|Year : 2018 | Volume
| Issue : 2 | Page : 132-136
Psychiatric comorbidities among opioid-dependent patients attending department of psychiatry, regional institute of medical sciences hospital, Manipur
Rakesh Mohanty1, Gojendra Senjam2, Ningombam Heramani Singh2
1 Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Department of Psychiatry, Regional Institute of Medical Sciences, Imphal, Manipur, India
|Date of Web Publication||29-Jun-2018|
Dr. Rakesh Mohanty
Department of Psychiatry, Central Institute of Psychiatry, Room No-43, New Post Graduate Boys Hostel, Kanke, Ranchi - 834 006, Jharkhand
Source of Support: None, Conflict of Interest: None
Context: Substance use disorder coexisting with other psychiatric disorders poses complex diagnostic and therapeutic challenges. Comorbidity is often associated with high rates of continued substance use, greater psychosocial impairment, and increased utilization of services. The intervention for coexisting psychiatric morbidity may improve outcome for the drug dependent. Aims: The aim is to study psychiatric comorbidities and the relation of psychiatric comorbidities with sociodemographic factors and pattern of opioid use in opioid-dependent patients. Settings and Design: This study was conducted in the department of psychiatry in a tertiary hospital. It was a hospital-based cross-sectional study. Subjects and Methods: Eighty consecutive patients with a diagnosis of opioid dependence syndrome made as per the International Statistical Classification-10 diagnostic guidelines were included. All patients were administered with a semi-structured questionnaire to collect sociodemographic profile and pattern of opioid use. MINI PLUS English version 5.0.0 scale was administered to find out psychiatric comorbidities among them. Statistical Analysis Used: Data collected were analyzed using descriptive statistics and Chi-square test using SPSS version 21. Results: In the study population, psychiatric comorbidities were found to be 77.5%. Depression and suicidality were found to be present in majority of the study population followed by generalized anxiety disorder and panic disorder. Conclusions: Our findings have implications for treatment intervention and better management. Proper treatment of comorbidities can probably help to decrease the severity, duration, and complications of drug dependence. Hence, there is a need for screening all opioid dependents for psychiatric disorders who come for detoxification.
Keywords: Comorbidity, opioid, opioid dependent, outcome, pattern
|How to cite this article:|
Mohanty R, Senjam G, Singh NH. Psychiatric comorbidities among opioid-dependent patients attending department of psychiatry, regional institute of medical sciences hospital, Manipur. Indian J Soc Psychiatry 2018;34:132-6
|How to cite this URL:|
Mohanty R, Senjam G, Singh NH. Psychiatric comorbidities among opioid-dependent patients attending department of psychiatry, regional institute of medical sciences hospital, Manipur. Indian J Soc Psychiatry [serial online] 2018 [cited 2019 Nov 19];34:132-6. Available from: http://www.indjsp.org/text.asp?2018/34/2/132/235652
| Introduction|| |
The term opioids describe a class of substances that act on opioid receptors. Numerous opioid receptors though identified, the physiologic and pharmacologic responses in human are best understood for the mu (μ) and kappa (κ) receptors. In the most interesting actions of opioids are those affecting the central nervous system. The phenomenon of tolerance and physical and psychological dependence, which develop following chronic drug intake and which together make up the major undesirable side effect of the opioid drugs, is popularly known as narcotic addiction. The National Household Survey, 2004, of drug use in the country found that the nationwide prevalence of opioid use is 0.7%. Among the opioid users, the largest proportion were opium users followed by heroin, cough syrup, and other opioids, and 22.3% of the abusers were dependent as per the tenth revision of the International Statistical Classification of Disease and Related Health Problems (ICD-10) criteria. Heroin use, in Indian towns and cities, has followed the pattern of being smoked or chased through the nasal route. Unlike the European and American countries, the use of heroin through injection route has not been one of the popular routes in most parts of India, except the North Eastern states.
A useful definition of comorbidity is the “joint occurrence of two or more mental disorders occurring with each other and/or with medical conditions.” Comorbidity is usually associated with high rates of continued substance use, psychosocial impairment, and increased utilization of services. Hence, intervention for coexisting psychiatric disorders may improve outcome for the drug-dependent patients.
