Background: Alcohol use and related illnesses have become a major public health problem in the south Indian state of Kerala with rising sale reported every successive year. Ours is a teaching hospital catering to patients in the northern districts of Kerala and has a de-addiction ward and OPD services running for more than 10 years. In this context we thought of doing an analysis of the patients getting inpatient care at this center for alcohol dependence syndrome (ADS). Objective: To collect data on all cases admitted in the calendar year 2012 with ADS to the de-addiction ward of our hospital and look for various patterns based on information available by doing a chart review.
Methods: Case records of all patients admitted with ADS in 2012 were recalled from the records library and information gathered based on the data sheet prepared which covered the relevant demographic and clinical variables and the details of treatments(s) offered during the stay. Results: All were males. 96.7% of the sample had >10 years of alcohol use. 76.6% had less than 10th standard education. 75.6% were married. 96.7% were from the ‘BPL ‘category. 54.4% had delirium; 37.8% had seizures and. Lorazepam was the commonly used detoxification agent. 72.2% had positive family history.
Conclusion: This study helped in finding out the profile of patients seeking care for ADS at a tertiary care center and to identify lacunae in existing services.
Alcohol has been used in India from ancient times.1 Predominantly, beverages obtained from plants (like toddy from palm trees) were used in earlier times. Later on with advent of modernity, distilled spirits entered. Increasing consumption of alcohol has been reported from India only recently. Reasons cited include the fact that that this is a source of revenue for state governments, and as part of social changes occurring in the context of globalization.2 Adverse health consequences of alcohol and smoking are too well known to be discussed in detail here.3 It is also shown that alcohol increases sexual risk taking thereby increasing chances of spread of HIV infection, especially among the urban poor.2
Alcohol use and related illnesses is becoming a public health problem in the south Indian state of Kerala with rising sale of alcohol reported for every successive year.4 Smoking is also highly prevalent among younger males, especially from the lower Socio Economic Status.4 Smoking, heavy alcohol use, lack of exercise etc are risk factors for the life style diseases like hypertension, diabetes and coronary artery disease and cancer. Morbidity and mortality parameters of Kerala are comparable to developed countries with a high prevalence of the above disorders.5 Compared to the rest of India (11.2 per 100,000 people), the suicide rate in Kerala (24.3 per 100,000 people) is more than two fold high6. Use of alcohol and other substances is a known risk factor for suicide.6
Very little data exist on the profile of patients seeking care at psychiatric facilities for alcohol use related problems from India. Our Government Medical College hospital caters to patients in the northern districts of the state and has de-addiction services (inpatient ward and OPD) running for more than 10 years. In this context we thought of doing an analysis of the patients getting inpatient care at this centre for alcohol dependence syndrome.
To collect data on all cases admitted in the calendar year 2012 with alcohol dependence syndrome to the de-addiction ward of Government Medical College and look for various patterns based on information available by doing a chart review.
Case records of all patients admitted to one clinical unit of the psychiatry department with a diagnosis of alcohol dependence syndrome in 2012 were recalled from the records library and data gathered based on the data sheet prepared. This included information regarding psychiatric diagnosis, physical and psychiatric co morbidities, results of liver function tests and other relevant demographic and clinical variables. Details of treatment offered including pharmacological and psychosocial interventions were also collected.
Results are presented in tables 1, 2, 3and 4. There were a total number of 264 admissions during the calendar year 2012. Among them 129 case sheets (48.9%) had a diagnosis of alcohol dependence syndrome according to the ICD 10 criteria.7 All these case sheets were recalled. Out of this, 28 case sheets were excluded as they were readmissions of patients already included in their first admission. 22 patients had more than one admission in 2012 itself. Only the details from the case-sheet of the first admission of these cases were taken for analysis. Elevan charts had to be excluded for the following reasons. 5 case sheets were incomplete and one was untraceable and 5 patients left against medical advice before proper assessment was over (within 24 hours of admission). Thus there were 90 charts (pertaining to 90 patients) after the above exclusions. The results of analysis of these patients are presented below
Socio demographics: All were males. The mean age of the patients was 44.34 years (20-78 years). 76.6% had studied up to 10th standard, 17.7% up to plus two and 5.5% were degree educated. 34.4% were involved in unskilled labour, 40% in skilled and 17.8 in semiskilled labour.75.6% were married. 84.4% were from Hindu community. 96.7% belongs to low socioeconomic status (Below Poverty Line).
Clinical variables: It was routine admission through OPD in 67.7% of them while 32.2% were admitted from emergency department. 50% had a previous attempt at de-addiction. 72.2% of them had a family history of alcohol use and 22.2 % had a family history of mental illness with affective disorders being more common. Mean age of onset of alcohol use was 17.34 years (Range - 12 -25 years). Mean amount of alcohol use was 19.96 units (Range for this - 10 -35 units). One unit of alcohol was defined as 30 ml of locally available Indian made foreign liquor like brandy, whiskey etc. 100% of the sample reported high frequency of drinking more than 5 days per week or all 7 days in many of the patients. Majority were using cheaper brands of Indian made foreign liquor which is mostly sold by the government run Beverages Corporation. Few used toddy which is sold through licensed toddy shops. People using other forms of locally brewed country liquor were extremely rare and usually hailed form remote hilly areas
Co-morbidity: 58.9% had a complicated withdrawal with delirium in 54.4 % and seizures in 37.8 % of them.17.8 % had an additional diagnosis of alcohol induced psychotic disorder and 7.8% Alcohol induced amnestic disorder. Additional diagnosis other than substance related were noticed which include organic disorder(1.1%), psychotic disorder in 2.2%, affective disorders in 2.2%, anxiety disorders in 1.1% and personality disorders 4.4%. Nine patients (10%) were admitted following suicide attempt under intoxication. 81 (90%) patients had nicotine dependence and 3 (3.3%) had nicotine use according to ICD-10 criteria. All of them were smokers few additionally had pan chewing.
Psychosocial problems: 68 (75.6%) of the sample were married. Out of this 44 (64.7%) had psychosocial issues with his spouse. They needed interventions from the professionals. 28(31.1%) had issues with his parents or siblings and 12.2% with people at workplace. 28.8% had a legal issue related to alcohol use. 80% of them were either not working or irregular at their work
Investigations: Lab tests revealed elevated mean liver function test (LFT) values: AST (135.05 IU) ALT (101.7 IU) Mean Blood MCV was (89.73).
Treatment: Most of them (94.4%) received lorazepam as the detoxifying agent with a mean cumulative dose of 50.71mg during the whole hospital stay.
On an average 2 sessions addressing the psychosocial issues (range 1 to 5 sessions) were given for each patient by psychiatric social worker, apart from the routine sessions given by the resident in charge during the stay as inpatient.
Mean duration of inpatient stay was 11.35 days (2 -30days). 61.1% were discharged after full treatment 28.8% were discharged at request before completion of treatment.