Suicides among sexual minority populations in Asia: a battle in the shadows.

Sexual minorities, comprising of individuals with non-heterosexual orientation or non-binary gender identities, are being increasingly recognized as populations with distinct needs throughout the world. These communities face several psychological and socio-political challenges, making them vulnerable to mental health conditions, including suicides. Research indicates a higher risk of suicidal deaths and attempts in sexual minorities as compared to the general population. However, this remains an under-researched topic in South Asia where social integration and minority rights are still in their nascent stages. This narrative review aims to understand the various issues related to suicides among sexual minority communities of South Asia.

The Top 100 Most Cited Publications on Suicide: A Citation Analysis.

Suicide is one of the leading causes of death globally and a matter of public health concern. Biomedical research on suicide has grown exponentially over the past few decades. Although numerous articles are published on suicide, only some exert significant influence in the evolution of scientific understanding. The number of citations a publication receives are a proxy marker of its impact on the field. Hence we aimed to analyze 100 top-cited articles on suicide till May, 2023, using Google scholar as the search database. These citation classics provide important insights into the historical development and trends in suicide research.

Portrayal of Suicide in Bollywood Movies Over Last Two Decades: A Content Analysis.

Aim: To analyse Bollywood movies depicting suicides, released in last two decades, on content and scientific accuracy. Methodology: Online movie databases, blogs were accessed along with Google search to compile a list of movies portraying suicide (thought, plan, or act) in at least one character. Each movie was screened twice for details of character, symptoms, diagnosis, treatment, and scientific accuracy of depiction. Results: Twenty-two movies were analyzed. Most characters were middle-aged, unmarried, well educated, employed and affluent. Most common motives were emotional pain and guilt/shame. Most suicides were impulsive, method of choice was fall from height and resulted in death. Conclusion: Cinematic depiction of suicide may promote misconceptions among viewers. Alignment of cinematization with scientific knowledge is needed.

Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India.

Background: Healthcare providers working with victims of physical trauma are exposed to significant human suffering at work. This may place them at risk of burnout, secondary traumatic stress (STS), and other psychological disturbances. This study aimed to evaluate the professional quality of life and psychological well-being among trauma professionals. Methodology: This was a cross-sectional study conducted among 153 staff members (nursing officers, resident doctors, and faculty) of a Level 1 trauma center in North India. The Professional Quality of Life (ProQoL-5) and Depression, Anxiety, and Stress (DASS-21) Scales were used. Results: More than 50% of the participants had a moderate risk of burnout and STS. In addition, 54% of participants reported having anxiety, 40% stress, and 36% depressive symptoms. Depression, anxiety, and stress were all strongly predicted by burnout and STS. Conclusion: Psychological distress symptoms were seen in a significant portion of professionals working in the trauma center. Workplace interventions for the promotion of psychological well-being among trauma professionals are recommended. How to cite this article: Gupta S, Bhatia G, Sagar R, Sagar S. Assessment of Psychological Well-being Among Medical Professionals Working with Patients Who Suffer from Physical Trauma: An Observational Study from India. Indian J Crit Care Med 2023;27(7):493-502.

Characteristics Associated with Substance Use and Non-use Among Street Children in Delhi, India: A Community-based Cross-sectional Epidemiological Study.

Background: Street children are vulnerable to adverse health and risk behaviors and drug use. Substance use among street children has been well documented in several countries. This study reports sociodemographic and peer, family, and stress-related factors associated with substance use and non-use in a representative sample of street children of Delhi. Methods: This cross-sectional survey was conducted through six NGOs working with street children, using Respondent Driven Sampling, in nine districts of Delhi (n = 766, 7-18 years). The multivariable model was developed by applying binary logistic regression analysis. Results: The rate of substance use was 49%. Significant association was found between substance use in the past year and increasing age [Odds Ratio: OR (95% Confidence Interval)] [1.22(1.12,1.33)], male sex [4.34 (2.28,8.26)], lacking psychosocial support from family/relatives [3.27(1.84,5.80)], being engaged in earning from illegal sources, [3.04(1.75,5.29)], family use of substance [2.59(1.38,4.89)], presence of substance-using peers [29.86(14.38,62.01)], lack of non-drug-using peers [2.35(1.46,3.79)], and not possessing basic amenities [2.26(1.31,3.93)]. Conclusion: Multiple modifiable factors exist within the family and peer group, including risk and protective factors or a consequence of substance use. Some challenges in the form of difficulty in reaching out to them and poor treatment seeking by those using substances warrant intensification in both primary and secondary prevention initiatives.

