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Cloud computing is a distributed platform that offers dynamic provisioning of on-demand resources to the users. The rapid growth of cloud computing is due to its adaptive nature that brings enormous benefits to the organizations. OpenStack is a cloud operating system used to build public and private clouds. OpenStack consists of a number of interconnected entities that are combined to govern the processing of compute, network and storage resources. Resource scheduling in OpenStack deals with provisioning of compute resources. Nova-scheduler is a component of OpenStack Compute service which is responsible for resource scheduling. The default nova-scheduler used in OpenStack is Filter Scheduler. The scheduling approach presently used is ineffective in terms of cost, resource usage and energy cost per server. To address these issues, we propose a SLA (Service Level Agreement)-aware resource scheduling strategy which provides better gain to both customers and cloud service providers. We carry out the experiments using real-time multinode private cloud setup. The results reveals the effectiveness of the designed resource scheduling model.

Background & objectives: CAGE-AID questionnaire is a short, useful screening tool for substance dependence. Assessment of one family member for the screening of substance dependence in the family could be useful in clinical practice and research. In this study, we aimed to assess the validity of the Family CAGE-AID questionnaire for the diagnosis of substance dependence. Methods: Cross-sectional assessments using CAGE-AID and Family CAGE-AID questionnaires were conducted both for the study participants (n = 210) and their family members. The participants were recruited from two different treatment settings: a treatment seeking population from a de-addiction centre, and non-treatment seekers for substance use disorders from the psychiatry outpatient department. ICD-10 criteria and subsequent detailed clinical interview by a trained psychiatrist were used for the final diagnosis of substance dependence. Results: In the psychiatry outpatient group, the scores on CAGE-AID and Family CAGE-AID questionnaires were significantly correlated with the ICD-10 symptom score (r=0.81 and 0.70, respectively). In the same group, inter-rater agreement of the Family CAGE-AID was good with CAGE-AID and moderate with ICD-10 diagnosis of substance dependence (Cohen′s kappa 0.78 and 0.61, respectively). A cut-off score of three on Family CAGE-AID was found to be 95·8 per cent sensitive and 100 per cent specific. Interpretation & conclusions: Family CAGE-AID questionnaire is a valid screening instrument for the diagnosis of substance dependence, with acceptable sensitivity and specificity of a cut-off score of three. The simplicity and the brevity of such an instrument can be valuable in the clinical settings of developing countries and also for epidemiological studies.

Perceived stigma towards substance use may determine family members' willingness to help in the treatment process of a substance user. This study aimed to compare the perceived stigma towards substance use among Indian substance users and their family members. Fifty dyads each of alcohol- and opioid-dependent men and their family members were recruited through purposive sampling. Perceived stigma was assessed using Perceived Stigma of Substance Abuse Scale (PSAS) in both the dependent men and the family members. PSAS scores of patients and the family members correlated with each other in both the alcohol- and opioid-dependent groups. Being currently employed predicted higher PSAS scores among patients, while being unmarried predicted higher PSAS scores among family members.

Background and aims: Medical illnesses appear to be more common in substance users than non-users. However, research on medical co-morbidities with substance use disorders is sparse from developing countries. This study aimed to study the occurrence of medical co-morbidites in a sample of patients in India.Methods: This cross-sectional observational study was carried out at the de-addiction centre in northern India which caters to patients seeking treatment for alcohol detoxification and opioid use disorders and smoking cessation. Consecutive newly registered patients with substance use disorder were recruited and information was gathered using a structured questionnaire. Charlson Co-morbidity Index (CCI) was calculated.Results: In total, 406 consecutive participants were enrolled. Of the total, 215 patients (53.0% of the sample) had co-morbid medical disorders. The organ systems affected in descending order of frequency was gastrointestinal (24.9%), neurological (12.1%), cardiovascular (6.9%), in...

Despite clinically relevant implications, stigma towards substance users remains an understudied area, especially in developing countries. This study aimed to find the extent of stigma towards substance use reported by substance users attending a de-addiction centre in India. Purposive sampling was used to recruit consenting fifty patients each dependent on alcohol and opioid from a tertiary care hospital in north India. Demographic and clinical details were recorded. The Stigma Scale and the Perceived Stigma of substance Abuse Scale (PSAS) were administered to both the groups to assess stigma. Alcohol dependent subjects reported higher stigma than the opioid dependent subjects on the Stigma Scale (t = 3.234, p = 0.018). Linear regression showed that duration of dependence, being employed and currently abstinent predicted greater stigma experienced as per the Stigma Scale. Presently being employed and higher per-capita income predicted lower perceived stigma towards substance users as per PSAS. Stigma in substance users remains a major clinical concern, minimizing which can help mitigate negative clinical consequences like delayed treatment seeking and reduced treatment compliance.

Background The association between cannabis and psychosis has long been a matter of debate, with cannabis widely perceived as a harmless recreational drug. Methods Electronic bibliographic databases like PubMed and Google Scholar were searched using the format “(psychosis or schizophrenia or synonyms) and (cannabis or synonyms)”. Cross-linked searches were made taking the lead from key articles. Recent articles and those exploring the genetic factors or gene–environment interaction between cannabis use and psychosis were focussed upon. Results Heavy cannabis use at a n young age, in association with genetic liability to psychosis and exposure to environmental stressors like childhood trauma and urban upbringing increases the risk of psychotic outcome in later life. Conclusion Cannabis acts as a component cause of psychosis, that is, it increases the risk of psychosis in people with certain genetic or environmental vulnerabilities, though by itself, it is neither a sufficient nor a necessary cause of psychosis. Although significant progress has been made over the last few years, we are yet to find all the missing links. Further work is necessary to identify all the factors that underlie individual vulnerability to cannabis-related psychosis and to elucidate the biological mechanisms underlying this risk.

