delegates about identifying and management of Dual Diagnosis. The focus was on management of cases in the clinical practice.

 Furthermore, A PGIMER spokesperson disclosed, “A recent study published in a peer reviewed journal from our centre showed that one in every third person visiting our centre is a case of Dual Diagnosis.” She pointed that the PGIMER has been running a weekly Dual Diagnosis Clinic since 2011and more than 660 patients had been registered in this clinic.

The study was carried out on 179 patients that came as outpatients to the Drug De-addiction and Treatment Centre at the PGIMER between April 10, 2013 and June 28, 2013 from across the region.

“The prevalence of Dual Diagnosis was 58 (32.4%). Duration of use and dependence (in months) of alcohol, opioids and nicotine was was shorter and of cannabis and benzodiazepines was longer in Dual Diagnosis group. This study screened the largest number of substance use disorders patients visiting a tertiary care centre in India using a sound methodology. The prevalence reported in our study is lower than reported in some western hospital based and community based studies,” says the abstract of the study.

It needs to be pointed out that PGIMER is seen as the second most important health medical facility in the country after AIIMS in Delhi.

The study further points out that in the group that showed Dual Diagnosis alcohol was the predominant substance (50 %) followed by opioid (41.4%). The next was cannabis (6.9%) and nicotine (1.7 %). The most common opioid used by this group was heroin (31.9%). This was followed by synthetic opioids.

The PGIMER recently held a special continuing medical education programme on the “Dual Diagnosis: Facing the Reality and the Challenges” aiming at capacity building for enhancing the diagnostic and management skills of psychiatry trainees and young psychiatrists. More than 150 delegates from different parts of India attended the programme where experts comprising guest faculty addressed queries of the delegates about identifying and management of Dual Diagnosis. The focus was on management of cases in the clinical practice.

Reference:

https://www.esciencecentral.org/journals/profile-of-patients-with-dual-diagnosis-experience-from-an-integrated-dualdiagnosis-clinic-in-north-india

http://www.catchnews.com/health-news/alcoholics-and-drug-addicts-have-a-higher-probability-of-mental-disorders-55760.html

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