Exploring the clinical variables among drug-dependent HIV-Positive patients: Implications for treatment strategies.

This study explored the profile of HIV positive patients seeking treatment at a tertiary care addiction treatment facility. A retrospective study was done to collet detailed information on clinical characteristics: drug use (type, age of initiation, duration), general medical condition and past treatment history. The study included 138 patients with mean (SD) age 30.2 (8.3) years. Opioid dependence with injecting drug use (IDU) was diagnosed in 97% of the patients. The median age of injecting onset was 24.5 years (IQR 20-31 years). The most frequently injected substances were pheniramine (60.1%) and buprenorphine (59.4%). Past treatment seeking was reported by 57% patients and interestingly they were less likely to present any medical condition (2 =69.611, p < 0.001). Variability in the age of onset of drug use indicates the need for broad based approach to prevent IDU and motivation to seek treatment may lead to better health conditions.

Neurological Soft Signs in Cannabis Use Disorder with or without Psychosis: A Comparative Study from India.

OBJECTIVE: The purpose of this study was to assess and compare neurological soft signs in patients of cannabis use disorder (CUD) with and without co-occurring psychosis in a treatment-seeking sample. METHODS: We included 30 right-handed male subjects aged 18-65 years diagnosed with CUD (as per DSM-5) without any co-occurring psychiatric disorder in group I and those with co-occurring non-affective psychosis in group II. Group III consisted of 30 age and sex-matched, right-handed, healthy subjects with no psychiatric or medical conditions. Neurological Evaluation Scale (NES) was applied to measure neurological soft signs across the groups. We also used the Severity of Dependence Scale (in CUD with or without co-occurring non-affective psychosis groups) and Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Barnes Akathisia Rating Scale, Abnormal Involuntary Movements Scale, and Simpson Angus Scale (in CUD with co-occurring non-affective psychosis group) . RESULTS: Our data suggested higher total NES mean scores in CUD with (20.53 ± 13.77) or without co-occurring non-affective psychosis groups (15.93 ± 9.86) as compared to healthy controls (6.20 ± 5.40) (χ2 = 23.12; p < .001). However, there were no differences between cannabis use disorder with or without co-occurring non-affective psychosis groups. The mean of subdomain scores of motor incoordination, sequencing of complex motor tasks, sensory integration, and others was significantly higher in CUD with or without co-occurring non-affective psychosis groups compared to healthy controls. CONCLUSION: Impairment in neurological soft signs is present in patients with CUD regardless of a co-occurring psychosis. Cannabinoids might be interacting with the brain circuits known to be involved in schizophrenia.

The Past, Present and Future of Literature Pertaining to Betel (Areca) Nut: A Citation Analysis.

Objective and method: Betel (areca) nut has recently received interest from researchers and policy makers for its role as a psychoactive substance. It was historically limited to Asia-pacific region, but with the advent of globalization, it has become an equally challenging public health problem across the globe. Previously published literature can give us valuable insights in terms of historical interest and understanding related to betel nut. With the expansion of biomedical research a huge number of articles have been published on the same. In terms of understanding the impact of an article, citations are considered a proxy estimate measure. Thus we decided to analyze the top 100 cited articles (till November 2018) related to betel nut. The search in Google scholar database was done with the help of freely available software, Publish or Perish. Results: Overall we found that most articles were published from the fields of dentistry and oncology, with relatively minimal contribution from the field of Addiction Psychiatry. Hence, most articles have addressed the issue of epidemiology and mechanism with lesser share of treatment related publications. Various important information related to these articles have been discussed including the institutions, countries, journals and impactful authors in the field. Subsequently, original research articles are further classified into descriptive/epidemiology, mechanism, management, scale/measurement, imaging and medical psychiatry. Importance: This citation analysis provides valuable information with regards to the emphasis of researchers in the field, and areas where more emphasis is required from contemporary world.