Aim: The article aims to study the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naive patients with schizophrenia. Materials and methods: Forty-six antipsychotic naive patients diagnosed with schizophrenia were evaluated for the presence of metabolic abnormalities using International Diabetes Federation and modified National Cholesterol Education Program – Third Adult Treatment Panel criteria. Results: Five patients (10.86%) fulfilled International Diabetes Federation criteria for MS and six patients (13.04%) met modified National Cholesterol Education Program – Third Adult Treatment Panel criteria for MS. Additionally, 14 (30.43%) more patients fulfilled 2 out of the 5 criteria for MS and another 19 (41.3%) fulfilled 1 criterion for MS. Of the 19 patients who fulfilled one criterion for MS, 18 had an abnormality other than increase in waist circumference. Conclusion: Findings of the present study suggest that although only few antipsychotic naive patients diagnosed with schizophrenia have MS, a significantly large proportion of patients have subsyndromal MS. Awareness of this in clinicians can have implications in the selection of antipsychotic medication.

To the Editor: The review by Wolff et al1 on cannabis-related stroke was an interesting read. The authors have discussed the available evidence on cannabis-related stroke in detail and have also looked at the proposed mechanisms of the same. However, a few questions remain unanswered. It would have been interesting to know what the method of consumption was in the cannabis users who developed stroke. Because cannabis is usually smoked with …

Although catatonia is known to psychiatrists for more than a century, it is still poorly understood, often under recognized, have inspired debate and criticism about nosological status of the catatonic syndrome in recent times without reaching its conclusion. It can present with a number of psychiatric and medical illnesses and is easily treatable, though treatment response varies depending upon the underlying condition and can lead on to a multitude of complications, if not treated. Some issues are more than forty catatonic signs are available to scientific audience for diagnosis; threshold number for labelling varies according to the nosological system followed and the underlying condition; and mood stabilizers like carbamazepine and lithium are helpful in some cases of idiopathic periodic catatonia. Researchers have been asking for a separate diagnostic category for catatonia since long and the debate has gained pace over the last few years, with new editions of both DSM and ICD coming up. Therefore, this paper looks at the controversies associated with the diagnosis and classification of catatonia, the arguments and counter-arguments and future directions, in crisp.

Childhood disintegrative disorder is a rare disorder, characterized by regression of acquired skills after a period of normal development. The case of childhood disintegrative disorder presented here was found to have vitamin B12 deficiency and hyperhomocysteinemia on extensive evaluation to find a probable cause for regression. This case illustrates the need for a thorough evaluation of all cases of childhood disintegrative disorder so that treatable causes of regression, like vitamin B12 deficiency, are not missed.

The article aims to study the prevalence of metabolic syndrome (MS) and subthreshold MS in antipsychotic naïve patients with schizophrenia.Forty-six antipsychotic naïve patients diagnosed with schizophrenia were evaluated for the presence of metabolic abnormalities using International Diabetes Federation and modified National Cholesterol Education Program-Third Adult Treatment Panel criteria.Five patients (10.86%) fulfilled International Diabetes Federation criteria for MS and six patients (13.04%) met modified National Cholesterol Education Program-Third Adult Treatment Panel criteria for MS. Additionally, 14 (30.43%) more patients fulfilled 2 out of the 5 criteria for MS and another 19 (41.3%) fulfilled 1 criterion for MS. Of the 19 patients who fulfilled one criterion for MS, 18 had an abnormality other than increase in waist circumference.Findings of the present study suggest that although only few antipsychotic naïve patients diagnosed with schizophrenia have MS, a significantly large proportion of patients have subsyndromal MS. Awareness of this in clinicians can have implications in the selection of antipsychotic medication.

Women are known to have an increased risk of common mental disorders. Much of this vulnerability has been attributed to psychosocial factors. Life event research is one of the ways in which the role of psychosocial factors in causing stress and illness can be assessed. The presumptive stressful life events scale (PSLES) is widely used in India for this purpose. This paper looks at the inherent weaknesses of this tool for use in Indian women. The issues raised here may be relevant to other Asian populations as well.

Objectives: This study aimed to assess the progression from one substance dependence to another in a sample of treatment-seeking substance users. Materials and Methods: The present cross-sectional study was based on a consecutive sample of patients with substance use disorder attending a de-addiction service in North India. Information was gathered about the demographic details and substance use pattern from the patient, family members, and previous records using a structured questionnaire. Results: Two hundred seventy-three patients out of 406 consecutive participants were dependent on more than one substance of abuse (67.2% of the sample). Most of the subjects were male, married, employed, and of urban background. In this sample of 273 patients, the substance of first dependence in descending order of frequency was tobacco, opioids, alcohol, and cannabis. Of those patients who had become dependent on opioids, it was the initial substance of dependence among 51.3%. Conclusion: Initial dependence to illicit substances without progressing through “gateway” of alcohol and nicotine dependence can occur due to socio-cultural influences. Knowing the sequence of dependence to substances can help design focused preventive measures.

Trichotillomania is a poorly understood complex disorder of multifaceted pathology which often requires an interdisciplinary approach for management. While sharing similarities with obsessive-compulsive disorder, compelling differences between these have also been noted. We present three cases of trichotillomania highlighting the remarkable variability seen in the presentation of this disorder. In doing so, we discuss on resolving the classificatory issues and call for a consensus on the understanding of the disorder.