BehavioR: a digital platform for prevention and management of behavioural addictions

Behavioural addictions have been identified as an emerging public health problem. The unprecedentedpace of the digital revolution, resulting in an ever-increasing use of internet-based technologies,provides the opportunity to create a unique resource to assist in offering public health interventions inthe World Health Organization South-East Asia Region. The ability to deliver evidence-based treatmentand preventive programmes that can be accessed by mobile phones, for example, increases access toa wide range of populations, including hidden or hard-to-reach populations. BehavioR (the Behavioraladdictions Resource hub) has been established with the aim of offering a one-stop resource centre forbehavioural addictions. The expected end-users of this digital platform include patients, caregivers, thegeneral public, health-care providers, academics, researchers and policy-makers. The platform can beused to offer digital health interventions to patients; strengthen the capacity of health-care providers forearly detection of, screening for, intervention in and management of behavioural addictions; and serveas an online repository for reliable information on behavioural addictions for the general public.

Depression and physical noncommunicable diseases: the need for an integrated approach

Depression is globally the third-leading cause of disability in terms of disability-adjusted life-years. Depressionin patients with diseases such as cancer, diabetes mellitus, stroke or cardiovascular disease is 2–4-foldmore prevalent than in people who do not have physical noncommunicable diseases, and may have amore prolonged course. The significant burden due to depression that is comorbid with chronic physicaldisease, coupled with limited resources, makes it a major public health challenge for low- and middle-incomecountries. Given the bidirectional relation between depression and chronic physical disease, the clear wayforward in managing this population of patients is via a system in which mental health care is integratedwith primary care. Central to this integrated approach is the Collaborative Care Model, adapted to the localsociocultural context. In this model, care is jointly led by the primary care physician, supported by a casemanager and a mental health professional. Various successful initiatives in low- and middle-income countriesmay be used as templates for collaborative care in other low-resource settings. The model involves a rangeof interwoven components, such as capacity-building, task-sharing, task-shifting, developing good referraland linkage systems, anti-stigma initiatives and lifestyle modifications. Policies based on adoption of thisapproach would not only directly address depression that is comorbid with physical noncommunicabledisease but also facilitate achievement of Sustainable Development Goal 3, to “ensure healthy lives andpromote well-being for all at all ages”.

Co-occurring depression and alcohol-use disorders in South-East Asia: a narrative review

Depression and alcohol-use disorders frequently co-occur and the presence of one augments the adverseconsequences of the other. This article reviews and synthesizes the available literature on depression andalcohol-use disorders from the World Health Organization (WHO) South-East Asia Region, with respect toepidemiology, screening instruments, interventions and services, and policy. In common with other low- andmiddle-income settings, data from this region on co-occurring depression and alcohol-use disorders arescarce. The wide variations in language and cultural diversity within the countries of this region further makethe identification and management of people with co-occurring depression and alcohol-use disorders a majorchallenge. A range of interventions for individuals with the two disorders have been studied. However, mostof this work has been done in high-income countries, highlighting the need to explore the effectiveness andcost effectiveness of various pharmacological and non-pharmacological interventions in the WHO South-EastAsia Region. Much of this region comprises low-resource settings, with a dearth of trained personnel andresources. Flexible transdiagnostic approaches, delivered by community health workers and integrated intoprimary health care may be a pragmatic approach. Such services should form part of strengthened nationalresponses to alcohol-related public health problems across the region.

Time Trend For Substance Use Disorder And Psychiatric Disorders Among Patients Seeking Treatment From A Dual Diagnosis Clinic Of A Tertiary Care Substance Use Disorder Treatment Centre In India

Objective: The study is aimed at assessment of time trend for substance use disorder and psychiatric disorders among patients seeking treatment from a dual diagnosis clinic of a tertiary care substance use disorder treatment centre in India. Methods: The study is based on chart review of the patients seeking treatment from the Dual Diagnosis Clinic of a tertiary care substance use disorder treatment centre. The records of the patients seeking treatment over a six-year period (2009-2014) were reviewed. Information was collected on sociodemographic variables, substance use disorder and co-occurring psychiatric disorder. Results: A total of 289 patients sought treatment from the dual diagnosis clinic of the centre. Majority were male (97.2%). Primary drugs of abuse were nicotine (74.4%), alcohol (49.5%), cannabis (38.4%), and opioids (28.7%). Most common co-occurring psychiatric disorders were psychiatric disorders, including schizophrenia (45.0%), Major depressive disorder (24.9%), Bipolar disorder (18.3%), anxiety disorder (4.5%) and OCD (2.4%). Most patients with psychotic disorders and depressive disorders had co-occurring alcohol dependence. Most patients with bipolar disorder had co-occurring cannabis dependence. There was a marginally significant increase in proportion of subjects with cannabis dependence (PTrend= .07). There was no significant time trend for various co-occurring psychiatric disorders. Conclusions: The findings of the current study suggest that there has been a marginally significant increase in proportion of subjects with cannabis dependence over the six study years. However, the proportion of co-occurring psychiatric disorders was stable across these years. The findings of the current study suggest that the centre should be prepared to cater to an increasing proportion of patients with cannabis dependence and possibly co-occurring psychotic disorders in the coming years. ASEAN Journal of Psychiatry, Vol. 17 (2): July – December 2016: XX XX.

The Role of NMDA Receptor Antagonists in Nicotine Tolerance, Sensitization, and Physical Dependence: A Preclinical Review

Nicotine, the primary psychoactive component of tobacco products, produces diverse neurophysiological, motivational, and behavioral effects through several brain regions and neurochemical pathways. Various neurotransmitter systems have been explored to understand the mechanisms behind nicotine tolerance, dependence, and withdrawal. Recent evidence suggests that glutamate neurotransmission has an important role in this phenomenon. The aim of the present review is to discuss preclinical findings concerning the role of N-methyl-D-aspartate (NMDA) receptor neurotransmission in mediating the behavioral effects of nicotine, tolerance, sensitization, dependence, and withdrawal. Based on preclinical findings, it is hypothesized that NMDA receptors mediate the common adaptive processes that are involved in the development, maintenance, and expression of nicotine addiction. Modulation of glutamatergic neurotransmission with NMDA receptor antagonists may prove to be useful in alleviating the symptoms of nicotine abstinence and facilitate tobacco-smoking cessation.