Cognitive impairment in opioid use disorders: Is there a case for use of nootropics?

Opioid Use Disorders (OUDs) are often associated with cognitive impairments, which may lead to an increased risk of relapse. These cognitive deficits do not resolve with abstinence or medication-assisted treatment and may require targeted management. While psychotherapies and neuromodulation techniques have been studied for their effectiveness, they have certain limitations and challenges. Cognition enhancing prescription drugs like donepezil and memantine, which are used in dementias, have shown promise in a small number of studies examining their role in the reversal of opioid-induced cognitive deficits. The authors explore the potential role of nootropics in improvement of cognitive decline associated with OUDs.

Movies and matters of the mind- portrayal of psychiatric illnesses in Bollywood over last two decades: A content analysis.

AIM: to analyze Bollywood movies depicting psychiatric illnesses, released in last two decades, on content and scientific accuracy. METHODOLOGY: Google search was done to compile a list of Bollywood movies portraying psychiatric illnesses. Each movie was screened for character details, symptoms, diagnosis, and accuracy of depiction. RESULTS: Twenty-eight movies were analyzed. Most characters were middle-aged, unmarried, employed, and affluent. Most common symptom was aggression and diagnosis was Schizophrenia. Treatment-seeking was low and common outcome was deterioration. CONCLUSION: Bollywood's depiction of psychiatric illnesses differs from research evidence in many aspects. Greater alignment between cinematic portrayal and research evidence is needed.

Trends of Change in Empathy Among Indian Medical Students: A Two-Year Follow-Up Study.

Background: The development of an empathic approach is essential for doctor-patient relationships. Medical training is a challenging time that may affect empathy. This study aimed to assess the change in empathy in students during medical education. Methods: One hundred and fifty MBBS students were recruited at admission and assessed for empathy, interpersonal reactivity, and general health. They were followed for two years and assessed at three intervals. Results: A significant decline was seen in empathy for both male and female students. The decline was correlated with psychological stress. Gender, family structure, having siblings, and increasing General Health Questionnaire score predicted change in empathy. Conclusion: Empathy declines with advancing training, varying with constitutional and situational factors. The medical curriculum should include skills like empathic communication as well.

The silent epidemic: Death by suicide among physicians.

Suicidal deaths among physicians have been on a steady rise in the past few decades, despite being a part of the healthcare system, training for early identification and easy access to treatment services. While there is no doubt that this warrants concern at individual, institutional, and community levels, physician suicide remains an under-researched topic. We examine the correlates of suicidal deaths among physicians along with risks and protective factors conferred to physicians as a population and emphasize the need for preventive and risk-reduction initiatives that are specifically tailored for physicians and the healthcare provider community.

Understanding the epidemiology of substance use in India: A review of nationwide surveys.

Substance use is a public health concern on a global and national levels. There is a scarcity of nationally representative systematic research on the epidemiology of substance use in India. This narrative review aims to discuss the various large epidemiological surveys providing data on substance use in India. Attempts have been made to extract data pertaining to special population groups as well.

Portrayal of illicit drug use in bollywood movies over the last two decades: A content analysis.

AIM: to analyse Bollywood movies depicting illicit drug use, released in last two decades, based on their content. METHODOLOGY: Online movie databases, source books and blogs were accessed along with Google search to compile a list of movies portraying illicit drug use in at least one character. Each movie was screened twice for details of character and drug use pattern. RESULTS: Total 22 movies depicting 25 characters were included in analysis. Majority of characters were male, young, students and affluent. Intoxication was the commonest state and social adversities were most common complications depicted. Treatment seeking was low and most common outcome was death. CONCLUSION: Cinematic depiction of drug use may promote some misconceptions among viewers. Alignment of cinematization with scientific knowledge is needed.

Role of corneal collagen cross-linking in bullous keratopathy: A systematic review.

