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Introduction: Opioid agonist treatment (OAT) is an effective treatment for opioid dependence syndrome in adults. However, studies on effectiveness of OAT in adolescents are limited; existing studies show varying retention rates. The present study aimed to assess OAT retention rates in adolescent patients with opioid dependence syndrome registered in a community drug treatment clinic in Delhi, India, and to analyse factors associated with retention at 1 year. Methods: Retrospective cohort study. All adolescents (n = 130) aged 10–19 years, started on OAT from January 2020 to July 2022 were included. Baseline and follow‐up data was extracted from online record system maintained at the clinic. OAT retention rates at different timepoints were assessed. Multivariable logistic regression was used to discern factors associated with one‐year retention. Results: The participants' mean age was 16.9 (SD 1.4) years. Mean age of starting opioids was 14.9 (SD 2.2) years; 29.5% (n = 38) injected opioids. The 6‐, 12‐, 18‐ and 24‐month retention rate on OAT was 64.4%, 45.6%, 38.7% and 29% respectively. The retention rates with buprenorphine and methadone were comparable. Multivariate logistic regression showed retention for less than 12 months to be significantly associated with younger age of starting heroin, involvement in illegal activities, absenteeism from school and substance use in family. Discussion and Conclusions: The 12‐month retention rates on OAT in adolescents is comparable to retention rates in adults. Various factors associated with early age of onset of opioid use are also associated with lower retention rates on OAT. [ABSTRACT FROM AUTHOR]

Background: People with Substance Use Disorder have higher adverse outcomes associated with COVID-19 infection that can be reduced with COVID-19 vaccines. Various factors influence the acceptability of COVID-19 vaccines. We assessed COVID-19 vaccine-related knowledge, attitude, and beliefs in patients on Opioid Agonist Treatment (OAT) from a community clinic in an urban impoverished area in Delhi, India. Methods: Cross-sectional design. We interviewed 200 adult males using a structured questionnaire. Results: The participants' mean age was 27.4 (SD 6.8) years; majority (68%, n = 136) had less than 10 years of schooling. While family members of 77% (n = 154) of the participants were vaccinated for COVID-19, only 32% (n = 64) of the participants had been vaccinated with at least a single dose. 43% (n = 86) felt they are ineligible for vaccine due to their addiction or their ongoing addiction treatment (46.5%, n = 93). Though the majority (78.5%, n = 157) were willing to get vaccinated, they had not done so due to concerns, such as fear of vaccine-related adverse-effects (35%). Conclusions: COVID-19 vaccination rates in individuals with opioid dependence are much lower compared to the general population. There are several misconceptions related to COVID-19 vaccinations in this population that needs to be addressed to achieve universal vaccination against COVID-19 infection. [ABSTRACT FROM AUTHOR]

Various factors limit the acceptability of methadone as an opioid agonist treatment (OAT), in which case, buprenorphine becomes the preferred alternative. The classical approach is to gradually taper methadone to a low dose and buprenorphine is initiated after some opioid-free period, which generally takes weeks. A novel approach known as ’microdosing’ or the ’Bernese method’ might serve as a valuable alternative. We describe two cases where the patients were successfully transitioned from methadone to buprenorphine using this method. [ABSTRACT FROM AUTHOR]

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. Untreated co-occurring substance use and substance use disorders (SUDs) in patients with medical conditions may be associated with unfavourable medical outcomes. Understanding the prevalence of substance use and SUDs among patients admitted to hospital for medical illness may help in developing appropriate strategies to manage SUDs in this population and improve the outcomes of medical illness. We assessed the prevalence of substance use and SUDs among patients admitted for medical illnesses and the association between substance use and medical illness. Methods. This cross-sectional study was done in an inpatient setting in a multidisciplinary teaching medical institution in India. Using systematic sampling, adult patients admitted in various departments for at least 24 hours were interviewed using standard instruments by psychiatrists trained in the study methodology. Results. Two hundred and ninety patients participated. Their mean (SD) age was 42.2 (15.6) years. One hundred and nine participants (37.6%) reported lifetime use of any psychoactive substance, with tobacco being the most common substance used (91, 31.4%), followed by alcohol (69, 23.8%) and cannabis (12, 4.1%). Lifetime alcohol use was significantly associated with diseases of the circulatory system. Lifetime use of any substance or of alcohol, and current use of any substance or tobacco were significantly associated with injuries, poisoning and other consequences of external causes. Conclusions. A large proportion of patients hospitalized for medical illness reported the use of psychoactive substances or had SUDs. The use of some of these substances was also associated with injuries as well as diseases of the circulatory system. [ABSTRACT FROM AUTHOR]

