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

Sir,

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

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