Aversive Reaction Between Disulfiram and Betel Quid Among Inpatients With Alcohol Use Disorder in Bhutan: A Preliminary Study.

Betel quid (BQ) is commonly used in the Asia-Pacific region. Disulfiram is prescribed for people with alcohol use disorders (PwAUDs) after the completion of detoxification as an alternative to rehabilitation. This prospective observational study reported the aversive reactions and common symptoms of disulfiram and BQ in PwAUDs. Participants included PwAUDs admitted to the psychiatric ward at the Jigme Dorji Wangchuck National Referral Hospital for detoxification, who were on Disulfiram and using BQ at the same time. Aversive reactions between disulfiram and BQ were observed for 100 patients over a year. Twenty participants showed aversive reactions between BQ and disulfiram. Common symptoms included sweating, diarrhea, dizziness, tremors, palpitations, shortness of breath, nausea and vomiting, and headache. Since PwAUDs in Bhutan are inducted on disulfiram after detoxification, and most use BQ simultaneously, this study will help inform health care providers to educate people about the aversive reactions of disulfiram and BQ.

Policy and governance to address depression and suicide in Bhutan: The national suicide-prevention strategy.

Suicide and mental disorders are a growing public health issue in Bhutan, due in part to a rapidly transitioning society. The burden of suicide has been recognized by the Royal Government of Bhutan and, as a result, it introduced the country's first ever national suicide-prevention plan in 2015. The 3-year action plan takes a holistic approach to making suicide-prevention services a top social priority, through strengthening suicide-prevention policies, promoting socially protective measures, mitigating risk factors and reaching out to individuals who are at risk of suicide or affected by incidents of suicide. This article documents Bhutan's policy and governance for addressing depression and suicide within the context of its national suicide-prevention strategy, examines progress and highlights lessons for future directions in suicide prevention. Since the endorsement of the 3-year action plan by the prime minister's cabinet, the implementation of suicide-prevention measures has been accelerated through a high-level national steering committee. Activities include suicide-prevention actions by sectors such as health, education, monastic communities and police; building capacity of gatekeepers; and improving the suicide information system to inform policies and decision-making. Suicide-prevention activities have become the responsibility of local governments, paving the way for suicide prevention as an integral mandate across sectors and at grass-root levels in the Kingdom of Bhutan.

Psychoactive substance use by psychiatric patients in the National Referral Hospital, Bhutan: a retrospective analysis.

BACKGROUND: The costs to the individual and to society of psychoactive substance use is of growing concern in Bhutan. This study aimed to assess the relation between the demographic variables of patients admitted to the National Referral Hospital for first-time detoxification and the psychoactive substances used. METHODS: The demographic variables and types of psychoactive substance used by 284 substance users were reviewed. Data were collected through patients' history sheets and admission registers, and analysed through descriptive statistics, one-way analysis of variance and independent t test. RESULTS: The commonest psychoactive substance used was alcohol, followed by cannabis, nitrazepam, dextropropoxyphene, glue (inhaled) and chlorphenamine/ pseudoephedrine/codeine-containing cough syrup. Only 14% of participants were aged 45 years or older. Most patients used more than one substance; the mean number of psychoactive substances used was highest among males, individuals aged 15-24 years and those who were unemployed. CONCLUSION: Among patients admitted for first-time detoxification, harmful use of alcohol is the most common, followed by cannabis and illicit prescription drugs. Preventive measures should be prioritized on a need-based strategy. The findings of this study indicate that some of these preventive measures should be focused on males, unemployed groups and youth, and should involve raising awareness of harmful use of substances and the services available to treat substance use disorders.