Brain neurochemistry in unmedicated obsessive-compulsive disorder patients and effects of 12-week escitalopram treatment: 1 H-magnetic resonance spectroscopy study.

AIM: The purpose of this study was to examine treatment-related neurochemical changes in 28 unmedicated obsessive-compulsive disorder (OCD) patients using 1 H-magnetic resonance spectroscopy (1 H-MRS). METHODS: We included subjects diagnosed with OCD (n = 28), each with a total duration of illness of less than 5 years, as a study group and age- and sex-matched healthy controls (n = 26). The inclusion criteria for the OCD group were right-handed individuals aged 18 years or older who had not been on any specific treatment for OCD for the last at least 8 weeks and who had no other psychiatric comorbidity. A pre-post and case-control design was employed in which OCD patients underwent 1 H-MRS at baseline and 12 weeks after treatment with escitalopram (n = 21). Clinical assessment was carried out using a semi-structured pro forma Yale-Brown Obsessive Compulsive Scale and the World Health Organization Disability Assessment Scale 2.0 before and after treatment. Volume-localized 1 H-MRS was carried out with a 3-Tesla Philips MR scanner. RESULTS: Our data suggested higher levels of myoinositol (mI), total choline (tCho), and glutamate+glutamine (Glx) in the medial thalamus at pre-assessment in OCD subjects as compared to healthy controls and a significant reduction in tCho and Glx after treatment in OCD subjects. The mI levels in the caudate nucleus and Glx levels in the anterior cingulate cortex were significantly correlated with disease severity on the Yale-Brown Obsessive Compulsive Scale. CONCLUSION: Our study supports the hypothesis of a hyper-glutaminergic state (as suggested by increased Glx levels) and neurodegeneration (as suggested by increased tCho and mI in the thalamus) in cortico-striato-thalamocortical circuitry in OCD patients as suggested by previous studies using MRS as well as other functional imaging studies.

Do Addiction Science Journals Endorse Unbiased Reporting of Research? A Systematic Evaluation of Instructions for Authors.

Introduction: Well-structured instructions for authors in journals help researchers in reporting unbiased results, which subsequently facilitates the review process. There have been reports of systematic evaluations of instructions for authors from journals in various medical specialties. However, precise information on the nature and extent of these instructions for authors in addiction science is lacking. Hence, this study systematically evaluated the instructions for authors for journals in addiction science. Methods: A total of 1139 journal titles were retrieved across multiple databases. Finally, 88 exclusive titles fulfilling the eligibility criteria were considered in this study. The four domains evaluated were journal characteristics, reporting, statistical reporting, and ethical requirements. Results: More than half of the journals were published by academic institutions or professional societies. Less than one-fourth of the journals endorsed adherence to various reporting guidelines and endorsed the Consolidated Statements on Randomized Controlled Trials guidelines to the maximum level (14.8%). Approximately, half (48.9%) of the journals had a separate section on "statistical analysis." The various parameters of statistical reporting were suboptimally endorsed. Conclusion/Importance: The instructions for authors in addiction science journals provide insufficient information in various domains. There is an urgent need to improve the author instructions segment of addiction science journals so that the process of research dissemination can occur more effectively. A higher rate of endorsement of various reporting guidelines and statistical reporting may help to minimize reporting bias as well as prevent unnecessary delays in the publication of important research findings.

An Observational Study of Treatment Seeking Users of Natural Opiates from India.

