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Background and Aims: Assessment of the severity of substance use disorders (SUDs) in a culture-sensitive manner can help gauge the current condition of the substance user and assess change with time. The present study aimed to develop a scale for the assessment of the severity of SUDs in the Indian clinical context. Methods: Based upon the review of literature on previously available instruments and a consultative meeting of experts, a clinician-rated scale was developed that finally comprised 41 items. A briefer 5-item scale with current and lifetime versions was also developed. The scales were applied to patients with SUDs at six different clinical sites. Results: The instrument was applied to 720 patients (98.2% males, mean age: 34.6 years). The Cronbach's alpha of the full scale was 0.852. The inter-rater reliability Pearson correlation coefficient of the full-scale was r = 0.821 (P < 0.001), and the intra-class correlation coefficient single measure was 0.800 (95% confidence interval: 0.724-0.956). A four-factor solution was suggested to be the most tenable. The mean application duration of the full scale was 13.4 minutes, and that of the briefer version was 2 minutes. Conclusion: This validated scale could be a potentially useful assessment measure for the severity of SUDs in the Indian context. The utility lies in the simplicity of administration and scoring and the balance between brevity and thorough assessment. [ABSTRACT FROM AUTHOR]

Background: Substance use disorders (SUDs) are among the leading causes of morbidity in the population. In low- and medium-income countries like India, there is a wide treatment gap for SUD. A multicentric study on the care pathways for SUD in India can help to understand service provision, service utilization, and challenges to improve existing SUD care in India. Aim: We aimed to map pathways to care in SUD. We compared the clinical and demographic characteristics of patients who first consulted specialized services versus other medical services. Methods: This was a cross-sectional study of consecutive, consenting adults (18-65 years) with SUD registered to each of the nine participating addiction treatment services distributed across five Indian regions. We adapted the World Health Organization's pathway encounter form. Results: Of the 998 participants, 98% were males, 49.4% were rural, and 20% were indigenous population. Addiction services dominated initial (50%) and subsequent (60%) healthcare contacts. One in five contacted private for-profit healthcare. Primary care contact was rare (5/998). Diverse approaches included traditional healers (4-6%) and self-medication (2-8%). There was a 3-year delay in first contact; younger, educated individuals with opioid dependence preferred specialized services. Conclusion: There is a need to strengthen public healthcare infrastructure and delivery systems and integrate SUD treatment into public healthcare. [ABSTRACT FROM AUTHOR]

Objectives: The response to antipsychotic therapy is highly variable. Pharmacogenomic (PGx) factors play a major role in deciding the effectiveness and safety of antipsychotic drugs. A hybrid type 2 effectiveness-implementation research will be conducted to evaluate the clinical utility (safety and efficacy), cost-effectiveness, and facilitators and barriers in implementing PGx-assisted management compared to standard of care in patients with schizophrenia attending a tertiary care hospital in eastern India. Methods: In part 1, a randomized controlled trial will be conducted. Adult patients with schizophrenia will be randomized (2: 1) to receive PGx-assisted treatment (drug and regimen selection depending on the results of single-nucleotide polymorphisms in genes DRD2, HTR1A, HTR2C, ABCB1, CYP2D6, CYP3A5, and CYP1A2) or the standard of care. Serum drug levels will be measured. The patients will be followed up for 12 weeks. The primary endpoint is the difference in the Udvalg for Kliniske Undersøgelser Side-Effect Rating Scale score between the two arms. In part 2, the cost-effectiveness of PGx-assisted treatment will be evaluated. In part 3, the facilitators and barriers to implementing PGx-assisted treatment for schizophrenia will be explored using a qualitative design. Expected outcome: The study findings will help in understanding whether PGx-assisted management has a clinical utility, whether it is cost-effective, and what are the facilitators and barriers to implementing it in the management of schizophrenia. Trial registration: The study has been registered with the Clinical Trials Registry–India (CTRI/2023/08/056210). [ABSTRACT FROM AUTHOR]

