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.

Relationship of emotional intelligence and capability of answering higher-order knowledge questions in physiology among first-year medical students.

Emotional intelligence (EI) has a positive correlation with the academic performance of medical students. However, why there is a positive correlation needs further exploration. We hypothesized that the capability of answering higher-order knowledge questions (HOQs) is higher in students with higher EI. Hence, we assessed the correlation between EI and the capability of medical students to answer HOQs in physiology. First-year undergraduate medical students (n = 124) from an Indian medical college were recruited as a convenient sample. EI was assessed by the Schutte Self-Report Emotional Intelligence Test (SSEIT), a 33-item self-administered validated questionnaire. A specially designed objective examination with 15 lower-order and 15 higher-order multiple-choice questions was conducted. The correlation between the examination score and the EI score was tested by Pearson's correlation coefficient. Data from 92 students (33 females and 59 males) with a mean age of 20.14 ± 1.87 yr were analyzed. Overall, students got a percentage of 53.37 ± 14.07 in the examination, with 24.46 ± 9.1 in HOQs and 28.91 ± 6.58 in lower-order knowledge questions (LOQs). They had a mean score of 109.58 ± 46.2 in SSEIT. The correlation coefficient of SSEIT score with total marks was r = 0.29 (P = 0.0037), with HOQs was r = 0.41 (P < 0.0001), and with LOQs was r = 0.14 (P = 0.19). Hence, there is a positive correlation between EI and the capability of medical students to answer HOQs in physiology. This study may be the foundation for further exploration of the capability of answering HOQs in other subjects.NEW & NOTEWORTHY This study assessed the correlation between emotional intelligence (EI) and the capability of medical students to answer higher-order knowledge questions (HOQs) in the specific context of physiology. The finding reveals one of the multifaceted dimensions of the relationship between EI and academic performance. This novel perspective opens the door to further investigations to explore the relationship in other subjects and other dimensions to understand why students with higher EI have higher academic performance.

Effect of Social Media on Diet, Lifestyle, and Performance of Athletes: A Review of Current Evidence.

PURPOSE OF REVIEW: Social media (SM) plays an important role in providing diet and health advice to athletes, but it also carries with it a risk of credibility in the information sought for and received. The objective of this review is to assess the knowledge gap on how SM influences dietary and lifestyle practices in athletes. RECENT FINDINGS: For this, relevant literature was searched in three leading databases with appropriate keywords, which were subjected to proper scrutiny that led to inclusion of 22 articles (original research papers, reviews, viewpoints, and commentaries). The current era of digitalization has seen an over-reliance on internet and SM for nutrition and lifestyle advice for an athlete. SM has become a powerful tool in athlete's choice of food, nutrition information, healthy living, and performance, with merits and demerits. Their role in choosing dietary supplements and particular food types (e.g., ketogenic diet), body image, self-esteem and eating disorders, and in lifestyle and performance are discussed. SM should be used with caution and should not be used alone as a source of information for nutrition related pieces of advise by athletes. Any food type and supplements trending in SM should be discussed with a sports nutritionist before consumption. SM influencers having a big follower base may not always be disseminating the right knowledge on food and nutrition, thus caution should be exercised. For optimal benefit to the athlete, SM information should be in alignment with recommendations provided by sports nutrition and coaches.

PROBLEMATIC USE OF SMARTPHONE AND NOMOPHOBIA AMONG MEDICAL AND NURSING UNDERGRADUATE STUDENTS OF A TERTIARY CARE REFERRAL HOSPITAL IN INDIA AND ITS ASSOCIATION WITH QUALITY OF LIFE: A CROSS-SECTIONAL OBSERVATIONAL STUDY.

BACKGROUND: Overuse of smartphone amongst today's young generation has assumed an epidemic proportion. Assessment of severity of Nomophobia and Smartphone use related problems is important as it can help to ascertain the current adverse consequences of Smartphone problematic use. The study aims to assess the association between smartphone dependence, nomophobia and quality of life in undergraduate medical and nursing students in a tertiary care referral hospital cum medical institution in India. SUBJECTS AND METHODS: This cross-sectional study involved 437 medical and nursing undergraduate students, which involved assessing their dependence for smartphone and nomophobia using the Test for Mobile Phone dependence (TMD) questionnaire brief version and Nomophobia Questionnaire (NMP-Q) respectively. RESULTS: The average hours spent on smartphone per day for the study population was 3.2 hours. Smartphone dependence was found in 12% of study participants. Nearly 50% in each batch had moderate degree of nomophobia and around 13-15% had severe nomophobia. Both smartphone dependence and nomophobia were significantly associated with each other and had significant associations with poorer quality of life in the medical and nursing students. Preclinical medical students scored higher in all the domains of Smartphone dependence and nomophobia questionnaire and were associated with poor quality of life compared to other batches. CONCLUSION: Excessive smartphone use is associated with poorer quality of life in medical and nursing students. More studies in future are required that will involve various age groups and other educational streams which willadd up to the existing knowledge on technology addiction.