The relationship between spirituality and behavioural addictions is complex. Although some studies have suggested spirituality to be a protective factor helping in recovery from addictive behaviours, others have found spirituality to be a potential risk factor. To better understand the relationship between spirituality and various behavioural addictions, this review summarises the literature on the association between spirituality and the following behavioural addictions: gaming disorder, gambling disorder, problematic internet use, problematic smartphone use, compulsive sexual behaviour disorder and compulsive buying/shopping disorder. Implications for clinical practice and future research are discussed. [ABSTRACT FROM AUTHOR]

Background: About one-fourth of individuals who are dependent on opioids use opioids through injecting route. Most of such individuals start using opioids through noninjecting route much earlier before they transition to injecting opioids. It is important to identify important factors that delineate individuals who inject opioids from those who use opioids through other routes, which was the objective of the present study. Methods: This was a cross-sectional study design. Four hundred treatment-naïve opioid users with opioid dependence were selected using a snowballing sampling technique. The drug use details, family relations, social and occupational functioning, and peer network history were assessed using a self-developed questionnaire and the use of structured instruments such as the Leeds Dependence Questionnaire Scale, High-Risk Behavior Scale, and Functional Status Questionnaire Scale. Comorbid psychiatric symptoms were assessed using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Ask Suicide-Screening Questions was used for assessing different domains of suicidality. Results: The mean age of the participants was 26 (standard deviation = 6) years. One-third (n = 136) of these were injecting opioid users (injecting drug users [IDUs]) and the remaining were taking opioids through other routes (non-IDUs). In multivariate analysis, IDUs (as compared to non-IDUs) had higher rates of family history of opioid use (odds ratio [OR] =3.53, 95% confidence interval: 1.17–8.69), incarceration history (OR = 2.16, 1.78–3.11), lower employment (OR = 0.53, 0.31–0.84), more people with <5 years of education (OR = 4.31, 2.60–12.73), lower age of starting opioid use (OR = 0.44, 0.26–0.69), more concurrent sedative use (OR = 5.60, 4.34–7), more self-harm attempts history (OR = 1.88, 1.16–3.2), larger peer groups (OR = 1.89, 1.11–2.63), and greater involvement in selling illegal drugs (OR = 1.81, 1.49–3.67). Conclusions: Various factors are significantly associated with using opioids through injecting route in individuals with opioid dependence. These factors can help identify individuals with opioid dependence who are likely to transition to injecting opioids. [ABSTRACT FROM AUTHOR]

Addiction medicine is a rapidly growing field with many young professionals seeking careers in this field. However, early-career professionals (ECPs) face challenges such as a lack of competency-based training due to a shortage of trainers, limited resources, limited mentorship opportunities, and establishment of suitable research areas. The International Society of Addiction Medicine (ISAM) New Professionals Exploration, Training & Education (NExT) committee, a global platform for early-career addiction medicine professionals (ECAMPs), conducted a two-phase online survey using a modified Delphi-based approach among ECAMPs across 56 countries to assess the need for standardized training, research opportunities, and mentorship. A total of 110 respondents participated in Phase I (online key informant survey), and 28 respondents participated in Phase II (online expert group discussions on three themes identified in Phase I). The survey found that there is a lack of standardized training, structured mentorship programs, research funding, and research opportunities in addiction medicine for ECAMPs. There is a need for standardized training programs, improving research opportunities, and effective mentorship programs to promote the next generation of addiction medicine professionals and further development in the entire field. The efforts of ISAM NExT are well-received and give a template of how this gap can be addressed. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has significantly affected treatment services for people with substance use disorders (SUDs). Based on the perspectives of service providers from eight countries, we discuss the impact of the pandemic on SUD treatment services. Although many countries quickly adapted in provision of harm reduction services by changes in policy and service delivery, some went into a forced abstinence-based strategy. Similarly, disruption of abstinence-based approaches such as therapeutic communities has been reported. Global awareness is crucial for responsible management of SUDs during the pandemic, and the development of international health policy guidelines is an urgent need in this area. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) has added gaming disorder to ICD-11 as a clinical condition associated with distress or interference with personal functioning. This inclusion leads to clinical and public health benefits, such as harmonising terminology, offering clinical landmarks and improving monitoring capabilities and data comparability. Training health professionals to identify and manage gaming disorder is a key challenge for countries. In the present paper we compiled opinions from different countries around the globe on their state of preparedness and needs to tackle this issue. The global views on the topic feed arguments for developing an evidence-based and cross-cultural training tool for gaming disorder management by health professionals. [ABSTRACT FROM AUTHOR]