Introduction: The aim was to evaluate the outcome of tobacco cessation services. The primary objective was to find the association of early retention in services with tobacco cessation outcomes. Secondarily, it tried to find other sociodemographic, clinical, and treatment-related predictors of tobacco cessation. Methodology: The outcome would be evaluated through a retrospective-prospective design. The retrospective design was recorded based, while the prospective design was done telephonically by calling the patients and enquiring about their status after at least 6 months since their first visit. Patients with "No tobacco usage in last 1 month" were considered "abstinent." Those who "reduced their usage in last 1 month" by about 50% were considered to have "reduced" usage, whereas others who "continued their usage in same previous manner" were considered "same" user. Results: Out of 356 patients registered between June 1, 2021 and February 28, 2022, 81 (22.75%) could not be contacted, 221 (62.08%) had "reduced usage" after a tele-follow-up of at least 6 months, 50 (14.04%) patients have retained similar amount of usage and 4 patients expired. Of the 221 who reduced usage, 53 were abstinent (14.48%). "Initial retention in services" that is a single physical follow-up was significantly associated with "reduced usage" (P = 0.003) in the tele-follow-up with a median duration of 13 months. With regard to "abstinence," none could stand the test of significance after correction in the logistic model except "types of tobacco usage" which predicted a statistically significant effect with an odds ratio of 3.15 (P = 0.01). Conclusion: This study reveals important information regarding "type of tobacco" as a predictor of abstinence and "initial physical retention" as a predictor of "reduction in tobacco usage." Such studies need further clarification in future, more robust face-to-face studies with biochemical verification. [ABSTRACT FROM AUTHOR]

Media provides and shapes public knowledge, perceptions, and attitude towards people with substance misuse. We aimed to explore the content and specific themes of Indian online news articles on substance use or persons with substance misuse. We followed an exploratory qualitative design to analyze online news media reports published between July 1 2020 and June 30 2021. Hundred articles met the selection criteria. Our content analysis was based on a checklist. Thematic analysis was done by the coding, categorization, and theme generation after meticulous data immersion and triangulation. Sixty percent of articles had pessimistic headlines and portrayed substance use or persons with substance use negatively. Fifty-one percent articles were on alcohol. Twenty-seven percent articles focussed supply reduction, whereas only 5% positively discussed the role of treatment. We identified seven themes. Most frequent themes were legal-criminal aspects of substance use (n = 39), psychosocial and health hazards of substance use (n = 30), and propagation of public stigma (n = 25). Two other prevalent themes were the business and marketing of alcohol (n = 20) and sociocultural aspects of substance use (n = 9). The theme, treatment strategy, appeared in only five articles. There is an urgent need for media guidelines for responsible reporting of substance misuse. We suggested a set of recommendations for media reporting. [ABSTRACT FROM AUTHOR]

Background and Aim: Pandemic and consequent lockdowns are likely to affect the drug market by the sudden disruption of the supply chain. We explored the change in the availability, access, purity, and pricing during lockdown from respondents seeking treatment for drugs, alcohol, and tobacco dependence. Materials and Methods: A cross-sectional survey was conducted among 404 respondents from seven treatment centers across India. A structured questionnaire assessed the change in availability, access, quality, and price of substances used during the first phase (March 24–April 14) and the second phase (April 15–May 3) of lockdown. Results: A majority of the respondents in treatment used tobacco (63%) and alcohol (52%). Relatively few respondents used opioids (45%) or cannabis (5%). Heroin (44%) was the most common opioid the respondents were treated for. Seventy-five percent, 65%, and 60% of respondents treated for alcohol, tobacco, and opioid problems, respectively, reported a reduction in the availability and access during the first phase of the lockdown. In the second phase, respondents with alcohol and tobacco dependence reported greater availability than those with opioid and cannabis dependence. The reported price of all substances increased more than 50% during the first phase of lockdown and remained higher throughout the second phase. Deterioration in purity was reported by more than half of the people who used opioid. Conclusion: Lockdown could have affected both licit and illicit drug markets, albeit to a varying degree. The observed changes seemed short-lasting, as suggested by the recovering trends during the second phase of lockdown. [ABSTRACT FROM AUTHOR]

Background: The unprecedented first wave of the COVID-19 pandemic severely impacted mental health services globally. However, the negative impact of such disruptions on people with substance use disorders (SUD) seeking treatment remains unclear. We aim to explore the behaviors adopted by these individuals to overcome the service disruptions. Materials and Methods: We explored the changes related to substance use behavior (quit attempts, withdrawal experienced, treatment-seeking, and risky behaviors), and behavioral changes in response to COVID-19 lockdown. A cross-sectional survey was conducted among 404 people with SUD seeking treatment from seven centers across India. They were assessed by a specially designed structured questionnaire during the first wave (June–September) of the pandemic. Results: An overwhelming majority experienced withdrawal symptoms, with close to half making quit attempts and seeking treatment during the lockdown. Three-fourth of the sample reported difficulty in accessing treatment services and medications. Patients with opioid use were significantly more likely to think about quitting (χ2 = 20.408, P = 0.000), make attempts (χ2 = 12.436, P = 0.000), seek treatment (χ2 = 7.536, P = 0.006), and self-medicate for withdrawal symptoms (χ2 = 5.885, P = 0.015). In turn, those with alcohol use were more likely to use telepsychiatry services (χ2 = 35.143, P = 0.000) and experience stigma by family members (χ2 = 29.951, P = 0.000) and neighbors (χ2 = 17.725, P = 0.000). Among COVID-19 safety precautions, majority practised wearing masks and social distancing but not others. Conclusion: COVID-19 lockdown led a significant proportion of substance users, especially opioid users, to make quit attempts and seek help. However, these could not be sustained due to difficulty in accessing treatment services. Further, significant proportion failed to adhere to COVID-19 safety precautions. [ABSTRACT FROM AUTHOR]

