Study of Psychiatric Morbidity and Psychosexual Dysfunctions in Patients of Alcohol Dependence

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1 OCTOBER 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.2 Original Article Study of Psychiatric Morbidity and Psychosexual Dysfunctions in Patients of Alcohol Dependence Siddharth Aswal, KK Verma, Anand Mathur, Harphul Singh, Lokesh Jain, Thalor Kapur Department of Psychiatry, S.P. Medical College and Associated Group of Hospitals, Bikaner Abstract Introduction: Alcohol dependence is a major threat to public health throughout the world. Just as a virus, use of alcohol and alcohol trafficking knows no bounds or limitations. It spreads all over a country; from nation to nation, to the entire globe infecting every civilized society irrespective of caste, creed, culture and geographical location. Aims: To study the psychiatric morbidity and psychosexual dysfunctions among patients of alcohol dependence. Material and Methods : 50 alcohol dependence patients attending psychiatry OPD and admitted in Deaddiction ward under Department of Psychiatry, J.L.N. Hospital, AJMER, who fulfilled the inclusion criteria constituted the sample of study (study group). These alcohol dependence cases were compared with 50 matched controls preferably relatives or family members of alcohol dependence, who were not abusing any substance at present or in the past except tobacco (control group). Psychiatric morbidity and psychosexual dysfunctions were assessed by Eysenck s Personality Inventory, Indian psychiatry interview schedule, and Brief sexual functioning questionnaire. Results and Conclusion: In conclusion our study highlights that most of studied groups were Hindu male between years age and belong to urban area, mostly were married, primary educated, unemployed and belong to joint families, lower and lower middle class status. Most of patients suffered from depression and impotence due to alcohol dependence in comparison of normal healthy control. Key Words: Alcohol dependence, psychosexual dysfunction, psychiatric morbidity Introduction In recent years nothing has come to light more shockingly than alcohol addiction. If this evil is allowed to take roots and spread, not only our present generation but the generations to come will fell victim to one of the most dangerously potent indulgence. 1 On a historical background, the consumption of alcohol and other psychoactive drugs has probably been prevalent since time immemorial in India. In ancient texts details of the procedures for their preparation and description of their effects are available. Arthashastra of Kautilya (which is believed to be written in 3rd cent. B.C.), Charak Samhita, Raghuvansham and Kumar Sambhavam of Kalidas, Manu Smiriti and some of the later Brahamana, Bauddha and Jain text mention the names of various intoxicants. 2-8 Various researches have shown that the consumption of drugs in our country is increasing. The initiation of alcohol intake probably depends largely on social, religious, and psychological factors, although genetic characteristics might also contribute. According to psychological theories alcohol reduce tension, increase feeling of power, and decrease the effect of psychological pain. According to psychodynamic theories the anxiety lowering effects of lower doses of alcohol is the hypothesis that some people use this drug to help Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society 379

2 DELHI PSYCHIATRY JOURNAL Vol. 15 No.2 OCTOBER 2012 them deal with self penetrative harsh superegos and to decrease unconscious stress levels. 9,10 Sex is the highest level of intimacy with which two persons relate to each other. In our country this wonderful, fascinating, yet mysterious aspect of human life has always been kept a closely guarded secret despite India being the home of the greatest epic on sex the Kamsutra by Vatsayan and its ancient monuments display various aspect of sexual behaviour in the most explicit ways possible. Although small doses of alcohol in healthy individuals appear to enhance sexual receptivity in women and facilitate arousal to erotic stimuli in men, continuous and/or heavy drinking may cause significant sexual impairment. Aims Considering the report of alcohol abuse and dependence in India, there have been very few studies to know about occurrence of psychiatric morbidity and psychosocial dysfunction in patients of alcohol dependence. Keeping this in mind the present study has been planned with the following aim. Study the psychiatric morbidity and psychosexual dysfunctions among patients of alcohol dependence. Meterial and Methods 50 alcohol dependence patients attending psychiatry OPD and admitted in Deaddiction ward under Department of Psychiatry, J.L.N. Hospital, AJMER, who fulfilled the inclusion criteria constituted the sample of study (study group). These alcohol dependence cases were compared with 50 matched controls preferably relatives or family members of alcohol dependence, who were not abusing any substance at present or in the past except tobacco (control group). Psychiatric morbidity and psychosexual dysfunctions were assessed by Eysenck s Personality Inventory, Indian psychiatry interview schedule and Brief sexual functioning questionnaire. Inclusion Criteria 1. Persons in the age range from years. 2. Persons who gave informed consent. 3. Alcohol abusers who fulfilled the criteria of alcohol abuse according to ICD-10 by WHO 11 and confirmed by two consultant psychiatrists. Exclusion Criteria 1. Persons below 18 years and more than 60 years of age. 2. Persons suffering from any serious medical and surgical illness. 3. Substance abuse other than alcohol [multiple abuses]. Results In our study the most of studied groups were Hindu male between years age and belong to urban area, mostly were married, primary educated and unemployed belonging to joint families, lower middle and lower class status, (Table 1). On PEN Inventory alcohol dependent scored higher on Psychoticism (40%) and Neuroticism (64%) as compared to contr ols (18% on Psychoticism and 42% on Neuroticism). The difference between both the groups was found to be statistically significant (Table-2). Most of patients were suffering from Depression, Anxiety spectrum disorder (Generalized Anxiety disorder, Panic attacks etc.) (Table-3). Table 4 shows most of patients reported impotence and loss of libido due to alcohol dependence in comparison of normal healthy control. Table - 1: Sociodemographic Factors of Alcohol Dependent and Controls Age (yrs.) Study Group (N=50) Control Group (N=50) (4%) 1 (2%) (18%) 11 (22%) ²=2.957, (26%) 18 (36%) p= NS (36%) 16 (32%) (10%) 3 (6%) > 40 3 (6%) 1 (2%) Religion Hindu 28 (56%) 30 (60%) X² = , Muslim 22 (44%) 20 (40%) p= NS Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society Contd...