Background: Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods: 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results: 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions: In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions. [ABSTRACT FROM AUTHOR]

Cannabis use is highly prevalent globally, yet little is known about primary cannabis use disorder patients, especially in India. The present study's objective was to assess clinical profile, internalized stigma, and pathways to care among this population in India. A total of thirty patients with cannabis use disorder were recruited over a nine-month period using an exploratory cross-sectional design. Assessments were undertaken using a semi-structured proforma, Internalized Stigma of Mental Illness (ISMI) – Hindi version, and WHO – Mental Health Encounter Form. Data was analyzed using SPSS V20.0. All participants were males, with a mean age of 24.57 (7.76) years. Marijuana (ganja) was the commonest form of cannabis consumed (n = 26; 86.7%). The mean duration of cannabis use and dependence was 5.03 (3.69) and 3.98 (3.22) years. The most common reason for seeking treatment was family pressure (n = 21; 70%). The mean score of ISMI-Hindi was 2.66 (0.55), suggesting moderate internalized stigma. Most participants' first treatment contact was a psychiatrist at a tertiary care de-addiction center (n = 29; 96.7%). This study highlights the need for interventions to reduce stigma in patients with cannabis use disorder patients. [ABSTRACT FROM AUTHOR]

India has a huge burden of substance use disorder (SUD). The national response to the problem of SUD has been to support addiction treatment centers either in government hospitals or in nongovernmental settings. The existing number of addiction treatment facilities is less compared to the burden of substance use in India. The existing models of treatment in India place undue emphasis on inpatient treatment of SUD. Community-based treatment aims to bring the treatment of SUD closer to the patients in their community. Community-based treatment of SUD utilizes existing services available in the community by establishing an integrated network of community-based services. There have been different models of community-based care for the management of SUD in India. Most of them, however, address short-term withdrawals and do not provide long-term treatment in community. National Drug Dependence Treatment Centre, AIIMS, New Delhi, has been providing community-based treatment for SUD since the 1990s. Two of the three community drug treatment clinics (CDTCs) are in operation for more than 5 years now and cater to the population residing within a defined catchment area. The CDTCs use infrastructure available in the community to operate the clinics. The clinics are run daily by a team of nursing staff, while the doctor is available only twice a week. A menu of options, ranging from short-term treatment to long-term agonist maintenance treatment is provided in the clinic. Both pharmacotherapy and psychosocial interventions are provided. Each clinic caters to hundreds of patients through these facilities. There is a need to expand CDTCs in India considering their cost-effectiveness, acceptability, and overall effectiveness, especially in urban colonies with higher substance-related problems. [ABSTRACT FROM AUTHOR]

Substance use disorders in the elderly population can be assessed through scales and questionnaires. These scales are used for not only screening for substance use disorders but also for assessment for improvement with time and/or intervention. Validity parameters of these scales help us know how do they perform during application in the clinical or community setting. The objective of the review was to (1) review available validated screening tools for substance use disorders, (2) summarize elderly-focused studies, and (3) provide recommendations for use in clinical care. We aimed to review the validated scales of substance use disorders in the geriatric population. We looked at PubMed and Web of Science databases for identifying English language peer-reviewed publications that reported at least one validity parameter for scale in geriatric patients with substance use disorders. We identified 22 studies, with majority of them focusing on alcohol use disorder. Alcohol Use Disorder Identification Test and Cut Down, Annoyed, Guilty, and Eye-Opener Questionnaire (CAGE) were the most common scales used in the population. While most of the studies reported acceptable area under receiver operator curve, sensitivity, and specificity, some of the studies reported lower sensitivity/specificity at optimal cutoff. Validity parameters of various scales have been assessed in the geriatric population. Using suitable cutoffs, they can be useful in the screening of elderly individuals with substance-related problems, so that due evaluation and care can be provided. More instruments need to be assessed for validity to diagnose tobacco use disorders, benzodiazepine use disorders, and other substance use disorders. [ABSTRACT FROM AUTHOR]