The article focuses on the development of the psychiatry curriculum as a major subject at All India Institute of Medical Sciences, Rishikesh (AIIMS-Rishikesh). Topics discussed include the process of expert consultation under the Indian Psychiatric Society (IPS) followed by AIIMS-Rishikesh, number of hours of theoretical teaching and clinical skills posting in psychiatry in the undergraduate curriculum, and importance of the integration of the curriculum with other subjects.

We report a rare case of paranoid schizophrenia presenting with continuous mutism for about three years. This 26-year-old woman with multiple Schneiderian first-rank symptoms ['Schneiderian' refers to those symptoms established by the German psychiatrist Kurt Schneider for the diagnosis of schizophrenia] did not have any catatonic features, and she would fluently communicate by gesturing or writing. Since there was serious impairment in biological functions not readily correctable by antipsychotics, she was started on electroconvulsive therapy. She responded well to 14 sessions of electroconvulsive therapy along with oral haloperidol. We also discuss the cultural implications of prolonged mutism. To the best of our knowledge, this is the first case of mutism in noncatatonic paranoid schizophrenia that responded well to electroconvulsive therapy described in the literature. [ABSTRACT FROM AUTHOR]

Objectives: Since 25th March 2020 India went into a complete and extended lockdown. Alcohol production, sales, and purchase were barred with this overnight prohibition order. We conducted a qualitative analysis of the media reports published within the first month of the nationwide lockdown with the objectives (a) using the media reports as indications of possible public health impact and population response of a sudden alcohol prohibition in India, (b) suggesting areas for future research.Methods: We performed thematic and content analysis of 350 articles published online in national newspapers between the 26th March, 2020 and 25th April, 2020. Initial inductive, followed by deductive coding was done in this exploratory thematic analysis.Results: The thematic analysis revealed four main themes: the beneficial aspects of the policy, the harmful aspects of the policy, non-compliance and attempts to change and / or subvert the policy, popularity and level of public buy-in of the policy. We generated relevant sub-themes under main themes. Two additional themes, not directly related to the sudden prohibition, were use of stigmatizing language and ethical concerns. The content analysis showed the frequency of the appearance of the main themes and proportions of sub-themes and codes under those main themes.Conclusion: The harms, perceived from the media reports, should be balanced against the potential benefits. Absence of a national-level alcohol policy was made apparent by the reflexive, disconnected, and conflictual measures. Future research could systematically examine the potential ramifications of alcohol prohibition on public health, social, and economic aspects. [ABSTRACT FROM AUTHOR]

Background: Sudden alcohol prohibition in India during the COVID-19 pandemic presented an opportunity to test whether Google Trends data could indicate population responses and the public health impact of alcohol policy. We hypothesized, following prohibition: there would be a significant change in the relative search volumes (RSV) of alcohol-related queries; that temporal analysis of the trends would reflect a public response to policy changes; and that geospatial analysis of RSV would correlate with the prevalence of alcohol use.Methods: Three different search periods were used to test the hypotheses. The search inputs were based on potential public response to alcohol prohibition, as evidenced by the literature, newspaper articles, and consensus. We used RSV as the unit of analysis. Mean RSV of search queries, pre-post implementation of prohibition, were compared. Smoothing of scatter plots examined the temporal association of trends with policy measures. Multiple linear regression tested the relationship of state-wise RSV and alcohol use prevalence.Results: Post-implementation of prohibition, a significant increase in the RSV was observed for searches related to alcohol withdrawal (p<0.001), how to extract alcohol from sanitizer (p = 0.002), alcohol home delivery online (p<0.001), alcohol home delivery (p<0.001), and sleeping pills (p = 0.006). The trends suggested a decrease in general interest in alcohol but increased demand, and a possible connection with changes in policy measures. State-level RSV and alcohol use prevalence did not reveal a significant relationship.Conclusion: Google trend is a potential source of rapid feedback to policymakers about population responses to an abrupt change in alcohol policies. [ABSTRACT FROM AUTHOR]