3 OCTOBER 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.2 Table - 1: Sociodemographic Factors of Alcohol Dependent and Controls (Contd...) Age (yrs.) Study Group (N=50) Control Group (N=50) Domicile Rural 12 (24%) 14 (28%) X²= , Urban 38 (76%) 36 (72%) p=0.8197ns Occupation Never employed 7 (14%) 4 (8%) X²= Presently unemployed 16 (32%) 5 (10%) p= Self employed 13 (26%) 16 (32%) Significant Full time 3 (6%) 10 (20%) Part-time 11 (22%) 15 (30%) Education Illiterate 5 (10%) 3 (6%) X²= Primary 18 (36%) 7 (14%) p= Middle 12 (24%) 10 (20%) Significant Secondary 8 (16%) 14 (28%) Sr. secondary 4 (8%) 12 (24%) Graduate & above 3 (6%) 4 (8%) Marital Status Unmarried 12 (24%) 8 (16%) X²=7.949 Married 30 (60%) 41 (82%) p= Divorced/Separated 8 (16% 1 (2%) Significant Socio-Economic Status Upper class (2450 & above) 2 (4%) 3 (6%) X²= Upper middle class ( ) 2 (4%) 4 (8%) p= NS Middle class ( ) 7(14%) 12 (24%) Lower middle class ( ) 18 (36%) 15 (30%) Lower class (Below 370) 21(42%) 16 (32%) Family Type Joint 23 (46%) 20 (40%) X²=3.016 Nuclear 13 (26%) 18 (36%) p= NS Extended nuclear 12 (24%) 12 (24%) Living alone 2 (4%) 0 (0%) F/H Of Alcohol Dependence Yes 22 (44%) 11 (22%) X²=4.523, No 28 (56%) 39 (78%) p= Significant Table-2: Personality Characteristics Distribution of alcohol dependent and controls according to score on PEN Inventory Score on Extraversion Study Group (N=50) Control Group (N=50) > (46%) 32 (64%) (X² = 4.857, p <.05), < (54%) 18 (36%) Significant Score on Neuroticism > (64%) 21 (42%) X² = 4.014, p <.05), < (36%) 29 (58%) Significant Score on Extraversion > (46%) 32 (64%) (X² = 2.586, p >.05), < (54%) 18 (36%) Nonsignificant Score on Lie Scale > (28%) 9 (18%) X² = , p >.05), < (72%) 41 (82%) Nonsignificant Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society 381

4 DELHI PSYCHIATRY JOURNAL Vol. 15 No.2 OCTOBER Table - 3: Distribution according to presence or absence of Psychiatric illness Psychiatric Illness Study Group (N=50) Control Group (N=50) No illness 23 (46%) 44 (88%) Depression 14 (28%) 4 (8%) Anxiety spectrum disorder (Generalized 5 (10%) 2 (4%) Anxiety disorder, Panic attacks etc.) Personality disorder 4 (8%) 0 (0%) Bipolar Affective Disorder 2 (4%) 0 (0%) Schizophrenia spectrum disorder (Schizophrenia, 2 (4%) 0 (0%) Delusional disorder etc.) (X² =19.399, d/f = 5, p=0.0016, p<.001), Highly significant. Table - 4: Distribution of Psychosexual Dysfunctions in Alcohol Dependence Psychosexual Dysfunction Study Group (N=50) Control Group (N=50) No Dysfunction 12 (24%) 39 (78%) Loss of Libido 13 (26%) 5 (10%) Excessive Libido 4 (8%) 0 (0%) Impotence 14 (28%) 4 (8%) PME 2 (4%) 2 (4%) Delayed Ejaculation 5 (10%) 0 (0%) (X² =19.198, d/f = 5, p=0.0023, p<.01), highly significant. Discussion The present study was hospital based study. It was aimed at investigating the relationship of sociodemographic factors in alcohol dependents and normal controls. In addition the study was designed to find out the various personality characteristic of the subjects of alcohol dependence, psychiatric morbidity and psychosexual dysfunction in alcohol dependent. Our study reveals that most of alcohol dependent patients were presently unemployed, primarily or middle class educated, divorcee and separated. Family history of alcohol dependence was also highly significant among alcohol abusers in comparison of normal healthy control group. This suggest that long term use of alcohol leads to unemployment and interpersonal relationship problem leading to separation, as some studies, 9,10 have also reported similar finding. Psychiatric morbidity was significantly more in alcohol dependent (54%) as compared to controls (12%). In various psychiatric diagnoses, depression was the most common diagnosis in alcohol dependent (28%) followed by anxiety disorder (10%), Dara et al. 10 reported, rates of concurrent psychiatric symptoms among 326 patients entering deaddiction treatment and examined the effects of Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society their symptoms on the outcome of addiction treatment. He said that results revealed majority of the patients in the sample (63%) had significant psychiatric symptoms at the time of admission into deaddiction treatment with 32% patients with combined depressive and anxiety symptoms. Rui et al. 12 found a high prevalence of depression in drug addicts regardless of the type and duration of drug abuse and a significant association between depression and severity of drug addiction. In our study, prevalence of personality disorder was 8%, similar results were reported by other studies, which described the prevalence of comorbid personality disorders in psychiatrically hospitalized adults with both substance use and nonsubstance use axis 1st disorder, and assessed relationship between axis 2nd psychopathology and pretreatment addiction severity and treatment outcome Bipolar affective disorder and schizophrenia spectrum disorder 4% each. In control group 8% suffered from depressive disorder and 4% suffered from anxiety disorder. No control was found to be suffering from personality disorder, bipolar affective disorder or schizophrenia spectrum disorder. The statistical difference between both the groups was found to be significant.

