"Harm reduction approach for tuberculosis and substance use disorders: A review of approaches and implications in the Indian context".

There are limitations to traditional treatment approaches in addressing the needs of individuals with dual comorbidity of TB and SUD. The concept of harm reduction as a distinct approach to addressing substance use, focusing on minimising the negative consequences associated with it rather than advocating for complete abstinence. Different harm reduction strategies, such as opioid substitution therapy, needle and syringe programmes, testing for viral infections etc. have been effectively employed for SUDs in past. Similarly, TB risk minimization approaches like improving housing and nutrition and focused testing strategies are considered as harm reduction strategies for TB management. The relationship between tuberculosis (TB) and substance use disorders (SUDs) involves a complex interplay of biopsychosocial factors. It is crucial to prioritise integrated and closely monitored care in order to address the treatment challenges and potential drug interactions that may arise. In light of the acknowledged challenges like limited awareness, infrastructure, drug resistance, and stigma, it is imperative to explore potential avenues for the implementation of harm reduction strategies targeting individuals with comorbid TB and SUD in India. Potential strategies for addressing the issue includes a range of measures, such as augmenting investments in healthcare, integrating policies, tackling social determinants, and establishing shared platforms for psychosocial rehabilitation.

Treatment resistant psychosis in children and adolescents and clozapine: Nuances.

With proliferation in research on high-risk psychosis spectrum diseases, it is crucial to distinguish a prodrome or psychosis-like episode in children and adolescents from true psychosis. The limited role of psychopharmacology in such circumstances is well-documented, underlining the difficulties in diagnosing treatment resistance. To add to the confusion is emerging data on the head-to-head comparison trials for treatment-resistant and treatment-refractory schizophrenia. Clozapine, the gold-standard drug for resistant schizophrenia and other psychotic psychopathology, lacks FDA or manufacturer guidelines for use in the pediatric population. Possibly due to developmental pharmacokinetic (PK) considerations, clozapine-related side effects are more commonly seen in children than adults. Despite evidence of an increased risk for seizures and hematological problems in children, clozapine is widely used off-label. Clozapine reduces the severity of resistant childhood schizophrenia, aggression, suicidality, and severe non-psychotic illness. There is inconsistent prescribing, administration, and monitoring of clozapine, and limited database evidence-backed guidelines. Despite the overwhelming efficacy, problems remain regarding unambiguous indications of use and risk-benefits assessments. This article reviews the nuances in the diagnosis of treatment resistance psychosis in childhood and adolescents and its management, in particular highlighting the evidence base for clozapine in this population group.

Depression and quality of life among elderly: Comparative cross-sectional study between elderly in community and old age homes in Eastern India.

BACKGROUND: Depression among elderly is an emerging public health concern. Along with other comorbidities, depression affects the quality of life and functional ability of the geriatric population. This study aimed to assess the depression and quality of life among elderly and compare these parameters among the inhabitants of old age home and in the community. MATERIALS AND METHODS: A cross-sectional study was conducted among the elderly of the community and old-age homes in the urban areas of Raipur, Chhattisgarh between March and July 2016. Hundred elderly (50 in each group) participated in the study. Geriatric Depression Scale 15 (GDS-15) and Older People Quality of Life (OPQoL)-35 scale were used to assess the geriatric depression and quality of life, respectively. Association between depression and demographic variables were analyzed by Chi-square/Fisher's exact test. Pearson's correlation coefficient was calculated between GDS-15 and OPQoL-35 scale. RESULTS: The prevalence of geriatric depression was 59%. Quality of life was better among the old-age home elderly participants than that of community elderly when compared for score of life over all (11.78 vs. 13.56), health (12.8 vs. 14.0), social relationship (10.48 vs. 13.9), control over life (11.92 vs. 14.08), home and neighborhoods (9.38 vs. 12.36), psychological and emotional wellbeing (10.96 vs. 13.7), financial circumstances (14.5 vs. 16.7), and leisure and activities (13.86 vs. 15.28). Moderate positive correlation was observed between depression and quality of life. CONCLUSION: The higher prevalence in our study emphasizes the need to delineate the actual burden in the elderly population and provide necessary supportive measures. It needs to be addressed adequately through a coordinated primary care approach and community and social support. Timely and adequate management of depression can improve the quality-of-life outcomes.

Management of Alcohol Withdrawal Syndrome in Patients with Alcoholic Liver Disease.

Alcohol withdrawal syndrome (AWS) is a common condition that is seen in treatment-seeking patients with Alcohol use disorder (AUD) and alcoholic liver disease (ALD). AWS, which typically starts within 4-6 h of the last alcohol use, can range from mild symptoms such as insomnia, tremors, and autonomic hyperactivity to more severe symptoms such as seizures and delirium tremens. Clinical Institute Withdrawal Assessment Scale-Alcohol Revised (CIWA-Ar) is the most commonly used scale to assess AWS in clinical practice. The presence of moderate withdrawal as indicated by a score of more than 8 is an indication for pharmacotherapy. Lorazepam and oxazepam are preferred agents for the management of AWS in the setting of ALD. In severe ALD, benzodiazepines should be used cautiously with monitoring due to the risk of excessive sedation or precipitating hepatic encephalopathy.

Complicated Alcohol Withdrawal-An Unintended Consequence of COVID-19 Lockdown.