BACKGROUND: The type of opioid used influences the severity and complications experienced. Natural opiates (opium and poppy husk) use is a socio-culturally accepted phenomenon reported in India. However, studies on their profile, quality of life, and addiction severity are limited. OBJECTIVES: The objective of this cross-sectional, observational study was to assess the socio-demographic profile, clinical profile, addiction severity, and quality of life of treatment-seeking natural opiate users. METHOD: Hundred subjects aged 18-65 years using opium or poppy husk seeking outpatient treatment at a tertiary addiction treatment center in India were interviewed to collect information on their socio-demography, natural opiate, and other substance use. Additionally, their addiction severity and quality of life were assessed using Addiction Severity Index-Lite and WHO Quality of Life-Bref instrument, respectively. RESULTS: All subjects were male with a mean age of 44.6 (±11.0) years. Majority (97%) used poppy husk daily orally. Curiosity/experimentation (63%) was the most common reason for starting opiate use. The past month rates of tobacco, alcohol, cannabis, and sedative-hypnotics use was 58%, 33%, 3%, and 12%, respectively. Only 4% injected any opioid. Inability to afford opiates (72%) was the most common reason for seeking treatment. Rates of medical, familial, social, psychological, and legal complications were low, while the WHOQOL-BREF scores fell between 40 and 50 across various domains. Conclusions/Importance: Natural opiate users may constitute distinct subgroup of opioid users with fewer/no complications despite long duration of uninterrupted use. These findings would be important in planning management strategies for people dependent on natural opiates.

Effect of high-frequency repetitive transcranial magnetic stimulation (rTMS) in patients with comorbid panic disorder and major depression.

OBJECTIVE: To explore the role of dorsolateral prefrontal cortex (DLPFC) stimulation in the treatment of panic disorder with comorbid depression. METHODS: The present study reports findings from retrospective analysis of 13 treatment-resistant patients diagnosed with comorbid panic disorder and depression, given 20 sessions of high-frequency transcranial magnetic stimulation (rTMS) over left-DLPFC over a period of 1 month. RESULTS: There was a significant reduction in both the panic and depressive symptom severity, assessed by applying Panic Disorder Severity Scale (PDSS) and Hamilton Depression Rating Scale (HDRS) at baseline and after 20 sessions of rTMS. There was a 38% and 40% reduction of PDSS and HDRS scores, respectively, in the sample. The changes in PDSS and HDRS scores were not significantly correlated (ρ = -0.103, p = 0.737). CONCLUSIONS: High-frequency rTMS delivered at left-DLPFC may have a potential role in treatment of comorbid panic disorder and depression. Future studies done on a larger sample in a controlled environment are required to establish its role.

Acute REM sleep behaviour disorder associated with alcohol withdrawal: A case report and literature review.

INTRODUCTION: Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by the loss of REM sleep muscle atonia and the enactment of dreams. Acute RBD associated with alcohol withdrawal syndrome is known, but the studies are limited, particularly on its neurobiological underpinnings and management alongside the withdrawal state. This work attempts to address this using a case study and relevant literature review. CASE PRESENTATION: A 40-year-old male with alcohol dependence (for 20 years) reported new-onset terrifying nightmares and violent behaviours in his sleep precipitated by alcohol withdrawal states for the last 18 months. The polysomnographic finding of REM-without-atonia supported the diagnosis of RBD. He was treated with chlordiazepoxide 100 mg/day (gradually tapered and stopped) and thiamine supplements. Post-discharge, he remained abstinent and symptom-free during the three months of follow-up. DISCUSSION: RBD related to alcohol withdrawal syndrome has been previously described in a few anecdotal reports. Sudden withdrawal from central nervous system suppressants like alcohol is hypothesised to cause a homeostatic imbalance in gamma-aminobutyric acid (GABA) pathways and 'REM rebound', resulting in the clinical and polysomnographic picture of RBD. Benzodiazepines have been found to be useful in both RBD and alcohol withdrawal. CONCLUSIONS: Alcohol withdrawal syndrome may present with acute RBD, which can be treated with a short course of benzodiazepine. However, further studies are needed to explore the long-term course of RBD in these patients.

National Drug Laws, Policies, and Programs in India: A Narrative Review.