Addictive disorders have become increasingly common in India. The health consequences of addictive disorders are immense, and the need for specialized addiction treatment and training far exceeds the capacity and human resources that currently exist. At the same time, increasing demand and treatment gap, need for specialized care, and the emerging sector of medical tourism in the country open avenues for superspecialty training in addiction psychiatry as an attractive career option for Indian psychiatrists. Human resource development and capacity building in the addiction psychiatry field in India is the need of the hour. In the present article, we describe the existing scenario and challenges related to addiction psychiatry training among postgraduate psychiatry trainees and psychiatrists in India and scope for the future. [ABSTRACT FROM AUTHOR]

Chronic pain is associated with higher rates of psychiatric comorbidity, including substance use disorders. Patients with chronic pain often require opioids for their pain relief. Often, clinicians are reluctant to prescribe opioids to patients with chronic pain due to fear of patients becoming dependent on opioids. Diagnosing opioid addiction in chronic pain with comorbid prescription opioid use is challenging, as some of the symptoms of addiction overlap with those of physical dependence. A 28-year-old female presented with a history of recurrent abdominal pain beginning at the age of 16 years. The patient was diagnosed with chronic pancreatitis and was prescribed tramadol orally or injections for pain. The patient started experiencing craving with repeated administration of tramadol. She started using it daily and increased her dose to about 6-7 ampoules per day. She also developed complications due to injections. She was not able to work due to her pain, as well as injection use. She would go to multiple chemist shops for getting herself injected with tramadol injections. She also developed depressive symptoms in this period. Due to abdominal pain, the patient was admitted in the gastroenterology ward, from where she was shifted to the psychiatry ward for the management of opioid misuse and depressive symptoms. The patient was diagnosed to be suffering from opioid dependence syndrome with depressive episodes, for which she was provided tablet buprenorphine 14 mg/day dose along with tablet sertraline 150 mg/day. The case demonstrates several challenges in the diagnosis and management of opioid dependence and chronic pain when they occur simultaneously. [ABSTRACT FROM AUTHOR]

Drug use, including opioid use disorder, is one of the rapidly rising and serious problems affecting populations globally. There is a treatment gap and delay in presentation of drug users to treatment centers. The present study aimed at assessing the pathways to care among opioid-dependent individuals seeking treatment from a community-based treatment center in India. In a cross-sectional observational study conducted at a community clinic of the National Drug Dependence Treatment Centre (NDDTC), New Delhi, India, a total of 100 treatment-seeking drug users (age 18–60 years) fulfilling DSM IV TR criteria for opioid dependence were recruited. The data were collected using a semistructured pro forma based on patient self-report and the encounter form used in the World Health Organization (WHO) Pathway Study. All participants were male, were mostly married, were employed, and belonged to nuclear families. Ninety-eight percent of participants has ever used heroin in a dependent fashion and 20% were using it currently. Mean age of the participants was 40.83 years (SD 12.7). Median age of onset of heroin use was 22 years (IQR 12). Median duration of heroin use was 138 months (IQR 132). Only 21% of participants visited the community deaddiction clinic at the first contact with care. The median time for first treatment-seeking attempt was 9.5 years (IQR 7). The study findings suggest significant delay between onset of drug-related problems and first treatment contact. There is a need to increase the availability and accessibility of treatment services to reduce the delay in treatment seeking. [ABSTRACT FROM AUTHOR]

Background: Natural opiate users constitute a large proportion of opioid dependent individuals in India, and enjoy socio-cultural sanction in certain parts of the country. However, no study has assessed the pathways to care among this population in India. Objective: To assess the pathways to care among treatment-seeking natural opiate dependent individuals. Method: This cross sectional, explorative study was conducted at a tertiary care drug treatment centre located in North India. A total of 125 male participants aged >18 years, seeking treatment for natural opiate dependence from our outpatient clinic were included. A semi-structured proforma and WHO mental health encounter form was applied to assess socio-demographic, treatment details and pathways to care. Results: The mean age was 46.17 (±11.98) years. Poppy husk (phukki/doda/posht) was the most common primary natural opiate used (84%). First point of treatment contact was addiction psychiatrist (n = 90; 72%) in majority. First time treatment seeking was either by self-referral (60.8%) or referral by relatives and friends (24.8%) with mean time lag of 18.63 years after the onset. Conclusion: Natural opiates dependent patients seek treatment late in the course of their illness, often directly from a tertiary addiction treatment centre. Barriers to seek treatment needs to be addressed. [ABSTRACT FROM AUTHOR]

