Dynamics of neurotransmitter and extracellular vesicle-derived microRNA landscapes during heroin and methamphetamine withdrawal

Circulating miRNAs in small vesicles known as exosomes within blood have been emerging as a new research hotspot in the field of psychiatric disorders. The aim of this work was to characterize the changes in exosomal microRNA profiles, both short-term and long-term, during substance withdrawal using a cross-sectional study design. Using weighted gene co-expression network analysis, a series of known, conserved, and novel exosomal microRNAs were identified as being associated with withdrawal stage and key neurotransmitters GABA, choline, and serotonin. Bioinformatics analyses established that the differences in the miRNA profile target signaling pathways are associated with developmental and intellectual abnormalities. Notably, a set of dysregulated microRNA signatures including hsa-mia-451a and hsa-mir-21a resulted in an AUC of 0.966 and 0.861, respectively, for predicting patients with substance use disorders. Furthermore, hsa-miR-744a-5p was positively correlated with serotonin, and its important role in maintaining neuronal development and function was revealed using an in vitro human induced pluripotent stem cells derived neuronal model. Taken together, these data suggest that the microRNA content of circulating exosomes represent a biomolecular “fingerprint” of the progression of substance withdrawal and may uncover the putative mechanism of how these exosomal microRNAs contribute to central nervous system development and function.

Alcohol Withdrawal Cases As a Consequence of COVID-19: A Clinical Analysis

Background: The COVID-19 pandemic has been followed by the shutting down of bars and liquor shops. This condition has led to the acute unavailability of alcohol, and subsequently increasing the number of cases of alcohol withdrawal. Objectives: This paper reports the clinical profile of cases of alcohol withdrawal presented to the psychiatry department following the non-availability of alcohol due to the COVID-19 lockdown. Methods: The patients were referred to the psychiatry department from the emergency medicine department and some of them directly to the psychiatry department. Thirty-two patients with alcohol use disorder and alcohol withdrawal were included in the study. The study data were collected using a semi-structured proforma and then were tabulated. The obtained data were assessed by the Chi-square test and unpaired t-test where appropriate. Results: The Mean±SD age of the study patients were 38.84±11.64 years. The Mean±SD years of consumption of alcohol was 13.50±7.8 years in the sample (range 1-30 years) and Mean±SD days of last consumption of alcohol was 3.88±1.8 days (range 2-10 days). There were no significant differences between stockers and non-stockers in various parameters. Conclusion: Alcohol and substance withdrawal have increased in the wake of the lockdown and COVID-19 pandemic and there is a need for non-COVID-19 setups to be created to cater to the needs of these patients.

Cortical Ribbon Sign in Acute Hepatic Encephalopathy with Sequential Atrophy

A 59-year-old man presented with confusion, decreased level of consciousness, and generalized tonic–clonic seizures. He was intubated and promptly stabilized on antiepileptic medications. He was not in status epilepticus. He improved after seizure control, though he remained confused. He was neither acutely intoxicated nor were there any substance withdrawal concerns prior to his presentation. Furthermore, no metabolic, electrolyte, or nutritional perturbations were identified. He did, however, have a history of alcoholic hepatitis and was awaiting a liver transplant, but his blood work did not reveal evidence of fulminant hepatic failure at presentation (international normalized ratio – 1.17, platelet count 161,000/µL, ammonia 18 µmol/L, blood urea nitrogen 4.5 mmol/L, and his liver enzymes were only remarkable for an elevated alkaline phosphatase of 143 U/L).

Delirium in the course of dependence upon gamma-butyrolactone (GBL) - a case report

Gamma-butyrolactone (GBL) is an organic chemical compound of the lactones group, undergoing biotransformation into gamma-hydroxybutyrate after the intake (GHB). Because of the easy access, low price and fast psychotropic effect, GBL is becoming increasingly popular substance having intoxicating effect. Taking of GBL causes dose-dependent euphoric, sedative, hypnotic effects. Its use can quickly lead to physical dependence with severe course of withdrawal syndromes. Withdrawal symptoms resemble those occurring in the course of addiction to alcohol or benzodiazepines. In some patients, delirium develops during substance withdrawal. There are described severe, life-threatening complications in the course of delirium in GBL-dependent patients. The management of withdrawal syndromes and delirium mainly involves administration of benzodiazepines. In this paper, we present a case of delirium in 24-year-old man addicted to GBL hospitalized in a psychiatric ward. Delirium in this patient went without complications and was successfully managed with diazepam and lorazepam.