Background: Drug use is a major public health issue in India. Significant changes in the approach toward drug use have happened in the last few decades. Despite this, no systematic attempt has been made to document the same in the scientific literature. This narrative review attempts to discuss the major drug laws, policies, and national programs of the Government of India (GoI). Methods: A thorough search was conducted to look for policies, programs, acts, and notifications related to substance use/drug use on various websites of different ministries of the GoI. Acts, programs, and policies addressing substance use were identified. Results: Various drug laws, programs, and acts from the GoI provide a multipronged approach to curbing the procurement of drug use along with its prevention and cure. The Ministry of Social Justice and Empowerment (MoSJE) is the nodal ministry for drug demand reduction. The enactment of the Narcotic Drugs and Psychotropic Substances (NDPS) Act 1985 and Policy 2012 and the implementation of India's Drug De-Addiction Program (DDAP) are important landmarks in this journey. Conclusion: The GoI initiatives for reducing the mental health burden in this country in general and substance use disorders (SUDs), in particular, are immense. The acts/statutes/laws/notifications are all interlinked. Stakeholders in mental health, public health, and policy-making need to upgrade themselves with the relevant statutes to curb the menace of drug use.

Burden of alcohol use and inclusion of alcohol use disorder medications in the essential medicine lists across 132 countries: An observational study.

Harmful use of alcohol effects the health of the population. The treatment coverage of alcohol use disorders (AUD) varies among countries. The study aimed to determine the inclusion of AUD medicines in various national Essential Medicine Lists (EMLs) and its association with alcohol consumption. It was a secondary data analysis of alcohol consumptions and AUD related medicines in EML. Data were extracted from the WHO Global Essential Medicines database and the WHO Global Status Report on Alcohol and Health 2018. Data were extracted for 194 countries. Only 132 of 194 countries (68.0%) had EML, and among the 132 countries only 27.3% had included AUD medicines in their EML. Only 36 countries had included any of the AUD medicines in their EML. Disulfiram was included by 23 countries, while Acamprosate and Naltrexone was included by only four and 19 countries, respectively. Among the countries, 36.1% were from upper-middle income countries and 16.65 from low-income countries. The inclusion of AUD medicines in national EML was neither associated with alcohol consumption parameters nor the alcohol consumption related policy parameters. Considering the high prevalence of AUD and its complications, there is an urgent need to focus on including AUD medicines in national EML for making AUD treatment available and accessible across the world.

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.

Toward a national policy on Alcohol: A complex public health issue in need of urgent action.

Alcohol use is a major public health issue. It is also associated with a range of family, social, and economic problems. This led multiple countries worldwide to adopt national policies for alcohol regulation. Over the years, alcohol use and related problems have increased in India. The existing regulatory framework on alcohol varies greatly across states in terms of government sanctions, pricing, and legal drinking age, resulting in variations in its availability and prevalence of alcohol use disorder and related harms. Despite alcohol use being mentioned in several national policies and plans, a comprehensive national policy addressing alcohol is lacking. In this manuscript, the need for a dedicated national alcohol policy is underscored, emphasizing its potential to mobilize resources, prioritize interventions, and guide various stakeholders. The timely implementation of such a policy is crucial to address the multifaceted challenge of alcohol use effectively.

Nonprescription use of buprenorphine tablets among patients at a tertiary care addictive disorder treatment center in India: Observa-tions and implications.