Effect of vortioxetine versus venlafaxine on cognitive functions in adults with major depressive disorder: A randomized-controlled trial.

Background: Vortioxetine and venlafaxine are antidepressants which have shown established efficacy to treat major depressive disorder (MDD). There are no studies that compared them for their efficacy in cognitive symptoms of depression. The study aimed to compare the effect of vortioxetine and venlafaxine on the change in cognitive scores in adults with MDD. Methods: The present study was an open-label, active-controlled parallel design randomized clinical trial. After randomization, baseline clinical evaluations by Montgomery-Asberg Depression Rating Scale (MADRS) and Social and Occupational Functioning Assessment Scale (SOFAS) were done and coding (subset of WAIS-IV), WCST, TMT, Stroop test, PGI memory were used to assess cognition in 100 unmedicated MDD patients. They were reassessed after eight weeks of monotherapy with vortioxetine or venlafaxine. Results: Primary cognitive measure (coding score) was found to be significantly higher (Mean Difference = 0.680; 95% CI:.202 to 1.158; P = 0.006) in vortioxetine in comparison with venlafaxine. Stroop test scores (word score, color score, color-word score) were also found to be significantly higher with vortioxetine. In other cognitive measures (WCST scores: total trials, total errors score, total perseverative responses score, total perseverative errors scores; TMT-A and B scores), a significant decrease in scores with vortioxetine in comparison with venlafaxine were observed. A significant decrease in MADRS and increase in SOFAS scores were observed with vortioxetine in comparison with venlafaxine. Both the drugs alleviated the symptoms of depression but vortioxetine was better tolerated. Conclusion: Our study findings suggest that improvement in cognitive scores is significantly higher with vortioxetine than venlafaxine over the eight weeks of monotherapy. Clinical Trial registration number: CTRI/2020/07/026819 (Registered with Clinical Trials Registry- India).

EFFECT OF PSYCHOLOGICAL FIRST AID ON MENTAL HEALTH IN HOSPITALIZED STABLE COVID-19 PATIENTS: A PRE-POST RESEARCH DESIGN.

BACKGROUND: The COVID-19 pandemic is known to affect mental health of sufferers. Psychological First Aid (PFA) is a mental health service for individuals in crisis, which can be provided to anyone regardless of age and it does not require mental health expertise. Its effect on mental health issues of COVID-19 patients has not been studied effectively. The present study aimed to assess the psychological impact and effect of PFA on mental health in stable COVID-19 hospitalized patients. SUBJECTS AND METHODS: This was an interventional study with a pre-post research design in a tertiary government teaching hospital in eastern India. 93 stable patients who were admitted in a period of a month with COVID-19 were included in the study after obtaining appropriate consent. They were provided PFA (both structured individual and group sessions) by trained nurses. The Depression, Anxiety, and Stress scale (DASS-21) was used to assess depression, anxiety, and stress in the patients before and after intervention. RESULTS: The mean age of study population which comprised of 68.8% males was 56.2 ± 13.7 years. Median scores for depression, anxiety and stress were 4, 6 and 6 on admission and 0, 2 and 2 respectively before discharge after intervention (P<0.001). 13%, 25.9% and 8.6% were the combined percentages scores of patients with varying levels of depression, anxiety and stress at the time of admission which were reduced to 4.3% (P=0.046), 5.4% (P=0.001), 2.2% (P=0.03) respectively before discharge after intervention within one week. CONCLUSION: PFA may be a cost-effective intervention in stable COVID-19 admitted patients who had depression, anxiety, and stress.

Paroxysmal dystonia and psychotic exacerbations in chronic psychosis: Diagnostic dilemmas and preliminary treatment approaches.

Patients with chronic psychosis on prolonged antipsychotic therapy may present with paroxysmal dystonia along with an exacerbation of their psychotic symptoms: paroxysmal dystonia and psychotic exacerbations (PDPE). The interindividual variability in the clinical presentations of PDPE can pose challenges in its diagnosis and treatment. The objectives of this work are to (i) discuss this rare phenomenon through a series of 10 patients and a relevant literature review, (ii) conceptualize its neurobiological underpinnings, and (iii) explore the preliminary treatment approaches for its management. Acute stress and/or a dysfunctional gamma-aminobutyric acid (GABA) ergic or dopaminergic system may be implicated in the pathogenesis of PDPE. The episodes respond acutely to parenteral benzodiazepines, while long-term management can be achieved by reducing antipsychotic doses, switching to clozapine or using central GABA enhancers. This article is the first attempt at conceptualizing and exploring treatment options for the rare condition PDPE and intends to guide future research in this regard.

Stigma and discrimination among persons with mental illness in a tertiary care medical institution in Southern India.