Corneal cross-linking (CXL), a corneal strengthening procedure, is known to alter anterior stroma swelling behavior and is one of the treatment modalities of bullous keratopathy (BK). There are multiple studies published on the role of CXL in the treatment of BK. These articles had heterogeneous study population, different protocols used, and variable conclusions. This systematic review aimed to determine the role of CXL in the treatment of BK. The primary outcomes considered were changes in central corneal thickness (CCT) after 1, 3, and 6 months of CXL. The secondary outcome measures were changes in visual acuity, corneal clarity, subjective symptoms, and complications after CXL. We included randomized control trials (RCTs), observational and interventional studies, and case series with reports of more than 10 cases in this review. In RCTs, the mean pre-CXL CCT (794.0 ± 178.5 µm) in the intervention group (n = 37), decreased at 1 month (750.9 ± 154.3 µm) followed by a subsequent increase, but this difference was not significant during the 6-month follow-up (P- value 0.28, 0.82, and 0.82 at 1, 3, and 6 months, respectively). In noncomparative clinical studies (n = 188), the mean pre-CXL CCT (794.0 ± 178.5 µm) decreased at 1 month (710.9 ± 127.2 µm, P < 0.0001). Seven of the 11 articles included in the review reported no significant improvement in vision with CXL. The initial improvement in corneal clarity and clinical symptoms was not sustained. Current evidence suggests that CXL has short-term efficacy in the treatment of BK. More RCTs with high-quality evidence are needed.

Essential substance use disorder medications in Asia Pacific countries: An observational study.

AIM: To analyze national lists of essential medicines (NLEM) of Asia Pacific countries for inclusion of substance use disorder (SUD) medications. METHODS: An observational study was conducted using the most recent versions of NLEM of all 55 Asia Pacific countries till April, 2022. SUD medication details were extracted and analyzed. RESULTS: NLEM of included nations contained a median 2 medications for long term SUD management. Sixteen countries had atleast one medication for opioid use disorder and 13 for alcohol use disorder. Four countries had atleast one medication for opioid, alcohol, and tobacco use disorders. CONCLUSION: NLEM expansion is needed considering public health burden of SUDs.

Celebrity drug use reporting in Indian media and its impact on drug-related online search behavior: An infodemiology study.

AIM: We aimed to examine and interpret the changes in internet search volumes for keywords representing different drug use-related themes before and after the drug use started being discussed in the Indian news media during recent celebrity drug trials. MATERIALS AND METHODS: Data were extracted using Google Trends framework in health-related research. Search keywords were prepared under four broad themes: General interest in cannabis use, drug use being a criminal/unlawful act, help seeking for cannabis use, and help-seeking for drug-related problems. The mean relative search volume was analyzed and compared pre- and post-media discussion about celebrity drug use using SPSS V23.0. RESULTS: A significant increase was noted in online search interest for keywords related to themes of general interest in cannabis use and drug use being a criminal/unlawful act once the media discussion on the celebrity drug use started. However, no corresponding increase was noted in online search interest for themes of help seeking for drug-related problems in general and cannabis use in particular. CONCLUSION: Media discussions on celebrity drug use may impact the online search behavior of the general public adversely. There is an need to develop and adhere to drug use reporting guidelines by media professionals.

Sublingual buprenorphine-naloxone precipitated withdrawal-A case report with review of literature and clinical considerations.

Buprenorphine- Naloxone Fixed Dose Combination (BNX) is widely used to manage opioid use disorders. Contrary to evidence based concepts about sublingual bio-availability of naloxone, a few small studies have reported non-negligible amounts absorbed sublingually. But the extent to which these amounts exert opioid antagonist effects is yet to be established. We hereby report the first case of opioid dependence who developed a rare phenomenon of moderate to severe opioid withdrawal symptoms on administration of sublingual BNX after several days of being stabilized on plain buprenorphine (BUP). The case demonstrates the need to consider using buprenorphine monotherapy whenever such adverse effects are encountered. We also discuss the possible pharmacological explanations behind this rare side effect.

Treatment experience for opioid use disorder during COVID-19 in India: Learning from patients.

The COVID-19 pandemic and its containment strategies have presented unique challenges to India's healthcare infrastructure. While a national lockdown initially resulted in the closure of all licensed liquor shops, it also made healthcare facilities dedicated to the treatment of substance use disorders challenging to access. Addiction treatment services have been functioning at limited capacity with a lack of consensus on operating procedures. In this article, we present actual case scenarios where lockdown affected substance use and the treatment process, and discuss the policy implications and considerations for both.

Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study.

BACKGROUND: Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment. METHODS: This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD-) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals. RESULTS: About a fifth (n=24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants (n=8, 33.3%) were willing for the treatment of any kind, and only a half (n=3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status. CONCLUSION: Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population.