AIM: To assess the impact of COVID-19-related lockdown in India on alcohol-dependent persons. METHOD: We examined the change in the incidence of severe alcohol withdrawal syndrome presenting to hospitals in the city of Bangalore. RESULTS: A changepoint analysis of the time series data (between 01.01.20 to 11.04.20) showed an increase in the average number of cases from 4 to 8 per day (likelihood ratio test: χ2 = 72, df = 2, P < 0.001). CONCLUSION: An unintended consequence of the lockdown was serious illness in some patients with alcohol use disorders.

Portrayal of alcohol in Bollywood movies: A mixed methods study.

INTRODUCTION: Exposure to alcohol in popular movies during adolescence is associated with higher rates of alcohol use. We aimed to assess the extent and pattern of depiction of alcohol in Bollywood movies, and to analyze the trends in portrayal of alcohol over three decades selected for the study. MATERIALS AND METHODS: We selected the top five grossing movies for each year of the three decades selected (1961-1970; 1981-1990; and 2001-2010). Content analysis was conducted for each scene depicting alcohol in the movie. We compared quantitative variables across the three decades to assess for any changes in the portrayal of alcohol and performed qualitative content analysis for the text description of the context, in which alcohol was depicted in each movie. RESULTS: Of the total 150 movies analyzed, 135 (90%) movies contained at least one scene depicting alcohol. Alcohol scenes comprised 7% of the total movie time. Majority of the scenes (92.2%, n = 976) showed the substance (alcohol) itself. Spirits were the most common alcohol beverages depicted (75.1%, n = 733). Only 7.9% of scenes (n = 84) depicted alcohol brands. About 67% (n = 709) of scenes showed characters consuming alcohol or appeared intoxicated. Most scenes portrayed hero (n = 253, 35.7%) consuming alcohol. Female characters were depicted in 7.5% (n = 53) alcohol scenes. The third decade (2001-2010) had the least proportion of scenes depicting Spirits and the highest proportion of scenes depicting beer and wine. Decade three also had the most proportion of scenes set in clubs, bars, discotheques or restaurants, scenes with characters of "positive" shade depicting alcohol use, and the scenes portraying heroine with alcohol use. CONCLUSION: There is an increasing trend toward alcohol depiction by positive characters for fun and relaxation, and toward depiction of low-concentration alcohol such as beer in recent decades. The impact of changing trend of alcohol depiction on the Indian viewers, especially young audience, needs further study.

Social stigma and its determinants among people living with HIV/AIDS: A cross-sectional study at ART center in North India.

INTRODUCTION: HIV/AIDS-related stigma and discrimination together have long been recognized as one of the main obstacles in the prevention, care, and treatment of HIV and AIDS. Yet, little has been done on a large scale to combat them. Stigma still precludes many in need of treatment and care for people living with HIV/AIDS (PLHIV). The purpose of this study was to assess the social stigma among PLHIV and the factors influencing it. MATERIAL AND METHODS: This hospital-based cross-sectional study was conducted among four hundred PLHIV attending the antiretroviral therapy (ART) center of a tertiary care institute of Haryana, India, using a semi-structured questionnaire and Berger Stigma Scale. Data analysis was performed using SPSS version 20.0 software to explore the relationship between a dependent (social stigma score) and other independent variables. RESULTS: The overall mean stigma score in our study was found to be 110.96 ± 17.05. The stigma score in the male PLHIV was higher than in females. Male gender, younger age group (18-25 years), nuclear family, and rural residents PLHIV experienced more stigma as showed by the logistic regression analysis. CONCLUSION: Stigma and discrimination are a continuous deterrent for program implementation or successful outcomes. Education, behavior change strategies, and building supportive environments to the targeted population (young, single, and rural residents) can provide a roadmap in ending stigma and discrimination.

Internalized stigma and its correlates among treatment seeking opium users in India: A cross-sectional observational study.

Opium has been used in India since ancient times for social, recreational, religious and medicinal purposes. Opium users seem to constitute a distinct sub-population among opioid users, who have minimal complications, better functioning and socio-cultural acceptance. Prominent levels of stigma have been reported against people who use opioid drugs, but the same cannot be extrapolated to opium users. There is a vast number of opium users in India, and it is prudent to understand the stigma faced by them to better address their problems. Hence, in the current study we aimed to assess the internalized stigma and its correlates among opium users who seek treatment at a tertiary care drug treatment centre in North India. 117 adult male participants having opioid dependence (opium being the most common opioid in last 3 months) were assessed using Internalized Stigma of Mental Illness (ISMI) scale - Hindi version. The stigma scores were in the mild to moderate range, which was less than that found in previous studies among heroin and alcohol users in similar setting. Moreover, higher stigma scores were associated with lower educational status and higher proportions of income spent on substances. This is the first study to document stigma among opium users. Further research needs to be conducted to understand the determinants of stigma in this population.

Behavioral and emotional manifestations in a child with Prader-Willi syndrome.

Prader-Willi syndrome is a neurodevelopmental disorder characterized by mental retardation and distinct physical, behavioral, and psychiatric features. Maladaptive behaviours, cognitive impairment, and impediments in speech and language seriously affect the early development and long-term functioning of individuals affected by the illness. We present a case of a 9-year-old child with Prader-Willi syndrome whose behavioural symptoms were treated with low-dose antipsychotic medications.