OBJECTIVE: Nonprescribed use of drugs is a clinical and public health challenge fueled by diversion of controlled opioids like buprenorphine. In this study, we report the nonprescription use of buprenorphine and buprenorphine-naloxone for the first time in India. DESIGN: A cross-sectional observational study utilizing semistructured interviews. SETTING: A tertiary care addictive disorder treatment center in India, which provides inpatient and outpatient medically oriented care that includes agonist treatment (buprenorphine) or detoxification and antagonist treatment (naltrexone). PARTICIPANTS: Patients aged 18-65 years, registered at the center, and who had a history of current (within the past 6 months) nonprescription use of buprenorphine tablets were recruited. MAIN OUTCOME MEASURES: Participants were questioned about demographic and clinical factors and details of nonprescription use of buprenorphine and buprenorphine-naloxone using a structured questionnaire. Since both buprenorphine with naloxone and buprenorphine without naloxone are available and transacted on the street "loose" out of the blister packs, we were unable to differentiate the use of plain buprenorphine and a combination of buprenorphine- naloxone. RESULTS: A majority of the participants used nonprescribed tablets buprenorphine and buprenorphine-naloxone with an intent to control the withdrawal symptoms, and the reason for this use was that other patients shared their prescriptions of these medications. About half of the participants injected the tablets, and liquid pheniramine was most commonly used as the solvent for dissolving the tablets. A "high" was perceived by around half of those who injected. Participants reported knowing, on an average, around 13 peers who injected the tablet buprenorphine or -buprenorphine-naloxone. CONCLUSION: Nonprescription use of tablets buprenorphine and -buprenorphine-naloxone is a clinical concern and also an important public health issue. Geographical and systemic expansions of the availability of buprenorphine may reduce the "demand" for nonprescribed buprenorphine, while the opportunities for diversion from treatment centers can be minimized through more careful clinical prescriptions and monitoring practices.

Violence against psychiatric trainees from Asian countries: A pilot online survey.

Background: Violence against psychiatry trainees is an important issue to the medical profession. However, this matter has been under researched, especially in Asian countries. Aim: We aimed to explore the rates and factors associated with violence against psychiatric trainees in Asian countries. Methods: An online, 15 item cross sectional pilot survey was designed and disseminated among psychiatric trainees in Asia through the World Network of Psychiatric Trainees, national and local networks of trainees, and social media. The questionnaire sought to enquire about the experience of physical, verbal, and sexual assaults and its impact. Data were analyzed using Statistical Package for the Social Sciences (SPSS) V20.0. Results: A total of 467 responses were obtained from psychiatric trainees in 16 countries in Asia. More than two thirds of participants (n = 325, 69.59%) reported a history of assault. Psychiatry inpatient units were the most common setting (n = 239, 73.54%). A relatively lower proportion of participants from the East Asian countries reported an assault, compared to other countries (χ2 = 13.41, P = 0.001). Sexual assault was more common among women compared to men (χ2 = 0.94, P = 0.002). Conclusion: Violence against psychiatric trainees seems common across Asian countries. Our findings call for further systematic investigation of the phenomenon and suggest the need to develop programs to protect psychiatric trainees against the threat of violence and its subsequent psychological complications.

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.

Improving Treatment of Substance Use Disorders through Community Drug Treatment Clinics: An Experiential Account.

India has a huge burden of substance use disorder (SUD). The national response to the problem of SUD has been to support addiction treatment centers either in government hospitals or in nongovernmental settings. The existing number of addiction treatment facilities is less compared to the burden of substance use in India. The existing models of treatment in India place undue emphasis on inpatient treatment of SUD. Community-based treatment aims to bring the treatment of SUD closer to the patients in their community. Community-based treatment of SUD utilizes existing services available in the community by establishing an integrated network of community-based services. There have been different models of community-based care for the management of SUD in India. Most of them, however, address short-term withdrawals and do not provide long-term treatment in community. National Drug Dependence Treatment Centre, AIIMS, New Delhi, has been providing community-based treatment for SUD since the 1990s. Two of the three community drug treatment clinics (CDTCs) are in operation for more than 5 years now and cater to the population residing within a defined catchment area. The CDTCs use infrastructure available in the community to operate the clinics. The clinics are run daily by a team of nursing staff, while the doctor is available only twice a week. A menu of options, ranging from short-term treatment to long-term agonist maintenance treatment is provided in the clinic. Both pharmacotherapy and psychosocial interventions are provided. Each clinic caters to hundreds of patients through these facilities. There is a need to expand CDTCs in India considering their cost-effectiveness, acceptability, and overall effectiveness, especially in urban colonies with higher substance-related problems.