The proportional contribution of mental disorders to the total disease burden in India has almost doubled since 1990. Stigma and discrimination are major barriers to seeking treatment for persons with mental illness (PMI). Stigma reduction strategies are thus crucial, and for this, there needs to be an understanding of the various factors associated with them. The current study intended to assess stigma and discrimination in PMI visiting the department of psychiatry in a teaching hospital in Southern India and their association with various clinical and sociodemographic factors in them. The index study was a descriptive cross-sectional study involving consenting adults who presented to the department of psychiatry with mental disorders from August 2013 to January 2014. Socio-demographic and clinical data were collected using a semi-structured proforma, and the Discrimination and Stigma Scale (DISC-12) was used to assess discrimination and stigma. Most of PMI suffered from bipolar disorder, followed by depression, schizophrenia, and other disorders, such as obsessive-compulsive disorder, somatoform disorder, and substance use disorder. Discrimination was experienced by 56% of them and 46% had stigmatizing experiences. Both discrimination and stigma were found to be significantly associated with their age, gender, education, occupation, place of residence, and illness duration. While PMI suffering from depression experienced the highest discrimination, those with schizophrenia faced the stronger stigma. Binary logistic regression revealed depression, family history of psychiatric illness, age of less than 45 years, and rural locality of residence to be the significant determinants of discrimination and stigma. The study thus found that stigma and discrimination were associated with multiple social, demographic, and clinical factors in PMI. A rights-based approach to PMI is the need of the hour to tackle stigma and discrimination, which is already included in recent Indian acts and statutes. Implementation of these approaches is the need of the hour.

COVID-19 Pandemic and the Provision for Electroconvulsive Therapy and Other Non-Invasive Brain Stimulation in India: A Template for Future Pandemics.

The coronavirus disease (COVID-19) has emerged as a major public health concern worldwide. While containing the infection and caring for the ill has been a focus over the last 2 years, there has also been a burgeoning concern for mental health issues during this never-ending pandemic. The focus of health care machinery prioritized confronting and containing the pandemic that had majorly side-lined other aspects of public health. This also impacted persons with mental illness (PMI) requiring Electroconvulsive Therapy (ECT), an often essential and life-saving treatment and thus an essential procedure. ECT and other non-invasive brain stimulation (NIBS) services have seen a setback during this pandemic both in terms of its accessibility by the PMI and in effectively delivering its benefits by psychiatrists. In this article, we will be discussing the problems with provision and delivery of ECT services as well as other NIBS during this pandemic with a brief outline on the solutions for such with special focus on a developing country like India. This article will also endeavour in providing a roadmap in the delivery and provision of NIBS modalities of therapy for future pandemics, if any.

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.

Neuroplasticity in Depression: A Narrative Review with Evidence-Based Insights.

Major Depressive Disorder (MDD) is one of the leading causes of disability worldwide. The current pharmacological treatment options for MDD, which rely on the mono-amine hypothesis, has their limitations with respect to treatment non-response, partial response etc. This propels for a search for a novel neurobiological understanding of MDD that can lead to novel treatment options. A literature search strategy was thus employed using relevant keywords pertaining to the topic in PubMed, Embase and Google Scholar. Systematic reviews and meta-analyses, narrative reviews and clinical trials were reviewed to incorporate the most robust evidence-based literature available. A total of 37 publications were narrowed down based upon the topic. Alterations in brain neuroplasticity, as evidenced by changes in neurotrophic factors and from neuroimaging, has been found to be a strong patho-mechanism for MDD. This link has been exploited to stimulate psychopharmacological research to treat MDD.

Comparison of Acute Followed by Maintenance ECT vs Clozapine on Psychopathology and Regional Cerebral Blood Flow in Treatment-Resistant Schizophrenia: A Randomized Controlled Trial.

BACKGROUND AND HYPOTHESIS: In treatment-resistant schizophrenia (TRS), Clozapine is only approved treatment with undesirable side-effects, warranting better alternatives. Our hypothesis is acute followed by maintenance Electroconvulsive Therapy (M-ECT) will be comparable in efficacy and safety to Clozapine in TRS. STUDY DESIGN: In this open-label trial, 60 TRS patients were randomized equally to M-ECT (following an acute-course) or Clozapine. Positive and Negative Syndrome Scale (PANSS), Clinical Global Impression Schizophrenia Scale (CGI-SCH), Montreal Cognitive Assessment (MoCA), and Global assessment of functioning (GAF) were measured and compared within and between the groups at baseline, 6 weeks, 12 weeks, and 24 weeks. SPECT-CT brain was done at baseline and 24 weeks to compare the changes in regional cerebral perfusion between the groups and correlate with the changes in the outcome-measures. STUDY RESULTS: The PANSS-T scores changes from baseline over the observation-points were significant in both M-ECT and clozapine groups (P < .001), with comparatively better reduction with M-ECT (P < .001). Similar trends were observed in PANSS subscales, CGI-SCH and GAF in both groups, with significantly better improvement with M-ECT over the study-period. After 24 weeks, there was significantly better perfusion with M-ECT in bilateral prefrontal and temporal cortices (P < .05). With M-ECT, a positive correlation was found between changes in PANSS-P scores and left-lateral Temporal cortical perfusion (r = .465, P = .017). CONCLUSIONS: Acute followed by M-ECT was more effective than clozapine over 6 months in reducing the positive and negative symptoms, general psychopathology, illness-severity, and improving the global functionality in TRS [clinicaltrials.gov: NCT03807882].