Introduction: Major Depressive Disorder (MDD) is a broad heterogeneous diagnostic construct. Previous studies have shown that it can be resolved into several symptom-clusters which are proposed to be associated with single nucleotide polymorphisms (SNPs) of the serotonergic pathway (5-HTTLPR, 5HTR1A, 5-HTR2A)., Methods and Material: In a cross-sectional study conducted at a tertiary level mental health care set-up in north India, 80 out-patients with MDD were evaluated with Montgomery Asberg Depression Rating Scale (MADRS) and then genotyping was done. The different clinical and genetic variables were compared across the factor structures of MADRS. Also, the comparison of the genetic data of cases was done with the pre-existing database of the non-blood related healthy ethnically-matched controls., Results: There was no significant association between age, gender, other clinical variables, SNPs like 5-HTTLPR SS/SL, rs6295 CC/CG/GG, rs6311GG/GA/AA, rs6313 CC/CT/TT and different factor-structures like 'detachment' consisting of items like concentration difficulty, lassitude, inability to feel; 'psychic anxiety' consisting of suicidal thoughts and inner tension; 'mood-pessimism' consisting of symptoms like apparent sadness, reported sadness, pessimistic thoughts and 'vegetative symptoms' like decreased sleep, poor appetite. Neither there was any association between genotype of the cases compared with the controls., Conclusions: No significant association was obtained between the four-factor structures of depression in MADRS and serotonin transporter and receptor SNPs in a study with a small sample size. This study evaluates whether depression symptom-clusters have distinct genotypic determinants and necessitates more comprehensive studies for unravelling the genetic determinants of depression., (Copyright © 2019. Published by Elsevier B.V.)

Tapentadol is a centrally acting opioid analgesic which has partial opioid agonistic and norepinephrine reuptake inhibitor action similar to its nearest congener and tramadol though with a relatively higher μ-affinity. It has abuse potential, is a scheduled drug, yet currently is not known to be an opioid widely misused in India. However, under the current drug abuse legislation in India, where common prescription opioids such as dextropropoxyphene have been banned, tapentadol may take the center stage of pharmaceutical opioid abuse in the near future. We present a series of two cases where the opioid use started with codeine, dextropropoxyphene, and buprenorphine but moved on to tapentadol and tramadol due to ease of access and cost. These cases highlight the potential of tapentadol in replacing dextropropoxyphene as the widespread prescription opioid of abuse and also emphasize the current controversies regarding opioid control policies in India., Competing Interests: There are no conflicts of interest.

Background: Major Depressive Disorder (MDD) is a broad heterogeneous construct resolving into several symptom-clusters by factor analysis. The aim was to find the factor structures of MDD as per Montgomery and Asberg Depression Rating Scale (MADRS) and whether they predict escitalopram response., Methods: In a longitudinal study at a tertiary institute in north India, 116 adult out-patients with non-psychotic unipolar MDD were assessed with MADRS before and after treatment with escitalopram (10-20mg) over 6-8 weeks for drug response., Results: For total 116 patients pre-treatment four factor structures of MADRS extracted by principal component analysis with varimax rotation altogether explained a variance of 57%: first factor 'detachment' (concentration difficulty, lassitude, inability to feel); second factor 'psychic anxiety' (suicidal thoughts and inner tension); third 'mood-pessimism' (apparent sadness, reported sadness, pessimistic thoughts) and fourth 'vegetative' (decreased sleep, appetite). Eighty patients (68.9%) who completed the study had mean age 35.37±10.9 yrs, majority were male (57.5%), with mean pre-treatment MADRS score 28.77±5.18 and majority (65%) having moderate severity (MADRS <30). Among them 56 (70%) responded to escitalopram. At the end of the treatment there were significant changes in all the 4 factor structures (p<0.01). Vegetative function was an important predictor of response (p<0.01, odd's ratio: 1.3 [1.1-1.6] 95% CI). Melancholia significantly predicted non-response (p=0.04)., Conclusions: Non-psychotic unipolar major depression having moderate severity in north Indian patients as per MADRS resolved into four factor-structures all significantly improved with adequate escitalopram treatment. Understanding the factor structure is important as they can be important predictor of escitalopram response., (Copyright © 2017 Elsevier B.V. All rights reserved.)