Patterns of Psychiatric Illness in a Tertiary Care Centre of Arunachal Pradesh: An Observational Study.

Introduction:Monitoring the pattern of psychiatric illness among inpatients is essential for understanding the burden and trends of disease, in addition to designing and developing focused preventive and interventional strategies. Given the significant regional variation in the prevalence of mental illness, the present study evaluated the profile of psychiatric illness among inpatients admitted to a tertiary care center situated in the North East of India. Methods:Information from case records of consecutively admitted patients aged 18 years and above over the preceding three years, coded under the International Classification of Diseases, 10th edition (ICD-10), was reviewed. Details of socio-demographic parameters and psychiatric illness as well as substance use were extracted and represented by using descriptive statistics. Results:There were 371 admissions over the above-mentioned time frame. Subjects had a mean age of 36.5±10.45 years and 80.05% of them were males. Substance use disorders (77.62%) were the most commonly noted among study participants, with the majority being diagnosed with opioid dependence (43.93%) and alcohol dependence (29.92%), followed by tobacco dependence (2.16%). Psychotic disorders (5.12%), anxiety disorders (6.19%) and mood disorders (1.88%) were noted in a much lower proportion than anticipated. More than half (n=248) of subjects were aged 18-34 years. Conclusion:A disproportionate overrepresentation of substance use disorders among psychiatric inpatients in the North Eastern state of Arunachal Pradesh in India contrasts with the profile noted in other parts of the country. Notably affecting the younger age group, the findings of the present study highlight the need for the development of targeted preventive and interventional strategies to address the same. The study could help inform mental health policy initiatives and guide focused mental health care provision. These could include the establishment of centers for addiction medicine, enhancing training in addiction medicine for health professionals, counseling services and development of long-term rehabilitation for those suffering from substance use disorders.

Does Cannabis Use Influence Opioid Outcomes and Quality of Life Among Buprenorphine Maintained Patients? A Cross-sectional, Comparative Study.

OBJECTIVES: Use of various psychoactive substances can influence outcomes of patients on opioid agonist treatment (OAT). While use of alcohol and cocaine has shown to adversely affect OAT results, associated cannabis use shows mixed results. This study aimed to assess the pattern of cannabis use among opioid-dependent patients maintained on buprenorphine. Additionally, the study compared the dose of buprenorphine, opioid-related craving and withdrawals, productivity, and also quality of life between those with and without recent (past 90-day) cannabis use. METHODS: We collected data on demographic and drug use details in 100 randomly selected adult male patients attending a community drug treatment clinic, who were stabilized on buprenorphine for more than 3 months. Other measures included scores on World Health Organization (WHO)-Alcohol, Smoking and Substance Involvement Screening Tool and WHO-Quality of Life-Brief (WHOQOL-Bref) version. RESULTS: The average duration of maintenance treatment with buprenorphine was 96 months, with excellent compliance for buprenorphine (86.92 ±â€Š9.58 days in 90 days). Thirty-five per cent had used cannabis in past 90 days, with lifetime use of cannabis in 77%. Participants using cannabis currently were on lower doses of buprenorphine (mean dose per day: 7.9 mg vs 8.9 mg; P = 0.04). Yet, there was no significant difference in the rates of opioid use or opioid withdrawals and craving between the 2 groups. Compliance to OAT, number of days of employment, daily earning, and WHOQOL-Bref scores in all domains were comparable between those with and without cannabis use. Duration of cannabis use, current use of alcohol, and dose of buprenorphine predicted current cannabis use in multivariable logistic regression analysis. CONCLUSIONS: Cannabis use does not negatively influence opioid outcomes among patients receiving buprenorphine maintenance treatment. There is no difference in productivity and quality of life between individuals maintained on buprenorphine with and without current cannabis use.