5 OCTOBER 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.2 The findings of our study match with various previous studies done by others. 10,12,16 in which they found higher psychiatric morbidity in alcohol dependent. Psychosexual dysfunction was significantly more in alcohol dependent as compared to controls. In various psychosexual dysfunction diagnoses, impotence was the most common diagnosis in alcohol dependent (28%) followed by loss of libido (26%), delayed ejaculation (10%), excessive libido (8%) and premature ejaculation (4%) but 14% patient showed no dysfunction. In control group 8% patient were showing impotence and 4% premature ejaculation. 78% of the control group was found without any sexual dysfunction. This suggests that alcohol use for long time causes various sexual dysfunctions. The findings of our study match with various previous studies done by others on sexual dysfunction in alcohol dependent patients which found that psychosexual dysfunction was more common in alcohol dependence then normal control person As the rising prevalence converges on the signature pattern of frequent heavy drinking, the burden of health attributable to alcohol will mount dramatically. It is often assumed that noncommunicable diseases affect higher social classes disproportionately, as mortality levels fall and national incomes increase. Indian society is currently undergoing another tectonic shift in its Socio-economic fabric. The impact of globalization and economic liberalization (exposure to satellite television, rapid socioeconomic transition and growing disposable incomes) appears to have influenced a widespread attitudinal shift to greater normalization of alcohol use leading to prevalence of psychiatric as well as alcohol related psychosexual dysfunctions. The alcohol consumption should be discouraged and the mental health workers as well as the Gover nment should make immediate programs to detoxification and long term arrangements for rehabilitate the alcohol dependents. Suggetions for Further Reaserch 1. Though the sample size of the present study was just adequate, it would be worthwhile to replicate it on a bigger sample in order to have wide applicability of the findings. 2. How much is the psychiatric intervention useful in these patients and what extent of help should be given. Further controlled studies are recommended. 3. Though female alcohol dependence is very less, but its prevalence and difference from male alcohol dependence need to be found. 4. Personality of the spouse (especially wife) and the family environment may be a triggering or execrating factor should also be studied. Refrences 1. Gilder M, Mayon R, Cowen P. Misuse of alcohol and drugs: In Shorter Oxford Text book of Psychiatry. 4th ed Oxford: Oxford University Press 2001; pp Dube KC, Handa SK. Drug use in Health and Mental illness in Indian population, Br J Psychiatry 1971; 118 : Veenstra M Y, Lemmens P H, Friesema IH, et al. A literature overview of the relationship between life-events and alcohol use in the general population. Alcohol Alcoholism 2006; Jul-Aug; 41(4) : Veenstra MY, Lemmens PH, Friesema IH, et al. Coping style mediates impact of stress on alcohol use: a prospective population-based study. Addiction 2007; 102(12) : Chavan BS, et al. Prevalence of alcohol and drug dependence in rural and slum population of Chandigarh. A community survey. Indian J Psychiatry 2007; 49 : Prescott CA, Kendler KS. Genetic and environmental contributions to alcohol abuse and dependence in a population-based sample of male twins. Am J Psychiarty 1999; 156 : Bhatia MS, Jhanjee A, Srivastava S. Pattern of psychosexual disorders among males attending psychiatry OPD of a tertiary care hospital. Delhi Psychiatry J 2011; 14 : Farr ell M. et al. Psychosis and drug dependence: result from a national survey of prisoners. Br J Psychiatry 2002; 181 : Blane HT, Leonard KE, eds. Psychological Theories of Drinking and Alcoholism. 2nd ed. New York: Guilford Press Delhi Psychiatry Journal 2012; 15:(1) Delhi Psychiatric Society 383

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