Studies of psychiatric comorbidities in opioid abusers suggest that up to 80% patients meet the criteria for at least one nonsubstance use disorder during their lifetime while current disorders have reported in 30%–70% of the patients. Depression among mood disorders and antisocial personality disorders were the most common psychiatric diagnoses reported in patients dependents on opioids followed by dysthymia and anxiety disorders.
The purpose of this study is to examine the extent of psychiatric comorbidities associated with opioid use in this region where opioid use is relatively common as compared to other parts of the country. Literature search on the subject found that there are only a few studies of the incidence and prevalence and pattern of opioid use and psychiatric comorbidities in opioid-dependent patients. Hence, the present study is, therefore, an attempt to find out the sociodemographic profile, pattern of opioid use, and psychiatric disorders in opioid-dependent patients.
Aims and objectives of the study
The aims and objectives were to study psychiatric comorbidities and the relation of psychiatric comorbidities with sociodemographic factors and pattern of opioid use in opioid-dependent patients.
| Subjects and Methods|| |
All eighty patients with a diagnosis of opioid dependence syndrome made as per the ICD-10 diagnostic guidelines  treated both on an in- and out-patient basis in the department of psychiatry were considered for the study. All the study participants were administered the tools meant for the purpose of the study after 2 weeks of detoxification and experiencing minimal or no opioid withdrawal symptoms at the time of the assessment. Interviews were done by the researchers in both English and Manipuri languages whichever language the patient was able to comprehend. During the interview, adequate privacy was maintained. Prior permission was taken from the institute's Ethical Committee before the commencement of the study. All patients were included in the study after obtaining informed consent.
Nature of the study
This was a hospital-based cross-sectional study.
Purposive sampling was used in this study.
Inclusion criteria and exclusion criteria
Patients who satisfy the criteria for opioid dependence syndrome as per the ICD-10 and who were willing to participate and gave informed consent were taken for the study. Those who were having a history of major medical and neurological disorder, history of head injury, who refused to give consent, or who were dependent on other substances were excluded from the study.
Duration of study
The data were collected from October 2012 to September 2014.
The following tools were used:
- ICD-10 diagnostic criteria
- Sociodemographic pro forma
- Semi-structured questionnaire to assess the pattern of substance use
- MINI PLUS English version 5.0.0.
Data collected were checked and scrutinized and then entered in a master chart using Statistical Package for the Social Sciences version-21 software (IBM corporation, Armonk, New York, United States). Statistical analysis was done using descriptive statistics and Chi-square test.
| Results|| |
The data collected are summarized in [Table 1], [Table 2], [Table 3], [Table 4]. The statistical methods were used to ascertain the level of significance of association between variables.
|Table 4: Relation between psychiatric comorbidities with sociodemographic profile and pattern of opioid use|
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| Discussion|| |
In the present study, eighty patients satisfying the ICD-10 criteria for opioid-dependent syndrome were studied. All the patients were males between the ages of 22–52 years. Maximum number of patients belonged to the age group of 21–30 years with a percentage of 45% followed by the age group of 31–40 years with a percentage of 43.8%. Maximum number of patients were Hindus (55%) followed by Christians (25%), and other religions which include Jainism, Buddhism, and indigenous religion Meitei (12.5%) and Muslims (7.5%). The marital status of the population comprised of married (57.5%) followed by unmarried (42.5%). The employment status of the population comprised of employed (62.5%) followed by unemployed (35%) and students (2.5%). The study sample had a majority of education of higher secondary (42.5%) followed by graduates and postgraduates (26.3%) and medium school and secondary school (26.3%) and illiterate and primary school (5%). There were forty nuclear families and forty joint families. In the majority, family income was in the range of 10,000–30,000 (52.5%) followed by <10,000 (35%) and >30,000 (12.5%). Majority of participants were from urban (81.3%) than rural population (18.8%).
