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Comments on: “Externalizing psychopathology and cognitive functions in patients with early- and late-onset alcohol dependence”

Astha, ; Tekkalaki, Bheemsain; Patil, Sandeep

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Indian Journal of Psychiatry: May–June 2022 - Volume 64 - Issue 3 - p 326
doi: 10.4103/indianjpsychiatry.indianjpsychiatry_611_21
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Das et al.[1] have compared the externalizing psychopathology and cognitive functions in patients with early-and late-onset alcohol dependence. We found the study interesting and relevant; however, we have some comments about its methodology and external validity.

The participants with <8 years of formal education were excluded from the study. This is a major concern, as there is sufficient evidence that the individuals with externalizing psychopathology have higher school dropouts and lesser educational qualification,[2] leading to selection bias.[3] Authors have also included patients diagnosed with alcohol-induced psychosis and have followed them up till their “condition became clinically stable.” The presence of cognitive symptoms (at least residual) secondary to psychosis cannot be ruled out here.

The flowchart depicts the various medications that the participants were started on after being enrolled in the study, namely benzodiazepine (chlordiazepoxide, oxazepam, and lorazepam), anticraving agents (acamprosate), or zolpidem. However, there is no information about any other psychotropics such as antipsychotics or antidepressants (except trazodone) if patients were on. This is important as these medications can also affect the cognitive functioning.

Although the study design of this study appears to be of a cross-sectional study, there are few points that create a doubt such as the mention of dropout rates and cognitive functions being measured 2 months after the recruitment.

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Conflicts of interest

There are no conflicts of interest.


1. Das A, Kar SK, Dalal PK, Gupta PK Externalizing psychopathology and cognitive functions in patients with early- and late-onset alcohol dependence Indian J Psychiatry 2021 63 233 9
2. Fried R, Petty C, Faraone SV, Hyder LL, Day H, Biederman J Is ADHD a risk factor for high school dropout?A controlled study J Atten Disord 2016 20 383 9
3. Tripepi G, Jager KJ, Dekker FW, Zoccali C Selection bias and information bias in clinical research Nephron Clin Pract 2010 115 c94 9
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