Lysergic acid diethylamide (LSD) is a semisynthetic compound with strong psychoactive properties. LSD has been used as an adjunct to psychotherapy and treatment for various forms of drug addiction as well as a drug of abuse by the hippie counterculture movement of the 1960s. The literature regarding LSD is limited, and it has hardly been studied after it was banned in the 1970s. LSD is known to cause psychological dependence, but physical dependence on LSD is unknown. Continuous use of LSD is also unknown. We describe a case where the person used LSD continuously for a period of two years as his primary drug. He developed a craving, and tolerance to LSD and contrary to known literature the tolerance did not disappear rapidly on discontinuation. Additionally, he developed both physical and psychological symptoms on discontinuing LSD – a factor responsible for continued use. To the best of our knowledge, this is the first report of physical dependence to LSD. [ABSTRACT FROM AUTHOR]

Inhalant use is a global problem but in spite of its large prevalence and significant physical and psychological complications, there is inadequate literature on the management of inhalant dependence. Inhalants are also considered a substance of adolescence with most users giving up use in adulthood. There is also limited literature on co-occurring behavioral and substance addictions and the linkage between them. We describe the case of 28-year-old man who had been using toluene in a dependent pattern for 14 years. He also had problem gambling in the past, abstaining from which led to an increase in the daily quantity of use of toluene. The patient was tried on Carbabmazepine but following an adverse event he was prescribed Aripiprazole. He improved over the course of 6 weeks and has been abstaining from inhalants since 3 months. [ABSTRACT FROM AUTHOR]

An exploratory study was conducted on 23 consecutive treatment-seeking adolescent inhalant users at a tertiary drug dependence treatment center in India. Sociodemographic, clinical parameters and neuropsychological functioning were assessed using semi-structured interview, Composite International Diagnostic Interview (CIDI 3.0) for diagnosis, checklist for health damage and withdrawal symptoms, Malin's Intelligence Scale for Indian Children (MISIC), Memory for Design test and Stroop test. Routine biochemical testing and urinary hippuric acid level for recent inhalant use, measured using Gas Liquid Chromatography with Nitrogen Phosphorous Detector (GLC-NPD) was conducted. All participants were urban males (mean age 16 [SD = 1.8] years), who used either ink eraser fluid (87%) or glue (13%). Most participants experienced inhalant withdrawal (80%) and revealed high prevalence of psychiatric co-morbidity (52%), behavioral problems (43.5%), and neuropsychological deficits. Biochemical analysis validated recent (1–3 days) toluene exposure in 69.6% of participants, consistent with self-report. Management plans should take these issues into consideration. [ABSTRACT FROM AUTHOR]

Background: Inhalant abuse among adolescents is a growing problem worldwide including developing countries like India. It is important to understand the nature of adolescent inhalant abuse behaviour in order to counter the emerging problem.Aims: 1. To assess sociodemographic profile of treatment-seeking adolescents with inhalant abuse. 2. To explore inhalant abuse behaviour among treatment-seeking adolescents.Method: A 6-month long explorative study on 23 consecutive male adolescents seeking treatment for inhalant abuse (aged 13–18) in a tertiary de-addiction centre of India was conducted using a semi-structured questionnaire and a checklist to inquire about the perceived effect of inhalant abuse.Results: All adolescent males [mean age 16 (SD = 1.86) years] belonged to urban area and enjoyed adequate social support. “Sniffing” was the commonest route of inhalant abuse. Experimentation and peer pressure were the commonest reasons reported by adolescents for initiation (65.21%), whereas boldness (56%) was the commonest perceived effect of inhalant abuse.Conclusions: While experimentation and peer pressure contribute in initiation, perceived effects like boldness contribute in continuation of adolescent inhalant abuse in India. Increase in confidence and boldness is a much-desired effect in growing adolescents, and the abuse of inhalants reinforces the same. [ABSTRACT FROM AUTHOR]