Mean age of initiation of opioid use was found to be 22.94 years, with a standard deviation of 5.965. Minimum age was 10 years and maximum age was 36 years. Mean duration of opioid use was found to be 7.79 years, with a standard deviation of 5.975. Minimum duration of use was 1 year and maximum was 25 years among them. Sixty percent of participants had used opioid for >5 years. Patients were asked for types of opioid use and majority of them were using a combination of heroin, pharmaceutical opioid, and opium (47.6%) followed by only heroin users (33.8%), only pharmaceutical opioids such as Spasmo-Proxyvon capsule, or cough syrups containing synthetic opioid users (18.8%). Majority of the opioid users were using a combination of routes such as intravenous, oral, and/or inhalation (48.8%) followed by only intravenous users (30%), oral route (20%), and only inhalation users (1.3%).
Psychiatric comorbidities were found to be 77.5% among opioid-dependent patients in our study. In a study conducted by Robins et al., they showed that psychiatric comorbidity in opioid abusers suggests that up to 80% patients meet the criteria for at least one nonsubstance use disorder during their lifetime. A study by Kumar et al. found that 76% of patients had psychiatric comorbidities among opioid-dependent patients. A study by Brooner et al. documented psychiatric comorbidity in 47% of the sample (47% women and 48% men). Antisocial personality disorder (25.1%) and major depression (15.8%) were the most common diagnoses. In our study, depression was found to be present in the majority of patients followed by suicidality, generalized anxiety disorder, panic disorder, specific phobia, social phobia, schizophrenia, and bipolar disorder with no personality disorders. A study by Borgohain and Phookun  found that 80% of the substance abusers had psychiatric comorbidities, which include 12% with schizophrenia, 54% with affective disorder, 9% with anxiety disorder, and 4% with antisocial personality disorder. A recent prospective study by Basu et al., 2013, reported that mood disorders were the most common disorders, with personality disorder to be less commonly reported. Another very recent study by Balhara et al., 2017, found that the likelihood of a psychotic patient consuming opiates was lower and use of opiates was associated with the presence of depressive disorders.
No statistically significant correlation was found between sociodemographic variables such as age group, religion, place of residence, marital status, employment status, education status, and family income with psychiatric comorbidities. No statistical significance was found between the types of opioid use and psychiatric comorbidities. No statistical significance was observed between the different types of routes and psychiatric comorbidities. In the study population, age of initiation was grouped into two groups: one group having age of initiation <20 years and another group having age of initiation >20 years. Association of psychiatric comorbidities was found to be statistically significant in patients who have earlier age of initiation of opioid use (P = 0.028). To see the relation between the duration of opioid use with psychiatric comorbidities, the study participants were grouped into two groups, one group comprised of patients using opioid for <5 years and the other group comprised of patients using opioid for 5 or above years. Highly statistical significance was found between the two variables. Association of psychiatric comorbidities was more in the study population who have used opioid for longer duration (P< 0.000).
| Conclusions|| |
In our study, psychiatric comorbidities were found to be 77.5%. The different types of psychiatric disorders found in these patients were major depressive disorder, generalized anxiety disorder, panic disorder, suicidality, social phobia, specific phobia, schizophrenia, bipolar disorder, and dysthymia. The co-occurrence presents challenges for diagnosis as well as for optimal patient management. Our findings have implications for treatment intervention and better management. Proper treatment of comorbidities can probably help to decrease the severity, duration, and complications of drug dependence. Hence, there is a need for screening all opioid dependents for psychiatric disorders who come for detoxification.
Strengths of the present study
This is a cross-sectional study conducted in an institute situated in north-eastern region of India where the prevalence of opioid use is high as compared to other parts of India. In this study, psychiatric comorbidities were assessed in a tertiary hospital. The study also examines in detail the sociodemographic factors, opioid dependence characteristics, and their correlation with psychiatric comorbidities.
Limitations of the study
The study was limited to male patients only; hence, results cannot be generalized. Being a cross-sectional study, recall bias may affect the result. Hence, long-term longitudinal data collection is suggested to get the reliable results.
Recommendations and future directions
The future studies on comorbidity in opioid dependence should focus on large sample size and longitudinal assessments of patients for psychopathology, noting how the prevalence of psychiatric disorders change over time and affect treatment response, dropout rate, and outcome. Does the coexisting psychopathology influence the treatment-seeking behavior of opioid dependents? This issue can be examined.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]