Ketamine was developed in the late 1950s as a potential general anesthetic agent. However, soon it became drug of abuse due to its property of giving “high”. Ever since there have been no systematic studies of ketamine abuse, dependence or withdrawal states in humans, barring some anecdotal case reports. Recently researchers have shown interest in ketamine as a novel agent for the treatment of depression. However, most research does not shed light on its addiction potential. In this paper, we present a case of ketamine dependence with interesting phenomenology, withdrawal symptoms which responded well to naltrexone. Implications of such cases for health professionals particularly psychiatrists and addiction specialists is discussed. [ABSTRACT FROM AUTHOR]

In the most recent edition of Diagnostic and Statistical Manual (DSM) that is DSM-5 many modifications have been made in substance use disorder section. These include changes in terminology; sections and categories; diagnostic criteria; threshold for diagnosis; severity; and specifier. Additionally, there have been certain additions and omissions from the earlier version. Critical evaluation of the changes made to the section on disorders related to use of psychoactive substances in India context has not been published so far. The current paper presents a critique of the changes made to the substance use disorder section in DSM-5. The rationale for these changes put forth by DSM-5 work group on substance related disorders have been discussed. Additionally, attempt has been made to highlight the possible future challenges consequent to the current nosological revision for substance use disorder category. Overall DSM-5 seems to be promising in fulfilling its goal of DSM-ICD harmonisation and movement towards an internationally compatible and practical diagnostic system for mental health disorders. It has increased the scope of addiction by inclusion of behavioural addiction. It has also tried to balance the categorical and dimensional approach to diagnosis. However, the real test of this newer edition of one of the most commonly used nosological systems will be during clinical care and research. This will help address the debatable issues regarding the changes that DSM-5 brings with it. [ABSTRACT FROM AUTHOR]

It is a well-known fact that substance users have used different innovative techniques and routes of administration for consumption of conventional psychoactive substances to get high. However, reports of using unconventional substances to get high are rare and puzzling for addiction specialists. There are hardly any scientific publications on psychoactive properties of such unconventional substances. We present a rare case of opioid-dependent syndrome, who also reported using tail of Indian wall lizard to get high. [ABSTRACT FROM AUTHOR]

Fronto-Temporal Dementia (FTD) is a cluster of syndromes, characterized by progressive deterioration of cognition, language and/or behavioural changes associated with degeneration of the frontal and temporal lobes. A 53-year-old man was admitted with a history of gradually progressive behavioural disturbances, disinhibition, unprovoked anger outbursts, apathy, disorganised behaviour and impaired self-care. A clinical diagnosis of Fronto temporal Dementia (behavioural variant) was made. Extensive investigations found no abnormality except in FDG-PET scan of the brain which revealed hypo metabolism in bilateral anterior insular region. Insula is an important brain area implicated in emotional awareness and behaviour control. Hypo metabolism in insular region in the absence of any structural neuroimaging findings, in a case of behavioural variant of Fronto-temporal dementia suggest that, it might be one of the earliest neurobiological changes occurring in this disorder. [ABSTRACT FROM AUTHOR]

Depression is a highly prevalent and severely disabling condition globally. Despite being a major cause of disability worldwide, little progress has been made in the last three decades in developing rational and novel pharmacological treatment options for the management of depression. Recently there has been growing interest in the role of kynurenine pathway in pathophysiology of depression. In this paper, the potential role of kynurenine pathway inhibitors in the management of depression particularly in secondary and reactive depression and the development of novel antidepressant drugs targeting kynurenine pathway are discussed. [ABSTRACT FROM AUTHOR]

The article presents the case of an unmarried woman with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and schizophrenia. Topics include symptoms of MRKH including primary amenorrhea and normal development of secondary sexual characteristics, MRKH syndrome's association with neuropsychiatric manifestations such as anxiety, depression and suicide, and complex micro deletion's link to the MRKH syndrome.

A letter to the editor is presented in response to the article "Nicotine Replacement Therapy (NRT) for Palliation of Nicotine Abstinence Syndrome - Is it Worth?" by P. Singh which appeared in the May - August 2015 issue.

A letter to the editor is presented in response to the article "Effects of Ceftriaxone on Ethanol Intake: A Possible Role for xCT and GLT-1 Isoforms Modulation of Glutamate Levels in P Rats" by H. Alhaddad, S. C. Das and Y. Sari, which appeared in a previous issue of the journal.

A letter to the editor is presented in response to the article "Catatonia in a Patient With Bipolar Disorder Type I," in a previous issue.

The article presents a case study of a 11-year-old boy with catatonia.